Everyone gets annual eye exams.
Or maybe it is better said that everyone should get an annual eye exam. Regardless if you get that annual exam or have never seen an optometrist, chances are you have some sort of vision related issue that should be addressed. Maybe you haven’t had an eye exam recently because you are afraid of getting that puff of air in your eye or hate the sensation of having your pupils dilated. Perhaps it is the cost of the exam and the glasses or contacts that really bother you, you suspect that you are getting ripped off.
Well, let me give you the inside track on some of the behind the scenes aspects of your local optometrist office. The following information comes from over thirteen years in the optical field doing everything from performing tests on patients, manufacturing eyeglass lenses, training people on how to properly use contacts and managing a staff of a dozen people doing everything from scheduling to insurance billing.
All of the information that follows is meant to serve the best interest of the consumer, to dispel misconceptions and clarify details that a lot of optical stores might not want you to know. Hopefully this saves someone some time and money and restores consumer faith in the importance of getting your annual eye exam.
What is the best eyeglass cleaning spray to use on my anti-glare lenses?
Never buy eyeglass cleaner and I mean NEVER! No matter what the promise offered by the salesperson or bottle, the best cleaner for your eyeglass lenses is always going to be a mixture of 1 part rubbing alcohol to 4 parts water (preferably distilled, but tap will work if you have nothing else). Run your glasses under lukewarm tap water a couple of times a day just to make sure that you are getting all the dust and dirt off, but a small spray bottle with the above mixture (you can mix two drops of dish soap in there is you sweat a lot or get a lot of oil on your lenses) and a microfiber cleaning cloth are all that you need to ensure your lenses are clean and the coatings not ruined. Windex and other cleaners meant for glass will destroy the coatings on your lenses, do not use them (and save yourself the money)
Is there anything to this special “eyeglass cleaning cloth” thing?
The cleaning cloth; microfiber really is the best thing to use. The cloth is designed to trap dust and dirt and lift it away from your lenses. If left on your lenses dust and dirt can cause micro-scratches in the surface of the lenses that will cause them to fail over time. If you do not have a microfiber cloth, stop by your local optometry office and ask for a few free ones; a reputable office will have an extreme excess of these cleaning cloths (they get one with every pair of lenses they get from their lab, and generally save those and give their patients a company branded one). If you find yourself in a pinch, use a soft cotton cloth or simply shake your glasses lightly until most of the water is off. NEVER use paper towels or tissue, they are paper products and the wood fibers will destroy your lenses as surely as dust and dirt will.
What do you think about eyeglass cases?
Never pay money for an eyeglass case. First, you should always get one with your frame. Second, the local optometrist office should have plenty of cases in a box somewhere from frames they sent back to the manufacturer without also sending the case. You might not get the case you want, or get one in a color that matches your frame, but the best place for your glasses to be if not on your face, is in a case.
That annoying puff of air in my eye is possibly the single most anxiety inducing portion of the eye exam experience. Is it important?
Absolutely, that test measures the pressure of the gel inside of your eyes. There is an acceptable range for those pressures and anything outside of that should cause an optometrist to do further testing, but ideally you have this test done by the same office for multiple years and your “normal” is the baseline that the doctor can compare against. This is important for diagnosing and treating glaucoma. The good news is, the puff of air isn’t necessary. There is a more accurate and less intrusive test that involves eye drops to numb the surface of the eye and a tonometer that will actually make contact with the surface of your eye to measure the pressure. Ask if that is an option instead of the puff of air.
Do I really have to get me eyes dilated; those damn drops make me super sensitive to bright lights hours after you have left my doctor’s office?
That part of the exam may be the most vital to the health of your eyes and possibly the rest of your body. Those drops actually paralyze the muscles that cause your pupils to constrict when light in shining into your eyes, your pupils are the windows into your eyes. In order for the optometrist to properly evaluate your health, both eye health and otherwise, they need to be able to see as much of the interior of your eye as possible. If you are having some sort of imaging done (Optomap, OCT or GDX) this is even more important as a clear picture of your retina is critical with these tests. A few hours of discomfort seem like a fair exchange for the ability to check for diabetes, hypertension, hyperthyroidism, and a number of other conditions including possible brain tumors. There should not be a charge for this though, unless you are coming in on a different day than your initial exam.
Does it matter if I go to an Ophthalmologist versus an Optometrist?
A lot of people believe that since an Ophthalmologist is a medical doctor that specializes in the eye that they are more qualified than an Optometrist which does not require a degree in medicine. It is true that an Ophthalmologist is able to do a lot more with the eye medically (surgery and some medications, mainly), but they specialize in conditions and diseases of the eye and the bulk of their day to day experience is centered around the surgical aspect, where as an Optometrist focuses on correcting vision with eye wear and diagnosing & treating some conditions and diseases of the eye. There is a lot of overlap, and for the majority of eye related concerns you might have, either option is available. But, in my experience, the dependability of correct vision from an Optometrist is much higher than an Ophthalmologist, constant exposure and experience correcting vision translates into more accurate prescription.
Why do contact lenses cost so damn much at an optometrist office when they are at least 30% less online or at Costco and Sam’s?
