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Comment by harles | Hacker News Reader

I hope something comes of this. Going to an optometrist felt like going to a car dealership the last time I went. Blue light filtering was that worthless upswell they wanted to push on everyone. This situation reminds of Cheerios claiming to lower cholesterol[0] and I hope it similarly gets FDA scrutiny - although my amateurish interpretation of the law is that blue light blocking claims are vague enough to not run afoul of regulations.

Overall this situation is just sad because I heard it first from ads, then vision professional, and now folks I know. It seems like it’s infected our collective consciousness without any serious questions of it’s true.

Edit: [0]: https://abcnews.go.com/Business/Cholesterol/story?id=7574156

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I got this same feeling a few trips ago to the vet. It was like all they cared about was trying to upsell me to put my dog out and clean her teeth. The nice assistant whispered to me “I wouldn’t do any of that to my shepherd” *wink.

Inevitably I had to go back since then and the next it seemed like they cut that crap as it wasn’t like that before and hasn’t been my last 2 trips. Still leaves bad taste in your mouth because you want to do the right thing but not get ripped off.

There was a NPR episode about this (forgot the exact show, might have been planet money). Apparently a ton of vets are being bought out by private companies. Back then, vets would sell to one of the younger vets in their practice when they retire. These private companies are out competing in terms of price hence all these upsell.

Private equity, in particular, IIRC. Very motivated by profit maximization, without regard for long term longevity of the businesses.

> without regard for long term longevity of the businesses.

Or your dog.

A lot of these bought out vets are basically forced to close 24 emergency calls. Some cities like Rochester, NY are basically devoid of 24hr vet care.

Better hope whatever emergency fido is dealing with can wait till morning, because private equity has some blood to let.

Freakonomics Radio did a deep two part series on private equity firms buying up all of the local veterinarians. Definitely worth a listen if you are interested in this stuff.

Should You Trust Private Equity to Take Care of Your Dog? (Episode 531) https://freakonomics.com/podcast/should-you-trust-private-eq...

Do You Know Who Owns Your Vet? (Episode 532) https://freakonomics.com/podcast/do-you-know-who-owns-your-v...

For what it's worth, the same thing is happening to human healthcare in the US.

everything is is bought corporatized and then because just like Gov's big corporations are not great at dealing with bespoke situations, their focus is just making money which leads to upsell methodologies and "capture and hold" subscription models...

I hate it, but I cant see a way out. I self host a lot of stuff at the moment to get away from as much as I can. but there is only so much you can do.

You thought that routine preventative dental care was an unnecessary upsell?

Are you saying that we should routinely anesthetize our animals to clean their teeth?

Sincere question: my relatively non-aggressive-at-sales vet, whose office has beocome a bit more aggressive recently, said this month that my nearly 12 year old dog has had a tooth fracture for over a year - and it needs a $X,000 removal relatively soon, for which he would have to go under anaesthesia and stay the day.

Pup has been eating fine, and continues to eat fine, including relatively hard stuff (no bones or bully sticks but softer dental chews). He does have an accumulation of plaque on said tooth which indicates he favors the other side, and despite the hard pitch, I doubt the vet is lying about a fracture.

The literature online is very equivocal about whether tooth removal is needed and says some fractured teeth are fine and don't cause pain.

Any advice / information sources you trust on how to triage this situation?

Get a second opinion?

I would consult with a few additional vets, perhaps some further out in the countryside and/or older.

You need to balance the quality of life of your dog, the cost, the change of death or other complications, along with alternative options (such as switching food when it gets worse).

Thanks. While steep, I’ll happily pay for the procedure if the risks are minimal and the impact on his quality of life is likely to be meaningfully positive.

Yeah, I'd be less inquisitive about price and more asking the other vets to "level with you on the risks".

And the risks may be acceptable, especially if it comes down to "dog continues to live with ever increasing pain" vs "99% chance of pain free vs 1% chance of peacefully passes away on the operating table".

My vet told me a lot of dogs have high pain thresholds and/or will hide their injuries, so they won't necessarily stop eating from mouth pain. He wasn't trying to upsell me, I was asking why my dog was avoiding food and wondering whether it could be a tooth problem (so unlikely to be the case).

That doesn't help much I know, just make sure you get advice from people you trust have a care about dog's quality of life.

makes sense. thanks.

All of the reputable information I can find, in addition to the advice of literally every vet I've ever worked with over the last 20 years, says "yes." What reputable source (not something like "naturalnews.com") do you have that says that this is unnecessary and dangerous?

What vets are selling is not the $100 dental cleaning people get. They do the procedure under general anesthesia and all the associated procedures brings the cost well over $1000. But the worst part is the huge risk to animal: something like 1% of cats die during cleaning under general anesthesia. This is a totally unacceptable risk to your pet for a cleaning. If it's actually for a serious dental condition, then you can weigh the risks. But it's pretty sad that vets push such a risky procedure.

