1800CONTACTS musings...

[Pete Hanlin]

This thought occurred to me over the weekend during a particularly boring CEC...

Given that 1800CONTACTS dispensed to their 1,000,000th patient this year, and given that we all know they dispense tons of lenses without a valid Rx, shouldn't it follow that they should have been sued by now?

I mean, do you mean to tell me they've never had a non-complier patient develop a corneal ulcer in over a million dispenses??? Even if they settled out of court, I would imagine that Optometric Business or Vision Monday would have reported a suit. If there haven't been any, is it possible that the chances of a corneal complication arising from the misuse of contact lenses is so minute that they really shouldn't require an Rx? (Just playing devil's advocate here, you all know I despise soft contact lenses :) .)

Opinions?

Pete

[slate83]

Diane Drake did a class on contact lenses at SECO. By the way, she did a very good job and I know she frequents the Optiboard.

She brought up the 1800 contacts subject but didn't address. She deferred to the end of the class to answer questions or offer opinions on the subject.

I asked her why the Georgia Optometric Associaton or the Opticians Association of Georgia doesn't go after these mail order contact lens companies. You see, it is illegal for these companies to mail contact lenses into our state. It is the law. Yet our doctors don't do anything about it. Nor are the opticians.

Can anyone make suggestions as to how this can be handled?

I really wish they would have a class on this subject of mail order contact lens. I would find it very informative.

[marblez]

I love the fact that Ga has the law you talked about. I hope if possible it is inforced. We used to get request from to validate rx's and our doctors wouldn't, so we didn't have much problems with this. I do advise my patients the risks of using them, but people just look at money these days.


christina

[Maria]

Pete, I see your point. But isn't it possible that the person who will get the mail order lenses, just to save a few quid, will be one or more of these;
a) not be having any kind of checkups,and not know there is a problem developing
b) be too pigheaded/embarrased to go to an opticians with a problem
c) be the 'ignore it and it will go away' personality type, particularly since over there you have to pay for healthcare, and the person in question has already proved to be a tight-**** (British slang for penny-pincher, nothing to do with homosexuality).

It's only been a year so far, so I would be interested to see if they still have no lawsuits a couple of years down the line.

Maria ' I can't wait for them all to go blind-that'll teach them :)' K

[Cindy Hamlin]

I understand there is a class-action suit against them in California. It is because they dispense without prescriptions.

[Pete Hanlin]

Actually, the case in California has run into trouble with the presiding judge. Apparently, he refuses to try 1800CONTACTS on the fact that they dispense without an Rx.

Instead, the state must prove that 1800CONTACTS somehow defrauded their customers by providing them contact lenses without the Rx of an OD/MD. In other words, the state has to prove that the patient was somehow financially hurt by not receiving an Rx from their doctor. Seems to me the only way to prove this is to find a patient with a complication who subsequently had to pay medical costs associated with remedying their problem.

Its interesting to compare a large company that releases 100,000s of contact lens boxes without an Rx to the private OD offices who get apoplectic if they sell a box one month outside the patient's Rx expiration. I side with the private ODs (naturally), but I find it interesting that there haven't been a notable number of medical complications associated with 1800CONTACT's policies.

Pete

[mikeh]

Pardon the heresy but is it possible that the major reason for expiration dates on Rxs is largely economical?

[ziggy]

My thoughts are, the reason for the lack of lawsuits are that the profit margin on contacts are generaly low. Most OD/MD's and LDO's make far more on specticals and/or exams. The people who will use 1800contacts are the same ones that will wear a 2 week lens for 6 months!! So why wast time or money trying to help some who don't want the help???

[hcjilson]

With apologies to Pete for getting off his topic.

While the expiration date on a Rx may smack of econonics, it actually has something to do with the patients best interest.Has anyone in optiboardland ever been given an Rx for anything other than spectacles which did not have an expiration date on it?(just out of curiosity)
Back to the topic!
Massachusetts is currently drafting regulations concerning the sale of contact lenses via the internet or mail similar to those of California, and others. California's problem (and every other state with regulatory authorities) is one of enforcement.A regulation without any teeth is no regulation at all.Eventually the case will be heard, if not in Cali, somewhere else.It will be an important case because it will set the precedent for the other states.If the companies involved (1-800 CL's etc) don't want to comply in the regulated states they will say something to the effect that they can't ship to CA,MA NY etc. (just like when we bought fireworks by mail in the olden days) :)Its going to be some time before that happens but the regulated states that I am aware of, are scrambling to get the regulations in place.
Even New Hampshire (Live free or Die!)is heading in that direction!
Best from the Cape



------------------
Harry J

[Diane]

OK,

From a lecturer's podium, I choose not to address certain issues, but that's not here.

If anyone dispenses contacts without a proper prescription, they are in violation of the law. They are in violation of whatever state law they are in, and from a national standpoint, they are in violation of federal law.

Just look at any of the multiple packaged lenses and other vialed lenses in your office/dispensary. Read on the package/vial. What does it say?:

Caution: Federal law prohibits dispensing without a prescription.

Look at the package inserts on your rigid lenses. Same thing.

We WONDER who can stop this? Everyone wants the other guy to "DO SOMETHING TO STOP THIS". Guess what? If we want something done, we have to do it ourselves. In vast numbers. Report them yourselves to your own state licensing boards, and to the Federal Trade Commission and The Food and Drug Administration. Don't call them, or call someone else to do it. Write letters and copy the the state attorney general's office, and the federal atorney general's office. If only one or two do it, little will be seen. If large number do a serious paper campaign, then something will start happening.

