Doctors, retailers disagree on contact lens sales

Michelle Swafford

Monday, April 18, 2005 | 9:53 a.m.

A federal law that gives contact lens wearers a right to shop around for their lens continues to leave eye doctors and retailers not seeing eye to eye.

The Fairness to Contact Lens Consumers Act became effective in February 2004 and enables patients to automatically receive their contact lens prescriptions from their optometrists or ophthalmologists and fill them with any lens retailer. The act states that physicians have eight business hours to respond to verification requests and, if they do not, the prescription that was called or faxed to the retailer is deemed valid.

Retailers such as 1-800 CONTACTS say some doctors are intentionally prescribing lenses that are available only through doctors' offices to increase profits, while local eye doctors say they prescribe what is best for their patients and that some patients damage their eyes when they try to save a few dollars.

"This is a good law and it is a very good first step," 1-800 CONTACTS spokesman Kevin McCallum said, adding that additional education is needed for doctors and consumers. "You don't know with certainty if this is the best (lens) for you or if it is the best for the doctor's retail business. This is a health care category where the primary health care provider sells the product they prescribe and that describes the behavior."

McCallum cited a 2000 article in Optometric Management magazine that said eye care products account for up to 65 percent of the total revenue for the average doctor's practice, which he says is why doctors limit the types of lenses they prescribe.

Doctors prescribe private label lenses that cannot be purchased elsewhere "to deceive the patient," McCallum said.

CooperVision Inc. is the only contact lens manufacturer that does not sell to retailers, while Johnson & Johnson, CIBA Vision Corp., and Bausch & Lomb Inc. sell to doctors and retailers.

The manufacturers that sell to retailers did so after they were sued by Nevada and 31 other states on antitrust allegations. In 2001, Johnson & Johnson agreed to pay $25 million in cash into a settlement fund, while Bausch & Lomb agreed to pay $8 million in cash and CIBA Vision agreed to pay $5 million. The American Optometric Association, which was also a defendant in the case, agreed to pay $750,000. Also, Johnson & Johnson and Bausch & Lomb agreed to provide consumer rebates worth $30 million and $9.5 million respectively.

Local eye doctors say there is little profitability in contact lenses anymore and that their charges are within a few dollars of other retailers.

The markup on lenses from a doctor's office is about $3 more per box than through an online retailer and patients can see the doctor and dicuss eye problems when they pick up their refills, Dr. William Harvey, a Las Vegas optometrist, said.

He estimates that about half of his patients purchase their contacts from him, while the other half opt to buy them from the wholesale membership clubs or from online retailers.

The biggest challenge with allowing patients to take their prescriptions to be filled elsewhere is that many patients do not return for eye checkups.

Refills are often processed beyond the prescription's one-year expiration date, which can damage patients' eyes if they are not checked to make sure a new prescription isn't needed, Harvey said.

"At this point in my practice, the problem of people coming back to see me to get their prescriptions is an issue, but it's not as big an issue as it was," he said.

The other challenge with the federal act is that the verification process by retailers such as 1-800 CONTACTS is automated, making it hard for optometrists' offices to inform retailers when there are problems with the prescription, Harvey said.

Dr. Jeffrey Austin, a Las Vegas ophthalmologist, agreed that regular checkups for patients who order from mail-order retailer is a big concern among doctors.

"We're on the line liability-wise," he said. "We're the ones that are responsible for the health of that eye. Optometrists need to tell patients that it's in their best interests to get their eyes checked on a regular basis no matter where they get their contacts."

It is recommended that contact lens wearers have their eyes checked at least every six months because a contact lens "does change the physiology of the eye. If it is not fit properly, it can damage the eye," Austin said.

Austin is president of the Nevada Optometric Association and said that although he does not prescribe glasses or contacts he often receives verification requests from mail-order retailers to fill patients' contact prescriptions that are not his patients.

He said he tries to respond to the faxes but is not always able to reach a person at the retailer and the prescriptions are likely filled.

Another way mail-order retailers take advantage of the law is by calling for verifications when the doctor's office is closed, Austin said.

The federal act has been a "thorny" issue for doctors and lens retailers, Austin said.

"It's been an issue on both sides," he said. "1-800 CONTACTS and other places like that want to sell contact lenses. They want to sell contact lenses with total disregard to the patient."

In 2004, 1-800 CONTACTS sold $212 million in contacts, but after expenses posted a $616,000 net loss, according to its 2004 annual report. The company said in its report that it expects between $220 million and $230 million in sales in fiscal year 2005.

Doctors prescribe what they feel is best for their patients, which sometimes means trying four or five types of contacts to find the best fit, Austin said. He also said the prescriptions are not based on contact lens sales.

"The profit on contact lenses is almost gone," he said.

Before the federal contact lens act took effect, eye doctors were encouraged to release prescriptions when patients requested them because "it was the right thing to do," Austin said.