By now you’ve already read, and ranted about, that opinion piece The Atlantic ran in late November. You know, the one with the very neutral and respectful headline: “The Great American Eye-Exam Scam.” Nuanced it is not.
The author, Yascha Mounk, recounts losing his glasses on vacation and the “ordeal” (his word) of not being able to get a replacement immediately, which forced him to use a pair of prescription sunglasses for a few days. This real-life Seinfeld storyline is an ordeal?
From this experience he spins an argument as facile as it is flawed. Requiring a prescription to buy corrective lenses in America, Mounk says, “creates unreasonable costs—and unjustifiable suffering” for people who can’t afford an exam or can’t spare the time for one. He acknowledges it does allow previously undetected eye problems to be uncovered, but then immediately downplays this hugely significant service to society by dismissively claiming “it is likely that a much greater number keep wearing glasses that are too weak—or won’t wear glasses at all—because they want to avoid the cost, time or stress of a visit to a doctor.”
America, he argues, should be more like countries that allow opticians to dispense glasses or contacts directly. No need to muck around with the “red tape” (again, his wording) of seeing a doctor. “So why does the United States require people who want to purchase something as simple as a curved piece of plastic to get a prescription, preceded by a costly medical exam?” he asks.
Well, for starters, it’s not “as simple as a curved piece of plastic.” Mounk treats corrective lenses like any other consumer good. I can walk into a store and buy a pair of shoes with no hassles. Think how absurd it would be if I had to see a podiatrist first. That’s the sort of argument he’s making. Of course, even if one were to go along with this line of reasoning, we all know that determining optimal lens power for any given patient is far more subjective than what an autorefractor spits out.
But the bigger thing he’s missing here is the interdependence between eye health and vision. The corrective lenses and the “costly” medical exam are not two distinct things; rather, they are two pieces of the same product: comprehensive care.
We all know the difference between eye care and vision care—the former considers the organ’s health and the latter its function. After beginning strictly on the vision side, optometry now fully integrates these two, and the whole is greater than the sum of its parts as a result. This has been one of the most consequential advances of optometry’s evolution into primary care providers.
But the author thinks this couple needs a divorce. He values convenience over quality, is cavalier toward health and flat-out oblivious about wellness and prevention. The routine exams he so denigrates give ODs vital access to patients over the course of a lifetime and a chance to steer them toward healthier habits. Absolving patients of personal responsibility in favor of instant gratification—now that would be an ordeal.