The great American eye-exam scam (2019)
theatlantic.com
theatlantic.com
For contacts, maybe not. That is a medical device that is in contact with a highly sensitive organ for extended periods of time, and is often re-used by design. A yearly contact lens eye exam is annoying but seems reasonable to ensure nothing changed in the last year to suggest the wearer should stop wearing contacts, or use a different brand or type
What's more, in foreign countries eye exams are frequently done by technicians who are not doctors. It's not that complicated to press the "start" button on an autorefractor. So even if eye exams are required, they can be done far more quickly and easily than at present.
In many countries in Asia and Europe, prescriptions aren't _required_ for hardly anything. You can buy drugs and glasses at will, including antibiotics. (Typical exceptions only for most stimulants and some -- but not all -- opioids.) In the US, where you can't get anything without seeing a doctor, including a box of contact lenses, one feels infantilized.
There are several good reasons for it. 1. Antibiotic overuse is a serious issue. If people could just get them without prescription they would use them for flu etc. Because they wouldn't be able to tell that it's a viral infection. Over time this would lead to even more antibiotic resistant pathogens than we have now. Plus there is the whole "kills your gut biome" thing.
2. Our healthcare is heavily subsidized and practically universal. The antibiotics and many other medications are, indirectly, payed for by government, with prices negotiated and set trough complicated process involving semi-state insurance companies and government. Letting people buy drugs without prescription could lead to abuse, like exporting them to third countries. Causing shortages etc.
https://www.ema.europa.eu/en/documents/report/infographic-ca...
I haven't heard of anyone doing that (why would anyone do that, actually?) instead of just going to a human doctor to get a prescription for human drugs.
In the Czech Republic, Slovakia, and Hungary, it's mixed, but generally _much_ more relaxed than the US. In many cases, even if a prescription is "required," pharmacists won't stand on principle.
I realize that one can't generalize across the entire continent, but there are certainly regions where things are more like Thailand or China than they're like the USA. And it's really no big deal.
In Spain not only you can't buy antibiotics at will, but you can't even buy 1 g paracetamol pills (you can buy 500 mg pills, though - I guess the government wants to protect people who can't add 500+500!). Some pharmacists will turn a blind eye with silly restrictions like paracetamol, though - but not all, because they might be fined if they get caught.
I know it sounds a bit absurd at first thought, but restricting the amount that can be bought at a time actually works for preventing overdosing. People are just less likely to swallow 12 500 mg tablets in one time than 6 1g tablets.
Also please drop the ad-hominem.
Contact lenses are a high risk medical device. Contamination or mis-use can cause serious permanent damage. Wanting to prevent permanent damage is a good thing.
Now as different countries had different policies for decades now, we can compare the health outcomes of these policies. My personal opinion is that the rules can be relaxed in the US, but I don’t have all the data and am not a policy expert.
Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage. There is no evidence that expensive yearly exams are necessary. The fact is that technology almost completely replaced the need for these people and so they built themselves into the medical system.
There is a risk classification system for medical devices. Most regulatory bodies have put contact lenses in the moderate to high risk category. E.g. the FDA classifies contact lenses as Class 2 out of 3.
You don’t put pencils in your eye for hours every day. The fact that most people use contacts just fine does not mean that there are no risks. If you want to know about them, talk to an eye doctor, they all have horror stories about contact lenses.
> Characterizing contact lenses as “high risk medical device” is completely ridiculous. Pencils can cause serious permanent damage.
No, it's not. That's a terrible slippery-slope argument and you know it. Contact lenses are an FDA Class II medical device. They are *designed* by the manufacturer for contact with the eyeball. A pencil is not.
> There is no evidence that expensive yearly exams are necessary.
There is a mountain of evidence suggesting that contact lenses can cause permanent blindness when used incorrectly. Feel free to search for it.
Also, contacts are not a high risk medical device. Only a moderate risk.
You can still buy disposables over the counter, though.
It's not hard, but at the first time, the guidance is really useful
It's the same in the US.
(Well I'm sure if you insisted they'd let you, but standard practice is to try again the next day. I know people who had to go several times before buying contacts)
Leeches do feel good anyway and if this guy from the other village needs to wash his hands before operating it means he's not clean to begin with.
The only possible utopia, imo, is one where everyone tries to create their own whilst simultaneously allowing for other, quite different utopias.
Whilst people continue to look to external authority/government for the answer (when they are the cause of the problems) we won't even start.
