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FEDERAL TRADE COM:-'1ISSION

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BUREAU OF

CONSUMER PROTECTION

May 14, 1987

The Honorable John A. Lynch

Majority Leader

New Jersey Senate

96 Bayard Street

New Brunswick, New Jersey 08901

Dear Mr. Lynch:

We are pleased to respond to your request for comments 1 on

pro~osed Senate Bill No. 1367, which would permit opticians to

fit contact lenses provided that they first obtain certification

as contact lens dispensers from the state board of opticians. 3

While we express no specific opinion on the need for the proposed

certification program, we do believe that allowing opticians to

fit contact lenses is likely to benefit consumers by increasing

competition and lowering prices for contact fitting services,

without impairing the quality of eye care. We therefore support

that portion of the bill.

The Federal Trade Commission is charged with maintaining

competition and protecting consumers from restraints of trade. 4

In accordance with this role, the Commission seeks to encourage

competition among licensed professionals, including, among

others, opticians and optometrists. The Commission's goal is to

assist the states in identifying and removing restrictions that

limit competition and increase costs without improving the

quality of care or providing other countervailing consumer

benefits.

1 These comments represent the views of the Commission's

Bureaus of Consumer Protection, Economics, and Competition, and

do not necessarily represent the views of the Commission itself.

The Commission has, however, voted to authorize us to submit

these comments to you.

2 The process of fitting contact lenses includes taking

measurements to determine the size, shape and specifications of.

contact lenses and adjusting the contact lenses to the patient's

eyes.

3 The bill creates standards for such certification,

including additional educational requirements.

4 See 15 U.S.C. §41 et. seq.

Bicentennial of the L'nited State~ Constitution

11787-1 ~87)
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We believe that a restriction preventing opticians,

regardless of their qualifications, from fitting contact lenses

may have this effect. Such a restriction presently exists in New

Jersey. Opticians are prohibited from fitting contact lenses,

which can only be done by optometrists and ophthalmologists.

This law clearly limits competition among members of these

groups, and, in consequence, is likely to increase prices and

decrease the availability of contact lens fitting services. 5

Allowing opticians to enter this market can be expected to force

all types of providers of contact lens fitting services,

including optometrists and ophthalmologists, to lower their

prices.

We believe that such competition is unlikely to have any

adverse effects on the quality of eye care provided to consumers.

A 1983 FTC staff study ("Contact Lens Study"), which was designed

to examine whether bans on contact lens fitting by opticians are

necessary to protect the pUblic, supports this conclusion. 6 The

study examined the quality of cosmetic7 contact lens fitting

among four types of eye care providers: opticians,8 private

5 This conclusion about the relationship between price and

restrictions on competition is supported generally by economic

analysis and by numerous studies. See,~, Bureau of

Economics, Federal Trade Commission, Restrictions on Advertising

and Commercial Practice in the Professions: The Case of

Optometry (1980).

6 Bureaus of Consumer Protection and Economics, Federal

Trade Commission, A Comparative Analysis of Cosmetic Contact Lens

Fitting by Ophthalmologists, optometrists and Opticians (1983).

A copy of this report is attached.

7 The Contact Lens Study covered only cosmetic contact

lenses -- lenses which are worn as an alternative to eyeglasses

in correcting vision. It did not cover therapeutic lenses, which

may be required for various medical reasons other than the simple

correction of vision, such as for cataract surgery patients. The

study also did not cover types of lenses which have only recently

become available, such as extended wear lenses. Therefore, the

stUdy provides no evidence indicating that opticians can fit such

lenses as well as other providers. On the other hand, we know of

no evidence that opticians generally provide lower quality

fitting of these lenses.

8 The opticians included in the study were permitted, under

the laws of their states, to fit contact lenses.

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optometrists, commercial optometrists 9 and ophthalmologists. The

study found that there was no significant difference in the

quality of cosmetic contact lens f~tting performed by the

different classes of providers. 10

The survey was carried out with the assistance of the major

eye care professional organizations -- the American Academy of

ophthalmology, the American Optometric Association, and the

Opticians Association of America. The association

representatives agreed upon the appropriate procedures to use and

standards to apply in examining the eyes of the study subjects.

The study included over 500 cosmetic contact lens wearers located

in 18 urban areas across the country.

All of the survey SUbjects had been fitted with contact

lenses within the preceding three years and were still wearing

them. An ophthalmologist, an optometrist, and an optician

examined the SUbjects for the presence of seven potentially

pathological conditions that are commonly associated with

improper contact lens fitting. The procedures closely resembled

those used by contact lens fitters to perform "follow-up"

evaluations of their patients. The findings of the examiners for

each of the seven cond~~ions for each eye were used to create a

summary quality score for each subject, which indicated the

overall health of the subject's eyes. The study also examined

the presence or absence of each of the seven eye conditions

individually. Expert statistical consultants and the FTC staff,

including economists with extensive expertise in survey research

and analysis, then analyzed the study data.

The findings of the study indicate that restrictions on

contact lens fitting by qualified opticians appear to be

unnecessary to protect the public. The study found that the

quality of cosmetic contact lens fitting provided by opticians

was comparable to that provided by ophthalmologists and

optometrists. We are aware of no reliable contrary evidence

indicating that restrictions on contact lens fitting by opticians

benefit consumers. Consequently, these restrict~ons are likely

to result in consumer injury by reducing competition without

providing countervailing consumer benefits.

9 Commercial optometrists included those who were

associated with chain optical firms, used trade names or

practiced in commercial locations.

10 The study also examined the prices of cosmetic contact

lens fitting services and found that there was a wide range in

prices. On average, ophthalmologists charged the highest prices,

opticians and non-commercial optometrists the next highest

prices, and commercial optometrists the lowest.

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As to licensing and certification, the Contact Lens Study

included opticians both from states that do and do not license

opticians, but ,the data has not been analyzed to determine

whether unlicensed opticians can fit contact lenses as well as

licensed opticians. We express no opinion as to the need for the

bill!s certification requirements, but would like to raise two

points that may be helpful in your deliberations. First, any

licensing or state certification requirements will necessarily

limit competition by restricting entry. We suggest careful

examination of the proposed requirements to ensure that they go

no further than necessary to ensure quality of care.

Second, you may wish to consider whether the statutory

certification requirements are as precise and specific as

possible, or whether they instead vest unnecessary discretion in

the certifying board. For example, a certification standard tnat

requires "completion of any educational programs required by the

board," may not provide sufficient guidance to the board

respecting what types of programs the legislature has in mind.

Anticompetitive consequences would result if a board employed

such broad language for unduly restricting entry into the

pyo:ession.

In conclusion, we believe removing the current prohibition

against contact lens fitting by all opticians, regardless of

qualification, would benefit consumers by increasing competition

without producing any decrease in the quality of care. He

therefore support that portion of the bill. As to licensing or

certification for opticians who fit contact l~nses, we suggest

that you carefully assess any such requirements to ensure tha~

they are as narrow and specific as possible.

We appreciate having had this opportunity to give you our

views. Please let me know if we can provide you with any

additional information, or can be of further assistance in any

other way.

Sincerely,

Ju ~U ('CUM L(~ (.. L~b cl

William MacLeod

Director

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