Occupational Licensing

Eye Doctors Don't Like Seeing Alternatives

The internet can increase options for consumers, but interest groups look for government restrictions to protect them from competition.


I just got new glasses—without going to an optometrist.

It's another innovation made possible by the internet.

Going to an optometrist can be a pain. You have to leave work, get to an optometrist's office, sit in a waiting room and then pay an average of $95 (in my town). But I got a prescription for just $50—without leaving my computer.

This is possible thanks to a company called Opternative ("optometry alternative"). The company claims its online test is just as good as an in-person eye exam.

I was skeptical. It's over the internet! How can a computer replicate what optometrists do in their offices with impressive-looking machines?

"This is the beauty of technology," answered Dick Carpenter, director of strategic research for the libertarian law firm the Institute for Justice.

Carpenter researched Opternative's test and concludes that it is just as good as an in-person exam. "Sometimes better, some research has indicated."

Here's how it works: First, you answer some medical questions.

Then, while holding your cellphone, you follow prompts on the phone while looking at your computer screen, selecting which lines look sharper, or which numbers you see.

One day later, they send you a prescription. Mine exactly matched the prescription I got from my ophthalmologist, a medical doctor who charges much more.

Fast, cheap, and easy.

So naturally, optometrists want this alternative banned. "This is really foolhardy and really dangerous," said former American Optometric Association president Andrea Thau on "Good Morning America."

She wouldn't do an interview with me. Nor would anyone else from her Association—despite our sending them emails for a month.

I assume they knew I'd mock them for trying to ban the competition. Which they are trying to do. They wrote the FDA that the at-home test "should be taken off the market."

What they're really saying is that patients should not have the right to make any choices in their own vision care.

The optometrists are bottleneckers. Bottleneckers: Gaming the Government for Power and Private Profit is the title of Dick Carpenter's new book. He studies how established professionals use government to limit competition.

Cosmetologists get laws passed that force hair-braiders to spend $5,000 on useless courses and tests. Restaurants limit food trucks. Established florists ban newcomers. Optometrists want to ban Opternative's test.

Bottleneckers like them have clout in legislatures because their lobbyists give politicians money. They persuaded 13 states to draft bills that would ban at-home tests.

In South Carolina, then-Governor Nikki Haley vetoed the ban, correctly calling it anti-competitive. But the legislators were beholden to the optometrists' lobby; they overrode her veto.

The optometrists say that a home test is too risky because no doctor is there to look for diseases. I confronted Opternative's spokesman about that. He said the test's questionnaire filters out sick people by asking questions like: "Any health conditions? … pregnancy, nursing, diabetes … Any medication that affects your vision? … Sertraline, Amitriptyline…?"

Obviously, a questionnaire is not as good as a doctor. But it does screen out some people. Opternative rejected me the first time I tried.

I then lied about my age to test their service.

I don't recommend lying on medical forms. But a cheap internet prescription is not much of a threat to public health.

Barbers claim an unlicensed barber might give you a bad haircut or cut you.

Florists say an unlicensed flower arranger might spoil your wedding.

The optometrists at least have a better argument: The at-home eye test might miss a disease.

But I say we consumers should get to choose what risks we take.

I choose to go to an ophthalmologist because I can afford it, and at my age, I want a glaucoma test.

But many young people don't want to spend that money. And many people just don't have time. That's probably why lots of Americans never go to any eye doctor, ever. Opternative at least gives them an alternative—a way to get a prescription without going to a doctor.

It's good to have a choice.


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  1. Italy, you’ve been warned.

    1. I think he threatened Italian television.

      Which is kind of a shame. The babes are Italianicious.

    2. I really hope no one at Reason ever corrects this.


  2. How is a “bottlenecker” different from a rent-seeker. I thought the latter term was used to mean a corporation or professional association using government to limit competition, restrict public choice, or otherwise get special perks. Did I miss something?

    1. It’s kind of the same thing, but “bottlenecker” has a snappier ring to it, and explains the problem better. I never understood why the term “rent-seekers” is used, it sounds like a description of landlords. Rents, of course, are legitimate charges for temporary use of resources owned by others. So why is the term used to describe people looking for government favoritism?

      1. I, too, have always had trouble with this term. I had a couple theories why it was used — but after taking a gander at wikipedia just now, I realize I was way off.

        “The expression rent-seeking was coined in 1974 by Anne Krueger.[3] The word “rent” does not as a rule refer here to payment on a lease but stems instead from Adam Smith’s division of incomes into profit, wage, and rent.[4] The origin of the term refers to gaining control of land or other natural resources.

        Georgist economic theory describes rent-seeking in terms of land rent, where the value of land largely comes from government infrastructure and services (e.g. roads, public schools, maintenance of peace and order, etc.) and the community in general, rather than from the actions of any given landowner, in their role as mere titleholder.”

      2. Re: DanS.,

        I never understood why the term “rent-seekers” is used, it sounds like a description of landlords.

        The term is being applied correctly. Rent-seeking does not mean becoming a landlord, but rather refers to specific political action (lobbying and such) by profit-seekers to keep competition low through regulation or licensing laws, as a way to turn their profits into RENTS, i.e. increase the certainty of their income towards absolute certainty.

    2. I think that bottleneckers are a subset of rent-seekers.

  3. But this is a nation of lawz! Of LAWZ, I say!

    (Doesn’t matter the topic, it seems to be a good enough go-to aegument for many a Trumpista)

    1. Is Mexico not a country with the rule of law? Asking for a friend from Guatemala who wants to emigrate to Mexico.

      Oh…you only think America shouldn’t have borders. Well that makes sense.

