Despite regulation designed to promote competition and empower consumers to compare prices and explore the market before purchase, it is unnecessarily difficult to buy glasses online in the United States because eyeglasses prescriptions lack a key piece of information consumers need to explore all their options—the pupillary distance (PD), a measurement used to align the lens to the pupils. The Federal Trade Commission (FTC) should take action to update eyeglass prescriptions requirements to include PD so consumers can buy glasses online more easily.
The FTC enacted the aptly named “Eyeglass Rule” in 1978 in response to complaints that consumers were unable to compare prices for eyewear before purchasing because doctors were reluctant to provide eyeglasses prescriptions. Eye doctors often sell frames and lenses in their offices, and by withholding the prescription, consumers had little choice on where to buy. (They did the same for contact lenses too.) The rule requires ophthalmologists and optometrists to provide a vision prescription at the conclusion of an exam without charging an additional fee or requiring patients to purchase goods. When purchasing was primarily conducted in-store or with the assistance of opticians or salespeople, the Eyeglass Rule successfully gave consumers the freedom to explore their options and purchase the glasses that best fit their needs. However, times have changed.
Online retailers have expanded the eyeglass market beyond traditional brick-and-mortar stores. Consumer Reports found that online and discount retailers can reduce the cost of prescription eyeglasses by 40 percent or more, and nearly half of consumers researched glasses online before buying in 2020, though only 14 percent purchased online directly. Unfortunately, consumers need to have their PD to order prescription eyeglasses online, and the Eyeglass Rule does not require eye doctors to provide it with their prescription. Securing the inclusion of the PD with a prescription is the key piece of information that would provide consumers with more options at reduced costs.
Some eye doctors measure PD when examining the overall eye and pupil health. But since adult PD rarely changes, is not considered medically significant, and is not required to dispense a prescription, some doctors may rely on an optician to complete this step when fitting a patient.
Five states now mandate PD inclusion to dispense a prescription. However, the failure to update federal regulations has left consumers with unequal access to the market. Updating the Eyeglass Rule would standardize practices across the country and ensure that all consumers, no matter where they received their prescriptions, are able to comparison shop online.
Unfortunately, opticians largely oppose this change, as they have opposed virtually all proposed changes to make it easier for consumers to purchase eyeglasses and contact lenses. When the FTC called for comment on the rule in 2015, the Opticians Association of Iowa argued that requiring the inclusion of a PD Measurement with a vision prescription would ultimately hurt the consumer because it could potentially increase the risk of error in measurement and the cost of a vision exam.
However, these objections are misguided. With regards to measurement errors, when the PD is not included in a prescription, consumers shopping online often resort to measuring it themselves. The National Association of Optometrists and Opticians (NAOO) noted in their comments, “the absence of a PD with an otherwise complete prescription makes it necessary for on-line sellers to… measure PDs remotely to complete an on-line sale of eyeglasses…or they must estimate pupillary distance, with the resulting risk of lower accuracy and higher remakes.” For example, consumers may be instructed to take a photo of their pupils aligned with a standardized object, like a credit card, or measure their PD with a ruler and self-report their findings. Regarding the cost of an exam, there is no reason to expect costs would be higher than current pricing. Consumer Reports found that some practitioners already charge an additional fee to provide the PD during the exam or offer a small reimbursement if glasses are purchased from an associated store. Although this is not a violation of the Eyeglass Rule, charging for PD (especially at rates that are disproportionate to the time and skill involved) appears mostly designed to make it harder for consumers to shop around for glasses.
The FTC should act, as it did in 1978, to strengthen consumer choice by updating the regulation to require optometrists to include the PD on a vision prescription. The eyeglass (and contact lens) market is much broader today because the Internet gives consumers more choice and lower costs, but the lack of updated federal regulation means that there is an unnecessarily steep barrier to entry to purchase glasses online.
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