A Parable of Cars and Contact Lenses
I drive into my local Shell station to fill up, and stick my card in the pump, but the pump refuses to dispense. I walk into the office and ask the store manager why I can't get gasoline. She checks my account, and says "Mr. Meyer, your Volvo fuel prescription has expired." I say, "Oh, well its OK, I am sure I am using the right gas." She replies, "I'm sorry, but the law requires that you have to have a valid prescription from your dealership to refill your gas. You can't make that determination yourself, and most car dealerships have their prescriptions expire each year to make sure you bring the car in for a checkup. Regular checkups are important to the health of your car. You will need to pay for a service visit to your dealership before we can sell you gas." I reply, "RRRRRRR."
OK, so if this really happened we would all scream SCAM! While we all recognize that it may be important to get our car checked out every once in a while, most of us would see this for what it was: A government regulation intended mainly to increase the business of my Volvo dealership's service department by forcing me to pay for regular visits.
So why don't we cry foul when the exact same situation occurs every day with glasses and contact lenses? The parable above is nearly exactly the conversation I had the other day with the operator at 1-800-CONTACTS, except with "gas" substituted for "contacts". I know that my contact lens prescription is a bit out of date, but I really needed them for a trip, and in terms of safety, a slightly out-of-date contact lens in my eye is much better than none (My contacts are about -6.5, which means I am pretty blind without them). No joy, though. I did not have time to get to the doctor, so I wore -5.0 contacts I found in a drawer just to have something. The operator told me that doctors have the prescriptions expire each year so that I am forced to come see them. Why with eye doctors do we consider this "for my own good" when in any other profession it would be called a scam?
In fact, each year I know my eyes get about 0.25 worse on each lens. I would really like to just self-medicate and order myself the next level up, but of course that is way out of bounds. Can't trust people to figure out their own lens correction (though we do allow this for reading glasses, go figure).
Tim:
It's not really 1-800 contacts fault, the last time I called them I had a really interesting conversation with the girl on the phone. She told me that the eye doctors would charge you one price for an eye exam if you were buying the contacts from them and a different price for an eye exam if you were getting your contact from 1-800 contacts. I think she told me there was a pending lawsuit they were involved in.
Sounds to me like the profession is laced with protectionism and cronyism.
Anyway, the solution is to stock up with extras when you buy your contacts. Also, if you find the right doctor, they will bump you up a level if you beg them. Its almost like having exray vision, I love the detail that I can see.
July 13, 2007, 12:25 pmDan:
"Regular checkups are important to the health of your car. You will need to pay for a service visit to your dealership before we can sell you gas."
You say this like it's a joke, but this is how things actually work in Japan. Every two years, you need to get your car inspected in the dreaded experience known as "shaken" (pronounced shah-ken, not like the verb "shake"). From the Wikipedia article about it:
"Before a test can be administered on a vehicle the owner of the vehicle must call up a Shaken center and make an appointment by phone after which the owner must fill out paper work at the center. The cost for the Shaken is broken up as follows: 1,400 yen for paperwork and processing, 25,200 yen for the testing, 29,780 yen for 24 months of validity and 8,090 yen for "Recycling Department"."
That comes out to about $600 per inspection, and that's for standard-sized cars. Larger vehicles have all sorts of other expenses thrown in. A family I knew their with a van and a standard car spent about $2,500 every other year for all the ridiculous licensing and inspection that was required.
July 13, 2007, 2:36 pmDan:
I've never been able to figure out why an optical 'prescription' is treated the same as a medicinal prescription at all. Exactly how much harm is there to be done in the irregular dispensing of ground lenses?
And if these lenses are so hazardous, why haven't we regulated the prism, binocular, and telescope industries!
(Well, obviously the answer is protectionism. But my mind cries out for at least a pretext on which to hang the regulations! None is forthcoming, alas.)
July 13, 2007, 3:09 pmoosk:
Protectionism is at the heart of the health care "crisis" we have now, and it's been brewing since the inception of the AMA. They are a guild, and their primary function is to limit competition and thereby artificially enhance their salaries. Coyote, I really wish you'd tackle the health care thing like you have climate change, especially in light of Michael Moore's latest agitprop. I agree that the health care system sucks to deal with, and it's highly inefficient, but too few realize how much of our medicine IS socialized already. We hate what we have, and yet we ask for more of it. Argh! Keep kickin' ass.
