In the past few months, I've gotten a number of emails and instant messages from people who have had their prescriptions "held hostage" at the optical shop. It's been awhile since I've seen anything like this. It makes me think that these stores are starting to feel the combined pinch of the economy (that we've all been feeling for the last year or so) and that the online eyeglasses retailers are taking market share at an faster rate.

Either way, there is no excuse for holding these prescriptions and frankly -- in the United States at least -- it's against the law.

The U.S. Federal Trade Commission enforces the so-called "Eyeglass Rule" which requires eye doctors to provide their patients (stop thinking of us as "customers") "one copy" of the prescription at the end of the eye exam.

If you EVER get any attitude or have your prescription held against your will CALL the Federal Trade Commission at 202-326-3528 or 1-877-FTC-HELP.

Here is the statute:

FEDERAL TRADE COMMISSION
PART 456--OPHTHALMIC PRACTICE RULES--


Sec. 456.2 Separation of examination and dispensing.

It is an unfair act or practice for an ophthalmologist or optometrist to:

(a) Fail to provide to the patient one copy of the patient's prescription immediately after the eye examination is completed.

Provided: An ophthalmologist or optometrist may refuse to give the patient a copy of the patient's prescription until the patient has paid for the eye examination, but only if that ophthalmologist or optometrist would have required immediate payment from that patient had the examination revealed that no ophthalmic goods were required;

(b) Condition the availability of an eye examination to any person on a requirement that the patient agree to purchase any ophthalmic goods from the ophthalmologist or optometrist;

(c) Charge the patient any fee in addition to the ophthalmologist's or optometrist's examination fee as a condition to releasing the prescription to the patient. Provided: An ophthalmologist or optometrist may charge an additional fee for verifying ophthalmic goods dispensed by another seller when the additional fee is imposed at the time the verification is performed; or

(d) Place on the prescription, or require the patient to sign, or deliver to the patient a form or notice waiving or disclaiming the liability or responsibility of the ophthalmologist or optometrist for the accuracy of the eye examination or the accuracy of the ophthalmic goods and services dispensed by another seller.

Revised as of January 1, 1999]
From the U.S. Government Printing Office via GPO Access
[CITE: 16CFR456.2]
[Page 453]

A note to optometrists out there; Start charging the appropriate amount for an eye exam and be up front about it. The more educated people get, and the more you try to hide your motives, the more you'll be hurting in the end.

Also, we, as patients, need to start lobbying for the PD (pupillary distance) to be included in the exam -- they have it and there is no extra work on their part to add it to the prescription card.

No topic has contributed more forum posts than those of pupillary distance and how angry some optical folks get when asked to provide it (the police were called -- BY THE OPTOMETRIST -- in one of the stories).

It dawned on me today as I read the seemingly thousandth forum post on the subject of PD, that if online glasses were truly inferior to their severely overpriced mall-store cousins, it would be in LensCrafters' best interest to gladly provide PD measurements to any and all who asked.

Upon delivery, if these online eyeglasses were so bad, people would surely flock back to the mall to pay the $400 "bad-eyesight tax", thanking the lab-coated cashier all the while for taking their money.

LensCrafters isn't doing this because they know that their 1000% mark-ups are in serious danger of evaporating (even further) once the toothpaste is fully out of the tube. Look at the recent Q1 2009 profit numbers for Luxottica (#1) and Saffilo (#2):

Luxottica: First quarter profits fall 36%

Safilo: First quarter net-profit falls 87%, net sales drop 11.7%.

If I was an investor, I'd be quite uncertain of a bounce even when the economy starts to head upwards. If I cared about those around me, I'd help spread the word. ;-)

As we've talked about so many times, for first-time online eyeglasses purchasers, getting the PD has been the highest (and certainly most annoying) hurdle to clear. The forums are lousy with stories of optometrists holding the values hostage.

I got an email from Cathy yesterday that made my eyes light up. There is a sea change taking place and (I can't believe I'm saying this) insurance companies may be behind it.

Cathy got an email from HealthPartners and here it is:

The Consumer Watchdog section of this Sunday's Pioneer Press is scheduled to include an interview with Dan Nelson, M.D., an ophthalmologist and associate medical director for specialty care for the HealthPartners Medical Group. Dr. Nelson was interviewed in response to a patient complaint about a HealthPartners eye clinic not providing a pupillary distance measurement as part of the patient’s eye exam. The patient wanted the measurement in order to purchase eyeglasses on the Internet. In the interview, Dr. Nelson emphasized:

Traditionally, pupillary distance is not part of the eye exam but it is a measurement taken by opticians when you purchase eyeglasses.

With the recent growth of low-cost Internet-based prescription eyeglass retailers, more patients will likely be seeking this measurement.

HealthPartners has changed its policy to provide the pupillary distance measurement to patients who request it because we want patients to have an accurate measurement. Some Web sites suggest that customers can do it themselves using a ruler.

HealthPartners will be working on incorporating the pupillary distance measurement into the eye exam to accommodate patients who wish to purchase eyeglasses on the Internet.

Patients with strong or complicated prescriptions should avoid purchasing eyeglasses on the Internet because there are a variety of measurements, in addition to pupillary distance, that are important in order to enjoy optimal vision from their eyeglasses.

Thanks for bringing this to my attention, Cathy! I expect many other insurance companies will follow suit on this. In fact, it'd be a great idea for you to force the issue with yours!

Good luck!

Related Posts and Links:

I got a comment to a post the other day that curled my hair. Read...

