MAIL ORDER

Mail Order Contact Lenses: A Telephone Survey

By Michael G. Harris, OD, JD, MS, John E. Esser, OD, Jonathan D. Owens, OD
January 2001

Calls to a mail order supplier resulted in orders filled without a valid prescription and 60 percent of operators offering advice.

Our patients depend on us to provide accurate refills of their contact lens prescriptions and appropriate advice about their visual and eyecare needs. As mail order and Internet contact lens suppliers become commonplace in today's high tech society, more patients consider obtaining their contact lenses and eyecare advice from these sources. In an attempt to see how a mail order contact lens company handles telephone requests for contact lenses and contact lens-related advice, we developed a telephone survey.

We devised five scenarios for the survey, with each scenario called in five different times. The telephone calls were made in California and spread out over a period of nine months from September 1999 through May 2000. For scenarios in which operator advice was sought, a different operator was used each time. The scenarios were as follows:

Non-existent doctor. We provided a prescription for a contact lens using the name of a doctor who does not exist, as well as a random phone number that wasn't a doctor's office. For each of the five trials of this scenario, a different fictitious doctor was used.

Contact lens with an incorrect base curve. We informed the operator that our contact lens prescription was written for a Bausch & Lomb Optima soft contact lens with an 8.5mm base curve. The Optima lens comes in an 8.4mm and an 8.8mm base curve, but it is not available in an 8.5mm base curve. We then stated that the doctor seemed unsure about the base curve, but had definitely written 8.5mm on the prescription form.

Advice on the proper soft contact lens solutions. We informed the operator that the doctor had instructed us to use a hydrogen peroxide care system. We stated that a friend uses a multi-purpose solution, which seems easier to use. We then asked if we could switch from the hydrogen peroxide solution to a multi-purpose solution.

Changing the replacement schedule. We told the operator we were wearing Bausch & Lomb Seequence II soft lenses and wanted to know if we could wear them on a three-month replacement schedule rather than the two-week schedule our doctor had prescribed.

Lengthening the time extended wear lenses were worn. We informed the operator that we were wearing Bausch & Lomb Purevision lenses on a weekly extended wear basis as prescribed by our doctor and wanted to know if we could wear them on a one-month extended wear basis. We stated that they seem expensive to wear on a one-week basis even though that was how they were prescribed.

Survey Results

Non-existent doctor. All five orders were filled with no questions asked by the operator.

Contact lens with an incorrect base curve. All operators informed us that the base curve 8.5mm did not exist for the Optima lens. The operators then asked us to recheck the prescription form. After confirming what the doctor had written, we asked the operators to tell us what base curves were available for the contact lens in question. The operators informed us that the lens was available in either an 8.4mm or 8.8mm base curve. We said the doctor must have meant to write 8.4mm because that is the closest number to 8.5mm. The operators asked if 8.4mm was the base curve that we wanted, and we said yes. All five orders were filled with the 8.4mm base curve.

Advice on the proper soft contact lens solutions. Three out of five operators told us it would be fine to switch from a hydrogen peroxide care system to a multi-purpose solution. The other two operators told us that we should consult our doctor about switching solutions.

Changing the replacement schedule. Three out of five operators told us to lengthen our replacement period from two weeks to three months as long as the lenses were comfortable. The other two operators informed us that we should consult with our doctor concerning a change in our replacement schedule.

Lengthening the time extended wear lenses were worn. Three out of five operators told us to lengthen our extended wear wearing time from one week to one month as long as the contact lenses were comfortable. The remaining two operators informed us that we should consult with our doctor about lengthening our contact lens extended wear time.

Discussion

In our first scenario, the non-existent doctor, all five orders were filled with no questions asked. This practice may not comport to the legal requirements for filling contact lens prescription in some states. California State Law (Business and Professions Code 2546.6) states: "Contact lenses may be sold only upon written prescription dated one year or less from the date the lenses are supplied, or within any shorter period of time that is specified by the prescription. If the written prescription is not available to the seller, the seller shall confirm the prescription by direct communication with the prescriber or his or her authorized agent prior to selling any lens, and maintain a record of that communication."