July 13, 2007, 4:33 pmla petite chou chou:
I have another real-life example of this. Since it looks like I'm the only female to read this so far I'll put it out there knowing all the readers are scientific. Women cannot obtain oral contraceptives without seeing a gyn every year. They tell you that it is for your own good because they check you for any number of diseases, and while I agree that it's good to find out if you have an STD (if you're the kind of chick to get those) or cancer, I think it is completely bogus. For one, people who cannot afford to go to a gyn or are too stupid to realize they should could have a reduced birth rate if contraceptives were easier to obtain (and less expensive, since we know there is no reason why a minuscule pill should cost so much). Two, we are all about being pro choice here so why don't I get the choice on whether or not I can get contraceptives if I have the choice on whether or not I go to the gyn? In my opinion, if a woman wants the pill but doesn't want to be inspected, she should be able to. My body, my choice right? That's what the liberals say.
July 15, 2007, 12:57 pmMark:
In America, at least, I don't think most liberals would say that. Most liberals would say it was the duty of the state to take care of you- i.e., seat belt laws, anti-smoking laws, mandatory participation in various social programs, and yes, enforced ob-gyn visits via whatever means necessary to ensure your well being.
Libertarians, on the other hand, would support your right to choose things for yourself.
BTW, here in Taiwan, both contacts and birth control pills (even emergency ones) are available without prescription.
July 16, 2007, 6:33 amJim Collins:
Some of these issues are driven by more than protectionism. Liability has a lot to do with it. I use a CPAP machine for sleep apnea and I understand why I needed a prescription for the machine itself, but I can't understand why I need a prescription for the mask. I wasn't too thrilled with the mask that came with the machine and went to purchase another one. The store wouldn't sell me a mask without a prescription. I had to make an appointment, pay full price because insurance wouldn't cover it, and get a prescription for that specific mask.
July 16, 2007, 9:17 amkatie:
i'm going through the same thing right now. i'm out of contacts, and i NEED to buy a box NOW, to tide me over until i can afford an eye appointment. the really stupid thing about this is that i am wearing OLD contacts, which could hurt my eyes. but i NEED to see, i'm -5.75 which is nearly as blind as you! i'd be better off wearing a slightly wrong prescription than old-as-crap contacts, which is what i'm doing right now. i can't even frickin' DRIVE without them. it's so messed up.
i also agree about the birth control thing, and i'm frustrated by that as well. and i agree, the liberals are the ones who make the government get in all of our business. it's pissing me off.
July 16, 2007, 12:41 pmla petite chou chou:
Yes, I am sure a lot of this type of protectionism came about because of the mentality that the government has to be there to protect us from even ourselves. If no one in America thought "well the government should have done something!!" then they may not have so many regulations like these. You can insert doctor in place of government, too. And there is probably some preemptive regulation as well. "Suzie had cervical cancer, we didn't know about it because she never came in for a checkup." "Well why didn't you make her do it??" "Bob died in a car accident. He wasn't wearing a seat belt." "Well why didn't you make him wear one!?"
July 17, 2007, 9:38 amdeodand:
I would estimate that 90% of licensing of professions and professionals; product standards; building, electrical, mechanical, engineering codes; zoning ordinances, pure food and drug regulations; and trade regulations really amount to anticompetitive laws which are sold to and by the politicians in "protection of the public" wrapping paper. And mostly these rules constitute an abuse of the public's trust insofar as the regulations serve primarily to overcompensate some at the expense of others. It's just another example of how political involvement can lead to wealth, and explains how it is that frequently politicians may start out poor, but they never retire poor. And it explains why business leaders would bother to pay big bucks to lobbyists and contribute generously to political campaigns. For the benefit of the public. Right?
Oh, and speaking as one who has held one kind or another professional license in several jurisdictions, continuously since 1965, I have to say . . .Well. Hey. Thank you very much.