> something like 1% of cats die during cleaning under general anesthesia

Pretty damning if true. Surely there are a wealth of sources that corroborate this figure?

Eta: also, it's important to know the early mortality rate of untreated animals versus those that do receive dental cleaning every year. Is it less than the claimed risk of the treatment itself?

The argument is not that it is unnecessary to clean their teeth, it is that it is unnecessary to put them under general anaesthesia in order to clean their teeth.

Depending on a cat, cleaning their teath while they're conscious might stress the fuck out of the animal, resulting both in quite uncomfortable for the cat treatment to keep them in a place and difficulties for the vet to get to the back of the teeth. Whoever does dental work for unsadated cats 99% only reaches for front teeth, and not actually potentially problematic areas.

I struggle to imagine the process of cleaning an animals teeth while they're concious. They would be near certain they are about to die. Then imagine doing that 5 or so times a day with animals you've never met before.

Our cat came back unable to meow after being put under. It was a couple of years before he was able to make a high pitched squeak, and he can't do it quietly - it's just a hoarse whisper if he isn't going for it full throat.

I'm on a Banfield membership plan for my dog that's like $50/mo after tax, so $600/yr. The plan comes with routine checkups with some basic lab work, "member rates" at their nation-wide clinics for any non-routine care, all shots included, and one dental cleaning a year. So even if the cleaning was 90% of the cost (I imagine its probably less) that's like $540/yr.

The dogs we had which we didn't do dental cleanings, their mouths were often in pretty rough shape by the end of their lives. Even with us trying to brush on regular schedules and giving good feeding, our geriatric dogs would often end up with lots of bad teeth in the final years of their lives. Meanwhile the dogs we've had which we've done yearly cleanings pretty much never had oral issues throughout their lives even well into very old age. Just my own personal anecdotes, but unless I see something reputable to change my mind I'll probably continue on yearly-ish cleanings.

I definitely do agree its probably way too much stress on a cat though. We did one dental cleaning with our cat and decided it was way too much stress on him and decided we wouldn't do another cleaning unless something got really bad. He's lived just fine without any dental issues for over a decade since that cleaning, so I imagine its probably pretty unnecessary.

Makes me wonder what you fed/feed your dogs. My parents always had GDs and they would get kibble. A certain amount and some water poured over it.

And of course the occasional potato. But never ever have any of those dogs had their teeth cleaned.

I wonder if dog teeth problem are a result of diet? Too much candy? Not enough chewing on sticks?

Pretty similar diets, pretty much exclusively kibble. Not usually with water poured on it. Plenty of chewing toys and sticks.

By their mouths being in bad shape I mean losing a few teeth at the age of like 13 or 14. But that led to a bit of a downhill spiral, because then they also would stop eating as well, they'd develop other issues, etc. They were all extremely geriatric.

Yea our German Shepherds never made it that old.

Maybe it's like humans. Lots of our ailments only show because overall we live longer.

> The dogs we had which we didn't do dental cleanings, their mouths were often in pretty rough shape by the end of their lives. Even with us trying to brush on regular schedules and giving good feeding, our geriatric dogs would often end up with lots of bad teeth in the final years of their lives. Meanwhile the dogs we've had which we've done yearly cleanings pretty much never had oral issues throughout their lives even well into very old age. Just my own personal anecdotes, but unless I see something reputable to change my mind I'll probably continue on yearly-ish cleanings.

Yes, there's a chance for dental infections migrating into the bloodstream and that leads to all kinds of complications. But here's the thing, anesthesia-based dental cleaning for pets should be based on need. Dogs are individuals. Especially the active chewers with healthy mixed breed backgrounds can be just fine without dental work -- just like I'm a middle-aged man with no cavities, an individual not an average. On the other end, Chihuahuas and many stubby-nosed breeds are notorious for bad teeth and needing teeth pulled out.

I don't think anyone (informed) is saying no dog ever should get major dental work.

What greed is doing here is trying to lower the threshold, make the pets that don't necessarily need the service at the moment / as often to go through the procedure.

What they do at my vet is do an oral exam & any indicated work if/when the animal is put under anesthesia for another reason. For instance one of our dogs has been needing 1-2 surgeries a year for the last couple of years (mast cell tumors) and has wound up with a variety of tagalong dental work.

It's not perfect but seems like a happy medium. In particular it scales a bit with age as older animals are going to be more likely to need such surgeries.

Then if you get a tooth issue later, insurance will deny coverage.

It's a scam.

