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Story appeared in the ACCENT section

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BRINGING CONTACTS INTO FOCUS

EYE CARE: Consumers are caught in the middle of a fight between optometrists and lens discounters.

January 22, 1997

MICHELLE NICOLOSI
THE ORANGE COUNTY REGISTER

Sharon Ratigan first became a casualty in the contact-lens war in 1995.

Until then, if she wanted her prescription, her doctor gave it to her. If she wanted to buy contacts from a discounter, no one tried to stop her. But in 1995, that changed: When she asked her doctor for her prescription after her eye exam, he refused to hand it over.

"At first I was calm," Ratigan, 35, said. "Then I got loud. I thought, `That's not right. You pay a lot of money. Why shouldn't I be able to get my prescription?' "

Ratigan is one of millions of contact-lens consumers caught in a tug-of-war between doctors and discounters who threaten to put them out of business, state Deputy Attorney General Tom Dove said.

Discount stores and mail-order contacts became popular in the 1980s, when disposable lenses increased consumer demand for contacts. Discounters charged $60 for lenses sold in some doctors' offices for $300. They cut into what was sometimes a 500 percent markup, leading contact trade groups to look for ways to put them out of business, Dove said.

In 1988, just 1 percent of contacts were sold through mail order. In 1994, that had grown to 9 percent of a billion-dollar business, he said.

Dove's two-year investigation of the contact-lens industry found that doctors and their organizations conspired to limit consumers' access to contacts by pressuring manufacturers not to sell to discounters. Manufacturers complied, he said, because they feared a doctor boycott.

The alleged efforts to cut off the supply of lenses to discounters cost the average consumer $50 a year, and adds about $150 million to the cost of lenses sold in the United States every year, Dove said.

In December, the state attorney general filed a case joined by 23 other states alleging that lens makers, doctors and their organizations "conspired to avoid competition (by) restricting or eliminating the supply of contact lenses to mail-order companies" and other discounters.

The American Optometric Association, Johnson & Johnson and other defendants said the charges are untrue. The California Optometric Association was named as a co-conspirator.

"The suit has no merit," said Charlotte Rancilio, spokeswoman for the American Optometric Association.

But Jamie Hundt, co-owner of Dial A Contact Lens in San Diego, said manufacturers cut off her supply of lenses because doctors "hated our cheap prices."

Now "they will not sell to us," she said.

Dove said doctors not only conspired to cut off the source of lenses to discounters, they also routinely refuse to give patients such as Ratigan their prescriptions, so they can't buy at discount stores, he said.

More than half of U.S. states have laws requiring optometrists to give patients their prescription; California does not because the Legislature has chosen not so pass a similar law, Dove said.

And a new law that took effect in January means contact prescriptions expire after one year.

"In Virginia, they've got it down to six months. Anything to get you back in the chair," Dove said. "We're losing ground here."

The American Optometric Association has no formal recommendation for how often a contact-lens patient should get a checkup, but once a year is a good guideline, said Dr. Stephen Miller, director of the clinical-care center for the American Optometric Association.

Annual checkups are in the best interest of the patient, said Dr. Michael G. Harris, attorney and associate dean at the University of California, Berkeley, where he is also contact-lens clinic chief and a clinical professor.

There are lots of conditions patients can develop without any symptoms, conditions that can mean permanant damage if they are not caught in time, he said.

But Harris said there is no reason patients who have had an exam and fitting should not buy lenses through a discounter as long as they see a doctor once a year.

"I've always recommended (that) once a patient has been successfully fitted with contact lenses, the patient receive a copy of their prescription. This, to me, is good patient care." If a doctor gives good care and has good prices, there shouldn't be a problem, he said.

So, why do so many doctors refuse to give patients their prescriptions?

"It's fear of liability, and I think there is some reality in that fear," said Harris, also an attorney. "The practitioner who does the prescribing can be liable for lenses provided by a third-party dispenser."

Dr. Michael N. Spitzer, president of the Orange County Optometric Society, said he does not give patients their prescriptions -- a policy that protects him legally and protects the patients' eye health, he said.

Getting contacts from your doctor ensures regular checkups and that patients will get good-quality contacts, he said.

Some patients get mad, but Spitzer said his policy is in the patients' best interest. Only about 15 percent of county eye doctors will give patients their prescriptions, he said.

"I've lost patients," said Spitzer, who believes doctors who give out prescriptions are wrongly bowing to patient pressure. He said those who think the motivation for not giving out

prescriptions is financial rather than health-related "are entitled to their own opinion."

Ratigan found a way around the problem: She would not take no for an answer. "I told him I paid for it, I want it."

Ratigan said she has changed doctors and now asks optometrists ahead of time whether they will give her a copy of her prescription.

"If they're not going to do it, I don't go to them," she said.

Dial A Contact Lens co-owner Hundt said she won't be happy until the law gives customers a right to their prescription and the right to buy contacts wherever they want.

"I want the right to be able to look for the best price," said Hundt, a contact-lens wearer. "That's what needs to be changed. Once we stop all of this, then we have won the contact-lens war."

Dove agreed "there is a need for further discussion about some of these restrictions. Consumers are clearly on the short end of the stick."

Harris disagreed, saying eye doctors have the consumers' best interests at heart.

"The patient's vision health is the primary concern of our young doctors," Harris said. "I truly believe that is the motivating factor" for most doctors, not profit, he said.

"I can understand how patients can be confused. . . . I hope as with all cases, those accused are assumed innocent until proven guilty."

CHART/LIST: TIPS FOR CONTACT-LENS USERS

What can you do to become a better contact-lens consumer? A few tips:

Call ahead and find out if an optometrist will give you your prescription so you can shop for low-cost lenses. Only about 15 percent of Orange County eye doctors will give you your prescription. State law allows eye doctors to refuse to release the information to you.

If the doctor doesn't release prescriptions, tell the office the price you have found for contacts. Often, an office will match or come close to the price you have found.

Don't go years without a checkup. You can develop problems without symptoms that can cause permanent eye damage. The American Optometric Association's general guidelines call for patients in their 20s, 30, and 40s to get checkups every two to three years, but contact-lens wearers should be seen more frequently. Once a year is a good guideline, but doctors' recommendations vary.

Sources: Dr. Michael N. Spitzer, president of the Orange County Optometric Society; Dr. Stephen Miller, director of the clinical-care center for the American Optometric Association; Dr. Michael G. Harris, attorney and University of California, Berkeley associate dean, contact-lens clinic chief and a clinical professor.