" a state has every legal right to regulate products that are shipped into that state from another state."
Again, no. That's interstate commerce, and is controlled by the Federal Government. Yes, certain, well defined products, such as tobacco and alcohol are controlled, but that is done by the Feds.
State X cannot tell a business in State Y they are not allowed to ship product to their resident citizens.
Forgive us if we don't defer to your Constitutional law credentials, Aurelius.
Of course there are federal regulations in place as well. But states routinely pass their own legislature independent of federal regulations, as long as these regulations do not conflict with federal regulation. This applies to just about anything, not just interstate commerce.Again, no. That's interstate commerce, and is controlled by the Federal Government. Yes, certain, well defined products, such as tobacco and alcohol are controlled, but that is done by the Feds.
In fact, your alcohol example is a perfect of how you are incorrect. The federal government passed legislation to prohibit alcohol in every state. It was eventually repealed, although alcohol sales and transportation are still regulated in each individual state. There are several states, for instance, that do not allow you to ship alcohol into the state from another state, while many other states do allow this.
That said, it is unlikely that many of the state statutes pertaining to the dispensing of eyewear specifically address interstate eyewear delivery, since these laws were originally conceived long before this particular delivery model for eyewear even became a consideration. I'm sure that much of this regulation will need to be clarified or reinterpreted by the appropriate state boards in the future, if not rewritten.
Best regards,
Darryl
Darryl J. Meister, ABOM
The difficulty is applying existing law to the new form of delivery. The definitions of various terms like "dispensing" were not written with internet sales in mind. Here's an example, Florida's definition of dispensing:
(9) "Optical dispensing" means interpreting but not altering a prescription of a licensed physician or optometrist and designing, adapting, fitting, or replacing the prescribed optical aids, pursuant to such prescription, to or for the intended wearer, duplicating lenses, accurately as to power without a prescription, and duplicating nonprescription eyewear and parts of eyewear. "Optical dispensing" does not include selecting frames, transferring an optical aid to the wearer after an optician has completed fitting it, or providing instruction in the general care and use of an optical aid, including placement, removal, hygiene, or cleaning.
Here's a hypothetical transaction: Florida citizen Bob is on his computer in Tampa. He orders some glasses from a company based in Texas (an unlicensed state) over the internet. An optician in Texas reviews his prescription, maybe even consults with him on the phone about lens materials. Further, manufacturing opticians in the lab further interpret the prescription, and a final adjustment is made before the glasses are shipped to Florida based on a photo Bob provided that showed he had a wide bridge and low ears. Bob receives his glasses and puts them on. Reading the definition above, were those glasses "dispensed" in Texas, or Florida? What if the facts are changed so that instead of an unregulated state, it's a regulated state like New York, and the optician who reviews the order before it goes to the lab is licensed by New York State? Which state's definition of "dispensing" should apply?
Another example: I'm Mr. Do-It-Yourself, still living in Florida, and a lab in China has given me an interface to order direct from them with all the same options as the VisionWeb interface. No one is going to review my prescription, it's going straight to the lab and is being shipped to me direct from Hong Kong. Forget for a second the difficulty of enforcing laws against a foreign company. The question is, was there "optical dispensing" under Florida law? If there was illegal dispensing, who did it? The Chinese company or Mr. Do-It-Yourself who "interpreted" and "designed" his glasses?
Mike, unfortunately, as far as states not being able to regulate interstate commerce, I don't think you're right, as much as I'd like you to be. States can regulate sales of products in their state by out-of-state businesses, unless the federal government "preempts" the area (that is, under the Supremacy Clause they pass a law that trumps state laws, as they did with the Fairness to Contact Lens Consumers Act). States have to be careful in how they regulate it, in that they can't favor intrastate business over interstate business, but they can probably regulate it by, say, requiring all sellers (in and out of state) to register with the Board, conduct prescription verification, etc. like North Carolina is going to do. Where it gets tricky is at what point do those regulations favor intrastate business interests to the point they are promoting those businesses over out of state businesses, which is where a dormant commerce clause issue exists. Would requiring in-person dispensing by a state-licensed optician cross that line? I'm not sure.