Anecdotally, every optometrist and ophthalmologist I met, who wasn't selling me something at the time of conversation, was pretty dismissive of the whole "blue light filtering" business.

The attempt to block blue light has been with us so long (like a decade or so), the blue-light-filtering products so well commercialized, and yet the underlying claim that blue light affects sleep remains to be inconclusive at best, which makes me doubly wary of its validity.

This. I went recently and something about my eye axis(?) or something was off a bit (which somehow most Americans have?) and mentioned how it’s causing eyestrain. There’s special lenses that correct for this that is… SIX HUNDRED DOLLARS more just for the lenses. Mind you, my glasses are usually really affordable because I have a weak prescription. I was dumbfounded when I heard the price.

That sounds, to my utterly unprofessional ass, like an astigmatism? Basically your eye is deformed slightly like a football, giving your prescription a strength, cyclical value (a cylindrical bias to the lens, as I understand it) and a rotation of that cylindrical bias for the eye.

It does require small stores to order them custom (larger stores can often grind them in-house), but $600 seems... off. Perhaps if it's a high refraction material (thinner lenses) with all the various coatings?

The nice thing is if you have your prescription, you can order glasses from anywhere (including online), your prescription is not tied to one provider.

"Axis" is a term used with respect to astigmatism, but correcting for astigmatism is a basic part of lensmaking, and even the cheapest pair of glasses can do it, so this is either something else, or an astoundingly bare-faced rip-off.

That’s real - you have some astigmatism.

When it’s not severe it’s hard to correct and annoying. For me, I have a hard time with night driving in the rain because of it. But I found the correction annoying in normal circumstances.

For astigmatism they’ll add cylinder to the lens, this could also be prism which is for when your eyes like to point in different directions.

To basically +1 the sibling comment, you likely have astigmatism. $600 is pretty high but lenses are quite a bit more expensive than standard spherical lenses.

It is incredibly common, but essentially your eye is elongated in one axis meaning that your lenses need to correct differently in each axis. It also means that despite having a low prescription, you may have focus issues across the spectrum of depth.

I have astigmatism (-3.75 diopters of it in one eye), and there has never been any extra charge for making my lenses. Where are you getting this idea that astigmatism-correcting lenses are quite a bit more expensive?

For that size of astigmatism I would think there was an extra price you don't get the price of a lens broken down like that (bi focals and the blue filter will show up as extras) So how do you know there is no extra.

I just had to pay more as my prescription on astigmatism went from 2 to 2.5

I go to https://www.goggles4u.co.uk/

There are frames advertised, with prices, before they have any idea what my prescription is. I add to cart, and give my prescription. The price is the same. So, they can't be adding extra for my astigmatism.

You likely had to pay more to get the thinner "high index" lenses. Otherwise lenses get pretty thick at that power, but they don't cost much more as long as you're willing to live with that thickness.

Ah - they all look thin to me.

I had my cataracts replaced and before that astigmatism was the least of the issues -20 diapotre for short sight are quite thick

I’ve seen some glasses manufacturers charge me more for astigmatic lenses specifically. Never to the magnitude the other person mentioned but also not at the same cost. It was part of the cost breakdown on the receipt, but likely they’re just fleecing people. I didn’t end up buying from them.

But in general, it’s been the same cost as non-astigmatic lenses.

What I meant to say is, lenses “may” be more but I accidentally dropped the “may ”. Too late to edit now

Do you mean prismatic lenses? I had awful headaches at one point and the optician added prism to my prescription, I don't think the cost changed at all (UK optician).

I believe prismatic lenses are normally used to correct muscle weakness which may cause eye strain (and double vision in severe cases). My prescription was changed back to no prism after a few years.

Edit: siblings are likely correct after reading your comment again. It's likely astigmatism which I also have. But $600 is still ridiculous.

My prisms aim to make me not cross eyed all the time, but I'm pretty sure my brain just compensated to make my eyes even more cross eyed to keep the double vision

Costco in-house optometrist test costs $60. No membership required.

At least then you know you're not being scammed.

Yep, it does sound like astigmatism. I have it. It only got detected when i was around 30 but apparently I've had it since birth. My first pair of glasses basically eliminated any eye strain / fatigue for the first few years in spite of having more cylinder than dioptries.

However, my lenses were never more expensive than my wife's who doesn't have any (astigmatism. she does have dioptries). Only difference is they're never in stock and I have to wait a couple days.

I've had the opposite experience. Despite having a pair of "computer vision" glasses included as part of my plan, the optometrists I've been to have all pretty much dismissed tinted lenses as woo-woo. They did suggest a pair of lower-power lenses for computer use, but that was it.

I say to my optometrist that I cannot have any color filters on my glass because of work. You cannot do colour grading with random filters. No pushing nonsense bluefilter since then.

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