Mail order: Public benefit or public health threat?

Optometric Management, Sep 2000 by Goodwin, Jennifer

What contact lens companies are doing to protect your patients and your practice.

As little as a decade ago, most eyecare practitioners would've laughed at the idea of contact lenses being sold in mass quantity by mail order. After all, contact lenses are medical devices that require the careful supervision of a certified eyecare professional. How could such an obvious risk to patient health be tolerated by governments, manufacturers, associations and even patients themselves?

A present-day view

Reality in the year 2000 paints a very different picture. 1-800-Contacts, the leader in mail-order contact lens sales, sold $98.5 million worth of contact lenses in 1999 - up 64% from the year before. Internet sales alone accounted for $18.7 million, which represents a 700% increase in online sales from the previous year.

The advent of mail-order contact lens companies has created a rift in the industry. Patients, manufacturers, professional associations and practitioners are all affected by the changes in how contact lenses are treated.

In this article, we'll look at the history and the different perspectives on an evolution that's rapidly changing eye care.

The changing face of medicine

Today's patient care isn't what it was in the past. The average patient is savvy about their overall medical care. They're better educated and they research ahead of time. They're also more affected by direct-to-consumer advertising.

Once the FDA loosened its regulations about advertising pharmaceuticals to patients, some contact lens manufacturers quickly followed suit and began to directly market contact lenses to consumers.

In turn, many patients come to the office with preconceived notions about contact lenses. They may even walk in to your practice with a coupon for a name brand product.

HMOs introduced the idea of cost cutting to the medical field, and patients quickly adopted this new mentality. Now, they shop around for the eyecare professional with the lowest fees and expect high-quality service and immediate access to the particular contact lenses they need.

If an eyecare professional can't compete, patients don't hesitate to go elsewhere for their care or for their vision products. According to an independent survey sponsored by Ocular Sciences Inc., one out of four patients who begin their lens wearing experience with an optometrist will go elsewhere to refill their prescription.

A double hit to O.D.s

As an O.D., you're in a unique situation because much of your income depends upon the sale of the prescription devices you recommend. Both service and products figure into your profitability, with products accounting for up to 65% of total income for the average practice. There's also been a growing concern among O.D.s about the potential dangers to patients of unsupervised dispensing.

Free enterprise vs. patient health

Stopping mail-order contact lens companies isn't as simple as asking manufacturers to stop supplying them with products. The American Optometric Association (AOA) and several manufacturers are dealing with a multi-state lawsuit because they allegedly tried to do just that.

An initiative to protect the public health was misconstrued as financially motivated and an attempt to restrict trade. Florida, New York and several other states saw that as collusion, an attempt to restrict free trade. An anti-trust suit quickly followed.

The Kansas Board of Examiners in Optometry has been involved in a lawsuit with 1-800-Contacts since May 1999. The Optometry Board alleges that 1-800-Contacts engages repeatedly in the sale of contact lenses without a prescription from an optometrist or other professional who's licensed to practice medicine or surgery.

The Board filed the suit in a state court seeking an injunction to prevent the mail-order company from further violation of the Kansas State statute.

CIBA Vision settled a lawsuit and is now forced to sell its products to companies like 1-800Contacts. Vistakon and Bausch & Lomb are still entangled in legal proceedings, which are diverting millions of dollars away from research, development and education.

The manufacturer story

For years, the leading contact lens manufacturers have indicated that they're allies of the eyecare practitioner. In fact, many of them have established programs to help O.D.s build their practices.

Many manufacturers state that they don't sell to mail-order companies. But given the huge lawsuits facing some of the industry leaders, that claim has been refined. Many now have a "no slit lamp, no product" policy. If there isn't an eyecare professional surveying the patient, then some companies won't sell their product to that company.

And yet, 1-800-Contacts claims that it carries 15,000 contact lenses in any one power at any given time. Where does all of this product come from?

Everyone speaks of the "gray market" - overseas sales and diverted product from eyecare professionals who chose to resell their inventory. The gray market is apparently large enough to provide the 100,000 contact lenses that 1-800-Contacts sells on a daily basis. And that number is growing.