July 17, 2007, 8:06 pmKevin:
Dan, we have mandatory car inspections here in California, too. Not every year, but at some interval you can't renew your registration without passing a "smog check" where they check your emissions levels. Costs about $40.
Last time I renewed one of my vehicles, the actual pollution levels measured at the tailpipe were fine, but I still failed the smog check ... because the "check engine" light was on. Had to replace a $100 oxygen sensor to pass the check and get the renewal sticker for my license plate.
July 18, 2007, 12:24 amRyan:
I feel your pain. I wear -7.25 in one and -6.50 in the other. I have had to wear 1 size in both before when I was running low with no scrip. Unintended consequence- people wear contacts that are years out of date and could be dangerous. Thanks for your generous protection of my health and well-being
July 20, 2007, 9:09 amIn the Know:
Blaming your eye doctor because you're too stupid to keep an adequate supply of contacts or a back up pair of glasses is pathetic. You knew you were running low why didn't you bother to be responsible and get an exam? Contact lenses are medical devices becuase they can, and do, injure the eye without the wearer even knowing it. (By the time you feel discomfort there is already damage, the question now is how the eye will heal.) Rules and laws governing contact lenses exist PRECISELY to protect morons like you, who think you know something when in fact you don't, from developing permanent vision loss due to an infection or injury. (You need to leave the doctorin' to actual doctors......)
You also need to consider the source of your info......1-800 contacts, the most notorious CL provider in the industry. A company that has been found several times to be in violation of state and federal laws governing the dispensing of CLs. If they are so good and reputable why have they been sued so many times and LOST? Why do they report in their shareholder report that they are in violation of many such laws?
It was partly because of these violations that the Federal Government passes a contact lens law in 2004 to protect consumers. IT IS THIS LAW, PASSES BY CONGRESS, THAT REQUIRES A 1 YEAR EXPIRATION DATE ON CONTACT LENS PRESCRIPTIONS!!! LOOK IT UP!!
THE NEXT TIME YOU TALK TO THOSE lying JERKS at 1-800contacts, inform THEM that the doctor who put the expiration date on the Rx was only following the law!!
Stop blaming the doctors for your laziness and stupidity, and start listening to them as trained doctors who know a hell of a lot more about eye care then you do, or the unskilled, minimum wage earning liars at unscrupulous companies like 1-800contacts.
August 1, 2007, 1:57 pmBetty:
At the end of the day, we know it all comes down to money. Its amazing that money was able to knock down the common sense of so many people and let an embarrassingly irresponsible thing like 800-contacts happen.
We need the kinds of regulations that require consumers to have medical devices prescribed by a professional. If it wasn't for these type of regulations standing in the way, there would be a 1-800-vicodin you could call and tell the operator that you know that vicodin the dentist gave you 4 years ago has expired, but you think that you should be able to decide for yourself what pain pill best takes care of your achy back. Is it a scam that you can't get presciption drugs just for the asking? The excuse that if you cant get your rx you will be forced to take something more dangerous until you can afford to go to a dr is rediculous.
The simple fact is that 800-contacts are doing what they are doing because there is so much money in it they were able to buy their way through the red tape. If this happened with every section of the healthcare industry, the pillpoppers would certainly be calling 1-800-vicodin for their fix, potheads calling 1-800-med-weed because they feel they would like some medical marijuana for their "glaucoma", and little girls calling 1-800-boobjob to find out where they can redeem their cokereward points for plastic surgery.
If you want to wear a medical device that covers the precious cornea of your eye, you owe it to yourself to get a proper exam every year, fill your prescription on time, care for your contacts as your taught to, and keep a good pair of backup glasses in case you need them. If you are not that responsible than you have no business wearing contacts.
If you are that responsible, than you owe it the the eye care professional who takes on the tremendous responsibility and liability to fit you with this medical device on your cornea (for the sake of your vanity) to buy your contacts from your eye doctor. Most eye doctors can dispense the contacts you need right there and actually show you how to use them, how to clean them. They also will address your needs as your vision or lifestyle changes and your contact use needs to be re-evaluated. Is the 18year old on the phone at 800-contacts going to do that for you?
