Startup Says It’s Changing Eye Care for the Better. Others See It Differently | Hacker News Reader

Startup Says It’s Changing Eye Care for the Better. Others See It Differently

nytimes.com

43 pointswiggles_md47 comments

“The company said it switched to phone-only cancellations from 9 a.m. to 6 p.m. on weekdays and suspended emails, like notifications about a customer’s first paid order following a free trial, that were “reminding” people to cancel their subscriptions.”

That’s some scummy behavior.

Since July 2018 it’s also been illegal for any business with paying customers in California, thanks to SB 313.

It seems entirely likely that two things are simultaneously true: Hubble contacts are more likely to have complications than the big manufacturers' lenses, and the big manufacturers engage in anticompetitive behavior.

Sounds like a great arena for some pro-consumer regulation or legislation.

I would have more sympathy for this take if the average optometrist did anything more than prescribe whichever lens is offering the best rebate or whatever.

Like, has anyone had the optometrist try multiple lenses and work to get a fit? In my experience they put you in something and then maybe if it is unpleasant they'll try something else, but it's dependent on you being proactive, much as it would be if you were in Hubble.

I’ve had the opposite experience. I get lenses recommended, then a repeat visit in about a month to check for lens fit and adjust as needed.

Short answer: Yes. Absolutely yes.

Long answer: I have Keratoconus, which means my cornea has uneven thickness across its surface, which causes bubbles in my cornea, creating a very uneven prescription across my eye. The contacts I use are called “scleral” lenses, which use a liquid-filled void to nullify my actual cornea shape, creating a new cornea. They are expensive, require specialized training to adjust, and nailing down a prescription involves doing adjustments with them in, and working backwards to figure out the proper prescription.

My optometrist worked on my prescription for around 6 months solid, going through around 12 pairs of $250 (per lens) contacts on their dime.

So, yeah. A good optometrist is fantastic, and does a ton for you.

Are you a candidate for corneal reshaping with topography guided PRK combined with CXL (corneal collagen crosslinking)?

Are you talking about T-PRK with CXL in Vancouver? Or one of the other protocols? My optometrist felt that doing T-PRK even combined with CXL would be a horrible idea for Keratoconus, but I haven't consulted with a surgeon directly yet.

The surgeon stands to profit, so I would be hesitant to trust them.

True, although using the same logic, my optometrist stands to profit from me continuing to need scleral lenses .

It's just that his logic sounds rather compelling - Keratoconus patients already have thinner corneas then normal, and PRK will disrupt the structure even further, making them even thinner in places. If CXL done at the same time is effective to strengthen the cornea, great - but if it doesn't (and CXL often needs to be repeated) you are now in a much more precarious position.

This is correct, but with topography guided PRK, the surgeon can (supposedly) leave thin corneal areas intact.

I am not a surgeon, nor a professional of any sort in ophthalmology. I just read a lot. Might be worth having the conversation with 2-3 surgeons based on your experience attempting to correct your vision using contacts.

Edit: I thought you were OP I replied to. Apologies for the confusion (about the contact lenses comment).

No, the degeneration has slowed enough that I'm not a candidate yet.

Yeah, I've had 2 great ones in my lifetime. One growing up and one now as an adult.

You're not likely going to find a great one if you're going to a Costco or Wal-Mart to get your prescriptions. One needs to go to a proper clinic.

My current one did my ICL surgery (a corrective surgery similar to cataract surgery, but a permanent contact lens instead of a lens replacement) several years ago.

Interesting to see someone else with this condition on YC . If you don't mind me asking, which area are you in and if you could PM the info of the optometrist. I am wearing sclerals as well, but the cost was far higher - around $5000 for the first round, and around $3500 when I went back 3 years later to see if we can improve vision and comfort even further. On the other hand, the fitting process was much more efficient - there was a new set of lenses ready daily, so although we went through 9 lenses for the right eye and 4 for the left on the first round, it took under 2 weeks.

Did you end up doing CXL? Are you considering it, or any of the other procedures.

About keratoconus patient here. I ended up paying around $2k for my sclerals. I'm in Oregon. Email address in profile if you want to know more.

I have not done CXL; it's not that bad.