(Mike, since you seem interested in this, the recent wine industry case Granholm v. Heald is worth a read, although it implicates the 21st amendment which obviously doesn't apply here.)
I think the North Carolina Board is on the right track. I think a national approach would be better though. Consider, a national regulatory framework would bring the other half of the states that currently aren't regulated at all under its purview. For those in favor of regulation this would be good, right? And national licensing would provide for greater mobility if an optician needed to move and switch jobs. But, a national regulatory scheme wouldn't protect existing businesses against internet sellers like the existing state based laws might...
Anyway, that's not what's interesting to me. More interesting and important to me is the question of whether online dispensing of eyewear can be ok? Isn't that the better question: can it be done in a way that is acceptable and prevents any potential harm to the patient? Because, and it's important not to lose sight of this, that's the point of these laws in the first place, to protect the patient - not existing businesses. I think that gets lost when the legal side of this gets brought up.
So my question to drk, Harry, and others here who are saying it's currently illegal, at least in their regulated state(s): should it be? And let's leave out the more extreme cases where there isn't a question: difficult rx's or offshore internet companies that make very poor quality product and off-prescription lenses. And let's assume that P.D. was given during the exam and not self-measured. Do you think that people shouldn't be able to buy their eyewear online, even if they're just a -2.00 sph? If so, why?
(to be clear, I'm not trying to just support my side here. I think that this is the more important discussion and am sincerely interested in opinions & debate).
Edit: Just saw Darryl's post above regarding the legal issues, and he's dead accurate, but was able to say it in less words than me. :)
If I knew your last name, I'd still call you by your first.Originally Posted by drk
It's dr, Mike. :)
No matter what painstaking effort taken by board-certified, highly trained professionals, you're always going to have a cheap @$$ school bus driver manually entering in their "prescriptions". Online glasses sellers are not face-to-face, don't have to read and retain a real prescription from a real professional, and cannot make sure that everything was done properly, like adjusting pantoscopic tilt or vertex distance on progressives or high power lenses, or ensuring that there is no vertical imbalance due to hyperorbits or non-level lenses, etc. etc.
No, it's NOT feasible, because any responsible regulation would have to exclude so many people/professions that it would be ridiculous. We'd have to, instead of having professionals regulate vision care, have more frequent school screenings, driver's license screenings, CDL and FAA examinations, etc. because, and I'll say it again:
DEREGULATING VISION CARE SPITS IN THE EYE OF:
which are all set up to work with real professionals for the protection of all.
- Bureau of Motor Vehicle vision standards
- Federal Aviation vision standards
- Commercial drivers licenses
- School screenings
- State boards regulating optometry
- State boards regulating opticianry
- State boards regulating medicine
Oh, you guys shouldn't be regulated, right? Just everyone else. All those vision standards developed for public safety are to be ignored, because they can buy online glasses from you or anyone, without a prescription and without professional oversight. All those school vision screenings may as well be discarded, because Johnny can pass the school screening on Monday with the glasses I made him, but would flunk it on Tuesday with unregulated online glasses that are screwed up.
Hey, I could certify that FAA pilot on Monday, and give him a new and improved Rx, and he can be flying you with the wrong glasses on Tuesday. Who's to know?
Your kid can get onto a school bus with bargain Bob who has poorly tinted sunglasses that induce the Pulfrich phenomenon.
Your wife can be driving down a dark two-lane highway in the rain and that semi driver coming at her can be overplussed by a half diopter reducing his reaction time enough to head-on collide.
Who are you kidding? Would you advocate this for any other medical profession? Do it yourself dentistry? Do it yourself hypertension treatment?
What possible rationale can anyone have for this?
Pulfrich phenomenon? Save me the trouble of googling that if you don't mind.
