Envision: seeing beyond presents the final article in a series developed to explore online eyewear retailers, how they operate and what they have to offer.

By Evra Taylor

Vancouver-based Coastal Contacts (www.coastal.com) has become the world’s largest seller of replacement eyeglasses, contact lenses and optical products. The brand is too young to be called iconic, but everything points in the direction of Coastal Contacts growing from its current “star” status to an even greater role in the retail eyewear landscape.

Coastal operates in Europe, North America and Australia, with the promise of a comprehensive product line, savings and shopping ease  –  in other words, affordable, convenient eyewear fashion.

Roger Hardy, founder and CEO, is unapologetically sure of himself and his offering. “We’ve been rated number one in key customer surveys. We run our own laboratory  –  we brought in Essilor people to run the lab  –  source all of our own product and control our own customer service.” Coastal offers a 366-day product guarantee, the only online optical seller to do so.

Hardy, who made his e-commerce debut in 2000, was partly motivated to enter the online marketplace by his discovery of the tremendous markup in contact lenses. “I saw that a $12 box of contact lenses retailed for $70; that was my ‘wow’ moment. I’ve seen many business models, but I’ve never seen this type of margin profile. People try us for the savings but they stay with us because our service level is so high,” he stated.

The Coastal.com web site design is trendy, hot and cutting edge, with an emphasis on style. Clearly, it has set its eye on the younger set that rejects the notion that eyeglass frame functionality and aesthetics are mutually exclusive.

The firm sells across all segments of the market, with a focus on 20- to 30-year-old women who spend $38 to $100 for frames, thus allowing them to enjoy multiple looks.

Coastal is also very engaged in the bifocal and progressives segments for the 45-plus set. At the same time, sales in the 55- to 60-year-old segment have been strong. The demographics reflect slightly more female customers than male, and an eyeglass frame-to-contact lens ratio of 70 per cent to 30 per cent. Hardy predicts additional growth for the eyeglass segment in the next three years, as online purchases represent dramatic savings compared to offline sales.

The company invests heavily in inventory. Coastal carries about six contact lens brands and 50-60 brands of eyewear, with 3,000 frame styles and 30,000 SKUs. In November 2013, Hardy placed global sales at approximately $220 million for the year.

Coastal’s Canadian division operates under the name ClearlyContacts.ca, which boasts, “the largest in-stock selection of designer frames,” and, “up to 50 per cent off optical store prices.” In 2014, the Canadian operation expanded to bricks and mortar stores in Vancouver and Toronto, with plans to open locations in selected Canadian cities including Calgary, as well as in Europe.

Hardy expects to keep refining his business model and to continue increasing brand awareness. “Our customers tell our story through referrals,” he said. “That’s the conduit for our message. The only way to build a brand is to do a good job.”

What’s the ultimate goal of this growing enterprise? According to the Coastal.com site, nothing less than becoming the “world’s optical store.”

By Evra Taylor

This is the second installment in a series that explores online eyewear retailers, how they operate and what they have to offer.

Despite resistance from the professional eyecare community, online optical sales have reached critical mass in North America.

In February 2012, CBC’s Marketplace reported that many Canadians are overpaying for prescription glasses due, in part, to weak competition in the market. According to the report, a pair of glasses can cost upwards of $1,000, with the most expensive part being the lenses. But this report also stated quality generic lenses that will serve most people are mass-produced and can cost as little as $2 to $10 to make.

In light of the high cost of eyewear, a sluggish economy and continuing high unemployment, it’s no wonder that dollar-conscious consumers are turning to the Internet for significant cost savings in optical wear.

Eyeglasses Online Review 2013 compared consumer reviews of online eyewear providers and identified the top 10, starting with the most highly rated, as: FramesDirect.com, Coastal.com, Eyeglasses.com, GlassesUSA.com, Glasses.com, Zenni Optical, GlobalEyeglasses.com, EyeBuyDirect.com, GlassesShop.com and 39DollarGlasses.com. Reviewers commented on frame selection, lens options, value, shipping, and help and support.

While the convenience of online shopping is not lost on those in the optical sector who oppose e-retail, problems relating to frame fit and return policies are often raised by opticians who contend that a hands-on experience cannot be replaced by a virtual try-on. Try-on features are now the point of entry for any online eyewear store serious about competing in an increasingly cluttered marketplace, but even the ability to visualize how an eyeglass frame will look on a person’s face is no guarantee of a perfect aesthetic – or fit.

Home try-on, however, is a feature offered by some online eyewear retailers such as Warby Parker. While the company does ship to Canada, it doesn’t offer its home try-on program outside of the U.S. The website’s virtual try-on service works from any location, but purchasers in the U.S. can order up to five pairs of glasses to try on at home for five days. Once they’ve made their choice – even if they decide not to buy any of them – they can return them at no cost.

To dispel the pure cynicism that is hard to resist in this era of price-driven expediency, it’s not all about the money all the time. Warby Parker appears to be as good as it is hip and it wears its heart on its virtual sleeve. Front and centre on the company’s website home page is the “buy a pair, give a pair” option, the company’s expression of good citizenship, whereby, for every pair of eyeglasses purchased, a pair is donated to someone in need.

Coastal.com, which claims to be the largest online contact lens and eyewear retailer in the U.S., and to have the biggest selection of designer and brand name eyewear at the most affordable prices anywhere on the web, has its Change the View Project, although it doesn’t give the impression of being as essential a part of the company’s DNA as Warby Parker’s charitable works.

While giving is good business, at the end of the day the bottom line is the most important feature of all. Will online retail replace bricks and mortar stores? It seems doubtful, as many shoppers still prefer the face-to-face service provided by the traditional shopping model. Only time will tell.

By Evra Taylor

Envision: seeing beyond, presents this first article in a series developed to explore online eyewear retailers, how they operate and what they have to offer.

Every once in a while one hears about a maverick entrepreneur who brainstorms an idea and develops a pioneering business concept. These are often viewed as hair brained flights of fancy that have absolutely no chance of succeeding. Dr. Dhavid Cooper, co-founder and president of FramesDirect.com, is such a maverick – except for the part about not succeeding.

In 1988, Cooper teamed up with fellow optometrist Dr. Guy Hodgson to establish a series of successful optometric practices, which would prove to be the model for FramesDirect.com. Hodgson currently is CFO and COO of the company.

After selling their practices in 1995, the pair began exploring other opportunities and wondered if they could predict where the optical industry would be in 15 years’ time. “We didn’t have a clear vision of what we wanted to do but we knew we wanted to create a business that operated 24 hours a day, seven days a week across the United States,” recounts Cooper.

The genesis of FramesDirect.com was in Texas, where Cooper and Hodgson set up a small office that would house what was later to become an online retail giant. They created a rudimentary website of roughly eight pairs of sunglasses, resulting in their first online sale to a customer in Florida. When Cooper asked how the gentleman had found FramesDirect.com in Texas, he replied, “I saw you on the worldwide web,” as it was then known.

“There was no model to follow as no one had ever sold eyewear online. My wife thought I was crazy,” says Cooper.

FramesDirect.com now offers more than 200 brands with 100,000 SKUs covering a range of higher-end eyewear, including eyeglasses, sunglasses and contact lenses. Approximately 40,000 unique visitors visit the site daily. “Imagine 40,000 people walking into your store today,” remarks Cooper. FramesDirect.com sells premium eyewear only.

Cooper knows that simply selling name-brand eyewear online is not enough to ensure success. As a result, FramesDirect.com emphasizes customer service and after-sale follow-up. “We have a very high-touch business model. We call every person who places an order and we educate our customers about their prescription. The company is run by optometrists and we reassure people that they’re in very capable hands,” explains Cooper.

FramesDirect.com enjoys roughly 30 per cent annual growth, including a significant amount of repeat business, which Cooper feels is the result of consumers’ increasing awareness that shopping for eyewear online is an option that offers all of the amenities of bricks-and-mortar shopping, with stay-at-home convenience.

According to Cooper, only about three per cent of eyewear is sold online in the U.S., signifying an enormous opportunity for future growth. “I doubt that the web will ever eclipse the standard store or the traditional doctor-patient relationship, but there is still room for 20-30 per cent growth.”

As a reflection of the growing popularity of online eyewear sales, Essilor, the largest lens manufacturer in the world, acquired a majority stake in FramesDirect.com in 2009.

And how is the optical industry reacting to online selling?

“The initial response from eyecare practitioners was very negative,” says Cooper. “But apart from some pockets of resistance, we no longer see that. However, the eyewear industry as a whole has been slow to adapt to Internet sales. I hope this will change.”

By Paddy Kamen

Wealthy people have been traveling for medical or pseudo-medical treatments for centuries: think ancient Roman spas, ‘taking the cure’ at European hot springs, or seeking the salutary effects of dry climates. But what would motivate a Canadian woman to travel to Panama to artificially change the colour of her eyes? 

According to a CBC News report, dated Jan.17, 2012, “Beatriz Murillo, 36, traveled from Toronto to a clinic in Panama and paid $8,000 to have a silicone disc placed on top of her irises to lighten the colour from brown to green.” The article states that Murillo has become virtually blind as a result of complications following on the surgery.  

Vanity motivates a large number of people to participate in what has become known as medical tourism. Josef Woodman, author of Patients Beyond Border[1], estimates that more than 50 per cent of medical tourism procedures are cosmetic. These include face-lifts, tummy tucks and cosmetic dental work. Popular non-cosmetic procedures include organ transplants, orthopedics, in-vitro fertilization, dentistry and even gender reassignment surgery. 

The clinic where Murillo went under the knife declined an interview with Envision: seeing beyond magazine, but a Mississauga-based ophthalmologist, Dr. Ike Ahmed, was able to talk about some of his experiences dealing with aftercare from similar procedures. 

“I know of five cases of iris implants and I have treated three,” says the glaucoma specialist. “It’s unfortunate, incredible and hard to grasp why anyone would put their vision at risk for a cosmetic procedure. Some people seem to think it is like getting a tattoo.” 

Dr. Ahmed says the iris implants have caused corneas to stop functioning and become cloudy from trauma to the eye. “We have seen corneal decompensation and glaucoma. One person developed a cataract as well, and some have had all three issues. One cornea required a transplant. The repercussions from this procedure are very serious and can cause permanent loss of vision.” 

Patients who undergo such risky procedures do not generally consult with an ophthalmologist in advance and often put off getting help when problems develop, notes Dr. Ahmed. “But we can sometimes halt disease progression if they seek medical help early.” 

Another cosmetic procedure that originated at the Netherlands Institute for Innovative Ocular Surgery (NIIOS) is the Cosmetic Extraocular Implant. In this procedure, a small, flat, ornamental object is inserted into the conjunctiva – the mucous membrane lining the inner surface of the eyelids and the front of the eyeball. The object, known as a Jewel Eye, is available in the shape of a heart, star, clover, musical note or as a custom design. There are patents pending on this procedure.  

While the website for the NIIOS claims that, “Patient satisfaction is high and no side effects of the treatment have been noticed with a follow-up of more than one year,”[2] Dr. Ahmed is not impressed. “While it is not as potentially serious as the iris implant, it can cause negative reactions.” 

Health care services have become global for-profit industries with hundreds of thousands of medical tourists traveling each year for medical procedures performed abroad. According to Woodman, “In 2011, Americans spent an estimated $15 to $20 billion on procedures abroad, including elective heart surgery, dental work, cosmetic procedures and infertility treatments.” Many countries are getting into the medical tourism business. Thailand welcomes over one million health travelers annually, with India, Mexico and Singapore welcoming hundreds of thousands. And the U.S.not only exports health seekers but also welcomes 600,000 each year.[3] 

Many Americans have come to Canada for eye surgeries, including refractive surgery, which was approved in Canada earlier than the U.S. “We see medical tourism here, with people coming for PRK, Lasik and intraocular lens implants, some of which are not available in the U.S., which is generally behind in terms of optic technologies,” explains Dr. Ahmed. “And most recently, they are coming for corneal cross-linking, a treatment for kerataconus which strengthens the cornea using ultraviolet light and nutrients.” 

Are Canadians traveling abroad for eye procedures? Dr. François Codère, a Montreal-based ophthalmologist and president of the Canadian Ophthalmological Society, says, “I haven’t heard of anyone going outside of the country to get eye care.” He points out that in Canada, even the most expensive refractive surgery costs under $5,000, which makes it hardly worthwhile to incur the expenses associated with medical travel. “And I would certainly not recommend it because the follow-up to surgery is very important. Infection can occur one week to 10 days after surgery. I wouldn’t want to have eye surgery without follow-up medical care.” 

Dr. Codère adds that while there were long delays for cataract surgeries in the past, which may have driven some people to go to other countries for the procedure, most provinces have reduced wait times to less than six months. “In Montreal, over 95 per cent of cataract operations are done within six months so the waiting times within ophthalmology have improved in the last five years. 

Dr. Ahmed says that he has known people who left Canada for eye procedures due to waiting lists. “But only a very small percentage of Canadians go out of the country for eye surgeries. In Canada, we’ve had great pioneers and leaders of the world in surgical technologies and it’s more likely that people will travel here.” 

As for the doctor who performed the disastrous surgery on Beatriz Murillo and other unsuspecting Canadians, Dr. Ahmed thinks he may have realized the error of his ways. “We had a rash of cases where we had to deal with the fallout from his work but the last one was about a year ago. Last I heard he had moved on.”  

And will there ever be an end to people who don’t have the good sense to take their health seriously? Josef Woodman has the last word: “Unfortunately and tragically, the most extremely “stupid” mistakes, though few and far between, are lethal. I know of one patient who traveled to Costa Rica for cosmetic surgery, did not heed her doctor’s advice to stay nearby to recover and to stay out of the sun.  She instead traveled deep into rural Panama, did not attend properly to her wounds, they became infected and she died. Thus, in general, I would say that not complying with doctor’s orders and reasonable measures pre- and post-op is unwise.”  

By JoAnne Sommers

Imagine a set of tinted lenses that can help to manage dyslexia. Now imagine that a similar set of lenses can also correct for colour deficiency (commonly known as colour blindness).

That is the promise of ChromaGen^®, an exciting series of products that’s now available in Canada through Centennial Optical.

ChromaGen is the brainchild of British optician and researcher David Harris, who began developing specially tinted lenses in the 1980s for people with colour blindness. In the course of his research, Harris discovered that by altering the wavelength of light that reaches the eye, the lenses also reduced visual distortions that make reading difficult for many people with dyslexia. 

ChromaGen, which has been available in theU.K.since 1997, was awarded ‘Millennium Product’ status for innovation and achievement by Britain’s Design Council in 1999. It has FDA clearance in theU.S., where it is sold by ChromaGen Vision, and was recently introduced into Canada through Centennial Optical, ChromaGen’s exclusive distributor in this country. 

The ChromaGen system consists of a series of lenses that incorporate combinations of 16 colour filters. Practitioners mix and match them to come up with the pair of lenses that works best for each client, says company President Ted Edwards. 

A different series of filtered tints works for each condition, he notes. For colour deficiency, ChromaGen lenses alter the light wave as it passes into each eye, which dynamically balances the speed of information travelling along the optic nerve to the patient’s brain. This enhances colour perception and discrimination, enabling the user to distinguish colour and experience the full colour spectrum. 

For those with dyslexia, the use of different ChromaGen filters effectively changes the speed of the information in the brain’s neurological pathways, allowing the eyes to synchronize, Edwards explains. 

“When the eyes are not dynamically balanced and are not working together properly, words appear to move, are blurry and out of focus, and people see double words or sentences. When using the ChromaGen filters, patients report that these symptoms simply stop. This is the world’s first non-invasive treatment for the visually dyslexic, presented in a simple pair of glasses.” 

ChromaGen lenses, which look neutral gray when viewed on someone’s face, are available in Trivex and CR39 for bifocals and progressives, as well as single vision and plano lenses. They are fitted in either contact lens or eyeglass form and are easily incorporated into any existing prescription and frame choice. The effects are instantaneous and there are no side effects, says Edwards. 

Rick Leroux is director of marketing and communications, lens division, with Centennial Optical. He calls the ChromaGen system a reading aid, rather than a cure for dyslexia. 

Leroux says Centennial conducted clinical tests with a Toronto optometrist who fit several staff members who have dyslexia with the system. “They love the fit and now read for pleasure,” he notes, adding, “We think we can help about three-quarters of people with dyslexia.” 

The condition affects about 23 per cent of the population, according to the Canadian Dyslexia Association. 

Ophthalmologists, optometrists and opticians all can perform the diagnostics associated with ChromaGen, provided they participate in a one-hour training session and purchase a diagnostic lens kit. To date, three Canadian practitioners – all of them in Ontario – are using the system. 

Leroux says the product is relatively expensive (it runs into the hundreds of dollars) but notes that patients complete a test that determines its efficacy before ordering the lenses.  

For further information, visit IReadBetterNow.com.

By Drs. Patrick Quaid (Optometrist, PhD) and Michael Naugle (Optometrist), CCEPro 2012 Co-Chairs

The eyecare industry has traditionally been fragmented in Canada, making it exceedingly difficult to credibly and effectively educate both provincial and federal governments about the issues affecting it. As seen with the rapid deregulation of ophthalmic dispensing and sight-testing in British Columbia, professional associations and regulatory colleges are increasingly being left out of the legislative process and are therefore increasingly removed from the process of maintaining and improving standards of care.

The Canadian Coalition of Eyecare Professionals (CCEPro) is the first pan-Canadian organization to unite the three ‘O’ professions:  opticianry, optometry and ophthalmology. It was formed to present a unified, cohesive body representing all ECPs, one that governments can approach when they have questions regarding eyecare legislation.

We believe that collaborative care is the way forward, both in terms of determining sensible eyecare legislation and in delivering eyecare itself.

Improving Healthcare Policy
According to the Cost of Vision Loss in Canada study conducted by CNIB and the Canadian Ophthalmological Society, the annual cost of blindness and visually compromised individuals in Canada is $15.8 billion. There are 800,000 Canadians currently living with blindness and/or partial sight, and every year another 40,000 Canadians lose their vision. Clearly, eyecare is an important issue needing careful consideration by both provincial and federal governments.

Governments are becoming increasingly concerned with the rising costs of health care and often make decisions designed to alleviate financial pressure. However, due to the short-term nature of politics, these decisions often don’t add up to long-term solutions.

CCEPro’s objective is to advocate for health policies and legislation that will improve the vision and eye health of Canadians in the long term in a manner that is fiscally acceptable to government.

The CCEPro mandate is simple:

1. To unite opticianry, optometry and ophthalmology in order to work cooperatively in providing the best eyecare to Canadians.
2. To encourage membership of professionals concerned about the long-term eye health and vision of Canadians.
3. To collaborate with government regarding the eyecare needs of Canadians.

How will we work together? By putting the public interest front and centre and having an open registry of membership from all areas of the eyecare field to ensure transparency, CCEPro hopes to have a positive effect on the eyecare landscape in Canada. We hope to engage with as many stakeholders as possible and invite individuals from across the eyecare industry — opticianry, optometry and ophthalmology — to become members. There is no cost to join.

A transparent and grassroots approach to growth is crucial to our success. We hope to ensure that all three eyecare professions have equal representation on the board of directors and in co-chair roles. We will also continue to support the mandates of regulatory colleges and associations, and have no intention of interfering with the roles of any of these groups.

CCEPro plans to discuss topics of interest to eyecare professionals and governments on a topic-by-topic basis with its membership in order to present unified opinions to government. This approach has been very successful in other jurisdictions, notably the U.K., where a similar group (U.K. Optical Confederation) has already raised awareness of the importance of improving driving-related vision standards.

CCEPro Co-Chair Dr. Patrick Quaid recently met with the Hon. Tony Clement, former Minister of Health and current president of the Treasury Board of Canada and Minister for FedNor, to introduce the concept of CCEPro. Minister Clement described such an organization as a “utopia for any government” and said he was impressed by the initiative.

There is more to come. We plan an official launch gala this October. Details will be available in the months to come. In the meantime, we encourage all stakeholders in the eyecare industry to join CCEPro and show your support for a unified, cooperative effort designed to provide the best eyecare to Canadians.

Visit www.ccepro.org to learn more about CCEPro and join the coalition.

By JoAnne Sommers

Canadians have embraced Internet shopping, spending billions of dollars annually on purchases of everything from winter vacations to new homes. In addition to convenience and time saving, the Internet offers consumers the benefits of greater product selection and lower prices. But at what cost?

In the case of glasses and contact lenses the lack of oversight and accountability can lead to serious problems for people who may wind up using devices that are inappropriate or worse, unsafe for them.

“There is zero oversight of online companies who sell glasses and contact lenses. They are, in essence, answerable to nobody,” says Dr. Patrick Quaid, (Optometrist, PhD), with IRIS The Visual Group in Guelph,ON, and co-chair of CCEPro (Canadian Coalition of Eye Care Professionals).

The potential perils of buying online glasses are highlighted by a study published in the Journal of the American Optometric Association (AOA) in September 2011. The study by Pacific University College of Optometry in Oregon found a 44.8 percent overall failure rate for glasses ordered online. The most common problems were incorrect prescriptions and failure to meet minimum impact-resistance safety standards, meaning the lens can crack or shatter.

In some cases, researchers received single vision lenses instead of multifocals — an unheard of mix-up, said Karl Citek, a professor of optometry at the College and lead author of the study. Lens treatments such as anti-reflection coatings were either incorrectly added or omitted. In nearly one-quarter of the glasses, at least one lens failed impact  testing, which is required because prescription eyeglasses are classified as medical devices by the Food and Drug Administration (FDA).

It’s not surprising that researchers found problems, given that ophthalmic lenses require  very specific measurements to get the best performance and visual outcome. There are about 15 measurements that are usually done by a licensed optician, optometrist or a staff person under their supervision. These include:

1. monocular PD (pupillary distance), which takes account of asymmetry between the eyes
2. segment height (centre of pupil to bottom of frame)
3. vertex distance (back of lens to front surface of eye)
4. pantoscopic tilt of frame
5. wrap angle of frame

If these measurements are not taken properly (or at all), the field of vision is reduced, the wearer may not be able to see properly at various distances, they could develop double vision, eye strain, headaches, or head and neck pain from hyper-extending to look through different areas of the lens not lined up properly to the eyes, says Dr. Daryan Angle, vice president, professional relations with IRIS, The Visual Group.

Such measurements are very difficult to do over the Internet using current technology because the frame must be on the patient’s face for most of them. And the larger the prescription the more vital these measurements are. Yet online glasses are typically dispensed using only binocular PD measurements.

“Focusing on one ophthalmic measurement to the exclusion of others makes no logical sense,” says Dr. Quaid. “There has been significant emphasis on PD, which ensures the horizontal alignment of the optical centre of the lenses to the centre of the pupil, yet many Internet dispensers disregard completely the vertical height of a prescription on progressive lenses by going to a “standard” or average. If only the PD is used they’re missing the bigger picture.”

Moreover, says Dr. Quaid, finished glasses almost always require some adjustment and custom fitting, something the web is ill equipped to provide. Nor is there any verification as to whether an optical prescription has expired for either glasses or contact lenses.

This is a major issue considering that certain patients should never wear contact lenses because of prior eye infections or corneal scarring, for example.

Dr. Quaid cites the example of one Ontario patient he personally saw who was advised to stop wearing contact lenses because of recurrent eye infections. Undaunted, she bought them online anyway, then visited his office three weeks later with another infection which ultimately resulted in corneal scarring. The woman has now lost some vision in the affected eye. “Who is accountable here?” asks Dr. Quaid.

Studies have shown that there is a four to five times greater risk of developing microbial lens keratitis, a condition that can lead to permanent vision loss, among those who wear contact lenses purchased online.

One problem with online contacts is that you don’t know whether the lenses are properly fitted to the eye, says Dr. Angle. A contact lens that is too flat for the cornea moves excessively and will irritate the palpebral conjunctiva, causing irritation and can potentially lead to giant papillary conjunctivitis (GPC). Chronic GPC can lead to scarring and/or permanent contact lens intolerance. A lens that is too steep or fits too tightly to the cornea will trap bacteria, debris and/or toxins between the lens and the cornea, which can lead to microbial keratitis or a sterile ulcer.

There is also a risk that patients who don’t see an eyecare provider regularly may over-wear their lenses, he adds. “Some patients self-adjust the power of their contacts by ordering stronger ones when there may be an underlying health issue not related to the power of their lenses.”

CCEPro also believes that unsupervised Internet dispensing is especially dangerous to children and seniors as they have a higher prevalence of eye conditions, which are important to detect in order to avoid long-term vision damage. Dr. Quaid cites the increased prevalence of binocular vision (BV) anomalies, which, when added together, affect approximately one in 10 children in the general population, with hyperopia more than +1.25DS being associated with lower academic achievement and convergence insufficiency overlapping in terms of symptoms with conditions such as ADHD.

Among seniors there is a risk of missing serious eye pathology such as age-related macular degeneration (AMD), glaucoma or diabetic retinopathy.

“The public often thinks that 20/20 vision indicates perfect vision and that their eyes are healthy, but we know that many patients with 20/20 vision can have significant eye disease and that children can have significant long-sightedness. This makes the need for regular eye exams imperative, especially among children and seniors.”

Dr. Quaid predicts that problems arising from the sale of online glasses and contact lenses will lead to long-term health care costs for government by reducing the incidence of eye exams, ultimately resulting in missed pathology in adults, and pediatric problems like amblyopia and strabismus in children.

“Who will take responsibility for problems when they occur?” he asks. “The online company who sold the appliance? That seems unlikely given that there are no safety precautions or controls in place.”

Dr. Quaid says that CCEPro does not oppose online dispensing per se. “We support consumer choice in eyewear dispensing as long as it is a regulated practice, meaning there are safeguards (i.e., a valid prescription and a regulated provider) in place to ensure patients’ eye health and that the entire process is directly overseen by a licensed eyecare professional. Our key message to consumers is: don’t sacrifice safety for convenience and cost savings.”

Answering the Challenge

There is increasing recognition that ECPs must adapt to the growing challenge of Internet sales or fall by the wayside.

Online sales of glasses and contact lenses now represent about 2.3 percent of the U.S.optical market, a figure that is expected to double to 5 percent over the next two to three years, says Daniel Beaulieu, president and CEO of DirectLab International Network and a member of the Vision Council of America.

“Within 18 months, U.S. Internet sales will pass $1 billion annually (the total U.S.market is now worth $30 billion a year). It’s happening gradually but the Internet is changing the industry forever.”

While there are no comparable figures for Canada, Coastal Contacts, the country’s top online seller, saw sales of both eyeglasses and contact lenses increase in the first fiscal quarter of 2012, compared to the same period a year earlier. In the quarter ended Jan. 31, 2012, Coastal’s eyeglass sales increased 63 percent to $10.3 million, while total contact lens sales rose 7 percent to $36.6 million.