According to this regulation, the seller, in this case the mail order company, should have contacted the doctor before filling the prescription since a written prescription was not provided. If the operators had tried to contact one of our "prescribing" doctors, they would have found that these doctors do not exist, and that the prescriptions were not valid.

In our second scenario, ordering a lens with an unavailable base curve, again all five orders were filled. The operators should not have asked us if the 8.4mm base curve lens was the one we wanted, but should have verified the proper base curve by contacting the prescribing doctor. Allowing patients to make decisions regarding the parameters opens the possibility of obtaining improperly fitted lenses. Dispensers who substitute contact lens parameters for those prescribed may not be in compliance with state regulations. For example, the State of California requires pharmacies, as third party dispensers, to make no substitutions in filling contact lens prescriptions. (California State Law (Business and Professions Code 4124.(c), under the Board of Pharmacy), states: "The contact lenses that are dispensed shall be the exact contact lenses that have been prescribed, and no substitutions shall be made.")

When we asked for advice about soft contact lens solutions, three of the five operators stated that it would be all right to switch from a hydrogen peroxide care system to a multi-purpose care system. Patients may encounter problems by switching care systems such as ocular allergies, lens discomfort and GPC. The decision to switch lens care systems should be made by the prescribing practitioner.

When we asked the operators if we could change the replacement schedule, three of five operators approved lengthening the replacement period from two weeks to three months. Increasing the wearing schedule could cause a host of problems including GPC, contact lens intolerance and ocular infection.

When we inquired about increasing the length of time a patient can wear contact lenses under extended wear circumstances, three of the five operators approved increasing extended wear from one week to one month. Increasing the extended wear period could cause complications, including possible sight-threatening infection. Without a doctor's prior authorization, patients should not increase the period extended wear lenses are worn. In addition, no soft contact lens is currently FDA approved for one month of extended wear in the United States.

California law regarding non-resident contact lens sellers (Business and Professions Code, section 2546.5(d)) states in part that "All questions relating to eyecare for the lens prescribed shall be referred back to the contact lens prescriber." Issues such as contact lens solutions, replacement schedules and extended wear wearing time qualify as eyecare-related questions. Thus, the operators should have referred all questions to the prescribing practitioner.

Conclusion

Mail order companies which allow operators to answer patient inquires about cleaning solutions and wearing schedules may be compromising optimum patient care. This could be potentially dangerous to contact lens wearers.

Filling a prescription, contact lens or otherwise, from a non-existent doctor should not be allowed. When patients are allowed to fill a contact lens prescription without being under the care of an eyecare professional, there is the potential for harm. A prescription specifies the parameters the prescribing doctor wants the patient to wear. This decision is based on clinical experience, diagnostic fitting, corneal evaluation and patient history. Changing lens parameters, such as base curve, can have an adverse effect on the health of the patient's eyes. Filling a prescription improperly or giving incorrect contact lens advice has potential clinical and legal ramifications for both patients and practitioners.

Contact lens practitioners must invite patients to ask questions concerning their lenses, lens care regimens, wearing schedule and options for refilling their prescriptions. Practitioners should continue to educate patients about their lenses and be an available resource to address questions and concerns. 

Acknowledgement: This study was supported by the Morton D. Sarver Laboratory for Cornea and Contact Lens Research, University of California at Berkeley School of Optometry.

dr. harris is associate dean, clinical professor and chief of the contact lens clinic at the university of california school of optometry, as well as an attorney-at-law.

dr. esser received his degree from the university of california school of optometry in 1999. he is the recipient the vision west scholarship award.

dr. owens is a 1999 graduate of the university of california school of optometry. he is a member of the beta sigma kappa honor society and the recipient of the wesley jessen achievement award.