Ensuring healthy eyes and healthy profits

As the nation’s primary eye health and vision care providers, doctors of optometry are committed to the health and safety of our patients. For me, as a practicing doctor, this means doing everything possible to protect and preserve their health, whether that means responding to emergency calls, calling my patient’s primary care doctor because I suspect hypertension or diabetes, or saving my patient’s life by detecting a brain tumor or aneurysm.

Like other physicians, eye doctors take an oath and hold ourselves to the highest standards and ethics to protect our patients’ health. The oath guides the way we practice and compels us to advise our patients of all options to restore, maintain or enhance vision, eye and overall health, even as we work within a competitive marketplace guided by laws and regulations which evolve as care advances and improved outcomes are achieved. We follow the letter of the law every day, whether we are diagnosing and treating eye diseases, or determining a patient’s contact lens suitability, individual fit and prescription.

{mosads}By contrast, from what I’ve observed, the primary goal of numerous online contact lens retailers is to sell as many contact lenses as possible. Many seem to feel little or no obligation to serve the patient’s best interests — rather, they appear to prioritize the pursuit of quick profits.

We take no issue with building a business. In fact, I, like many of my colleagues, own and run a community-based practice and employ other doctors, technicians and office staff, all of whom work hard daily to compete in a constantly evolving health care system. What we take issue with are companies that use their size to threaten competition by gaming the system and ignoring or circumventing the law, especially those laws enacted to ensure patient health, safety and quality care.

There is a clear threat to patient health and potential significant risk associated with the improper use of contact lenses. Purchasing contact lenses through the internet has been associated with a higher incidence of poor hygiene practices, which can result in adverse events – infection, keratitis or even corneal ulcers which can lead to loss of sight. Unfortunately, profit trumps risk for some. 

A web search yields several websites openly offering to sell contact lenses without a valid prescription — accepting expired or non-existent prescriptions — clearly violating current law and regulation. Many of their homepages boast “no prescription needed” and encourage consumers to buy years’ worth of contact lenses, despite prescriptions typically having a one-year expiration date. This is open defiance of current law that not only places contact lens sellers that do follow the law at a competitive disadvantage, but, more importantly, deceives the public, can harm patients vision and eye health, and disrupts the doctor-patient relationship.

For those contact lens sellers that do verify prescription information with the eye doctor, as required under the law, many use confusing and outdated communication methods including hard-to-understand “robocalls.” Even when an eye doctor is able to verify prescription information, it is often difficult, if not impossible, to reliably relay information back to the seller should the doctor have a question or concern, which makes the prescription verification process little more than smoke and mirrors. 

How do we fix this unacceptable status quo? Doctors of optometry support bipartisan legislation introduced in Congress this year. Supported by other respected organizations including the American Academy of Ophthalmology, the Advanced Medical Technology Association, the Association of Schools and Colleges of Optometry, the American Association of Diabetes Educators, the Contact Lens Institute, and the Coalition for Patient Vision Care Safety, the Contact Lens Consumer Health Protection Act, would strengthen current law by preserving what works with the current contact lens verification system while improving upon the areas that do not.

Predictably, the bill is opposed by online retailers including, the largest online seller of contact lenses. Opponents would rather put up smokescreens to mischaracterize this legislation than address the real reasons behind it. They don’t mention their unlawful practices that put patients at risk.

Here’s what else they won’t say: major online retailers are facing serious allegations of anti-competitive behavior and consumer fraud. The Federal Trade Commission filed suit against 1-800 CONTACTS in August for misleading consumers and driving up prices. The company is also facing multiple class action lawsuits which accuse the company of preventing consumers from comparing prices.

Congress recognized that patients would stand to benefit from having the choice of where to purchase contacts from when it passed the Fairness to Contact Lens Consumers Act in 2003. But lawmakers also recognized that contact lenses are FDA-approved medical devices that can cause harm if not used under the care of a licensed eye doctor. That is why the law set up a verification system. While today’s contact lens market is full of new products and healthy competition, instances of deceptive and abusive tactics by some online contact lens retailers are on the rise. S. 2777/H.R. 6157 would simply strengthen safeguards already in place to ensure that everyone follows the letter of the law and acts in the best interest of millions of contact lens patients. 

We recognize we work within a competitive marketplace that is guided by laws and regulations. When those are circumvented in ways that impede competition and compromise patient health, we have a duty to speak out. Doctors of optometry therefore urge lawmakers to support the Contact Lens Consumer Health Protection Act to confront irresponsible practices that put our patients at risk.

Andrea P. Thau, O.D., President, American Optometric Association. 

The views expressed by contributors are their own and not the views of The Hill.