The Great American Eye-Exam Scam | Hacker News Reader

The Great American Eye-Exam Scam

theatlantic.com

31 pointsfortran7717 comments

Prime example of regulatory capture.

Eye exams are remarkably automated with current technology. My last fitting took a few minutes and was mostly performed by the assistant. There’s no reason it couldn’t be performed at a retail store for a fraction of the cost. This is already the case in other countries.

I currently order 2-3 years of contacts at a time because my vision is stable for a decade now.

I have a friend who simply changes the date on his prescription in photoshop every year and orders online. I’m not recommending that, of course, but it speaks to the silliness of this situation.

At my last eye appointment, I directly asked the optometrist why this couldn't all be automated. His visibly frustrated response was that an eye exam is about finding early signs of eye diseases, like macular degeneration, as much as finding the prescription. I didn't have the guts to ask why that couldn't be automated.

Order a few pairs of backup glasses from an outfit like Zenni. You can enter any prescription you want - just use your most recent one. Optometrists like to leave off the distance between your pupils, so you need an optician to measure that, but there are easy ways to find it yourself. My method is just look at a distant object through binoculars, adjust until the image circles merge comfortably, and then measure the distance between the centers of the eyepieces.

The price is so low you can have several pairs of good quality backup glasses, and then just have one with you, at the same priority as, say, your medications.

I've used this scheme to also acquire a set of weakened glasses - I just fudged the prescription numbers myself - for use at the computer (I'm 54 and don't have much focusing ability left).

Aside from that you can also try Costco. No-BS optometry and very competitively priced eyeglasses.

> I've used this scheme to also acquire a set of weakened glasses

Yes, if you're over 40 and short-sighted, consider doing this. An optician recommended this to me a few years ago, and since then I always have a second pair of glasses which are 0.5 weaker.

If you're buying from Zenni, then 'Blokz' is a good addition for computer glasses, as long as you're not a graphic designer.

Depends on what you mean by "weaker". If you have a distance prescription and a reading prescription, move the reading prescription in the direction of the distance prescription.

Depending on the state, the optometrist has to provide PD.

But, there's an app for that: PD Measure

You do need to get that pupil distance correct. I mis-measured PD and the experience was extremely disturbing. It was as though my eyes would drift to weird angles to look through the correct part of the lens, but as soon as I moved my head they'd shift and try to regain the focus. Which they'd get and lose again. It was a bit like looking at the world with a low frame rate.

I went to the store and ordered glasses from them. While measuring I told this story, and she felt sorry for me and told me the number. (Apparently they have to give it to you if you ask, but company policy is to withhold it since that's their only advantage over cheaper online services. Besides, I had just spent a bunch of money on glasses, and wouldn't need new ones for some time.)

I had the optometrist write it down. I needed replacement lenses for my good glasses (broke one) and the best deal (by far) was Costco. The guy ignored the optometrist's PD and measured it himself with a gadget he had and the number was quite different. The glasses came out OK though they don't guarantee satisfaction putting new lenses in an old frame they don't have data for.

For ordering with Zenni, I tried the binocular method and then, I think averaged that with the other two numbers. The Zenni glasses are also fine. Sensitivity to centering may be greater if you have strong cylindrical. In my case it's less than 1/4 the spherical.

The $20 Zenni frames aren't quite as light or nearly indestructible as the $400 frames of my 22 year old good glasses. Plus you have to bend the little nose pad things yourself to get a comfortable fit. But now that I wear Zenni glasses around the house all the time, I've gotten used to them, and I may have bought my last pair of expensive glasses ever. Don't mail order frameless or bifocal glasses though.

Not all eye tests are equal. There are three things you might want:

1. Measure my prescription so I can buy the right glasses

2. All the above, but also check the health of my eyes with analogue tools (by a qualified optician/optometrist)

3. Check the health of my eyes with more advanced digital tools.

#1 is easy to get in developing countries, and often free. I once had an eye test of this type at a market stall in Beijing.

#2 is what you get in the UK for $0 to $30. Optical stores make their money on glasses and contact lenses, so they are happy to sell these tests at or below cost.

I had my first US eye test recently. Even with insurance, I paid $20 out of pocket for #2, and and $65 out of pocket for #3.

I'm not sure how much #2 would cost in the US without insurance, but I guess it's much more than in the UK.

Without insurance (mine doesn't cover vision) and seeing an optometrist at Costco (independent, so no motivation to sell you glasses), my last prescription cost around $90.

It's very important to get regular glaucoma checks, especially as you get older. Untreated, it can result in significant vision loss and even blindness.

https://en.wikipedia.org/wiki/Glaucoma

He's comparing an optometrist to a storefront eye exam. I've had one of those storefront eye exams once when traveling--better than nothing but the off by nearly a diopter. These days I'm much more sensitive, an error like that would leave me in a fair amount of pain. A quarter of a diopter change (my vision is nothing like stable) sends me running back to the optometrist I trust (I've had others not get it accurate enough.)

On the other hand, I've known my wife to be half a diopter off and not think the new lenses were any better. (Replacing a several-year-old damaged pair.)

I recently decided to just try to use online tools to estimate magnification for contact lenses. I ended up going with something like 6.0. Which turned out to be too much. But I am still able to use them in VR better than my existing glasses with have a defect now.

I am thinking of just buying another box at like 5.85 which is what I think my old prescription was.

I am in Mexico and lentesenmexico.com.mx does not require a prescription. The local optometrist would probably end up costing me an extra $40 or $50.

I definitely understand the need to screen for real health problems in the eyes, but in the US they have taken it to an extreme that just wastes a lot of people's money and feels like some kind of Mafia activity.

The real ripoff in getting glasses is the predatory market control of Luxottica - They are the one company behind almost any frame brand you care to name. The last glasses you take away from me are my $48 computer glasses from Marvel Optics. The worst quality-wise (lenses, not frames) are the ones I spent hundreds of dollars on. I'd like good frames and good lenses, but without literally paying more than I've paid for some (admittedly cheap) cars!

From 2019. 300+ comments. https://news.ycombinator.com/item?id=21653437

I just use MS Paint to change the date on my eye exam report. It simply works.

Won't say I haven't done this to order online glasses, but the point of TFA is that the real issue is that it should be quick, easy, and cheap to get an eye scan and updated prescription. Better yet, why can't we put free eyeball scanners in grocery and drug stores (like free blood pressure machines), and have those print out current results? There's no real reason for prescriptions at all except in cases where you're dealing with extraordinarily dangerous drugs or procedures. (Nobel economist Milton Friedman was famously against licensing doctors, as he said bad reputations would spread, something even more true in today's internet-connected world...)

Reply on news.ycombinator.com