Optometrists eye government to shut down app-based competition

Steven Greenhut

Greenhut writes for American Spectator, Reason and the Orange County Register.


Here we go again. Every time an innovative new industry pops up to take advantage of the boundless opportunities offered by phone applications and the internet, some threatened old-line profession responds with lobbyists and political donations. Those who can’t keep up with the upstarts turn to government to shut down the competition.

The brick-and-mortar firms always use bogus threats to public safety as the rationale, when the real reason has to do with protecting their turf. We’ve seen it repeatedly with ridesharing platforms, which have succeeded despite efforts by the taxi cartel and the airport-shuttle industry to depict these low-cost, convenient options as dangerous.

One need only type “taxis and grisly accidents” in a search engine to see that the taxi industry’s efforts are more about crushing a high-quality alternative than protecting riders. Fortunately, Uber and Lyft have gained a strong customer base, which is the key to snuffing out these shameless examples of “rent seeking.”

Legions of satisfied customers provide countervailing pressure on legislators, but what about new startups that have yet to build support? As CNN reported in May, “younger startups” are having a tougher time fending off the challenges because “they have smaller user bases to draw from – and entrenched interests are getting smarter about taking them on early.”

The latest example involves something known as telemedicine, which has been a growing industry for years. It involves “the use of electronic information, imaging and communication technologies, including interactive audio, video and data communications” to provide “health care delivery, diagnosis, consultation, treatment …”

That’s the official definition from the state of New Mexico, which is one of many states that allow this sensible practice. Many doctors are overloaded with patients, and it’s a good way to take some pressure off the health care system, at least when it comes to run-of-the-mill ailments that require advice and prescriptions. This is especially true given the exploding patient-to-doctor ratios following the passage of the Affordable Care Act.

So telemedicine hasn’t been controversial when dealing with primary care physicians, but there’s been determined pushback when it comes to optometry. New startup companies offer app-based options that traditional optometrists view as an existential threat to their livelihoods, rather than as a means to provide expanded eye care for the public.

For instance, a company called Opternative offers a 25-minute online exam using a computer and smartphone. Once the eye exam is complete, the company sends the exam results to an ophthalmologist to look for any potential eye diseases. It’s a simple and inexpensive way to get an eye check and a new prescription. The company touts a clinical trial vouching for the accuracy of the application.

One can argue, perhaps, that an in-person examination always is better. Even if that’s the case, an online examination certainly is far better than no examination at all. Many people who would rarely take the time to go to an eye doctor might be willing to download and application and take a short test in the comfort of their home.

Another company, Simple Contacts, allows people to renew their existing contact lens prescription after taking its online eye exam. These are great advancements for consumers, who should have the right to manage their own health care. No one should be strong-armed into using a service simply because the providers of it have used the political system to smother an alternative.

The American Optometric Association has launched federal and state efforts to essentially ban ocular telemedicine. The group filed an “expansive” complaint last year with the Food and Drug Administration arguing that Opternative’s online “’vision test’ app poses significant health risks to the public.” AOA claims that app has a potential for inaccurate prescriptions and missed diagnosis of eye disease and creates “a prescription with little meaningful input from an eye doctor.”

That’s rich given that optometrists aren’t actually medical doctors, whereas Opternative has ophthalmologists review the results. Perhaps the real reason for their concern is that “optometrists use the eye exams to lure customers into their shops to sell them products,” as W. Bruce Delvalle argued in a March column in the Hill. There’s nothing wrong with optometry or selling new eyeglasses, but neither is there anything wrong with consumers who want to bypass that process and order their glasses through a discount online distributor.

It’s hard to conclude that the group’s complaint with the FDA – and its political efforts at the state level – are about anything other than protecting market share. The trade group also is expected to step up its legislative efforts in Utah, New Mexico, Nevada, Minnesota and some other states. In California, the official state Board of Optometry has of course sided with the optometrists. It’s yet another example of “regulatory capture” – how members of regulated industries come to dominate the agencies that oversee their professions.

The California Optometric Association says it is “vigilantly working with AOA, the State Board of Optometry and the Medical Board of California to prevent Opternative from operating in California” and is “requesting members’ assistance in gathering evidence that providers in California are writing prescriptions for consumers based on the results of an online eye refraction technology.” That’s a pretty clear statement of the industry’s intent and tactics.

“Creative destruction” is difficult for those people who are in the industries that are facing new competition from lower-cost alternatives. But that’s life in a free society. Instead of misusing government to stifle competitors, old-line companies need to retool and adapt – and find new market-based ways to satisfy their customers.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

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