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Andrea Janoff: ‘Free market’ contact lens legislation could endanger patients’ eye health

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As the Chief of Cornea and Contact Lens service at Nova Southeastern University College of Optometry, I specialize in contact lens fittings and know the good, the bad and the ugly of contact lens use.

The “good” that comes from contact lens use is that millions of people achieve excellent vision and improved lifestyle with proper medical fitting and use of FDA approved contact lenses. That said, contact lenses are a federally regulated medical device that, when abused, can turn the “good” into the “bad and ugly” by causing severe damage to the eye, including vision loss.

Over the past decade, I have observed patient non-compliance steadily increase mainly because of the availability of online contact lenses and the role online sellers have played in undermining the doctor-patient relationship. In fact, research shows that patients purchasing contact lenses online are less compliant with FDA guidelines and consequently exhibit more eye disease and damage. This is because of the patient’s focus being shifted by online sellers from sound contact lens fitting, care and timely follow-up to cheapest price.

Legislation that has been filed in the Florida Legislature this year, would make it easier for patients to be targeted and ultimately harmed by discount contact lens websites and retailers. Put frankly, “free market” legislation would drive an even larger wedge between the eye care provider and the patient.

Online contact lens vendors have facilitated patients receiving contact lenses well beyond the prescription’s expiration dates. Some patients, who should have returned for an eye examination in one to two years for an updated contact lens prescription, were able to refill their old contact lens prescriptions online well beyond documented expiration dates.

Recently, I evaluated two such patients, one after four years and the other after six years of repeated online purchases of contact lenses using an old prescription. Of the two patients, one had significant corneal damage because the contact lens fit slowly “suffocated” the eye to the point that abnormal blood vessels had grown. I immediately refit this patient with a contact lens that provided a higher degree of “breathability” to the eye when compared with the brand of lens he was still wearing. Nevertheless, the damage was done but could have been avoided had the online retailer not sold lenses despite an expired prescription.

As a doctor, I am terrified by the idea of the Florida Legislature further allowing a “big corporation” to make eye care decisions, such as illegally extending a contact lens prescriptions or making substitutions for contact lens prescriptions based on price alone. I fear that the proposed free market legislation is motivated solely by narrow economic interests and will only further erode the essential patient-doctor relationship, harming the eye health of my patients. Please defeat Senate Bill 1400 and House Bill 1119.

Andrea Janoff is the chief of Cornea and Contact Lens service at Nova Southeastern University College of Optometry.

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