o.d. to o.d.
Contact Lens Practice in Turmoil
The specialty area that was once the darling of optometry faces many challenges today.

BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O., Chief Optometric Editor

Contact lens practice is quite controversial these days, which isn't necessarily a good thing. They once transformed optometry from a hands-off, mostly spectacle-oriented profession to one that touches the human cornea and manages its physiology. The field of contact lenses has been our high-status specialty and the most financially lucrative aspect of optometry.

However, I now hear some colleagues saying that they don't want to fit contact lenses anymore. O.D.s feel unappreciated by consumers who want it fast and cheap and by retailers, which seek only to capitalize on the next new business idea. Federal and state governments do not seem to grasp the issues.

Let's look at some of the recent events in the contact lens field:

Viewing the government's stance

• The FDA talks about deregulating plano tinted contact lenses, demonstrating a profound lack of understanding by implying that a lower dioptric power in a lens somehow reduces the health risk of wearing it.
• The Contact Lens Prescription Release Act of 2002, which mandates the automatic release of contact lens prescriptions to patients, is before Congress. Numerous states also have such legislation or are working on it.
• States choose to not enforce existing laws governing the sale of contact lenses as prescription devices.

Movements in the marketplace

• Some retailers unethically sell contact lenses to consumers without requiring valid prescriptions.
• These companies leave messages on doctors' answering machines after hours or they send faxes. If a doctor doesn't respond quickly, the sale occurs anyway.
• In cases where prescription verification isn't received (possibly for valid reasons, as when it has expired), these retailers advise the consumer to report the doctor to the state board of optometry or other consumer protection agencies.
• If an Internet retailer has difficulty obtaining certain lens brands, it suggests the patient switch to a more cooperative O.D. -- that is, an O.D. who would prescribe a lens that is available at the retailer's Web site.

Inside the industry

• Manufacturers sue contact lens retailers, which they believe sell lenses illegally. Contact lens retailers sue manufacturers for not agreeing to sell lenses to them.
• Manufacturers are also sued for charges such as price fixing and improper labeling.
• While it's impossible for doctors to know which manufacturer is at fault, patent infringement lawsuits put patients and doctors in a tough situation by removing lenses from the marketplace.
• A major vision plan insurance company forms a partnership with manufacturers to provide preferred pricing to its members.

Continuing the good fight

What is the individual optometrist to do in the face of all this? In my opinion, we should continue the good fight. As optometrists, we are the leaders in contact lenses. No one knows them better. The public demands this important vision correction tool.

So embrace contact lens practice, even with its challenges. Work with our professional associations to create a favorable legal environment. Participate in education and research. Look within your own practice to make contact lens care efficient and convenient for patients while still safeguarding their eye health. Release lens prescriptions promptly when requested and when current -- regardless of where the patient buys them.

Continue to provide contact lens materials -- pricing them for a fair profit and providing the service that makes them a good value. Your patients have the right to choose where they buy contact lenses, but in the end, most will choose you.

You may contact Dr. Gailmard at neil@gailmard.com.