"American optometrists spend a lot of money on lobbying"
November 28, 2019 6:48 AM   Subscribe

The Great American Eye-Exam Scam
The ordeal led me to look into a fact that has puzzled me ever since I moved to the United States a dozen years ago. In every other country in which I’ve lived—Germany and Britain, France and Italy—it is far easier to buy glasses or contact lenses than it is here. In those countries, as in Peru, you can simply walk into an optician’s store and ask an employee to give you an eye test, likely free of charge.
posted by Not A Thing (74 comments total) 34 users marked this as a favorite
 
To say that you can walk into an optician in the UK and get an immediate eye test is stretching the truth a bit. Generally you need an appointment (they may give you one later that day). A full eye test by an optometrist isn't expensive and, more often than not, you can get them for free, so commonly are vouchers given away. I don't remember being given a copy of the prescription until maybe a few years ago, though. This all refers to the same Specsavers that operates in the US.
posted by pipeski at 7:22 AM on November 28, 2019


I wish I had known it was this easy when I was in Italy, because damn did they have some amazing glasses in store windows there.
posted by noxperpetua at 7:25 AM on November 28, 2019 [4 favorites]


Do you want Fizz to rant, because this is how you get Fizz to rant?!?!

Forever ago I made a scene at an Eye Doctor's office when they refused to provide me my PD. This office knew that the PD (along with my prescription) was all that is required for me to go online to a website like zennioptical.com or eyeglasses.com and save $ hundreds of dollars. I just ordered two pairs of glasses with a fairly high prescription, all the latest UV, oilphobic, anti dust blah blah layers and I spent under $100.

The same pair at an Eye Doctor's office would be around $550+ here in Canada. It's such a fucking scam. Demand your full prescription and go online, don't mess with these doctors and their insane mark ups. That's me stepping off of my soap-box.

End rant.
posted by Fizz at 7:27 AM on November 28, 2019 [75 favorites]


Is it? I walked into America’s Best Eyeglasses and got an eye exam and had my glasses in 2 business days. It might have been less. I don’t remember. The eye exam was free with my purchase at the time. Also the optometrist was a surly, no nonsense sort and gave me the most accurate prescription I’ve ever had. I don’t mess around with other places or eye insurance for this reason.

My eyes are also not that bad so my lenses never tend to cost more than 50 or 60 bucks but this might change as I age.
posted by Young Kullervo at 7:27 AM on November 28, 2019 [4 favorites]


Sorry, I know the post is about eye-exams, but it's the eye-glasses and prescription that set me off. Sorry if that derails.
posted by Fizz at 7:29 AM on November 28, 2019 [1 favorite]


In Canada, you also have to have a prescription to get glasses, and the exam costs about $70. Your optometrist always gives you a copy of the prescription. But not a measurement of your pupillary distance. I assume one is required and the other is not, so you only get what's required. It adds hassle to ordering glasses online which is, I'm sure, why they don't give it to you.

Our optometrists (at last in Ontario, this may vary by province) are required to maintain a certain amount of fiscal disassociation from the optical dispensaries that they are clearly related to. They'll often have a door to separate them, even if the optometrist is literally inside the dispensary. It's very ridiculous.
posted by jacquilynne at 7:30 AM on November 28, 2019 [7 favorites]


To compound the scam, unless you are lucky enough to have insurance that has some form of vision coverage, just getting an exam can often be unaffordable to many, even if the optometrist offers a no-insurance discount. My optometrist's "discount" for an exam without insurance is $110.
posted by Thorzdad at 7:33 AM on November 28, 2019 [10 favorites]


ETA: I think the article is slightly misleading. You can indeed buy contacts without a prescription in France, but they DEFINITELY do not allow patients to obtain prescriptions from opticians. In fact IIRC the national association of ophthalmologists agitated actively a few years ago against any loosening of this regulation. Glasses and contacts can only be prescribed by an ophthalmologist and prescriptions last two years. In towns with only one or two opthalmos—and there are many—this can create significant problems. Even in big cities including Paris I have had to wait 2-4 months in the past.

That being said, unlike when I lived in the States the visit doesn’t cost 100 non-reimbursed smackaroos. So I still prefer the wait.
posted by peakes at 7:34 AM on November 28, 2019 [3 favorites]


Also, for anyone who cannot get their PD but has their prescription. You can measure your PD pretty easily these days, there are even apps I believe, as well as tools most of these online websites will mail you for free that let you measure. You just need a friend and to stare at a fixed point while your friend holds up the tool. Ugh.
posted by Fizz at 7:44 AM on November 28, 2019 [6 favorites]


Yes, I got a free, no-appointment-needed eye prescription (with PD) at a glasses shop in Germany. Blew my mind. They do tell you you should go to the eye doctor regularly though in case of health problems. Good luck with that, those guys are open for about two hours, twice a week around here.
posted by starfishprime at 7:45 AM on November 28, 2019 [2 favorites]


I love how American optometrists earnestly pose this argument about how essential their services are. Compelling Americans to see an optometrist helps to ensure that the largest possible number of cases of progressive eye diseases will be caught at an early stage. If "making sure Americans are healthy" were really true, we'd have a whole healthcare system that enabled people to see doctors for health maintenance at a reasonable cost.