Yes this gives more profit to your eye doctor, but wouldnt you rather your doctor make that money so they can invest in bigger and better, more advanced equipment to care for your family's eyecare needs? Would you go to your favorite cafe for lunch and ask them to prepare groceries you bought at the discount grocer to save a buck and expect the cook to be happy when you complain you didnt like your meal? Do you think you would be entitled to the cook's culinary abilities even though you didnt respect him enough to purchase the food he is offering to you? From a business standpoint it s no different.
Would you really rather give that profit to 800-contacts, giving less revenue to the eye doctors until they are all shut down and the only eye drs in town are the ones at walmart who only know how to fit teenagers in junk lenses like Acuvue? Whos going to address your contact needs as your eyes age, and who's going to take care of it if you have a child with an unusual power or visual need. I promise you the guy at Walmart will not be equipped to handle it, and the kid on the phone at 800-contacts will have nothing to say but sorry.
Its unfortunate that eye doctors were too damn busy trying to address the eyecare needs of todays busy people to rise up and not let 800-contacts happen. But it did, and the best thing you can do is not let be an example of how everything can sell out do to a few peoples greed and the stupidity of alot of lazy, uneducated consumers.
August 2, 2007, 9:31 pmmary:
OK... picture this... 600 miles away from home... 17 yr old son loses his left nite and day contact lens in the Atlantic ocean. I call the nearest vision center and am told that it would be no problem to replace the lens as long as we get a prescription faxed to their office from our MD. We do this and were then forced by the vision center to purchase 6 month supply for 170 bucks. We're told that they can't just order 1 box for the left eye. I'm contacting the licensing agency
August 14, 2007, 6:37 pmBrad:
""then forced by the vision center to purchase 6 month supply for 170 bucks""
NO ONE FORCED YOU TO BUY ANYTHING ! - maybe if your 17 year old - had his back up glasses - he would have no issues - OH - I forgot - " MOMMY and DADDY - I don't like to wear contacts " -- that is what comes out - well u should have invested that 170 bucks - in glasses -and he would be all set - and even learned a lesson - not to travel 600 miles from home - with only the set of cl's in his eyes -
as for the boxes of lenses he had to buy - you should be happy they allowed the rx to be filled - ( that is if it was expired ) _ hate to tell you - that night and days are NOT sold by the Lens - !!- so why should any vision are center that you do not currently do buiness with - open a box - and give you 1 pr - or even give you a pr of trials -
I have been in the field many many years - and there are LIGIT reaosns for the rx policies - Take a look at all the "FLEA MARKETS " selling non rxed colored lenses - and how many issues came out of that - kids where damaged - and they had no one balme but themslfs !
Our policy is - that we have no probelms if you walk - and not buy lenses from us - we will do our fittings = hand over the rx - as required by law - BUT what drives me nuts is when these folks come back - either saying - I ran out and i have something important i NEED A LENS NOW - or Im going away in the am - can i have a trial until 1-800 ships them to me !! FORGET ABOUT IT ! - why should I give a lens away - to someone that does not support their local store - and for me now not to have any for my pts - that do support us - and keep my 10 employees a job ?
All I HAVE TO ADD HERE TO ANYONE saying contacts expirations are a joke - or want everyone to bend over - and give them a lens - when they are in real need of them -
WHY NOT GO - AND PAY FOR LASIK :??? JUST GET IT DONE WITH !! DON"T TALK ABOUT - OH i am going to wait - or get it done soon - its been out for over 10 YEARS !! Get IT DONE AND OVER WITH- and you will not have to go thru these " so called inconvienances EVERY YEAR - SINE YOUR TIME IS SO MUCH MORE VALUABLE THEN EVERYONE ELSES !! SPEND THE 3 K - AND IT IS DONE !! esp with a -700 or even a -275 for that matter !
i just love when those -.50 or even -1.25 folks come in and say " oh im blind " i just get a chuckle out of it - ! Now that is a JOKE !