Sent from my BlackBerry® wireless device
It is a stereoscopic phenomenon experienced when the intensity of light perceived by one eye differs significantly from the intensity perceived by the other, which might occur, for instance, if one lens has much more tint than the other.Pulfrich phenomenon? Save me the trouble of googling that if you don't mind.
Best regards,
Darryl
Darryl J. Meister, ABOM
Drk, I agree with your argument but I disagree with who it argues with. The purchaser is obviously willing to give up all that expertise, professionalism and protection to save money.
Have you seen the movie Extraordinary Measures?
Businessman Brendan Fraser says to drug researcher Harrison Ford "Without investment capital your scientific theories won't help a single human being in reality."
And if you can't convince the masses that buying glasses online is a bad idea, all the arguments and even laws won't prevent their visual problems. We see this in British Columbia.
I'm just saying, we need to convince patients to want our services. We can't convince online sellers to stop selling. And BC showed us we can't convince government to protect the public either.
Sent from my BlackBerry® wireless device
It can also result (to a lesser degree maybe) from having a pair of polarized suns, with one lens off axis. That was a case I saw a few months ago. The other "optician" that works in the dispensary I part time in dispensed a pair of polarized suns to a lady with one lens' polarization off by about 50 degrees. No one could figure out why she was complaining and they said she was just crazy. Go figure. Took about 2 seconds for me to verify what I thought the problem was from her description. Sadly, licensing doesn't guarantee quality. But think, if this can get past the average license, what's coming out of chinese discount labs?
Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA
“As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein
drk, I think you misunderstood my question. I wasn't advocating for deregulation. In fact, I advocate for more (national regulation). And I think you know that I support prescription verification. So, what I was asking, do you think that some prescription eyewear can be delivered via the internet in an acceptable way? And if the answer is, no, none at all, then why?
MichaelP, I think DrK's answer to your question has already been posted.
Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA
“As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein
Except that, every single one of those examples can and does also happen without internet sales (as you just described with the off axis polar). This seems to be the main point from drk's post:
"they can buy online glasses from you or anyone, without a prescription and without professional oversight."
But what about licensed opticians who sell online, and with regulation that requires prescription verification? Is the answer still that it's not possible to deliver acceptable prescription eyewear online for any prescription?
(I'm not trying to be confrontational here. When posting on a forum, it's sometimes difficult to determine tone. I'm really just trying to talk about it with people like you and drk and Harry who are far more knowledgeable than me.)
Last edited by MichaelP; 12-16-2010 at 08:54 PM.
No false modesty, MichaelP, you're obviously a smart and articulate man. We just happen to disagree.
Sure, it CAN happen, but is it less likely with a regulated healthcare pro whose license is on the line to make sure the eyewear is correct? Of course. Would ANY of the situations DrK mentioned get past most ECPs? Oh h311 no! Its the professional eyes and hands on the eyewear and patient that makes the difference, and you can NOT duplicate that online.
It's obvious that you know this. It's obvious that it's detrimental to your business model to admit it.
Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA
“As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein
MichaelP
Can glasses be delivered via the internet in an acceptable way? Yes, to the dispenser. NOT to the wearer.
Why?
Because eyewear consists of more than just numbers. It must be ADAPTED to the patient, physically and visually.
You're welcome.
Sent from my BlackBerry® wireless device
Slightly askew, but sort of on-topic, is the issue of Drivers Licenses...here in wonderful Central MN, we have possibly the nations largest concentration of Somali immigrants (a whole 'nuther topic, but I digress)...these folks take and pass the drivers license test, but can't read a word of English. Even with the best eyewear in the world, if you can't read and understand the words on a road sign, how the heck do you get to drive?
I wear corrective lenses, it is stated on my license, but every time I go in for a renewal, the lady behind the desk asks me if I want to try to qualify without glasses!
Sorry, but I see this particular argument as a non-issue, especially in places like Florida where you have octogenarians still driving who can hardly see one car length in front of them much less being able to see over the top of the steering wheel.