I'm surprised that France and Canada both have lots of shenanigans still, given their general approach to medicine as being a public health thing rather than a profit center.

On to solutions for Americans.. is there some big, reputable contact lens seller outside the US who will ship to Americans without a current prescription? This works fine for drugs, I have to imagine it's possible for curved pieces of plastic too. How about eyeglasses?
posted by Nelson at 7:46 AM on November 28, 2019 [3 favorites]


My eye exams generally don't actually measure pupillary distance. Also I can measure it myself. Usual practice at the optometrist I've seen for the past mumblety years is if I buy glasses from them, the optician measures for free, or I can pay for that service separately.

And how many accidents are caused by drivers who can’t see the road as well as they should?

Idk, maybe we could consider regular vision tests (and other tests, like actually knowing traffic laws) as part of driver licensing? Everyone in the US basically gets driver's licenses in boxes of Cracker Jacks.
posted by asperity at 7:49 AM on November 28, 2019 [6 favorites]


To be clear: a different device is used to measure pupillary distance from what devices are used to determine the rest of your prescription. Or, at home, a ruler and a mirror.
posted by asperity at 7:52 AM on November 28, 2019 [1 favorite]


I have good, employer-provided health insurance + an additional, optional eye plan, and yet a new pair of glasses from my ophthalmologist's shop would still run upwards of $400 after figuring in the up-charges for no-line progressives and so on.

Happily, his office has been lovely about providing me with copies of my prescriptions and PD whenever I've asked.
posted by Annabelle74 at 7:56 AM on November 28, 2019 [2 favorites]


Optometrist visits at the local Walmart are about $50. Walk-ins ok. Not much, but still a barrier for some, enough for them to go without.

The complication is that plenty folks are clearly in favor of requiring an examination by someone with skill enough to function as a front line medical professional. Which requires a level of education and training. And also require that prescriptions expire after a certain length of time, to encourage staying on top of potential serious eye problems. These things end up costing at least some money. Additionally, plenty folks will give the side eye to a free exam that leads to the upselling of corrective lenses.

Barebones exams for corrective lenses should definitely be a thing, but places like the US have trouble accepting that level of care for people who can't afford better, often even if it means they end up going without.
posted by 2N2222 at 8:00 AM on November 28, 2019 [2 favorites]


Luxxotica needs to be burned to the ground.
posted by seanmpuckett at 8:02 AM on November 28, 2019 [27 favorites]


Yes, they've won in Canada. I've even had question on why an optician would want to keep my prescription - it's not like I can OD on glasses.

But I have to say that I really value my optician = many people I know are buying glasses online, but my optician really helps me. She checks the glasses when they come in, making sure that the lenses are in the right place, adjusting the arms so that they sit correctly. When one lens was slightly mis-made by the lab, causing distortions in my vision, my optician helped me identify why and had it replaced.

I go because she's really good and an expert on helping people with very strong prescriptions. But I know that we don't make her that much money - and as more people with simpler prescriptions go online, I worry about the future of her business. She still has to pay her rent, utilities, etc. But if she closes, I don't know what I will do.

I did not have any backup glasses or spare contact lenses on hand.

I learned the medium-hard way to ALWAYS carry spare glasses when travelling, after I lost the pair in the Pacific Ocean. At least it wasn't the HARD-HARD way. I missed seeing the Hotel del Coronado as anything other than a blur, but at least I had a pair in my hotel and didn't lose the entire vacation. I really can't see without my glasses.
posted by jb at 8:06 AM on November 28, 2019 [4 favorites]


I think the main scam here is the frames.
I've worn very fussy Coke bottle glasses with progressive lenses and prisms and the whole nine yards for decades and I guess it's never occurred to me to not get my annual eye exam because seriously my eyes are fucked up and change constantly. The fucking frames tho? Why can I not just use the same frames and get new lenses? Why do three pieces of plastic and a couple screws cost $200? Fuck Luxxotica.
posted by soren_lorensen at 8:07 AM on November 28, 2019 [9 favorites]


Idk, maybe we could consider regular vision tests (and other tests, like actually knowing traffic laws) as part of driver licensing? Everyone in the US basically gets driver's licenses in boxes of Cracker Jacks.

I remember being incredibly (but pleasantly!) surprised when I moved to Buffalo that I had to have an eye exam, either from a recent optometrist visit or right there at the DMV, to get (and to renew) my driver's license. Which is to say, I guess, that at least in New York State we're not bad drivers because we can't see, it's just that we're not paying attention.
posted by okayokayigive at 8:08 AM on November 28, 2019 [2 favorites]


To be clear: a different device is used to measure pupillary distance from what devices are used to determine the rest of your prescription. Or, at home, a ruler and a mirror.

Heh. Last time I went to my optometrist, my PD wasn't even measured until I was in their eyeglass store. And it was measured by the sales "technician" eyeballing my PD and marking corresponding dots with a Sharpie on the clear lenses of the eyeglass frames I had selected. Does "Sharpie" count as a "different device"?

FWIW, once when I had vision insurance, it limited me to using one of the national chains like Lens Crafters. So, I went, got examined by a young person who assured me they were an optometrist, and ordered new lenses based on that exam.

When I got the glasses the next week, I had a hell of a time adjusting. Nothing looked right, and there was all kind of distortion. So, I took them back (along with my old lenses) and they took a look. Turns out, the examiner had removed all of my astigmatism correction. They re-examined me (adding back the astigmatism correction) but they also made it bluntly clear that, A) The examiner had done nothing wrong, and B) If I still had problems with this re-done prescription, they would require me to be checked for diabetes before they would do anything else. Assholes.
posted by Thorzdad at 8:10 AM on November 28, 2019 [2 favorites]


Is it? I walked into America’s Best Eyeglasses and got an eye exam and had my glasses in 2 business days. It might have been less. I don’t remember. The eye exam was free with my purchase at the time.

Yeah, I'm a bit puzzled by the story in the pull quote. I too have walked into America's Best and finished up with an eye exam and two pairs of glasses for $79. I've also had a similar situation to the one in the piece--breaking my glasses like a day before leaving the country. Solved at Lenscrafters (which advertises free exams, as I recall, but I was a kid at the time so don't know) the same day.

I was pleasantly surprised by my current optometrist. He ran way late, which was annoying (lesson learned: make a morning appointment), but was thorough and when I said I needed to get back to work and would come back to get glasses, the receptionist basically insisted I take my prescription rather than trying to hold it hostage to buying glasses from them.
posted by hoyland at 8:11 AM on November 28, 2019


Also in Canada: this blue light lens garbage
posted by oulipian at 8:11 AM on November 28, 2019 [3 favorites]


I have eye insurance, which is about 120 a year but then only covers frames every other year and an yearly eye exam. My 18 month old recently threw away my glasses, and my prescription changed so I needed a new pair. It ended up being...200ish when it was all said and done with the cheapest instore frames and whatever part of the lenses it didn't cover.

I did get my PD to try out zenni because it's just not that expensive for what I need. I got my other glasses for $26.
posted by AlexiaSky at 8:14 AM on November 28, 2019


I remember being incredibly (but pleasantly!) surprised when I moved to Buffalo that I had to have an eye exam, either from a recent optometrist visit or right there at the DMV, to get (and to renew) my driver's license.

Interesting, I don't remember this at all in NYC. I guess they don't make you prove you have a decent prescription when you already have glasses. Illinois does some basic vision testing at the DMV, but I don't think I've done that sort of thing in any other state. Texas requires fingerprints and Minnesota makes you take the written test.
posted by hoyland at 8:14 AM on November 28, 2019 [1 favorite]


I too have walked into America's Best and finished up with an eye exam and two pairs of glasses for $79. I've also had a similar situation to the one in the piece--breaking my glasses like a day before leaving the country. Solved at Lenscrafters (which advertises free exams, as I recall, but I was a kid at the time so don't know) the same day.

I am definitely going to have to check this out. I have never been able to get new glasses in the US in less than 2 weeks. (Lately I have seen a few shops in big-city downtowns advertising same day service, but I've assumed they must charge big-city-rich-people prices.) My experience had been more or less as described in the article, although in my case the control country was South Korea -- there I could walk in to an eyeglass shop and walk out with new glasses within an hour or so, which everyone I knew in the US regarded as a categorical impossibility.
posted by Not A Thing at 8:16 AM on November 28, 2019


That's a capitalism.
posted by Reyturner at 8:18 AM on November 28, 2019 [2 favorites]


I have never been able to get new glasses in the US in less than 2 weeks.

To be clear, they didn't do the glasses on the spot, but I'm pretty sure it was less than two weeks. (It was a long way, so I probably went back the weekend after the glasses came in, not right away.) But, yeah, Lenscrafters did same day when I was a kid. (My prescription now is like -4.x. I was probably -3.x then.)
posted by hoyland at 8:21 AM on November 28, 2019 [1 favorite]


I have mixed feelings about this, because I'm an audiologist, and our industry doesn't function too dissimilarly, and because it IS a bad system, but I don't think it's a scam exactly, nor do I think it is the fault of optometrists. It is the fault of insurance, which traditionally only covers healthcare for your shoulders on down.

I love how American optometrists earnestly pose this argument about how essential their services are. Compelling Americans to see an optometrist helps to ensure that the largest possible number of cases of progressive eye diseases will be caught at an early stage. If "making sure Americans are healthy" were really true, we'd have a whole healthcare system that enabled people to see doctors for health maintenance at a reasonable cost.

I do not think their argument is disingenuous. In audiology, we make a similar argument, and catching early stage brain tumors or other progressive diseases is an important part of my job and was a critical part of my training. Many, probably most, optometrists and audiologists wish our services and medical devices were covered by insurance. It is not us stopping that - it's the insurance lobby. I can't tell you how much we fight for even just medicare to cover the services and products in our scope of practice and which most elderly people really need. But congress is convinced it would be too expensive (*eye roll* as we cut taxes for rich people etc). For example, a couple years ago, rather than expand medicare coverage to include hearing aids, the unlikely duo of Warren and Grassley introduced a bill, later signed and will go into effect this coming August, to de-regulate hearing aids so that a hearing exam is no longer required and hearing aids can be purchased over the counter. This will make it cheaper for people to get them, but things like brain tumors will be missed, people will not be fit appropriately, outcomes will be poor, etc. But this was the approach the government took, rather than expand insurance coverage, because that would have hurt insurance companies too much.

