Are you happy with the way you see the contact lens industry and your practice going? Are your contact lens patients safer with the current regulatory environment that is focused on convenience? I think most of us would agree that both are a resounding “NO.” Vision plans have devalued the professional component of care forcing us to sell product to survive. Online disruptors are heavily lobbying for convenience instead of care. Large corporate forces are squeezing us like never before. And, the FTC seems hell-bent on appeasing disreputable companies at the cost of patient health and outcomes. So, let’s talk about what we can all do to win.
Optometrists are at the front lines of a war for the protection of our patients’ health while at the same time fighting another front to have our practices survive the next 5 years. It seems like every corporation and government regulator is against us and care nothing about the patient. Let’s tackle each of these aggressors in detail and talk about what we can all do to survive and thrive.
Vision Care Plans (VCP’s)
While once on the side of private practitioners, it is now clear that VCP’s are squeezing the private practitioners like never before. For years, VCP’s have been devaluing the professional component of a visit by decreasing or holding constant the reimbursement for an eye exam. In order to stay solvent, the OD has two options: see more patient volume, or sell more product. VSP recently announced a severe financial penalty that punishes the OD for prescribing spectacle lenses that are not owned by VSP. This was explained to the industry as a turf battle between competing companies. So, what are the options left for the OD? Many voices on ODs on FB favor dropping VCP’s all together. This is a strategy that may work for some practices, but not for many. Patients of today have significantly more choices and limited loyalty. By and large, they will go where their VCP is accepted. So, dropping the VCP’s will send the patient to optical chains and online retailers that continue to accept those plans. Unfortunately, deals are being done on the large corporate level with providers that can service tens of thousands of VCP subscribers in one “foul” swoop. For example, Warby Parker now accepts certain vision plans. The rules are being written without private practitioners in mind.
At this stage, most online disruptors have their own contact lenses: Aquasoft (1-800 Contacts), Scout (Warby), Hubble, Waldo, and Joy (Aveo). The business model of most of these companies is to cut out any evaluation by a doctor that they see as a barrier to their sale. They exploit passive verification requirements, use untested online vision tests, and bend prescription requirements to sell more of their products. 1-800 recently purchased a company called 6over6, which has an online vision test that they hope will lend credibility to online vision tests. Currently, 1-800 is using a somewhat bogus test that they refer to as their Express Exam. This exam is seemingly used to sidestep prescription regulations and serves as a platform for an ophthalmologist to sign a contact lens prescription.
1-800 took a readily available Taiwanese silicone hydrogel daily disposable lens and branded it Aquasoft (Visco, Taiwan). This lens is heavily marketed on their website and does not appear to have trial lens sets readily available to optometrists. So, they are promoting a direct-to-consumer product that cannot be evaluated on the eye by an optometrist for fit or vision.
Warby Parker recently got into the game of marketing their own daily disposable lens, Scout (Menicon, Japan), by rebranding the Miru daily disposable. It was the experience of many optometrists that the Miru Daily lens failed in the US market because the lens was designed for the Japanese cornea (which has a different sagittal height, HVID, and keratometry).1
Interestingly, Warby must have realized very quickly that without their in-store optometrists prescribing the lens, it was going to go down in flames, so they pivoted, and started also selling all the big 4 lenses. Once again, the big 4 have been supporting the competitor of private practice.
Hubble, Waldo, and Aveo make no excuse about selling contact lenses (a class 2, regulated medical device) without a prescription. Hubble (St. Shine, Taiwan) does not provide diagnostic lenses to optometrists, likely because they know that ODs would never fit a Methafilcon lens (Dk=18.8), which does not satisfy the Holden-Mertz criteria for daily wear of lenses. In the popular media, Hubble has been called out for allowing prescriptions for patients who entered fake prescriptions and made up doctors’ names. Hubble has also been called out by the AOA who compiled all of the complaints to the FTC over a 2 year period of time and found that the vast majority of complaints were related to this lens. A New York Times article indicated that after taking an investment from oral care giant, Colgate-Palmolive, the company seems to be diverting its attention from contact lenses to supporting the oral care market. Waldo (Pegavision, Taiwan) and Joy (Aveo Vision, Malaysia) seem to be smaller players in the contact lens market and again rely on failures of passive verification to allow consumers to purchase their lenses.
It has been widely publicized now that the Federal Trade Commission (FTC) has released its final ruling on the changes to the Contact Lens Rule, during the COVID crisis. This rule change requires prescribers to have all contact lens patients sign an acknowledgement form that they received a copy of their contact lens prescription each year. The prescriber must keep this acknowledgement on file for a minimum of 3 years. The AOA and American Academy of Ophthalmology have slammed this ruling as overly burdensome and as an overreach of regulation. This rule change comes after a serious lobbying effort by Americans for Vision Care Innovation, a bogus group formed of 1-800, lens.com, and Smart Vision Labs. This groups spends millions of dollars in Washington DC lobbying for the relaxation of contact lens prescription rules, lengthening of contact lens prescriptions, and ultimately, generic contact lenses. The FTC favored the demands of for-profit companies instead of guarding the health of millions of patients. Ultimately, there is going to be much more abuse of passive verification by these unscrupulous companies and more patients will forego care if these companies do not require a valid prescription. Many more patients are going to leave your practices to purchase materials through these online middlemen.
So, how can we stop all of this bad behavior on the part of unethical companies? How can our practices compete with the convenience of purchasing contact lenses online? We need to get smarter and partner with smarter companies, who have the patients’ and doctors’ best interests in mind at all times.
Meet Eyeris, a company I co-founded with an expert in business strategy who has led many successful start-up companies outside the ophthalmic industry. Andy Barrow and I quickly realized why optometrists were being disrupted out of existence: we have not changed with the times. Although we place the patients’ health and well-being above all else, we missed the critical need for convenience. Simply put, patients want to purchase contact lenses at 9pm on a Saturday night, knowing that they are paying the lowest price available.
Eyeris provides a top-quality daily disposable contact lens available for prescription by private practice optometrists, OD/MD practices, and academics. The lens is available for sale by those practitioners and online, directly to patients who have been fit by an Eyeris network doctor. But, when the patient purchases online, the doctor who prescribed the lens always realizes the SAME margin as if the lens was purchased in-office.
The lens is one of the most inexpensive lenses available: $459 for an annual supply (no confusing rebates, just fair-trade pricing), but with one of the highest doctor margins out there: $200 (45% margin). It is not sold to online middlemen, distributors, or big-box retailers and is non-substitutable because of a unique base curve, diameter, and material (the FTC fines companies who substitute these variables). Patients can purchase directly from Eyeris, so they know they are receiving the absolute lowest price. They can even purchase with a monthly subscription service.
The Eyeris Daily has proven itself to be comfortable, breathable (Dk/t 31.25), wet at the end of the day, and loved by patients. Many of the top practices in the US have already made the Eyeris Daily their lens of choice. For more info on this lens and the company, join our private Facebook group: Eyeris ODs. Because, if anyone should make the margin on contact lens sales, shouldn’t it be you?
- Hickson-Curran S, Brennan NA, Igarashi Y, Young G. Comparative evaluation of Asian and white ocular topography. Optom Vis Sci. 2014;91(12):1396-1405.