    2. This is a nation of laws. Trillions and Trillions of laws.

  4. I just go with Eyeque and zenni, no fucking doctor needed. The fact that “prescriptions” even exist for eyeglasses is moronic. Sure having a kiosk to dial in your diopters is helpful and screening for eye conditions like glacoma also good but it’s not a “prescription”.

    1. All a prescription is is something a doctor writes down so that someone else can give you what you need. Prescriptions predate the legal requirements for them.

    2. For glasses I tend to agree with you, even while I know many optometrist’s, but to pretend that’s the reason why you should go back every so often is a little disingenuous. It’s kind of like saying that the blood pressure monitor in your local CVS is a ‘good enough’ replacement for your cardiologist. Sure, an optometrist isn’t as ‘vital’ to staying alive but if they catch something that keeps you from going blind I think it’s worth the measly amount of money most of them charge, even without insurance.

      But again, yeah I totally agree when it comes to an Rx for the glasses themselves. I’m perfectly capable of realizing if I need a new Rx on my own, but if my Rx has changed significantly enough that I notice than I should probably go back just to make sure it’s not something more serious.

      1. Measly? Last time I ALMOST went to an optometrist in the US, it was $385.00 for the exam and $75.00 more if I wanted a printout of the prescription on paper. In Taiwan the exam is free if you buy your glasses from the optometrist that administers the test.

        1. Then you got ripped off.

    3. I go to EyeBuyDirect.com You just have to “know” your prescription and fill it in. Lots cheaper. For other eye checkups I go to an actual eye doctor.

  5. I like Nikki Haley. If we have to choose from among the Republicans and Democrats, I wouldn’t mind if she became President.

    1. I wouldn’t mind if she did several things, especially if she did them in proximity to me.

  6. Why should pilots have licenses, AMIRITE?!

    You can do harm with the wrong prescription. If it’s too strong, it can make you become more nearsighted. It can also cause headaches. At what point is every little wet-behind-the-ears “I’m a big boy now so don’t tell ME what to do” pseudo-libertarian going to realize that you can’t do everything, and even if you think you can do some things, others cannot. Things like this should be restricted to trained professionals, like most things you dont understand. You sound like such babies. I get my eyes checked in person for $65, and I’m in and out in 30 minutes. It’s really not that big a deal. Stossel and others are most likely being paid to plug these online sites because there are prove financial ties between these companies and many “objective” people pretending to be pro-consumer. Well there won’t be much competition when it’s down to only one or two companies running the show. And when 40,000 optometrists and all their staff come looking for your jobs or don’t have money to spend at your business, you can still pat yourselves on the back because you saved $15 and all it cost you was your vision.

    1. Tigerclaw Stossel and others are most likely being paid to criticize plug these online sites because there are prove financial ties between these companies and many “objective” people pretending to be pro-manipulist pro-consumer


      At what point is every little wet-behind-the-ears “I’m a big boy now so don’t tell ME what to do” pseudo-libertarian going to realize that you can’t do everything,

      I can’t. However, that doesn’t mean that Opternative can’t. To suggest so is a serious logical flaw.

      even if you think you can do some things, others cannot

      Then they are free to go to an optometrist. This is a typical leftist viewpoint (if all can’t be saved, none should be saved).

      Well there won’t be much competition when it’s down to only one or two companies running the show

      Luxottica overwhelmingly dominates the eyeglass industry, and a many optometrists affiliate themselves with this near-monopoly. Yet you don’t seem to be complaining about them.

    2. Factually speaking, there are already far too many optometrists and the over supply is bringing down prices (or should). I know their salaries are getting lower as the market becomes more over-saturated.

      I can’t say that for sure outside of Texas, but I’ve been told by reliable sources that it’s nation-wide.

    3. When you want to shut down the competition with government force, it’s a sure sign you are incompetent. You want more customers? Lower your fees.

    4. “Why should pilots have licenses, AMIRITE?!”

      What a douchebag. A gooberment license does not reduce the risk of air travel, it just makes it more expensive. Consumers can and would regulate the industry by paying higher prices to airlines that can demonstrate their pilots are safe. Liability would weed out the airlines that are not safe.

      “We need more gooberment interfearence becuz public safety” does not make for good argument. It assumes a public unable to assess risk on their own.

    5. People who write ‘AMIRITE’ in their posts are huge fags, ignorant of most everything and have the analytical power of an earwig.

  7. The thing is, there HAVE been harmful ‘alternative’ medical practices. Injection of animal glands (no, that isn’t – or doesn’t seem to be – a myth) is the classic example. During the 19th Century traveling ‘medicine’ shows flogged tonics that ranged from the simply powerfully alcoholic to the actively poisonous. The ‘traditional Chinese medicine’ demand for Rhino horn is driving those beasts to extinction (helped along by the eco-activists who hate the idea of farming the animals).

    Government regulation is an understandable reaction to this nonsense. It isn’t the RIGHT reaction, but it’s understandable.

    1. In the sense that the government can be a arbiter between the parties involved it’s not necessarily the worst thing ever in determing harm-based offenses. The worst thing ever is the government deciding on the parameters of wrong-doing and then going after those offenses on their own. In that scenario, there is no one left to watch the watchers.

      Example: Who gets punished when the EPA, the agency tasked with making sure no one ‘harms’ the environment, actually dumps a shit ton of nasty into a Colorado river?

      Answer: Not the government.

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