To me, $100 for an eye exam is not expensive. It only seems expensive because it's out-of-pocket. $100 would be a considered a cheap family practice visit to get some antibiotics so long as insurance was covering 90%+ of it. $100 for a professional service from someone with a doctorate degree who has spent years and hundreds of thousands of dollars training to do the exam is not that unreasonable. What's unreasonable is that it isn't covered as part of any basic insurance package.

The mark-up on glasses at the optometrists, not unlike the mark-up on hearing aids, is due actually to the cheap cost of the services provided. There was a time when, because these services were out-of-pocket for most, it was more palatable to the consumer to have the costs of eye or hearing care attached to a product rather than services. The product and services were in some sense bundled, so that the high cost of service (cost to the provider) could be partially recouped through the product. Over time, the cost of providing services went up and up, and yet there was increasing pressure to lower the cost of the service, right down the making the eye or hearing exam free, and so all of the cost had to be more and more placed in the product. This has led to some truly ridiculous prices on glasses and hearing aids as sold through the professional provider.

And, as I mentioned before, as consumers increasingly balked at these increasing costs, the solution has been to open up the marketplace, with more over-the-counter products, or products not tied to your healthcare provider like Warby Parker etc. This is a better model for the consumer's pocketbook, but worse for their health, and worse for providers. The better solution? That would have been to regulate insurance to include provision of services in your head. The real scam in this country is the piecemeal insurance coverage for teeth, eye, and ear.

I am of course biased. I think the services I provide are important and make a difference. I have a doctorate degree and think I probably offer more to my patients than the hearing instrument specialists at costco or miracle ear. On the other hand, what I offer is more expensive, and I don't begrudge my patients who leave to go somewhere that is cheaper for them, because most of my patients (outside of Medicaid) have to pay out of pocket. And I hate that they have to. I hate it. It limits my ability to simply provide them good care, and it has been detrimental to eye and ear health providers generally as well as their patients, as evidenced by this thread.
posted by Lutoslawski at 8:22 AM on November 28, 2019 [53 favorites]


I have bought both glasses in-store (expensive) and online (not) and I have found the expensive glasses are better -- they fit better, they feel better, they everything better. I'm happy to pay something for the service they provide, because it is in fact better service, but there must be a middle ground.
posted by jeather at 8:24 AM on November 28, 2019 [2 favorites]


When we were in Japan we got three pairs of glasses made up while we waited (about 90 minutes) from a JINS store in the mall. It was something like $85 per pair all-in if I remember correctly. JINS now has a few stores in California but I'd be very surprised if they were allowed to operate the same way. Hopefully I'm wrong? It was shocking that even with a huge language barrier it was so much easier, faster, and cheaper.
posted by 1adam12 at 8:24 AM on November 28, 2019 [1 favorite]


I also don't find it takes long to get the glasses, once I have chosen them, though it depends slightly on if they have my prescription in stock.
posted by jeather at 8:26 AM on November 28, 2019


Optometrists, podiatrists and audiologists have a huge investment in lobbyists to fight on many fronts: against MDs and DOs (i.e., ophthalmologist, orthopedists and otolarynologists) for Rx power and surgical jurisdiction, and against less-learned competition (opticians in the case of optometrists) for Dx authority and appliance Rx power.

Optometry is very interestingly bi-modal in that there are large and prosperous free-standing optometry practices that have captive optician/dispensing capacity, and large optician/dispensing chains that have de facto captive optometrist (cf the optometist who works in the windowless consulting room in the back of the Lenscrafter's store).
posted by MattD at 8:36 AM on November 28, 2019 [4 favorites]


I think the real question to ask is what's the interval that provides the most bang for the buck for most people in terms of how often you need to get rechecked. For most people without major vision change, once every few years is probably enough. I've been wearing glasses since my teens. My vision doesn't change so quickly as to need new a new prescription more than once every five or six years. I need new glasses every two or so, given wear and so forth.

There's a lot of unnecessary, costly thrash and busy work in the system for me. Maybe we don't need enough optometrists to give check-ups every couple of years when people need to buy new again. Maybe we only need half that number, with checkups every few years.

Dentists do the same nonsense. A bunch in town were trying to push for 3-month intervals for cleanings. Fortunately most of the insurance companies said that there was only demonstrable evidence of 6 month cleaning being necessary. So that push failed. Unfortunately, optometrists visits aren't as commonly covered by an insurance plan in Canada, so there isn't a big commercial interest to similarly push back against the Doctors' Lobby for eye care.
posted by bonehead at 8:37 AM on November 28, 2019


I'm surprised that France and Canada both have lots of shenanigans still, given their general approach to medicine as being a public health thing rather than a profit center.

Here in Ontario, eye exams carried out by an optometrist were delisted from OHIP coverage several years ago for people over 20 and under 65 years of age (visits to an opthalmologist are still covered).

Like, how is the eye not part of the body?

I am of course biased. I think the services I provide are important and make a difference. I have a doctorate degree and think I probably offer more to my patients than the hearing instrument specialists at costco or miracle ear. On the other hand, what I offer is more expensive, and I don't begrudge my patients who leave to go somewhere that is cheaper for them, because most of my patients (outside of Medicaid) have to pay out of pocket.

Yeah, I need more than just a basic vision test when I get my peepers checked because I want someone who I can trust understands what to look out for as far as monitoring my choroidal nevus and a few other eye things that might warrant an escalation to an opthalmologist some day.
posted by mandolin conspiracy at 8:40 AM on November 28, 2019 [1 favorite]


Hey you can buy a pupillary distance ruler from major online retailers for a couple of dollars. Not that I condone Drs withholding info that really should be provided, but for less than 2 USD it's a moot point.
posted by dozo at 8:48 AM on November 28, 2019 [2 favorites]


Awhile back when me and my family was uninsured Rural Area (something? I can't remember the program, thought or was network but that didn't bring up anything on google) set up shop in Chicago and did free dental and vision screenings for free with assistance for glasses too.

We were definitely there, LOTS of people came that day. I was uninsured and my wife had medicare which doesn't cover screenings. My wife had a vision problem which was identified and she then had an appointment covered by medicare with an ophthalmologist because she had a microaneurysm in the eye (which while serious sounding turned out to be not a problem at all). Free vision screening are important. But making plastic frames 200 dollars doesn't help people live their daily lives. People just avoid it.

Glasses were invented by the 1300s! We should be able to do better!
posted by AlexiaSky at 8:53 AM on November 28, 2019 [1 favorite]


I've had good results measuring my own PD. All you need is a mirror, a ruler with millimetres, a strong flashlight and a speculum.
posted by Flashman at 9:00 AM on November 28, 2019 [2 favorites]


I guess I can see both sides. I think people should get their eyes checked by professionals, but I also am not particularly convinced that most people ought to have to have an annual eye exam in order to reorder their contacts. I guess I would feel better if I had more faith that these regulations were being formulated based on the needs and well-being of patients. I have very little faith that most organizations that speak for medical professional are invested in patients' health, rather than their own sense of entitlement to wealth and status, and it makes it hard for me to trust the rules that they impose on me.
posted by ArbitraryAndCapricious at 9:04 AM on November 28, 2019 [2 favorites]


I'm surprised that France and Canada both have lots of shenanigans still, given their general approach to medicine as being a public health thing rather than a profit center

Canadian optometrists, like dentists, spend a lot on lobbying too.

The machine you look into at a picture of a balloon gives you a prescription in like 5 seconds, the rest is mostly theatre.
posted by rodlymight at 9:16 AM on November 28, 2019 [8 favorites]


Wait, what? The balloon determines prescription? I thought the prescription part was the bit where they kept switching lenses and saying 'one is better, now two, now one, now two, now which is better?'
posted by jacquilynne at 9:31 AM on November 28, 2019 [4 favorites]


Lutoslawski, the argument is disingenuous because it boils down to "we would prefer that people forgo vision correction if they're unable to afford additional, unrelated diagnostic services."

Agree 100% that the evil lies with the insurance industry, but to me there's no contest between the alternative of allowing some cases of macular degeneration or glaucoma to go undiagnosed while providing people glasses against that of letting these still go undiagnosed because someone's parents couldn't afford the bundled exam, and meanwhile that person is now failing math because they can't read the blackboard.

It doesn't take seven years of training to run a phoropter and issue optical prescriptions, and the point of the article is that this should be offered as a standalone service separate from those provided by more highly-trained optometrists. Are those other services desirable? Yes. Would they be provided by a more just and equitable system focused on patient care instead of the status quo of perverse incentives? Yes. Failing that, we're left with a market economy, and the professional organization identified in the article is using its industry position and regulatory capture to distort that market in a way that's causing actual harm.
posted by 7segment at 9:40 AM on November 28, 2019 [2 favorites]


I started going to eye doctors who don’t sell glasses, because I was sick of the hard sell. There is often one such doctor at the entrance to Costco stores, for example (you don’t need to be a Costco member to get an eye exam). They tend to charge a reasonable flat rate for an eye exam, and give you no grief about handing you a copy of your prescription including your PD.

I have such a strong prescription that I need ultra-high-index lenses, so even Zenni Optical runs me more than $100 with no other add-ons. The last time I bought glasses at a regular optician’s, they cost nearly $500. It’s just not affordable.
posted by snowmentality at 9:43 AM on November 28, 2019 [5 favorites]


I'm surprised that France and Canada both have lots of shenanigans still, given their general approach to medicine as being a public health thing rather than a profit center.

Neither dental care nor routine eye exams/corrective prescriptions are covered by the public system in Canada, which is shameful as it means only people with good insurance can afford either. Usually the people with good insurance work relatively well paying jobs, so the poor and marginally employed are stuck paying out of pocket costs they can’t afford—for essentials.

Dental and eye care are essential, not luxury extras. I am happy to go to a professional in both cases, especially for my eyes because I have problems with my retinas and also a very high prescription which is tricky. My eye professional is a doctor of optometry who went to medical school and knows his shit. He stays up to date and is concerned with eye health—he has machines that check for glaucoma and retinal diseases during regular exams. He and his practice partners also lobby the provincial government to cover regular eye exams for everyone (there was a petition in the waiting room last time I was there), and they volunteer in elementary schools doing free eye exams. So, I respect him for actually putting his money where his mouth is about the importance of eye health. I am also always given a copy of my prescription with PD after every exam.

I don’t know if all eye docs are like him, though.

