Can We Stop Contact Lenses From Becoming More of a Commodity?

Advocacy could help to rein in an Internet Wild West mentality.

By Robert M. Easton Jr, OD, FAAO

Contact lens companies have spent billions of dollars on research and development of their products. In addition, they spend millions of dollars marketing their brands to the public. For years, eye physicians have done most of the research that went into to developing modern, healthy contact lens designs.

Yet Internet marketers and other market forces threaten to devalue these tiny, innovative creations. Can eye care practitioners help to prevent the further commoditization of contact lenses? Let us explore some of the forces at work. Today we have conflicting recommendations for eye examinations.

CONFLICTING RECOMMENDATIONS

The American Academy of Ophthalmology (AAO) recommends that Adults, with no signs or risk factors for eye disease, should receive a comprehensive medical eye evaluation at age 40 if they have not previously received one.1 The American Optometric Association (AOA) recommends that asymptomatic or risk-free adults age 18 to 60 years receive an eye exam at least every 2 years.2

Personally, I recall patients yearly, because I see changes in their eyes that must be addressed.

According to a study published last year, an estimated 40.9 million individuals age 18 years or older in the United States wear contact lenses.3 According to these study authors, approximately 99% of contact lens wearers completing a contact lens risk survey in 2014 reported at least one contact lens hygiene behavior that could put them at risk for an eye infection. Furthermore, one third of contact lens wearers reported experiencing a red or painful eye that required a doctor’s visit.3

Compliance is key, and people unfortunately forget what we recommend over time. This why I like contact lens wearers to return for a yearly eye examination.

THE WILD WEST

By contrast, when an eye care organization like the AAO recommends an eye exam at 40 years of age, a Wild West mentality can take hold. Certain entrepreneurs see a loophole allowing them to market directly to the public.

Take for example the Internet-only company Simple Contacts (SimpleContacts.com). The company’s main webpage declares, “With our technology, expired prescriptions are a thing of the past. In just five minutes, you can take our vision test and reorder your contacts all without the office visit.”

The instructions are indeed simple (see Simple Contacts). The company claims to have the best selection and even better prices. “With millions of contact lenses in stock from the brands you love, you’ll never have to shop around to find your lenses at the right price again,” the site proclaims.

THE REALITY

In reality, reportedly, the “world-class” ophthalmologist who reviews the tests is paid between $2.50 and $3.00 per case to approve or deny the prescription renewal. It takes 60 seconds to review the case.

Colleagues, I ask you: Where is the patient’s chief complaint? Where are the queries about wearing time, health history, solutions used. Who is assessing the patient’s vision with the contact lenses in each eye, performing the spherocylindrical overrefraction in each eye, checking the physiologic fit of the lens in each eye at the slit lamp. Who is verifying the new lens power and design, and who is performing the 1-week follow-up to be sure the change was proper and the lens design solved any chief complaint the patient had?

WHAT TO DO?

It is time for the AOA and the AAO to come together and get on the same page regarding eye exam frequency. It is time for state optometric and medical boards to look closely at these kinds of entrepreneurial organizations that are only making a profit rather than properly monitoring patients’ eye health.

In an attempt to protect patients, eye care providers should report suspected dispensing of contact lenses without a valid prescription from the original eye physician to stopillegalCLs@aoa.org. In addition, we should inform the US Food and Drug Administration and Federal Trade Commission about this type of activity that could harm our patients.

SIMPLE CONTACTS TESTING

1. Take the test

First, put in your contacts and take the test. It’s quick, easy, and designed by doctors!

2. Select your contacts

Next, find your preferred brand and enter your existing contact lens prescription. If you’re not sure, the information is printed on the box your contacts came in.

3. Sit back and relax

Within 24 hours, one of our world-class doctors will review your test to make sure your preferred contacts are still right for you. Once it’s approved, your contacts will be on their way!

Source: simplecontacts.com

We should also support AOA-PAC (www.aoapac.org) and support members of the US House of Representatives and Senate who are concerned about this issue. Two bills offering contact lens consumer protections are now before the legislature. If enacted, this legislation would ensure that online sellers of contact lenses are held accountable for deceptive, abusive, and illegal sales tactics that threaten public health.

Senate bill S.2777, the Contact Lens Consumer Health Protection Act of 2016,4 introduced in April by Sen. Bill Cassidy, MD (R-Louisiana), earned AOA’s support because of its intent to crack down on an array of Internet sellers’ tactics that can undermine, and in certain cases ignore, safeguards of the Fairness to Contact Lens Consumers Act.

The Senate bill is complemented by a bill introduced in the House in September by Reps. Pete Olson (R-Texas) and Kathy Castor (D-Florida). H.R.6157 seeks to modernize the prescription verification process for contact lenses and clarify consumer protections regarding their false advertising.5

Are we going to complain about the current situation but not do anything? Eye care providers should support these bills and make their concerns known to their elected representatives. It is time that we take ownership of the situation before the venture capitalists turn it into more of a Wild West than it already is.

1. American Academy of Ophthalmology. Frequency of Ocular Examinations - 2015. http://www.aao.org/clinical-statement/frequency-of-ocular-examinations. Accessed October 13, 2016.

2. American Optometric Association. Recommended Eye Examination Frequency for Pediatric Patients and Adults. http://www.aoa.org/patients-and-public/caring-for-your-vision/comprehensive-eye-and-vision-examination/recommended-examination-frequency-for-pediatric-patients-and-adults?sso=y. Accessed October 12, 2016.

3. Cope JR, Collier SA, Rao MM, et al. Contact lens wearer demographics and risk behaviors for contact lens-related eye infections--United States, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(32):865-870.

4. S.2777. Contact Lens Consumer Health Protection Act of 2016. https://www.congress.gov/bill/114th-congress/senate-bill/2777. Accessed October 13, 2016.

5. H.R.6157. Contact Lens Consumer Health Protection Act of 2016. https://www.congress.gov/bill/114th-congress/house-bill/6157. Accessed October 13, 2016.

Robert M. Easton Jr, OD, FAAO
• Diplomate, American Board of Optometry
• Private practice at Easton Eye Care, Oakland Park, Florida
• (954) 564-2025; dreaston@eastoneyecare.com