1. In the future we will identify genes which govern sociopathy, or at least predispose to it.
2. Parents will have the ability to edit the genomes of their kids before conception.
3. Nobody wants a sociopathic kid.
This is my headcannon for how humanity creates the Federation.
There's a kind of resume of all that in Strange new world first episode (there's also another episode regarding genetic modification but considering it didn't prevent all the other episodes from happening then I suppose it can be skipped but it shows how strong is the opinion of the federation on the subject).
I don't remember they talk much about the eugenic wars in TNG so it's most likely why it's not on your radar.
They are all on Netflix at the moment. If you want to watch only one episode I highly recommend the Star Enterprise one (and there's a nice tie-in with TNG ;).
The Federation's opinion of the subject is very strong in some episodes, and in others they completely forget about it.
Are you talking about the episodes where genetic engineering was illegal?
Or the episodes where they completely forgot about that?
> Are you talking about the episodes where genetic engineering was illegal?
> Or the episodes where they completely forgot about that?
Can't you guess ?
The ones that are absolutely not key plot points in the general Star Trek lore, of course.
Congrats on spoiling it for the sake of being a smartypants. Consistency problems in Star Trek, oh noes..
edit: well, well, well:
The station was mentioned in passing in The Lost Era novel The Buried Age, where Picard called it an exception to the rule (DS9: "Doctor Bashir, I Presume") that should have never been allowed.
Quite frankly, I chalk this up to too much Roddenberry in early TNG seasons and his love for psychic mutants (and giant talking heads with god like powers).
> "1893. When a series of suicides were vigorously discussed in United Kingdom newspapers, critic William Archer suggested that in the golden age* there would be penny-in-the-slot machines by which a man could kill himself." [1]
*"'Golden Age' denotes a period of primordial peace, harmony, stability, and prosperity." [2]
[1] https://en.wikipedia.org/wiki/Euthanasia_device#Suicide_boot...
If SPHEQ is within 0.5 diopters of each other it’s more or less expected.
This is the short version and there’s a lot more nuance (like the AX and ADD values on the Rx), if anyone is interested or has questions I can add more.
Source: I was CTO for an online eye exam and have some patents related to this.
As a life-long user, glasses with an error of 0.5 are unacceptable for me. That's the amount of change over years when it is time to get new ones.
Not all deviations are measurement errors. There are potential variable conditions of the eye (e.g., spasm of accommodation and sugar level). An online solution that can consider them properly is definitively worth a patent.
Throughout 30 years of wearing glasses, I’ve questioned many times whether the glasses are right for me. I may resist for a month or two but I always end up “adapting” to the new pair. When is this acceptable and how do I know when to speak up?
For A: I don’t really know, but use the ones that gives you B. Depending on the country, high end / non-chain stores can have better customer service and listen to your wishes, and answer your questions. There’s also smoke and mirrors and upselling so see if you trust the person.
B: for simple distance vision (if you are under 40) do a quick pin hole test and look at tree leaves or something. If your vision quality increases a lot you should not be satisfied. Same if you notice eye strain when looking at things in the distance.
Now for multifocal glasses it really depends on your use case (reading, computer work, etc), and it’s very difficult to get a really good correction. There’s no silver bullet. Find an optometrist or optician that you trust, so back to A ;)
Also, analyzing the accuracy of measurement tools and systems with regards to whatever is measured, is a core task of quality control.
The optometrists visit wouldn't give me a prescription for contacts without extra money. Insurance didn't cover it. Even though the data they need they already have from the eye check, they wouldn't write it on the paper unless I paid.
Getting glasses, they only covered a limited selection of frames, all crappy frames. The lenses wouldn't be anything but bare lenses with one or the other add on but not both, no scratch resistance, no glare protection, and there was a copay. So I compromised on what I got.
In the end, with the insurance cost for the year, I wound up spending a little more than if I'd just walked into the optometrists office and handed them cash and bought what I wanted, and I didn't get what I wanted. Vision insurance is a rip off.
A couple of years ago, I ordered 2 pairs of glasses, one for regular with anti glare and scratch resistance, and one prescription polarized sunglasses, for a grand total of 70 bucks with a 2 year expired prescription (my eyesight problems are from welding irresponsibly as a teenager and not degenerative, it hasn't changed since I got my first prescription) on a popular glasses buying site online. Still using them, but I have since ordered one additional pair with that same prescription that I don't really wear, for like 50 bucks with all those lenses add ons.