Here is a quote from a research paper on why dental care was not included when Canada’s national health insurance system was developed. It’s likely similar for eye care and hearing care, which is similarly not covered for most people.
dental care was not included because of significant decreases in dental caries and limitations in dental human resources as the country’s health legislation was being developed, alongside the presence of a viable alternative option to large-scale treatment services (i.e. fluoridation), and the belief that maintaining one’s oral health and the ability to seek out dental care were individual responsibilities, not social ones. [emphasis mine]
So yeah, before we Canadians start getting too smug, that rugged individualist bullshit that harms vulnerable people was allowed into our health care system too. Yes, the damage was somewhat limited, but dental and eye (and hearing) care are really bad omissions.
posted by hurdy gurdy girl at 9:48 AM on November 28, 2019 [8 favorites]


The real reason is cost. Puritanism is just the cover. The real reason is always cost.
posted by bonehead at 10:17 AM on November 28, 2019 [1 favorite]


I'm sure I pay too much money for my glasses, but they're perfect and I use them every waking minute. I've heard too many stories about sketchy glasses from cheaper places, and my optometrist is always acquiring expensive new equipment to keep track of any potential medical issues. (The privilege of having VSP insurance softens the financial blow.) My eyes and my teeth have been costly to maintain over the years, but I'd like to use them forever. Well, as long as forever happens to last for me.
posted by kozad at 10:19 AM on November 28, 2019 [2 favorites]


I guess I can see both sides.

Your prescription is fine, then.
posted by atoxyl at 10:46 AM on November 28, 2019 [17 favorites]


I'm surprised that France and Canada both have lots of shenanigans still, given their general approach to medicine as being a public health thing rather than a profit center

In Canada the provision of health care is often for profit. The basic insurance part is not and the provision is generally very heavily regulated but it is still a mostly a commercial industry.
posted by srboisvert at 11:15 AM on November 28, 2019


On to solutions for Americans.. is there some big, reputable contact lens seller outside the US who will ship to Americans without a current prescription?

I used to use OptiContacts. I haven't used it in a few years, but from what I recall, you only needed to provide a prescription once. After that, you could reorder indefinitely without a new one. I don't know whether this is still the case.
posted by dephlogisticated at 11:16 AM on November 28, 2019 [1 favorite]


Yeahbut .... if I hadn't been going to a University optometry department for checkups, I'd still be losing vision from painless glaucoma which they detected in their routine pressure test, years ago. Optometrists can't do that part of the routine checkup.

Luxottica -- yep, nasty place. Like Lenscrafters. Once long ago unknowingly I took a pair of plastic glasses in to them wanting to replace just the lenses. The counter guy took my glasses and twisted the frame 180 degrees, then pointed to the cracks he'd just caused and said I needed to buy new frames. Creeps.
posted by hank at 11:52 AM on November 28, 2019 [1 favorite]


Maybe I’m ignorant as to how my insurance works (I have vision included, am paying extra for it), but my eye exam was over $100 and then a years worth of contacts was like $250. They gave me my prescription though, so that’s nice? ¯\_(ツ)_/¯
posted by gucci mane at 12:00 PM on November 28, 2019


[...] JINS store in the mall. It was something like $85 per pair all-in if I remember correctly. JINS now has a few stores in California but I'd be very surprised if they were allowed to operate the same way.

Got my JINS glasses for around $100 out the door, in the most expensive real estate in the United States (San Francisco). It took longer to pick out frames than making the glasses. They don't nickel and dime you for every option too.

In the back they do eye exams too, I think it costs around $60 (without insurance). I don't think they do contact lens fittings for obvious reasons.

As a person who got all their previous glasses at Costco (which costs more, took weeks to make the lenses, had all kinds of add-ons, and required navigating the traffic jam that is Costco nowadays) it was an eye-opener.
posted by meowzilla at 12:14 PM on November 28, 2019 [1 favorite]


When I was in Japan, my wife had her prescription measured by the salesperson in the store. They had the little thing over in a corner, boom, get that done (for free) and then get your glasses (which were $100 with frames and transition coating on the lenses, Jins is awesome). So yes, this can be done by any smoe with a bit of training. But Japan seems to be much more reasonable about these sorts of things, even if vision and dental aren't covered by national insurance.

I also ordered glasses online. Three pair cost as much as a single pair here in the US. Which is good, because only one pair actually was worth a damn. I sent the most egregious pair back and got them back with the exact same mistakes. Do not order from Zenni if you have anything other than bog standard nearsightedness. If you have astigmatism, they will fuck it up in 3 out of 4 attempts. I was leaving for Japan, so I was unable to send them back yet again. I've settled for letting people know not to use them.

I honestly don't know what I'm going to do when my prescription changes again. I'm hoping it will coincide with my wife taking a trip to Japan, so I can tag along, have a vacation there and get glasses. If not, I guess I'll try another online place.

(For those who get the hard sell, I've found that "gee, I just can't decide between these two and I only can afford one, can I come back later when I decide?" works well for getting out of the glasses shop.)
posted by Hactar at 12:19 PM on November 28, 2019


On lack of preview: they're in the US? Hot damn, it'd probably be cheaper for a flight to SF, get glasses and head back to NYC. I'll have to look into that next time.
posted by Hactar at 12:21 PM on November 28, 2019 [1 favorite]


Here in Ontario, eye exams carried out by an optometrist were delisted from OHIP coverage several years ago for people over 20 and under 65 years of age (visits to an opthalmologist are still covered).

As part of a full checkup my family doctor recommended I get my eyes checked (my vision is fine so I've never had a reason to go to an eye doctor before). The exam cost around $100, and now that I think about it I should have checked with my insurance if they cover it, but it really should have been covered by OHIP. The doctor did some tests, confirmed that my vision was fine and said to get an exam in a couple of years to make sure everything is still fine.
posted by any portmanteau in a storm at 12:34 PM on November 28, 2019


This is how my former ophthalmologist built his 20+ square foot home and drives a brandy new Porsche 718 Boxster to park in his temperature controlled garage.
posted by DJZouke at 12:50 PM on November 28, 2019


More on how much the monopoly that is EssilorLuxottica sucks (contact lenses too!) and is blowing up prices for everyone.

https://www.theguardian.com/news/2018/may/10/the-invisible-power-of-big-glasses-eyewear-industry-essilor-luxottica
posted by longdaysjourney at 2:05 PM on November 28, 2019


My wife’s friends got two pairs of glasses while he was visiting us in Japan because they were about $50 each, with basic lenses, and the free eye exam (standard in Japan) took all of 5–10 minutes. His family went to the bar next door to get a drink and have a seat to rest for a bit, and they had just finished to their drinks when he met back up with them half an hour later, new glasses in tow.

I do not miss the American glasses racket even a little. It stands as compelling evidence that the natural end state of unregulated capitalism is monopoly.
posted by DoctorFedora at 2:06 PM on November 28, 2019 [2 favorites]


Luxottica -- yep, nasty place. Like Lenscrafters.

Not just like - Luxottica owns Lenscrafters, and Pearl Vision, and Sears Optical, and Sunglass Hut, and, and ...


you only needed to provide a prescription once. After that, you could reorder indefinitely without a new one. I don't know whether this is still the case.


This seems to be the case with Save-on-lens.com as well.
posted by Kirth Gerson at 2:14 PM on November 28, 2019


Australia here - Medicare pays a rebate for eye exams (about $60) for an exam every 3 years, or every 2 years if over 65 or have eye conditions. This doesn't really cover the cost of the exam and many optometrists will charge extra for things like retinal photography. Optometrists can also help diagnose disease (retinal detachments, glaucoma, diabetes related eye changes) and some can also prescribe limited medications for this. There are also some state based rebates (here,$200) for people on pensions. Having said that, my last pair of glasses at an associated store were close to $700 AUD and not that much better than my $100 online pair. I wouldn't want people to buy glasses directly as there are many problems with vision that indicate retinal or brain issues that may not be obvious.
posted by quercus23 at 7:29 PM on November 28, 2019 [1 favorite]


Optometrists can't do that part of the routine checkup.

Opticians can't do glaucoma tests. Optometrists can and do. And of course ophthalmologists can, along with lots of other medical stuff, but most people can start with an optometrist, even if their prescription is unusual.
posted by asperity at 9:16 PM on November 28, 2019 [2 favorites]


I admit I am something of a sunglasses-aholic. Since I like to get new glasses fairly often, this means going in for exams pretty regularly and they change my prescription every time even though I'm not there because of any change in my vision. I got really suspicious when they began trying to convince me to get bifocals. I am nearsighted, my close up vision has always been excellent. Obviously, I could tell that my close up vision was great, completely unchanged. I asked why I should get lenses for a problem that didn't exist, and they said it was "proactive." In other words, a total scam.
posted by WalkerWestridge at 9:45 PM on November 28, 2019


it was measured by the sales "technician" eyeballing my PD and marking corresponding dots with a Sharpie on the clear lenses of the eyeglass frames I had selected.

How else to do this? That's the way they always do me. Those of you suggesting measuring this yourself with a ruler, how about a pointer to a How-To?

Note that in the California DMV they do a vision test on the spot. Three standard charts are hung up behind the counter and you're instructed to read a small line, with one eye covered, then repeat with the other eye covered. Note that memorizing those letters is possible, while waiting in line.

Another regional aspect, several years ago when casting about for a new career I looked in to becoming an optician. No doctorate required, just a license you get by passing a test -- and it seems that in 28 states, nothing at all is required to be an optician.
posted by Rash at 10:12 PM on November 28, 2019


No doctorate required, just a license you get by passing a test -- and it seems that in 28 states, nothing at all is required to be an optician.

An optician is the person who makes/fits people with glasses. An optometrist does basic eye tests as well as things like glaucoma screenings and examining the retina. That requires a doctorate.
posted by hydropsyche at 4:50 AM on November 29, 2019 [3 favorites]


Note that memorizing those letters is possible, while waiting in line.

Unless the line is closer to the chart than the place you stand to be examined, there's no benefit to memorizing the letters. You can obviously read that line well enough.
posted by Kirth Gerson at 5:41 AM on November 29, 2019 [2 favorites]


Presumably while you're standing in line, you're allowed to wear your glasses.
posted by jacquilynne at 6:37 AM on November 29, 2019


Unfortunately, professional groups have a terrible record of disincentivizing low value care that keeps practices busy. I say this as a member of an overpaid group. asymptomatic people without risk factors just don't need it very often. FWIW screening retinal exam interpretation is going to replaced by machine learning within 10 years (maybe less). Glaucoma screening (which uses other methods eg tonometer in clinical practice) is further behind, but I won't be surprised when it picks up as reference data improves.
posted by a robot made out of meat at 8:04 AM on November 29, 2019


Here in BC I used to be able to get a free pair of glasses every 2 years on assistance. But the liberals got rid of that but not completely. They state in the forms that they cover glasses still but they only cover up to 175 bucks and 75 for the appt. The appt thing is ok but my lenses alone cost like 400 bucks for my failing horrible eyes.

