Why the hell can’t I buy contact lenses without getting an eye exam? (2025)

Every year around this time, when I need to replenish my supply of contact lenses before the new insurance cycle kicks in, I briefly become radicalized. My prescription has barely changed in the 30-odd years since I was diagnosed nearsighted and had my adolescence upended with the news that I would thenceforth be a four-eyed dweeb. And yet whenever I try to order new contacts, I am reminded that it is against the law to obtain lenses without an up-to-date prescription in the United States, for reasons that seem blurry until you squint your eyes and get uncomfortably close.

In practice, it means I have to get re-examined by an optometrist any time I need new contacts, only to be told my vision is exactly as weak as it’s always been (and that I should enjoy my few remaining “good years,” because mid-40s is when most people’s eyesight really falls off a cliff). But if I can go to a mini-mall and get eye surgery, why the hell can’t I walk into a pharmacy and just buy new contact lenses with the same prescription I’ve had since middle school? And why is it such a hassle in the United States when, almost anywhere else in the world, a person can immediately get contact lenses in any typical drugstore?

It’s because contact lenses are regulated by the U.S. Food and Drug Administration as “medical devices” and subject to rules imposed by the Federal Trade Commission that mandate a prescription and fitting performed by an eye-care professional as a condition of their sale. The FTC’s Contact Lens Rule mandates the enforcement of the Fairness to Contact Lens Consumers Act, which was passed by Congress in 2003 and implemented the following year. According to that rule, “A seller may sell contact lenses only in accordance with a contact lens prescription for the patient” that is less than one year old.

So here is a case in which something I support in theory (a strong regulatory environment, particularly in the healthcare industry) clashes with my lived reality, in which the eye-exam mandate feels like a crock of shit.

A writer for the Atlantic poked around this rule in 2019 when they found themselves stranded away from home without contacts or glasses, on a weekend when no optometrist was open nearby. The writer, Yascha Mounk, asked the president of the American Optometric Association (AOA), about the rationale behind the law, and got the following vague response:

“Today, at least 2.2 billion people around the world have a vision impairment, of whom at least 1 billion have a vision impairment that could have been prevented or has yet to be addressed … That’s why it’s clear to health experts, policy makers, the media, and the public that increased access to eye exams and eye doctors are needed to safeguard health and vision.”

Mounk points out an obvious fallacy in that argument: How many of those unaddressed visual impairments are people in the United States, or places with similar laws, who don’t get examined because of the barrier that the law puts in place? And isn’t “increased access” a grossly euphemistic way of describing an eye-exam mandate that in practice probably reduces the number of people seeking corrective treatment? And if there is not conclusive data showing people from less restrictive countries suffer worse outcomes from suspiciously purchasing contact lenses of whatever strength they want, how do we know that “increased access” actually matters?

An active prescription is required because that’s what optometrists in the United States recommend — or, I should say, want, because there is not conclusive evidence supporting the claim that lens-wearers need a yearly exam to prevent cancer, glaucoma, retinal vascular disease or any of the extreme outcomes optometric literature warns of, lest they befall a person who attempts to obtain contacts…without a new prescription (*thunderclap). Eye exams do plenty of good, but the idea that they need to happen every year just appears to have been repeated enough to generate SEO content in lieu of real data. (It is worth noting that ophthalmologists, who are doctors that specialize in medical care to the eyes —versus optometrists, who specialize in vision correction and are not medical doctors —recommend an eye exam “every few years” for most patients, as opposed to every year.)

It’s almost as if there’s money at stake

The AOA, which represents about 37,000 eye doctors nationwide, spends millions annually on efforts to influence federal lawmakers, with affiliated donors supporting Republican and Democratic political candidates almost equally, according to OpenSecrets.org. Surely that explains, at least in part, why the contact-lens law feels as if it was written by lobbyists. I’m assuming this is a whole genre of legislation both nationally and throughout statehouses, but offhand, I can’t think of another example that feels so obvious and egregious. Maybe it just seems that way because I encounter the effects of this law regularly and directly, and optometrists’ offices have always activated my bullshit antenna —not the providers themselves, who I’m sure are mostly earnest and diligent, but the business context in which they operate.

With optometry, the care and the commerce don’t even pretend to exist separately. Optometry is unique in that the practices are directly selling the treatment they prescribe. Virtually all optometrists’ offices also sell contacts and glasses; conversely, every place selling eyewear and lenses will also have optometrists on staff.

