In California, Your Contact Lens Prescription Isn’t All Yours--Yet

Ever been to the eye doctor, asked for a copy of your contact lens prescription and been told that you can’t have it?

Wait a minute! Isn’t your vision prescription a part of your medical record that your doctor is obligated to provide to you upon request? Actually, no.

Here’s why.

Federal law requires any eye doctor to provide patients with a written copy of their eyeglass prescription, but it’s silent on getting copies of prescriptions for contact lenses. Those come under state laws, which in California and 23 other states, leave to the doctor’s discretion whether to give you a prescription you can fill where you choose after your lens fitting.

The issue is at the center of a 7-year-old lawsuit in which attorneys general in 32 states, including California, have accused several optometric professional associations and three contact lens manufacturers of unfair trade practices.

For consumers, the issue is most likely to come up when you request your contact lens prescription in order to buy replacement lenses someplace other than through your eye doctor. Mail-order companies, Internet firms, large retail chains and many pharmacies sell contact lenses at discounted prices.

In California, eye doctors are required to post in their offices a notice stating whether it’s their policy to release contact lens prescriptions to patients. Most consumers probably aren’t aware of this law, or that they have the right to ask about the policy and go elsewhere if they’re dissatisfied.

Right now, 26 states have laws mandating that eye doctors release the prescriptions. Maryland, for example, requires doctors to provide a contact lens prescription to patients after an eye examination that includes a fitting and follow-up care. In most cases, the prescriptions are valid for two years after the initial exam.

When contact lenses first hit the market, wearers generally purchased them from the eye-care professional who fitted them. But with the advent of disposable lenses, worn by about one in 10 Americans, many consumers opted to purchase additional lenses from other, often cheaper sources.

The lawsuit filed by the 32 states charges that optometrists’ refusal to release prescriptions was part of a conspiracy with contact lens makers to keep patients from buying replacement contact lenses through other sources. It also charges that as a result, contact lens consumers were charged artificially high prices for lenses purchased since the beginning of 1988. The suit, initially filed in 1994 by 19 states in a Florida federal district court, names as defendants the American Optometric Assn., three contact lens manufacturers and an assortment of state and other optometric industry groups.

In a related case, 48 states (all but Georgia and Tennessee) joined in a private class-action suit filed on behalf of consumers who purchased contact lenses through eye-care professionals, said Thomas P. Dove, a California deputy attorney general leading the 32 states’ lawsuit.

Dove contends consumers have paid roughly $500 million in overcharges for contact lenses as a result of the industry’s and associations’ actions.

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One of the manufacturers, CIBA Vision, agreed to a proposed settlement in both actions, under which it will provide customer rebates and discount coupons for those who purchased lenses since Jan. 1, 1988. It already has begun wider distribution of its lenses.

Bausch & Lomb and Johnson & Johnson Vision Products (Vistakom), along with the optometric groups, remain defendants in the cases, scheduled to go to trial March 19 in federal court in Jacksonville, Fla.

Biard MacGuineas, a Washington attorney representing the American Optometric Assn., said the industry has not conspired to raise prices. He said manufacturers have a right to distribute through the outlets they choose, “just like many manufacturers decide I will sell my original designer inaugural ball gowns only at Saks [Fifth Avenue], but will not sell them at Kmart.”

With regard to the prescription release question, he said the association “has always said this is a matter of . . . state law.”

In 1988, he said, the association passed a resolution that no matter where you buy your lenses, they should only be sold if you’re going to have follow-up care.

Some optometrists say their principal concern in declining to release contact lens prescriptions is protecting the patient’s health.

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“Every optometrist is different,” said Dr. Edward Hernandez, president of the California Optometric Assn. Patients who come to his La Puente office can fill their contact lens prescriptions elsewhere--as long as they promise him that they’ll get regular eye care from him or someone else, “to make sure you don’t have any complications.”

“For example, I don’t want to see them getting four years’ worth of disposable lenses and me never seeing them back here. There are a lot of health issues [such as] diabetes, dry eyes,” Hernandez said.

Although many optometrists mark up the price of the lenses they sell, Hernandez said that he and his wife, who is also an optometrist, “have pretty much dropped our prices down to almost cost. We make our money on services and our professional fees.”

Dove contends that even those optometrists who are “very, very competitive” with mail-order sources still charge “a competitive price higher than it would be [but] for the conspiracy.”

Since CIBA settled its case and agreed to sell directly to the outlets, Dove said its sales have increased and there’s still no reports on file alleging anyone has suffered any eye problem as a result of getting their lenses through discount or other outlets.