My optometrist's receptionist called the law on me claiming I was disruptive, when I questioned why Dr. H walked away from me after I asked for my PD. When the cops came and questioned us both, the optometrist told them that the PD varied according to which frames a patient chose and how thick the lenses were, and that that's why he was refusing to give it to me.

I told the cops the PD was the distance between your pupils and they told me Dr. H was a doctor and that I wasn't, and that I didn't know what I was talking about.

My mother, another patient of Dr. H, was in the office with me when this occurred! I hadn't been to the eye doctor in five years because I couldn't afford it. If I weren't legally blind with uncorrected vision, I'd give up on them completely after this fiasco. I still need progressive lenses and I still don't know my PD...and I'm out $74.00.

This is obviously a person in need of affordable eyeglasses. The doctor, an "a-hole" to be sure, could have done a better job of explaining the fact that there are two PD's for multi-focal lenses -- and then provided the numbers. Isn't there some equivalent of a Hippocratic Oath for optometrists?

This is exactly the reason that I have a problem with the "connected" optometrist. It's like trusting Ronald McDonald to bring you to the best place in town for a hamburger -- sort of.

Read this and viewed the image while I stood in line for FIVE HOURS for the Daily Show today in St. Paul -- we got moved inside while the protests "raged" outside.

It's Awesome. Thanks Rob!

I was at my yearly checkup today and while I was left alone waiting for my eyes to dilate, I checked out the equipment. I noticed that the pupil distance is shown right on the "glasses machine", not sure what it's called. It's around on the doctor's side at the top left (sorry for the poor cameraphone photo).

So, one more way to try and get a pupil distance if your doc tries withhold it.

Click the image to see the very clearly marked '64'.

Kudos on the yearly checkup too!

PD (Pupillary Distance) measurement has been one of the most common threads in the 20 months that GlassyEyes has been around. Dispensing opticians appear to see it as a key to continued profits, and hold this very simple number (at least in a traditional single vision script) over our heads in order to over pay in their stores.

PD measurements aren't difficult to obtain as has been discussed over and over. There is nothing magical about them and optometrists themselves have debated over the accuracy of machines designed expressly to provide PD. I did my own. I measured my wife's uncle and he's thrilled with the result. There are many different ways to do it and you'll see each of them employed in professional environments as well as in bedroom and bathroom mirrors around the world.

Forum regular, IMQ came across a thread at the beloved Optiboard (http://www.optiboard.com/forums/showthread.php?t=30150) that has a number of interesting comments from supposed health care providers concerned more with profit over providing accurate (and complete) prescriptions.

"LeighLee" starts things off with an alert to all opticians:

Our OD called the Georgia Society of Optometry, and was told that we HAD to give the PD as part of the prescription if we do a refraction as part of the exam... We have never included PD as part of the refraction before. So we have never included a PD along with the RX that is handed to the patient... I am concerned that if we are forced to give the PD, more and more of our optical patients will go elsewhere, like ONLINE!!

"Fezz" would just as soon be snarky when providing the PD:

Write it down in inches and forget about it!

"MarcE" sees providing the PD as a big problem:

Yes Fester, including a PD on an Rx is terribly shortsighted.
This is not a small issue - it could be our biggest problem going forward.

"Against the Rule" makes the only solid point in the thread thus far:

If giving out PD's is going to bankrupt your practice, your practice ain't gonna be around long anyway.

I find all of this very disconcerting. I think, as a group, the people who use and contribute to this site are VERY concerned with their overall eye health. One thing is certain, I'm much more able to afford to get my eyes checked regularly now that I'm not going to have to tack on $400 for a new pair every time I get them checked. I'm also not wearing old, weak prescriptions any longer. Why would I? I can spend as little as $8 and get something that allows me to see the way I should be seeing when things change. I don't have to budget for this any longer. When I feel like things are starting to get a bit blurry, I'm in (paying these people who seem to want to inconvenience me) to get an updated prescription and make sure my eyes are healthy.

I think the real winners when everything shakes out in this field are going to be those professionals who actually act as professionals should. Give me what I've paid for and I'll keep coming back. If you can figure out a way to get the prices down on the glasses in your store (yes, I'll even wait a week or two), I'd gladly give you a shot.

Much has been said about the pupillary distance when ordering glasses online and the difficulty in obtaining it. It's a very important measurement and contrary to what the opticians will tell you, it's very easy to get -- in the comfort of your own home even!

A few of the sites have methods requiring you to have a friend hold a ruler up at the bridge of your nose or something akin to that. That's a pain and not very precise.

I've got a better way.

Here are the required tools:
1) a pair of your existing eyeglasses (doesn't matter too much on the prescription -- just so you can see through them)
2) a non-permanent marker
3) a ruler (with millimeters preferably*)

How to do it:
1) Stand in front of a mirror (3 to 4 feet back)
2) Close Obscure your left eye with a card or thick paper
3) Mark the center of the right pupil with on the eyeglass lens with the marker.
4) Repeat with other eye
5) Measure the distance between the two dots
6) You're done

You can have a friend do this for you also, but I had better results doing it myself. It works. I had my "professionally measured" PD from the last time I was mugged at Len Crafters, and it was identical to my latest measurement. Didn't surprise me at all as this was precisely the method they used to measure it.

Anyway, if the optometrist is giving you hell about getting the PD, tell 'em to stuff it and do it yourself. I think you'll be happy with the result.

* NOTE: If you don't have a metric ruler (and if you're a child of the seventies like me, you'll never be without one), just pop your standard measurement as such into the google and you'll get the number you need. Ex. "2 9/16 inches to mm" returns "(2 9/16) inches = 65.0875 millimeters".


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