It has to do with being able to buy in bulk and the related overhead costs. Most optometry office have a very small mark-up on contact lenses, generally between 10 and 20%, sometimes as low as 5% if the contact lens is expensive at the wholesale level. So, it isn’t because the small offices want to take your money. It is simply a matter of buying power, and the more people go to the Internet and “big box stores” the longer this disparity in pricing is going to exist. Thankfully, some contact lens manufacturers are enforcing a unilateral pricing policy. This will help ensure that patients are getting a fair price on their contact lenses while helping optometrists afford the time and attention that goes into handling the problems that occur with contact lens wearers that buy their lenses somewhere else but want their local optometrist to take care of any problems that occur.
I have left over contact lenses, why can’t I return them when I get a new prescription, they aren’t used?
Even though the contact itself is still sealed in its case, once the box has been opened, they are considered “used” and contact lens manufacturers will not take them back for credit. Only unopened boxes that have not expired are generally allowed for a refund or exchange, and sometimes it has to be within a specific time frame (30-90 days) depending on the brand of contact. Most optometrists will give you a pair of trial lenses to make sure the contacts are going to work before allowing you to purchase boxes.
Eyeglass frames with expensive brand names and labels, are they really worth the cost?
It is really hit or miss with this one, is a $400 frame better than a $50 one? Most of the time, yes, the more expensive frame is going to be better designed and manufactured than the less expensive one. While the name on the frame isn’t a direct indicator of quality, they reputation of the brand certainly is. The bigger and more established brands (Coach, Oakely, Rayban, etc) have a reputation that usually carries over into other consumer products and the strength behind their name is hugely important to them, so they have strict quality control standards. Buying a frame with a name that you do not know or that a quick Google search fails to suggest is popular, usually implies a lack of history and that might translate into the quality.
Eyeglass mark-up, what is standard?
Well, that is tricky. I have ordered frames that cost less than $1 and priced them at $129, I have ordered frames that cost $89 and priced them at $159. There is no universal “standard” for marking up the cost of eyeglasses, and there is generally not an MSRP guideline in place by manufacturers (some exceptions exist and are usually for high-end eyewear). The frames that are from a brand that you have never heard of or carry a famous name that you are surprised make eyeglasses are generally the extremely inexpensive frames and you usually pay very little for them. The high-end frames, with designer logos and fancy cases, those are the frames with minimal markup. It is not unusual for money to be lost on the sale of a frame after factoring in insurance payments.
Frames that carry a warranty are probably going to break, right?
No, not at all. In my experience, every single frame manufacturer offers a warranty of their frames for one year from the date it was ordered from them. This warranty only covers defects, but returns are generally accepted for anything short of obvious pet, car or mangling damage. If you aren’t told about the warranty, chances are high that your frame is discontinued and no warranty exists. In which case, you might want to consider another frame.
What is up with those things that measure my head at LensCrafters when I am looking for glasses, or those charts that tell me what glasses will match my face shape?
Those tools and charts are designed to make the experience easier for people that do not have a trained and experienced optician helping them, that is all. If you are using them or they are being used on you, go somewhere else to buy your glasses. A lot more goes into selecting the perfect frame than size and a formulated shape. The size of a frame is more than the number of millimeters across the lenses are and the space between them. There is the amount of space on the temple side and the thickness of the material itself. Not to mention the size of the lens and material from top to bottom. And those charts that match your face shape do not factor in your nose or ears, how close your eyes are together or the type of lens that you need. Then there is your prescription, do you have any idea how bad a highly myopic prescription lens looks in a cateye frame, especially if there is an astigmatism correction near 45 degrees? Bad, trust me. What you need to do is find an optician and try frames on. Let them select a few for you and narrow it down to one, they will know the frames to choose for round two, if you even need a round two.
The Affordable Care Act is going to force me to get eye exams, isn’t it?
Well, kind of? What is really happening with the ACA and optometry is that the medical establishment is directing people to get regular eye exams to correct vision and screen for known concerns that would otherwise go undiagnosed or cost a lot more to be diagnosed through a medical doctor. With an increased focus on pediatric eye exams and diabetes reporting, this will translate into a better quality of life for a large portion of Americans as well as a long-term decrease in taxpayer money spent on problems that could have been prevented if addressed sooner. Plus, there is a requirement that patient information move freely between medical practices, ensuring your care is continuous and complete.
Don’t you guys make most of your money off of my insurance company? Why do I have to pay anything?
There is a cost of doing business with insurance companies; in exchange for the pleasure of them sending patients to our office, we agree to reduce our usual rates when we bill for your exam and eyewear, some things even get removed completely from the claim. Generally speaking, your frame allowance is around 2 times what we get back, not to mention any discount given after the allowance. On eyeglass lenses it really depends on what exactly you are getting; single vision lenses are usually discounted up to 70%, while progressives can be more or less depending on the design and relationship the insurance company has with the lens manufacturer. Exams are usually reduced about 60% from an office’s usual and customary pricing. So, after all is said and done your local optometrist is discounting their services and product about 65%, which hopefully explains why we still collect money from you for upgrades to your eyewear.
Well, that is it for this round. I am already working on a follow-up to this and should have it finished and posted in a couple of months. In the meantime, let me know what you think about these little bits of “secret” information. Have they been helpful? Do want more details or feel that something that I have said is incorrect? Let me know by leaving a comment.