You don’t need a trench-coated informant in a parking garage to explain how this set-up would motivate an industry’s Washington spokespeople to help codify the direct pipeline between those two revenue sources. There are plenty of fucked-up and lamentable things about the relationship between health care and, say, the pharmaceutical industry, but at least there is a physical layer of separation: If your doctor prescribes a medicine, they’re not trying to sell it to you before you get through the lobby. At a dentist’s office, the toothbrush is free.

The Fairness to Contact Lens Consumers Act has one of those amusingly Orwellian names that suggests the opposite of what the law actually accomplishes. The legislation was introduced by former North Carolina senator Richard Burr, a Republican whose donors include — again, surely by coincidence — the North Carolina State Optometric Society. The “fairness” part refers to the text outlining the procedures for making a patient’s written prescription available to them, as the law requires providers to do. That’s nice, but it feels like some fairness dust sprinkled atop a shit sundae. (“Shit” being the underlying requirement that an active prescription is required in the first place. Iffy metaphor.)

The part of the law that requires a provider to proactively supply patients with written copies of their prescriptions, thus allowing them to buy lenses from other retailers, was vigorously opposed by the AOA. That is not surprising considering the timeline. (Here’s a fun history of the contact lens, starting with the first illustration of the concept in 1508 by, no shit, Leonardo da Vinci.) By the early 2000s, Americans were doing more of their shopping online, and services such as 1-800-CONTACTS and Lens.com were providing consumers with the same options at lower prices, since an online lens retailer can operate at a much lower margin than a brick-and-mortar optometrist’s office. The ensuing lobbying fight was pretty ballsy, since it mobilized the industry against just one piece of a law that otherwise ensured billions of dollars would remain in AOA members’ stores.

The source of the industry’s panic is not only the prospect of online lens sales, but the convenience of online and app-hosted vision exams that make the whole process more accessible and affordable.(Note again the abundance of SEO and AI-generated scare-content about online eye exams that do not seem solidly data-supported.) The industry’s opposition to rules facilitating the growth of those sectors is usually presented under the guise of “protecting” lens-wearers from harmful actors, as if there is some contact-lens black market that thrives on deception and exploitation. Which, maybe there is by this point. But what are they actually safeguarding, the wellbeing of consumers or their own nut?

You’ll never guess. Writing in Forbes in 2017, George Leef described the AOA’s lobbying efforts as a textbook case of “the power of the state (being) harnessed by interest groups to protect themselves against competition,” before going on to summarize the entire issue with 20/20 clarity:

“By using such innovations, millions of Americans who need vision correction could save substantial amounts of money. But savings for them means less revenue for optometrists and they are trying to stop that by asking politicians for salvation.”

Sure enough, in 2016, South Carolina lawmakers passed the Eyecare Consumer Protection Act, which banned residents of the state from obtaining prescriptions for corrective lenses through an online eye exam. Then-Gov. Nikki Haley —with whom I would have expected to agree on zero things, ever — vetoed the bill on the grounds that “it uses health practice mandates to stifle competition for the benefit of a single industry.” Her veto was then overridden by nearly unanimous votes in both chambers of the state legislature. I’m not going to look this up, but what do we suppose are the chances that a lot of AOA-affiliated money flowed into the campaign funds for lawmakers in South Carolina around that time?

Several years of messy legal challenges have followed, along with a seemingly haphazard lobbying effort by the online lens industry to counter the AOA’s political footprint. The AOA’s recent literature mentions an advocacy group called the National Association of Optometrists and Opticians (NAOO), which supposedly represents major online retailers but appears to have no web or social media presence.

I can’t really see clearly now

All of this culminated in an email last year informing me that Vision Direct, a UK-based lens retailer that openly sold contacts across national borders without requiring prescriptions (it’s legal there), would no longer ship to the United States, thus closing off the only Silk Road-type purveyor of “illicit” contact lenses that I was aware of. I’d been ordering lenses there for a few years without bothering to do math that would have informed me how the shipping costs offset a lot of what I’d saved by skipping a yearly exam. But it’s about the principle, dammit.

Meanwhile, the whole grift continues to unfold in plain sight, which, considering how many of us are subsisting on expired lenses, might be why they keep getting away with it.