I plan to go get my eyes checked next year again, just to make sure nothings changed as I've gotten older, but I will never go back to doing things the usual way with yearly checks and insurance and buying glasses at the optometrist and all that, it's a giant sham. My way isn't exactly $2 glasses like in India but for an average cost of 40 bucks per pair with the addons I like and maybe one optometrists visit every 5 or so years, I think I'm doing OK.
USA really seems to have lot of regulation despite all of the freedom talk. Or maybe it is freedom to regulate they have...
Even if I played the rhetorical game where it isn't a scam, they should give a pre test where if I read 20/20 I skip the exam and renew my prescription, sans doctor fees.
For limited prescription ranges it is also possible to give out a complete Rx via a remote examination but FDA has yet to approve a device on the US market for this. In the EU it is already being done.
Disclaimer: I worked for one of these companies.
When I order online from a site that has no physical presence in Texas, they do not care about the prescription date.
I was in and out in 20 min with a new set already ordered.
When I was in the US, getting a job done like this would be unheard of.
But why each year? I assume the Opthamologist association would say (as referenced in the article) that they need to look for ocular disease, or diseases that are detectable through eye exam (e.g. diabetes). Not clear to me!
So I always ask them to add it, though fortunately it’s easy to measure at home.
Much to my delight though when I was placing the order for my son’s new glasses online the form said “don’t have or don’t know your PD? Click here to measure it now!” which asked for permission to access the web cam, asked him to follow some basic instructions, and <30 secs later put his PD into the form for us.
I have found a way to make it 2 years on a 1y prescription.
You can get "myopic glasses" on eBay for real cheap, like 7$, without a prescription. They feel cheap, but the lenses work.
Contact lense websites will let you order as long as you have a valid prescription so I just buy a years worth when I get the prescription and again right before the prescription ends.
Separate issue is the contact lense websites are getting predatory and just add 200$ convenience fee at the checkout. Really annoying, I found one website that doesn't but I imagine if everyone else is doing it they can't stand their ground for long.
I saved money by ordering more. The incentives scheme, involving ordering contacts from the optometrist office rather than 3rd party, seems like a common convention.
Honestly, optometrists are a waste of time and money. However, it's still a good idea to visit an ophthalmologist from time to time as they can evaluate eye health in addition to optics. Glaucoma, macular degeneration, cataracts, and retinal detachment are all worth detecting early.
It took until age 40 for a reputable ophthalmologist to do an old-school 4 PRT to discover I had monofixation syndrome. [1] It also suggests diminished depth perception and explains why I can't see autostereograms.
https://eyewiki.org/Monofixation_Syndrome
1. This condition was mentioned by symptoms, not by name, in a B-movie nicknamed "Top Gun with helicopters". https://www.imdb.com/title/tt0099575
In Tokyo they tested my eyes and sold me a pair of custom fitted glasses in 30 minutes, and it was cheap.
especially when a sibling comment or talks about a 200 usd convenience fee. that is basically the airfare.
If it wasn't for zenni optical, I wouldn't know where I'd be personally.
If you aren't poor, that is. People save just to get a passport, let alone the travel costs and trying to get time off - and even then, your choices are limited. $200 is more than half a week's pre-tax wages if you make $8/hr.
However, they do these checks in Japan, but it's part of the annual health check-up, which everyone gets AFAIK, and is free. It's not done by optometrists, but by clinics that specialize in the annual check-up.
As for USD$200, that isn't going to get an American to Tokyo. Try multiplying by 10. Even before the pandemic it certainly wasn't $200 to cross the Pacific.
Also, I did not propose to go to Tokyo. There are plenty other locations that are more practical for Americans.
Not in my experience. They seem to have done away with yearly checkups altogether, claiming somehow they don't work (!).
Here in Japan, you get a yearly checkup (for free!) which checks all kinds of things: eyes, ears (audiometry), chest x-ray, abdominal ultrasound, blood test, stool/urine, etc. The idea is to catch problems early instead of waiting for patients to feel like there's a problem and see a doctor on their own. The American system doesn't seem to believe in this any more, though it did decades ago.
The Great American Eye-Exam Scam - https://news.ycombinator.com/item?id=26479078 - March 2021 (17 comments)
The Great American Eye Exam Scam - https://news.ycombinator.com/item?id=21653437 - Nov 2019 (331 comments)
Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html
Of course the statements in the article may still be correct after N years. That's good!
Edit: but the article should be the original source. Please see https://news.ycombinator.com/item?id=37505585.
<https://news.ycombinator.com/item?id=36989353>
The oldest item to make the front page was from 195 BCE: