The Never-Ending American Eye Exam Racket

Please, DOGE, allow me to buy glasses and contacts without a prescription.

(Tetra Images via Getty.)

On a beautiful summer day a few years ago, I rented a kayak. Looking forward to a serene afternoon on the Connecticut River, I pushed myself off the dock—and suddenly found myself immersed underwater.

The kayak, I realized, had capsized as it entered the river. I tried to swim up, toward the light, but found my way to safety blocked by my own boat. I swam down and away, finally coming up for air a few yards downriver. Once I’d clambered onto the dock, relieved to have found safety, I realized that the world was a blur.

Was the adrenaline rush so strong that it impaired my vision? No, the answer was far more trivial: I had been wearing glasses—which were now rapidly sinking to the bottom of the Connecticut River.

The experience was more embarrassing than it was scary. But it did have one serious consequence: I did not have any backup glasses or spare contact lenses on hand. The local optometrists did not have open slots for an eye exam. And since it’s impossible to buy eyewear without a recent doctor’s prescription, I had no idea when I’d be able to regain the faculty of sight.

Thankfully, I was the sheepish owner of a pair of flowery—and rather ill-judged—prescription sunglasses. So for the next days, I shame-facedly wore those in offices and libraries, inside restaurants and aboard planes.

Then I went to Lima, Peru, to give a talk. There, I found a storefront optician, told a clerk my strength, and purchased a few months’ worth of contact lenses. Though my Spanish is far from perfect, the transaction took about 10 minutes.

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In every other country in which I’ve lived—Germany and Britain, France and Italy—it is far easier to buy glasses and contact lenses than it is in the United States. Like in Peru, you can simply walk into an optical store and ask an employee to give you an eye test, likely free of charge. If you already know your strength, you can just tell them what you want. You may even be able to buy contact lenses from the closest drugstore without having to talk to a single soul—no doctor’s prescription necessary.

So why does the United States require people who want to purchase something as simple as a pair of glasses to get a costly prescription?

The standard argument in favor of the status quo is that impaired vision may point to serious health problems that a new pair of glasses will neither treat nor heal. Compelling Americans to see an optometrist helps to ensure that the largest possible number of cases of progressive eye diseases will be caught at an early stage.

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But of course the added cost of having to see an optometrist—without insurance, a comprehensive eye exam can cost as much as $200—also stops many Americans from accessing the corrective lenses they need to improve their vision. Is the desirability of an eye exam performed by a medical professional a sufficient reason to prevent Americans who cannot afford to visit an optometrist from buying glasses and contacts?

To steelman the argument made by the American Optometric Association (AOA),¹ and other defenders of the status quo, there is a real trade-off here. Every year, some Americans who visit an optometrist to get a new prescription will indeed discover that they have a serious condition that requires immediate care; if you have any reason to suspect that something may be wrong with your eyes, by all means do go to see a doctor. But though the trade-off is real, it also seems to me rather obvious that the disadvantages of the current system far outweigh its benefits.

There must be millions of Americans who keep wearing glasses that are too weak—or don’t wear glasses at all—because they want to avoid the cost, time, or stress of a visit to a doctor. Less well-off Americans, who don’t have insurance and lack the financial reserves for an extra doctor’s appointment, are especially likely to suffer as a result.

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How many thousands of Americans go through life seeing less well than they might because they don’t have an up-to-date prescription? How many students do poorly in school because they can’t read what’s written on the blackboard? And how many accidents are caused by drivers who can’t see the road as well as they should?

That is why I suspect that the real reason why America is such an outlier in international comparison isn’t that Americans are somehow more susceptible to eye disease than people in Peru or Germany; it’s that so many people have a vested interest in maintaining the system. The AOA doesn’t lobby so hard to keep the current rules in place because it cares about improving the eyesight of ordinary Americans; it does so because many optometrists would, if Americans no longer needed to book appointments with them to buy glasses or contacts, make a lot less money or even go out of business altogether.²

I first wrote about all of this in a viral article over five years ago, earning me a remarkably hyperbolic rebuke from the President of the AOA. But as I realized a few weeks ago, when my contact lenses were running out and I once again needed a new prescription, nothing has really changed.

Grudgingly, I called a local optometrist, taking care to inquire whether my optical insurance would cover the exam. When I showed up to my appointment, it turned out that the optometrist was merely in-network; even with insurance, the exam would cost me $40. I acquiesced, only to find the next unpleasant surprise at the end of my visit: Apparently, the optometrist had also carried out some additional test regarding the curvature of my eyes, which would not be covered by insurance at all; I was asked to pay another $40. And all that only got me a prescription with restrictions for which there can’t possibly be a coherent medical rationale: if I should ever decide to change the brand of contacts I wear, I’d have to go through the whole frustrating experience yet again.

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In his first weeks in office, Donald Trump has put attempts to cut government waste and unnecessary regulation at the very center of his administration. As the head of the Department for Government Efficiency, Elon Musk has taken the limelight with radical attempts to cut spending and transform the administrative state.

Some of these efforts are clearly counterproductive; as Musk acknowledged in a surreal cabinet meeting yesterday, his team had temporarily cut funds devoted to preventing the spread of Ebola, hardly a quixotic ideological project. More broadly, I am worried that these efforts may undermine the political neutrality of the bureaucracy, turning significant parts of the administrative state into handmaidens for the whims of whoever happens to occupy the White House.

But as the anomalous requirement to get a prescription every time you want to buy new glasses or contact lenses illustrates, there really are a million ways in which the lives of Americans are made unnecessarily expensive and cumbersome by regulations that protect the interests of politically powerful special interests. DOGE could do all of us a huge favor if it actually went after those kinds of rules with a vengeance.

So please, Elon, spare me another visit to the optometrist. Like the citizens of virtually every other country around the world, Americans should be allowed to buy any pair of glasses or set of contact lenses at a moment’s notice. Abolish mandatory eye exams.

A version of this article was originally published in November 2019.

1. As Barbara Horn, O.D., the president of the American Optometric Association (AOA), told me, “Today, at least 2.2 billion people around the world have a vision impairment, of whom at least 1 billion have a vision impairment that could have been prevented or has yet to be addressed … That’s why it’s clear to health experts, policy makers, the media, and the public that increased access to eye exams and eye doctors are needed to safeguard health and vision.”

2. Optometrists are also a source of revenue for opticians, from large chains like Specsavers to independent stores in malls and town centers across the United States. Since they often work on-site, they have an incentive to nudge their patients to buy the products on hand. When I went to an eye exam at a storefront optician in the United States a number of years before my kayaking accident, for example, the staff gave me the hard sell on glasses that would have cost hundreds of dollars, as well as on contact lenses that were much more expensive than identical ones sold by online retailers. Thankfully, I knew that laws passed in 1997 and 2003 (and since strengthened) gave me the right to demand a copy of my prescription. I stood firm, and later went online to order perfectly fine glasses and contact lenses at a fraction of the price. But how many customers give in to heavy-handed sales tactics?