I think you're missing the point of consumers purchasing eyewear online.But what about licensed opticians who sell online, and with regulation that requires prescription verification? Is the answer still that it's not possible to deliver acceptable prescription eyewear online for any prescription?
While a small number may be interested in the convenience factor, most are trying to save money. So the "Shopping Cart" total will be the most important point of comparison between websites. Consequently, if your online operation has extensive quality controls in place, relies on high-grade materials, and employs trained staff to manufacture, verify, and prepare the eyewear for delivery, there is no way your business model could ever remain competitive against a company who cuts as many costs and, therefore, corners as possible in order to undersell you.
Further, why would any successful online operation employ licensed opticians? How does the experience of a dispenser factor into an online purchase made by a consumer possibly thousands and without immediate access to the optician? In such a delivery model, qualified eyecare professionals are just unnecessary business expenses.
Landlord mentioned that the consumer is willing to give up "expertise, professionalism, and protection." But I don't think that this is strictly true. In my opinion, most eyewear consumers are unaware of the level of expertise and professionalism required to ensure safe, high quality, and properly performing eyewear. More specifically, they tend to take these factors for granted. So, more often, they are unwittingly making this sacrifice when purchasing eyewear online.
Best regards,
Darryl
Darryl J. Meister, ABOM
EXACTLY. When faced with medical bills, insurance, mortgages, food and general living expenses, people are going to opt for any way to save some money. Is it the best for them? I don't think anyone knows the answer for sure, but the consumer doesn't care. "They" see eyewear as a huge expense and look for ways to trim their costs. What they should be doing is asking "you" for less expensive options, but they don't.most are trying to save money
The answer is there, but you have to find it yourself.
It wasn't false modesty, but I appreciate the kind words. It's clear to me at least that many of the posters here including yourself know more about optics and patient care than I do though. It's the whole reason I participate on this board. I first started posting on here because I wanted to give the argument for the "other side", but really I've learned a lot, and if anyone can have a good, intelligent discussion about these issues it's you guys. The optical industry is oftentimes very reactive or non-responsive to emerging trends, and I don't think that's good for anybody.
I think you're right in that you cannot duplicate a professional's hands-on expertise in dispensing and fitting a pair of glasses. I have no problem "admitting" that, because I'm not one of those online guys out there telling people that their optician is ripping them off. I do think it's unfortunate that the professional's services have so far been priced into the pair of glasses, because then the patients don't see it. I also think there is far more sub-standard dispensing going on at brick and mortar stores than is usually admitted in these discussions too. But, we're having a discussion of what should be, not what is.
Back to my question though, is that hands-on expertise necessary in all circumstances? Is that -2.00 sph patient really getting necessary care? At what point is the professional's touch not just nice but necessary? Or, put another way, if you could draft regulations anyway you chose, do you believe that it's not possible to draft them in such a way that some patients are able to buy online and get sufficient glasses?
No, it's not possible. It would have to be worded like this:
"Glasses may be purchased online by anyone except the following:
Those who experience complications."
The problem is, you don't know who will experience complications until they arise. Do you really think all -2.00 sph patients will be uncomplicated? You're either on crack or you're not an optician.
Sent from my BlackBerry® wireless device
While online buyers are primarily looking to save money, they don't always go to the bargain basement. Otherwise they'd all just order from Zenni. They're willing to pay a little more for better customer service, better guarantees and warranties, and easier to use websites among other things. While online has been characterized as a race to the bottom so far, it won't remain that way. Just like brick and mortar patients don't all flock to Walmart, so too do online buyers not just run to the cheapest website.
It might surprise you to know this, but most online optical stores are owned by licensed (or, if not licensed, long time practicing) opticians.Further, why would any successful online operation employ licensed opticians? How does the experience of a dispenser factor into an online purchase made by a consumer possibly thousands and without immediate access to the optician? In such a delivery model, qualified eyecare professionals are just unnecessary business expenses.