I'm in Montana, and a vast majority of the costs were covered as medical expenses, so my health insurance covered the optometrist costs. I only end up paying the cost of the lenses themselves. The optometrist office themselves build the cost of the followup fittings into their normal billing prices; there were no costs for any of the followup meetings.

Most of the iteration time was the shipping, since I'm not near any contact lens manufacturers.

Does a ton for you, if you need a ton done*

I have sympathy for more complicated cases, but they're the 20% approaching 0.01%. They necessarily can't be used to justify the 80% case which is as the GP described.

If the 80% have picked low cost optometrists (such as those attached to big chain stores or glasses retailers), then you get what you pay for. My optometrist offers the same to anyone who uses her, and has for decades. The office specializes in optometry; and their waiting list for appointments is around 11 months long.

You miss the point. Those 80% didn't just choose low cost optometrists. They don't need high-end optometrists. A specialist with all the qualifications to help the issues with your eyes is far and above what I need to fix the relatively minor flaws in mine.

> has anyone had the optometrist try multiple lenses and work to get a fit?

Yes. Most good ones do this. Just as there are good and bad doctors, there are good and bad optometrists.

IMO, Hubble is straight up dangerous. Getting glasses online is relatively risk free. But when something is physically touching your eye, precautions need to be taken.

I assume by precautions you mean have periodic eye exams to verify that a particular contact lens prescription and model is still right for you. Once you have that, it really doesn’t matter what reputable source you get the lenses from.

Arguably annual exams/prescriptions are overly frequent for some people. On the other hand, bypassing verification on line is fairly trivial.

Yes. I tried several different brands till we found the ones that worked the best. Each trial I would get about two weeks worth so I could get a good feel for comfort and fit.

It is a little frustrating though that now I can’t just go somewhere and buy those lenses. The prescription verification isn’t terrible but it’s an annoyance.

Your doctor was (is) required to give you a copy or your prescription if you ask.[1] Next time, make sure they give you one and you can use that to verify when shopping around.

[1] https://www.ftc.gov/enforcement/rules/rulemaking-regulatory-...

Short answer: A lot of optometrists I've been to seem to only carry acuvue and can't imagine anyone wanting to use anything else. My mom used to have a favorite brand that wasn't acuvue and we'd have to argue it out with them every *(@#% time.

There’s nobody to like here. Your eye doctor can make a bunch of money selling you contacts and therefore doctors will say lots of dumb things about how dangerous Hubble is. Were the same doctors also talking about how dangerous contacts were a few years ago when this technology was state of the art? No. They are doing a much better job of looking out for themselves than for patients.

At the same time, it’s probably ALSO true that, if you can afford it, a brand using newer technology may be better. And you should talk to an eye doctor about the decision. I just wish eye doctors were not selling you anything and were in business to be doctors; that would make it a lot easier to trust that you were getting good advice.

PS I have a lot of experience with the price of contact lenses from my job, weirdly. For the best prices, you should buy contacts from either Costco or any online retailer besides 1-800 Contacts (Walmart, etc.). But I would suggest you buy the brand you’ve been prescribed.

In my experience, Optometrists are often not huge fans of contacts generally. Probably because, especially contacts that are worn too long, worn even when an eye gets irritated, etc. can lead to complications that generally don’t exist with glasses.

Also FWIW, my optometrist just passes me to the front desk when he’s done. No one pressures me to buy contacts or glasses from them and, in fact, I mail order my contacts from Walmart.

As someone working in this area, this is an interesting article.

The core issue of compliance is somewhat buried in the text, but worth pointing out. Optometrists' chief complaint is that very few offices seem to be prescribing the Hubble contacts brand specifically and yet, Hubble seem to be selling them to customers. This implies to them that either all prescriptions aren't being verified or are somehow being "passively" verified. Within the current rules set in place by the FTC, they believe it's unlikely quite so many prescriptions are passively verified.

The FTC is actually actively working on developing new rules around prescription verification to address some of these concerns. [1]

[1]: https://www.ftc.gov/news-events/press-releases/2019/05/ftc-s...

