Despite U.K. judge's ruling, mail-order contact lens sales continue

Issue: October 1998

ByChris O. Imafidon, PhD

LONDON - Vision Direct Limited, the first mail-order contact lens company in Britain, its managing director, Steffan N. Rygaard and optometrist Sutantar S. Sandhu, were found guilty of selling contact lenses without the supervision of a registered practitioner by Keith Maitland-Davies, a London judge.

The British General Optical Council (GOC), the statutory agency that regulates the practice of contact lenses, challenged this act of selling contact lenses by mail order. The court ordered Mr. Rygaard and Dr. Sandhu to pay the GOC $75,000; each of them must pay $37,500. In addition, they were fined $750 each ($188 for each offense).

Since Vision Direct was established, more than six other mail-order contact lens companies, including the Dutch firm Eye Care Direct and U.S.-based Contact Lens Depot, are now marketing lenses in the United Kingdom. Ironically, cosmetic contact lenses, such as plano tinted lenses, are not regulated here.

Vision Direct did not appeal the judgment; the company is selling lenses again after relocating to Holland, where such rules are less stringent.

In the highly publicized legal battle between Vision Direct and the GOC, Vision Direct maintained that it does "not deny practitioners their fees." Company representatives contact the patient's clinician if in any doubt about the prescription or package. They will refer all patients to their clinicians if patients have not had an eye examination in the past 12 months.

Safety checks were in place

Vision Direct added that some clinicians find the administrative side of lens and product supply tiresome and would prefer to spend more chair time with patients. In court, Vision Direct presented its watertight safety checks that were modified and supervised by its optometrist. The criteria included the following:

The patient had to complete and sign an order form, giving identification details, specifying current brand of contact lens and indicating the number of pairs of contact lenses required and the intended period of usage in months. Patients were told to enclose current used contact lens pull-foils and mark the right and left lens on the pull-foils. They were also given the opportunity to enclose a copy of their current contact lens prescription.
The order form had to be signed and dated by the patient. In addition, at the bottom of the form was this declaration: That the patient must have at least 6 months experience with contact lenses and have had a check-up within the past 12 months. Furthermore, it is important to have regular check-ups with an eye care practitioner. Vision Direct recommended a check-up twice a year. If, as a result of using contact lenses, the slightest symptoms of eye irritation were experienced, patients were to remove lenses immediately and contact their specialists.
The patient had to indicate on the form the date of the last check-up and sign and date that declaration indicating that he or she had read and accepted it.

During the court hearing, Mr. Rygaard gave details of some patients he rejected because of incorrect or inadequate information. He received all order forms, pull-foils, any prescription or any other documents and checked all of them for irregularities. Mr. Rygaard then consulted Dr. Sandhu on every order and forwarded the documentation to him for double-checking. Then, the order would be processed and delivery would be made to the purchaser. If there were any irregularities, Mr. Rygaard would contact the patient.

The court did not see these measures as consistent with the supervision required by section 27 of the Opticians Act of 1989.

New rules

The GOC is now considering a new code of conduct for contact lens practice. According to a draft, all patients will be issued a prescription that will contain the following: a life span/expiration date; the date of the next examination; the number of lenses required for the period; and an endorsement of the quantity of lenses supplied and the date.

It will be an offense to exceed the quantity supplied within the time frame, and any supply by another clinician must agree with the original prescription. The final version of the rules will be issued in November after a council meeting.

Reactions vary

In an apparent response, the Consumer Association, a consumer advocacy group, conducted a study of randomly selected practices to investigate whether practitioners are adhering to the strict supervision of contact lenses as stated by expert witnesses in court. The group published their results in August and claimed that optometrists were missing "vital checks" during contact lens consultation.

As an illustration of the press and public hostility to the verdict, a popular national columnist, Oliver James, wrote a column about this issue in The Independent, a respected newspaper. He said that Mr. Rygaard and Vision Direct lost this case because the GOC had managed to "pull the wool over a shortsighted judge's eyes, convincing him that the act of selling a contact lens has to be clinically supervised."

Mr. James, a Vision Direct customer, insisted that the sale of contact lenses was an example of how consumers were continuing to be "ripped off" by the government and business.

The British Chapter of the American Academy of Optometry was one of the first to relay the news of the judgment on its web site and provided visitors with information on how to get the full transcript. It described the decision as a legal "thumbs-down for mail-order contact lenses." Its secretary, Andrew Field, FCOptom, was one of the first to argue for a separation of professional fees from products long before the advent of mail order and the Internet. The full transcript is also available on the GOC's web site, www.optical.org.

Optometrists oppose mail order

Ian Hunter, FCOptom, OBE, Secretary General of the Association of Optometrists and one of the first optometrists to publicly call for legal action against mail order, said in the U.K. publication, Optometry Today. "The decision against Vision Direct is significant. This means that remote mail-order operations, whether involving registered practitioners or not, are against the law."

However, because of the relative ease of circumventing the law as it stands today, he added that, "relying solely on regulatory protection is not the way to preserve the role of the profession." He advised his colleagues to "charge appropriately for professional services and material." Until now, most practitioners combine their professional fees with the cost of lenses, which gives a misleading impression of the real price of the lenses.

The College of Optometrists in London, whose main role is conducting professional examinations for British optometrists, released a letter stating that "mail-order contact lenses were potentially dangerous," and advised the public to stick with their practitioners. After the verdict, the president was disappointed at the reaction of the national press.

In a letter to The Independent, College President, Gwyneth J. Morgan, FCOptom, wrote to register the College's disappointment with the article. She said it "dangerously misrepresented the issue of mail-order contact lenses." After explaining the purpose of professional regulation of the supply of contact lenses, Dr. Morgan concluded, "To advocate to your readers, in the face of a court ruling, that they support mail-order contact lenses can only put the ocular health of your readers at risk."

The response of contact lens manufacturers was varied. Some called it a hollow victory, while others see it a victory for safety over short-term savings.

The real victims of the ongoing trend may well be emergency room clinicians who will deal with the consequences of noncompliance.

For Your Information:
Chris O. Imafidon, PhD, can be reached at fax: (44) 181-470-2623; e-mail: imafidon@hotmail.com. Dr. Imafidon has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
Steffan N. Rygaard and Sutantar S. Sandhu can be reached at Vision Direct Limited, Freepost, Wirral; L45 1BR; fax: (44) 7000-20-34-7328; e-mail: info@visiondirect.co.uk; www.Vision Direct.co.uk.
The General Optical Council can be reached at 41 Harley St., W1N 2D5, London, England; (44) 171-580-3898; fax: (44) 171-436-3525; e-mail: goc@optical.org or optical@globalnet.co.uk; www.optical.org.
The Association of Optometrists can be reached at 90 London Road, SE1 6LN; (44) 171-261-9661; fax: (44) 171-261-0228; e-mail: aoptom@atlas.co.uk.
The British Chapter of the American Academy of Optometry can be reached at www.academy.co.uk.