I think that's probably true, and all the more reason for regulation.Landlord mentioned that the consumer is willing to give up "expertise, professionalism, and protection." But I don't think that this is strictly true. In my opinion, most eyewear consumers are unaware of the level of expertise and professionalism required to ensure safe, high quality, and properly performing eyewear. More specifically, they tend to take these factors for granted. So, more often, they are unwittingly making this sacrifice when purchasing eyewear online.
Best regards,
Darryl
But none of that has anything to do with the quality of the eyecare or eyewear. Joe Consumer is at least smart enough not to make a major purchase from a website that looks like it was built by a teenager using Microsoft FrontPage. In fact, using only those criteria, a site like Amazon.com would probably be the best place to buy eyeglasses online.They're willing to pay a little more for better customer service, better guarantees and warranties, and easier to use websites among other things
Oh, I'm sure that online optical businesses in the US at least will lure experienced eyecare professionals before laypersons, since eyecare professionals are already intimately familiar with the industry and overall eyewear delivery model. Nevertheless, this has very little to do with the eyecare service or quality of the finished eyewear, unless these licensed owners are personally reviewing, fabricating, and inspecting every order that comes in, which is obviously not practical, especially for larger operations. And it's not like the eyecare industry is completely devoid of unscrupulous individuals.It might surprise you to know this, but most online optical stores are owned by licensed (or, if not licensed, long time practicing) opticians.
Best regards,
Darryl
Darryl J. Meister, ABOM
Except that's exactly the business model of GlassesDirect, the largest online retailer in the UK. Every order is reviewed by a licensed optician, and you can call their 800 number and talk with one too. I think (but could be wrong) that FramesDirect also employs opticians to review each order. I have no doubt that this isn't happening at the very cheap, high volume discount sites like Zenni, etc. but again, that's where regulation could come in - "each order needs to be reviewed by a licensed optician." Pretty easy fix. And even without regulation, just like traditional businesses, online sites rely heavily on word of mouth to grow their customer base, and if they're delivering shoddy product because they're cutting all kinds of corners, they won't last long.
What we're really talking about here are really just basic business model competition scenarios. Just like Walmart isn't going to completely swallow the brick and mortar side, I don't think that online retailers will be completely beaten by those who decide to deliver cut-rate product.
Edit: Also, just one more comment about size, even if they're larger and doing large volume, that review and verification can still happen. It happens at labs processing 1000's of jobs per day during final inspection, every day.
Are we talking about some other country or the US? Because the UK and several other European countries generally have tighter regulations for fitting and dispensing eyewear, which might very well apply to online entities.Except that's exactly the business model of GlassesDirect, the largest online retailer in the UK
If you are not forced to employ licensed professionals to review every order, most online optical companies will not, simply because it is cheaper and, therefore, more competitive not to employ them. And, even if they do now, you can expect this to decrease with increasing price competition online.
I think it is far too early to tell how a company like FramesDirect will fare in the online arena in the long run. Secondly, do you actually know for certain that experienced, qualified opticians review each order? Or is there just some "experts" available in their customer service department to handle phone inquiries?FramesDirect also employs opticians to review each order.
Yes, but certainly not by the owner of the laboratory. And the qualified technicians who are inspecting each job represent one of the very costs that contribute to the local eyecare professional's cost of goods. Trained technicians cost money, and this overhead is factored into the cost of lenses to the eyecare professional and, ultimately, to the consumer.Also, just one more comment about size, even if they're larger and doing large volume, that review and verification can still happen. It happens at labs processing 1000's of jobs per day during final inspection, every day
And all of this ignores the obvious obstacle of frame adjustments, either prior to multifocal measurement, when the finished eyewear is delivered, or after the daily abuses of life. In a world where many if not most of the local optical shops have closed up due to online competitive pressure, is the patient or "online optician" expected to adjust or realign the eywear in order to ensure physical comfort and optical performance?
Best regards,
Darryl
Darryl J. Meister, ABOM
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