I don't have any problem with the other guy trying to make a living..."but follow the laws". Take care of the patient/consumer.

Explain why it is a concern for the safety and welfare of the general consumer, not to mention that the laws are in place and need to be inforced.

When we see enough sore eyes, and visually compromised eyes because of abuse, it's too late. We need to step up to the plate, now. Any eyecare professional who has concerns, individually. Numbers will count.

I've been informed that my single letter was important, but agencies act on numbers of single letters.

Ok, that's my soapbox for today.

Diane

[judyb]

I wonder if the lack of lawsuits is related to the patient's failure to blame the lens supply company for complications. These patients perceive that they have gotten the same goods at a better price and are in denial about side effects. Two examples:
I had a soft lens wearer who insisted on using saline for storage because it was cheaper and she was sure the solution manufacturers were ripping her off. No amount of time I spent explaining the difference between rinsing and disinfection would convince her. She had three eye infections in a nine month period, each time having to wear glasses for a few weeks while it cleared. She refused to replace the lenses after any infection episode and she insisted that her lack of a care system was not the problem. She actually said to me: "I KNOW that using saline has nothing to do with these infections, stop telling me that." She wanted me to fit her with a lens that wouldn't cause infections!

Another patient uses Acuvue bought mail order for extended wear. She wears them for one to three weeks at a time without removal, replaces them when they rip or start to feel bad and refuses to wear them into the office for assessment because she doesn't want to pay for a CL check (I'm the one ripping her off; the mail order place does not require an up to date RX and telling her she needs one is a scam). She does show up yearly for a refraction, fundus and IOP check and when I mention the 2 mm neo vasc that she has developed, she thinks I am fishing for a cl check fee

Both these people are "saving money" and they are not going to admit that they are getting less service or less value for the lesser cost.

[Pete Hanlin]

Both of these people will also be eager to sue someone when something goes seriously amiss. (Much like parents who continue to put little kids in the front seats of airbag equipped cars like to sue auto manufacturers when their child dies in a fender bender.)

I inquired about the various laws prohibiting the dispensing of cls without an Rx to a lecturer at SECO. He pointed out that the A.G.'s offices are currently busy just trying to keep up with the illegal dispensing of pharmacueticals (like Viagra). That's when I started wondering about the exposure of companies like 1800CONTACTS. Seems to me if there were a number of cases where patients were actually seriously harmed by procuring lenses without an Rx, there would be more serious attention given to the problem (e.g., Firestone tires on Ford Explorers).

I think what the general message of this string has suggested is that the nature of the complications doesn't usually rise to the sight-threatening level, so patients figure the infections and other maladies are either the cost of wearing contacts as they see fit- or the fault of the original examiner's imagined incompetence.

If you visit the "Just Conversation" section of OptiBoard, you can see a copy of an email I received just yesterday from a patient who purchased lenses (with an Rx from us) from a company called 1StopContacts. Turns out the contacts are uncomfortable, and he wants to know what we can do about it???

Pete

[Bobby Johnson]

I just say a press release saying that they had shipped over 4,000,000 orders. Can this be right?

[Pete Hanlin]

Hello again, Bob. There's no chance you happen to work with 1800Contacts (or a company associated with them) is there? You seem pretty well educated for someone who just purchases the occasional box of lenses... Then again, maybe you're just interested in the particular company (I look up info on companies I'm interested in all the time).

Not saying you are, and not saying its a problem if you are (but you're supposed to divulge that kind of relationship up front per OptiBoard rules).

Not trying to accuse or anything (I'd have sent you an email instead of posting, but you haven't listed an address).

Pete
PS- I figure I mentioned related to the number of customers the company has. The number of orders could easily be 4 Million. Congratulations to 1800Contacts for their success (I just wonder how many of those 4,000,000 boxes went to consumers with actual prescriptions for the lenses ;) ).

[This message has been edited by Pete Hanlin (edited 03-14-2001).]

[Bobby Johnson]

Sorry, I am however a customer. They are a publicly traded company and I signed up to get email alerts from them when they send out press releases.

[chip anderson]

Our problem is this: Our price of contacts has included unlimited check~ups or part of check~up fees. Yes we do bi~annual check~ups in addition to the physician's annual exam. What do we look for: Corneal disturbance, lens deposits, damage, etc. No charge or very minimal charge for same. Polish, jobs, edge repair, or in some cases re-fitting slightly extra. Problems that do not require an ophthalmologist, we fix, those we can't fix we send to the ophthalmologist (they are quite happy with this as those we serve would rather spend their time treating the sick, doing surgery, etc.).

Now as we opticians usually can't charge for examining the eye, we have charged for our lenses enough to be worth our time. We have held that contact lens fitting does not consist of measuring the eye and sending the measurements (or interpretation from some chart or our own expertise) off to a lab. The true measure of a contact lens fit is what happens to the eye after the lens is fit, not just at one week but over the decades. Mail order and other changes in the optical business and it's marketing have destroyed this and we don't know how to adapt. We know how to change if our objective is just to make the most money with the least effort, but to truly feel you are taking care of the patient, we don't know how to handle things now.

Chip