September 2, 2007, 11:51 amDonn:
My gosh! I love these people that feel that contacts are they're god given right and the exam is just a scam!!! WOW these are the folks from the shallow end of the gene pool!!! The simple reason why you NEED to have your eyes examined is not to determine if your prescription has changed. The Dr needs to determine the health of your cornea. A contact lens can cause all sorts of problems. It can deprive your cornea of oxygen, it can create a corneal ulcer, introduce infectious parasites, scar your cornea and thats just a little bit of what can happen. In fact there are 800 page books dedicated to contact lens complications!! If you go about getting contacts illegaly and do not follow your Dr's advice for wear and care you are putting your vision in harms way!! Just think you save a few bucks on an exam. But look at what it could cost you. Medical care for damaged cornea, new glasses (can't wear them contacts any more), medication, follow up examinations and the possablilty of purchasing more eye glass lenses if the damaged cornea is causing your prescription to change! Are you the same people who read a poison label and say "this is sh*t! It's all a scam! I'll do what I want!" and then take a chug?!
September 6, 2007, 8:34 pmDonn:
And as for the determining your own prescription I kind of agree with you. The refraction part of the examination is not really medical. This is why Opticians are pushing for the ability to refract. The main reason why OD's and MD's are fighting this is because Opticians are not qualified to daignose certain medical conditions. You would be amazed at how many diseases can be can can be determined by an eye examination. Now if your logic was to increase your RX .25 diopter a year how could you determine if you developed and astigmatism? conpensate for vertex? or when you get older your add power? refraction is a little more complex than you realize. As for the ready readers, those kind of got granfathered in and manufacturers argue that they are for magnification purposes. But if this was the case they should have labeled them with thier magnification power and not the power in diopters.
September 6, 2007, 8:44 pmFightMeImIrish:
The last few posts are ridiculous. Do you really want to live in a "Nanny-State" that imposes unnecessary laws, in order to protect you from yourself?
I understand that the purpose of a yearly eye exam is to check for eye disease in addition to the strength of the prescription. This should be carefully explained when you are initially fitted for your lenses. After that, IT SHOULD BE YOUR OWN RESPONSIBILITY TO TAKE CARE OF YOURSELF. Smart people will CHOOSE to get a yearly exam, but should not be REQUIRED to.
Should Band-Aids be outlawed because they can be used to cover wounds that require medical attention? Who are we as laymen to determine if a cut is deep enough for stitches? Even a shallow cut could easily become infected. Can a layman be expected to know what antibiotic to use or how exactly to apply it? Should we leave all the "Doctorin' to the Doctors" in this case as well?
If a person is irresponsible enough to misuse their contact lenses, and it results in eye damage, you can call it a hard lesson learned. I would rather manage my own affairs and consult professionals as I see fit. I am then responsible for the outcome. If you are not comfortable with that, then go to the eye doctor. Nobody should be forced to do anything!
The argument is also invalid because doctors are not the Unquestionable Experts that many believe them to be. They are regular people who studied hard, crammed for tests, and pushed through many years of schooling (Good for them!) But I would wager that, like everyone reading this, they DO NOT remember everything they learned college.
How many people who ARE under the care of an eye doctor, misuse their lenses by wearing them for way too long? Almost everybody? Does the doctor verify that they are changing their contacts as often as they should? No, the only thing he cares about is the $150 for the appointment.
Contacts are ridiculously over-regulated, I can buy glasses for farsightedness at the $1 store, but I need a doctors opinion for nearsightedness? And this guy ^^^^^ can't get contacts for his son on vacation? It just doesn't make sense.
September 7, 2007, 6:05 pmAdahy:
I have my so nice & soft contact lenses which I purchased from Lens.com through CouponAlbum site at reasonable price and I saved $10...so visit now and save your money.....
September 8, 2007, 1:18 amVince:
Ryan, In the Know & Mary,
While good eyecare is important, I think you're missing the point here. Do we really want the federal government intervening and dictating preventative medical measures? Let's pull the argument away from eyecare, and toward two equal, if not more pressing healthcare examples.
HEART DISEASE If your doctor told you that you have a predisposition to heart disease, would you want the federal government prohibiting you from eating a hamburger?
DIABETES. Should there be a government pass or card that demonstrates you have no family history of this disease, therefore allowing you to buy sugar candy?
At the end of the day, preventative healthcare should be an individual's choice, and not mandated by the government.