There are ways for eyecare professionals (ECPs) to embrace the Internet safely, says Dr. Patrick Quaid. “It’s not a bad thing if it’s regulated properly. The question is, are checks and balances in place to ensure that proper measurements are taken? That the prescription is checked to ensure its accuracy? That glasses are dispensed to the right person? That there’s follow-up to ensure the appliance works as intended and that the patient has somewhere to go with problems?”

Dr. Quaid says ECPs must also start charging realistic fees for their services and Dr. Michael Chaiken, O.D., agrees. Dr. Chaiken, the past-president of the Quebec College of Optometrists and current vice president of professional affairs with IRIS the Visual Group, says opticians and optometrists have long worked for free in the hope that people will buy from them in the future.

“That diminishes the perceived value of what they’re doing,” he says. “If we want people to value what we do, we must start charging reasonable fees for it. Otherwise, it creates the impression that our services are worthless.”

People don’t understand the real reasons Internet dispensers can sell so cheaply, says Dr. Chaiken. “For one thing they don’t have to pay staff to do the necessary follow-up. Online companies want people who have problems with their products to take them to an ECP for adjustment.”

Optometrists must also purchase expensive diagnostic equipment, which is used to conduct eye exams and diagnose vision problems, he notes.

“When customers compare our prices to those on the Internet we need to point out that the cost of caring for their eyes is incorporated into the charges for their glasses. Our fees will have to rise if we lose business on the glasses side; otherwise the quality of care will decline. My advice to ECPs is, start charging for your services and explain the reasons to your patients. Otherwise, you’ll go out of business.”

Instead of fighting the Internet, Dr. Daryan Angle suggests that ECPs use it to help educate their patients and improve service delivery.

“The public’s understanding of proper eyecare is poor,” he says. “Online companies talk only about price, reducing glasses and contact lenses to the level of commodities. But a strong web presence can help us explain the benefits of professional advice in choosing lenses based on the patient’s lifestyle, prescription and other needs. We can also use social media, including Facebook, twitter and blogs to convey the message that there’s much more to glasses and contact lenses than price.”

Another way to respond to the Internet challenge is to create your own website and retail products in a way that combines brick and mortar with the Internet. This model, which is gaining popularity in the U.S., is starting to make inroads into Canada.

IRIS plans to start selling contact lenses online to its own patients by early summer, joining other independent Canadian optometrists and some optical stores.

“Patients must have received proper in-person, up-to-date eye health examinations, contact lens fittings or progress checks at one of our locations by IRIS Doctors of Optometry and/or contact lens fitters,” says Dr. Angle.

A New Business Model

The development of increasingly sophisticated software is about to revolutionize the Internet dispensing of eyeglasses, says Daniel Beaulieu, president and CEO of DirectLab Network.

“Programmers have already developed software that can measure pupillary distance (PD) online and it is just a matter of months until it will be possible to measure fitting height, which is necessary for dispensing progressives. That means more sales on the web and fewer for eyecare professionals (ECPs).”

Beaulieu believes that because the Internet has changed the rules of the game,Canada’s ECPs must now change the way they do business. “They need to start selling to the public online in order to compete successfully with Internet dispensers,” he says.

Consumers can save more than 50 percent on the cost of glasses and contact lenses by buying them through an Internet dispenser, says Beaulieu, adding that in Canada, the average online cost of a single vision package, including frame and lens, is just $69.

“ECPs need to offer products of similar quality at comparable prices or they will lose sales.”

To that end, DirectLab plans to launch a web development package in support of ECPs later this year. “We will offer a complete website management service, including frames and lenses, at a price that will enable ECPs to compete with online companies,” says Beaulieu.

One significant advantage of the new model is that while customers will make their purchases online, they will have full access to local eyecare service for fittings and adjustments. And ECPs will be able to charge a fee for those services.

The new business model is similar to MyOnlineOptical, which Essilor launched in the U.S.two years ago. It combines the convenience of shopping online for eyeglasses, contact lenses, frames and sunglasses with the services available from an ECP’s practice. MyOnlineOptical.com now services about 1,100 practices in the U.S.