I splurge when I got an inheritance a year back and bought the top of the line progressives they had (and the one pair of frames that fit my wide head they had) and it cost 1000. Well, these are the last pair of glasses I'll have unless I win the lottery. It's so sickening they don't cover them here. I've already got dentures from having not enough coverage to save my teeth since when I was 13 and my dad died we no longer had coverage. Absolutely sickening.
posted by kanata at 9:23 AM on November 29, 2019 [1 favorite]


Maybe I’m ignorant as to how my insurance works (I have vision included, am paying extra for it), but my eye exam was over $100 and then a years worth of contacts was like $250. They gave me my prescription though, so that’s nice? ¯\_(ツ)_/¯

Vision insurance is a scam on the order of dental insurance. My company buys our insurance plans through a broker who comes in to our office and does a presentation every year explaining our benefits options during open enrollment. He's a very straight-talking guy and explains that our vision insurance only covers a refraction exam - basically the thing where they are like "which is better, A or B" with the flippy lenses. The second they do anything other than that, like the glaucoma poof or the looking at your retinas with that fancy camera thing, or whatever, it's no longer covered. And definitely not if you get an exam that provides the info you need for contacts. This is how every time the same thing you describe happens to me: I have insurance where in theory the exam should be like $25 but instead it's $100 or more.

For the glasses themselves, it's similarly confusing. You get a certain amount for the lenses alone and you might get a "discount" on the frames that is eaten up by the markup on the frames in the first place. Our insurance broker actually recommends going to Zenni or the like if your prescription is not too complicated.

Here's a rule of thumb: health insurance is true insurance, in that typically you pay up to a certain amount and the insurance covers the rest (terms and restrictions apply, the US system is a mess, etc etc). Dental and vision are the opposite; the insurance pays up to a certain (low) amount and YOU cover the rest.
posted by misskaz at 10:38 AM on November 29, 2019


Presumably, if you need glasses to see while driving, you wouldn't be so irresponsible as to drive without them. If you can't see well enough with glasses, you shouldn't have a license. I thought that was the point of the test.
posted by Kirth Gerson at 10:40 AM on November 29, 2019 [3 favorites]


The independent optometrist I went to recently strongly recommended computer glasses, and tested my vision at around 15 inches as well as reading/phone distance and regular distance. I hadn't realized how much I was hunching over my computer until I started using them, so it was worth it for that alone. Two pairs of glasses (computer/reading and distance/reading) ended up being around $230 after my insurance and FSA, which isn't cheap but I did voluntarily opt for the progressive bifocals and the non-reflective coating.

However, I did get my distance prescription and intend to pick up a couple more cheap pairs without the fancy stuff. For Eyes used to do a 2 for 99 deal, but don't seem to anymore, so I'll have to look around. I don't wear glasses except when doing something, so I keep my good ones in my purse and by my computer, and then I have backup cheap lenses or older prescriptions in my car, my go bag, by the TV, out on the porch and so on.
posted by tavella at 12:01 PM on November 29, 2019


Vision insurance is a scam on the order of dental insurance. My company buys our insurance plans through a broker who comes in to our office and does a presentation every year explaining our benefits options during open enrollment. He's a very straight-talking guy and explains that our vision insurance only covers a refraction exam - basically the thing where they are like "which is better, A or B" with the flippy lenses. The second they do anything other than that, like the glaucoma poof or the looking at your retinas with that fancy camera thing, or whatever, it's no longer covered.

Huh? My vision insurance (VSP) covers the glaucoma test and the retinal check.
posted by Autumnheart at 12:26 PM on November 29, 2019 [2 favorites]


Every vision insurance plan I've had, no matter how crappy, has at least covered the glaucoma puff test and looking at my retinas (though not with a fancy camera.) But it hasn't really mattered because my parents and sister all have low pressure glaucoma, so my general health coverage under Kaiser covers a bunch of fancy tests, including the camera, a field of vision test, and various other things they have to numb my eyes for.
posted by tavella at 4:52 PM on November 29, 2019


Fizz: "Sorry, I know the post is about eye-exams, but it's the eye-glasses and prescription that set me off. Sorry if that derails."

Previously on eyeglasses price-gouging.
posted by Chrysostom at 6:58 PM on November 29, 2019 [1 favorite]


Texas does also have a vision exam. They made me take it without my glasses, which I obviously failed, so my license has a corrective lenses restriction.

My eyes have been bad since I was like 8. I have worn glasses continuously since then. They steadily worsened until I was about 29. So I needed new glasses every year, which of course are not covered by insurance. It wasn’t until I got a really good job that I actually got glasses I wanted instead of whatever I could afford. And of course I always had to pick either glasses or contacts. Never both.
posted by LizBoBiz at 2:17 PM on November 30, 2019


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