I have no seen any compelling evidence that indicates those prescribed with contact lenses with a history of healthy eyesight are a threat to public safety without yearly eye exams.
While we may speak of the importance of eyecare, this federal requirement is an attempt to force individuals to have yearly eye exams. In this country, I find this precedent downright frightening.
October 5, 2007, 3:10 pmjoejoe:
Hey, Warren. If your eyes keep getting worse, you might want to get some glasses for when you're in front of the computer. Like me, you probably spend a lot of time with your eyes looking at objects only 18-36 inches away. I believe that your eyes adjust to this distance over time. Result: your eyes seem to keep getting worse. Also the constant use of your eye muscles to maintain a close focus could leave you with what feels like a headache.
So try wearing a set of reading glasses when using the computer and see how you feel.
October 23, 2007, 6:24 pmEsther:
I may be a liberal but in no way do I need the government or medical associations to tell me how often I need to get a check up. In addition to my long standing irritation at having to get an eye exam every 1 - 2 years so I can tell them how strong I'd like my glasses to be! I'm 51 & have been wearing them since age 3. I've also discovered recently that I can't get my teeth cleaned without first having the dentist give me a costly checkup first. I went so far as to write to the state licensing agency for dentists to no avail. They just kept telling me it was for my own good. This blog has inspired me to continue my battle. I'm going to write to my representatives & see where that gets me. I suggest anyone who has a problem with big brother health mandates do the same.
November 6, 2007, 2:35 pmAcuview:
If you want to save time, you can use a comparison shopping engine, like HealthPricer
April 24, 2008, 3:40 pmMark Murphy:
I have delt with this problem bev=fore...and here is the SOLUTION: Order your contacts from another country. I do it all the time. Problem SOLVED. This law is completly bogus I agree, I travel all the time in and out of the country. I have no time for yearly doctor visits to renew my perscription which has been the same for 15 years. (my eyes are not getting weeker). Next thing you know I will have to go to the doctor to get a perscription for condoms!
May 1, 2008, 8:32 pmcheryl:
When you're fit with contact lenses the Dr. that fit you is assuming responsibilty for your eyes. Therefore it should be up to the doctor to determine when your rx expires. Contact lenses are regulated by the F.D.A. Same as prescription drugs. Any vision loss due to contact lens abuse can never be restored. Why would you play russian roulette with your eyesight? I see people every day with corneal ulcers, scratched corneas, eye infections etc...due to abuse and over wearing their contacts. These people will not be able to wear contacts at some point because the scarring on the cornea will be so apparent that no Dr. in his or her right mind would ever fit that person again. So over wear your contacts but don't come running to me when you have any kind of eye health issue . What do I know I only went to school for 8 years and that's right you know everything.
July 19, 2008, 10:10 amAnonymous:
the car analogy is flawed. driving is a privilege not a right. some places you cant renew your license without a smog check (horrible thing trying to keep the air clean) God forbid if your brakes give out because you didnt follow the recommended maintenance.
Contacts are not a God given right.
if you think its too expensive or inconvenient to get an exam to get re-evaluated for contacts, then go wear your back-up glasses. If you dont have backup glasses, whose fault is that? If contacts are really that important to you, again whose fault is that when you run outa contacts and didnt plan ahead? True, most times contacts do not cause any problems, but when things go wrong like a corneal ulcer or infection from over-wearing or too tight of a fit, permanent vision loss may occur.
you know what they say, "its all fun and games till someone loses an eye"
http://www.applications.dhs.ca.gov/pressreleases/store/pressreleases/23-00.html
August 19, 2008, 12:48 amKontaktlinse:
Have you guys read the book "Jennifer Government" by this Australian writer Maxx Barry?
He is an ex-marketeer and his novel is a sattire around the consumerist world of the future.
The 'scam' that you came across, is exactly what has become of our world these days. Everything needs a credit card and cash. If this goes on, we will be suffering the consequences!!
Till then, good luck to volvo and eye sight prescriptions!
:P
November 28, 2008, 12:04 pmLeslie:
Now that you are keenly aware of eye physicians requiring contact lens patients to have an exam every year, you should never run out of lenses because you know you'll be required to have an exam before obtaining more.
December 9, 2008, 11:59 am