Letters: Are Eye Exams Necessary?

Readers discuss why glasses and contact lenses are so difficult to get in the United States.

Mario Anzuoni / Reuters

The Great American Eye-Exam Scam

In November, Yascha Mounk argued that vision-wear rules in the United States are too strict—and that Americans should be allowed to buy any pair of glasses or set of contact lenses at a moment’s notice.

“After all, the added cost of having to see an optometrist,” Mounk wrote, “presumably stops many Americans from accessing the corrective lenses they need to improve their vision.”

I work for a company whose goal is to provide high-quality, affordable eyewear to customers while helping others who don't have access to eye care. I've heard every "I've lost my glasses" story imaginable, in addition to many unkind reactions to a policy whereby we cannot accept expired prescriptions. Yet, personally, I stand by it.

Years ago, I visited my optometrist for a routine eye exam when he noticed my optic nerve had become paler than normal. He referred me to a neuro-ophthalmologist who diagnosed me with optic nerve sheath meningioma, a benign tumor wrapped around one of my optic nerves. For the next few years, frequent eye tests tracked the speed of vision loss, which, without an eye exam, would've gone undetected because my other eye was overcompensating. I received radiation to slow the progression of the irreversible, uncorrectable vision loss.

I understand that this is an unusual condition and that many people don't have access to affordable eye care. However, if it weren't for my optometrist, I most likely would've lost all vision in my right eye by now. Therefore, I think it's narrow-minded to fixate only on the barriers to eye exams in this country. Routine eye exams can save people from debilitating vision loss.

Lauren Brown
Nashville, Tenn.

Let's set the record straight about comprehensive eye examinations, as provided by the nation's doctors of optometry. Eye exams are an essential element of health care that safeguard vision and save lives. A doctor of optometry ensures the eye is healthy and can identify more than 250 systemic diseases—including diabetes, hypertension, cancer, and stroke—before they exhibit symptoms, placing patients on a path to early treatment.

To the experts, the evidence for eye exams is so compelling that in 2018 the Centers for Medicare and Medicaid Services launched an initiative urging all physicians to do more to educate and inform their patients about the importance of eye exams, recognizing them as efficiently-offered and accessible care. In 2018 alone, more than 300,000 Americans were diagnosed with diabetes through an eye exam provided by their doctor of optometry.

The organization I am proud to lead, the AOA (American Optometric Association), is a nationwide force for health and vision, having actively supported the enactment of 62 laws in 47 states during the last two decades that have expanded access to essential medical eye health and vision care to tens of millions more Americans.

In America, Mr. Mounk certainly has the right to choose to forgo the essential health care his own doctor and virtually all other doctors are recommending. However, when he uses a public platform to mislead, misinform, and endanger, the AOA and our doctors will speak out, correct his inaccuracies, and insist on an immediate retraction.

Barbara L. Horn, O.D.
President, AOA
St. Louis, Mo.

I agree this should be a simpler process. As an optician, I find it just as difficult as anyone else. I know I need an eye exam periodically; however, I should be the one who determines when. Unless I need a change in prescription, I don't want to be forced to go every year.

There has to be an easier way.

Laurie Bond
Walnut Creek, Calif.

Mounk’s report ignores the fact that there is a legal liability for any doctor, particularly with contacts, and that there are reasonable arguments to limit the time a prescription is valid.

Ken Henderson, O.D.
Mt. Vernon, Wash.

Having worked in the field of ophthalmology for 20 years, I feel compelled to comment. Contact lenses are medical devices that must be specially fit for your eyes. It is not just about the strength: The curvature of your eye must be taken into consideration and the right material prescribed. Both the curvature of the contact lens and the material affect how much oxygen is able to get to your cornea. When contact lenses do not fit properly, the damage is often sight-threatening and irreversible. In extreme cases, patients have needed corneal transplants or the eye removed due to severe infection. More commonly, we see patients with corneal neovascularization due to improperly formed contacts or contact-lens abuse.

Peggy Drum
Gastonia, N.C.

I understand the author's point and agree that something needs to be done regarding the cost of glasses. However, eliminating exams all together can be a costly mistake if you develop glaucoma, which sometimes has no symptoms and can steal your eyesight.

Martha Matthews Vasquez
Belleair Beach, Fla.

I tried to have some beautiful frames outfitted with nonprescription reading lenses and was told that the labs that create the lenses are not allowed to put them into frames without a prescription. Just another of the many irritating elements of the American health-care system. It's so much easier to get what you need from pharmacies in other countries, instead of navigating the doctors’ offices, their schedules and their paperwork.

Lita DeBoer
Bellingham, Wash.

Thank you for this insight about the way our system works here in the United States. I understand the reasoning behind the mandatory eye exams, but I don't agree with it. I live in a very rural area of northern New York, in one of the poorest counties in the state. We have a population of fewer than 110,000 people spread out over an area bigger than the entire state of Rhode Island. For recipients of Medicaid, it is very difficult to locate a place that will accept the insurance.

My frames broke in half two summers ago. They are acetate, and I learned that I could fuse them back together with acetone (after wearing my backup glasses for more than a year). It took a bit of research, but the solution was easier than trying to track down where my insurance is accepted and trying to get an appointment! I haven't had a fresh eye exam in five years. Where I live, when the system doesn't work for us, we get resourceful. It makes me wonder how many people in my area have undiagnosed vision impairments or progressive eye diseases that were not detected early on, as a result of this system.

You are spot-on when you conclude that “it’s reasonable to assume that it has an adverse impact on many people, especially underprivileged Americans—those who don’t have insurance, have little cash, or lack the social or financial capital to navigate our country’s byzantine medical system.” I couldn't agree more.

Bridget LaPage
Canton, N.Y.

Yascha Mounk replies:

Eye exams are a good way to check for a range of dangerous diseases, from progressive blindness to brain tumors. If you have the time and money to visit an optometrist, go make an appointment today!

But there are plenty of medical exams that are not mandatory even though they often help to uncover dangerous diseases. Do you need to see a dermatologist to buy skin cream? No. Do you need to get a prostate exam to buy drugs against incontinence? No.

To determine whether eye exams should be mandatory for Americans who wish to buy glasses or contact lenses, we need to look at the comparative benefits. Eye exams are useful. But is it proportionate to ban Americans from buying glasses or contacts unless they get an exam, thus making it more difficult for them to access vision care?

What’s remarkable is how few of the responses to my article address this point. In fact, Barbara Horn, the President of the American Optometric Association, fails to provide evidence that the incidence of eye diseases is higher in the many countries in which eye exams are not mandatory, and that this drawback outweighs the benefit of providing socio-economically disadvantaged Americans with easier access to eye care.

Until someone shows me compelling evidence that the burden imposed on disadvantaged people by the cost of a compulsory medical exam is justified by the benefits, I stick by my position. Abolish mandatory eye exams!