> When she was treated at an ophthalmologist’s office, they asked about her lenses. “I said Hubble and they said, ‘Oh, that’s it. You’re not the first,’” she said

I'm no expert, but that doesn't sound like a solid diagnosis. Sounds more like "we don't like those people". My immediate question would be "why are they at fault?" A corneal ulcer has many possible causes, and if I was the patient, I'd really like to know what exactly caused this condition. I mean, if Hubble is selling faulty lenses that causes this condition, at the very least you would be able to hold them responsible.

Hubble uses a contact lens with poor oxygen permeability...which can lead to infection/swelling.

"Hubble contacts are made with an old material called methafilcon A, which has a Dk/t of 18.8. Research shows that a Dk/t of 24 is necessary to maintain cornea integrity and avoid swelling."

https://www.reddit.com/r/YouShouldKnow/comments/9o6a0h/ysk_t...

The so-called prescription confirmation they do is incredibly bizarre.

https://qz.com/wp-content/uploads/2017/12/hubble-contacts-ro...

(From an earlier article on https://qz.com/1154306/hubble-sold-contact-lenses-with-a-fak... )

This article is really disappointing. There are a few key claims against Hubble but there's one in particular that it just astonishes me they didn't verify. If Hubble are substituting their own lenses when the prescription specifies a different brand it would be trivial to just call an eye doctor and say "Hi, we want to investigate this, we want to get a prescription from you, request contacts from Hubble and then check how their process works" .

Yet, they didn't bother. So all we have is speculation.

You can read more here and here https://qz.com/1154306/hubble-sold-contact-lenses-with-a-fak...

https://www.reddit.com/r/YouShouldKnow/comments/9o6a0h/ysk_t...

listen to their "verification" message

https://cms.qz.com/wp-content/uploads/2017/12/hubble-contact...

Hubble's lenses cost $54 per eye per 90-day supply. The sphere version of the daily lens I wear (Hubble doesn't sell a toric lens) is $52 per 90 lenses where I buy them, potentially less if you shop around. I found several mainstream daily brands online for less than $54, some of which are Si-Hy. Brands made from materials comparable to Hubble are already close in cost to Hubble, you can generally buy them online, and most places offer a subscription already, so I don't really see the appeal here.

One time user of contact lenses here: Most times, complications due contact lenses is because of improper care by the user. You need to clean lenses every time you want to wear or store them. You need to do this even with disposable lenses. It's a big hassle.

You don't have to clean daily disposables (like Hubble).

I mean, I'm sure some people are reusing daily disposables, but the idea is to just use and toss.

I switched to daily disposables a few years ago (out of ~15 years of contacts use) and I kick myself for not doing it sooner. I no longer have to spend like 4-5 minutes a day cleaning the lenses or throwing 2 week disposables 1 week into use due to protein buildup, and they no longer aggravate my allergies either.

People vary.

Extended wear disposables were so great for me when I switched many years ago. Protein buildup meant that even with cleaning contacts were uncomfortable by the time I had to replace them.

On the other hand I’ve never had an issue with 2 week extended wear.

How do the rate of complications for Hubble compare with the other brands?

I see what you did there

Looks like a submarine story!

http://www.paulgraham.com/submarine.html

I wonder who hired the PR firm to get this article published? Was it the optometrists? No, they don't have that much money.

I'd guess this article was bought with a grant from Johnson & Johnson, your friendly contact lens giant.

In any case, if you need contacts, skip Hubble. Go direct to Daysoft.

http://www.daysoft.com

Is every article focusing on a company a submarine? Maybe some events in business are just interesting and newsworthy on their own.

This isn't an event but a teardown of a business model on the basis that the older model users are scared of it.

That is true...but this article is very slanted. And it has all the characteristics of a PR firm pitched article.

Spreading FUD about your competitors is a time-honored business practice. These upstart companies represent a threat to the profits of the industry giants.

But I recommend Daysoft in the UK. $8 for 32 lenses! And no prescription needed.

http://www.daysoft.com/usa

That doesn’t really hold up. Reporters at the major non trade outlets complain about PR people constantly - conspiratorial to somehow tie this to a grant from J&J (?!) and not Hubble’s shady practices and user harm.

Meanwhile, why are you promoting Daysoft so aggressively?

You created an account just to make this comment? Interesting.

Your "shady practices and user harm" quip makes you think you might be a flack. Did your firm get this article published? Good work!

My promotion of Daysoft lets you know I am not flacking for Hubble!

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