Eyeglass and Contact Lens Prescriptions Policy
Board Policy on Eyeglass and Contact Lens Prescriptions, FTC Eyeglass Rule, FTC Contact Lens Rule, and FTC Fairness to Contact Lens Consumer Act
The law is very precise in the differentiation of eyeglass and contact lens prescriptions and therefore each will be discussed separately.
Release of Eyeglass Prescription – FTC Eyeglass Rule:
The FTC Eyeglass Rule requires optometrists and ophthalmologists (prescribers) to provide patients with a copy of their eyeglass prescription immediately after an eye exam that includes a refraction, without extra cost, even if the patient does not request it.
Prescribers can require patients to pay for their eye exam before giving the patient a copy of the prescription, but only if they also require immediate payment from patients whose exams reveal no need for glasses, contacts, or other ophthalmic goods. Proof of insurance counts as payment for eye exam fees.
Eyeglass Prescription Must Include:
Minimum information required pertaining to the lens power(s) on such prescriptions include the following for both the right and left eyes: the spherical power, the cylindrical power including the axis, prism (if prescribed) and the power of the add (when prescribed). Special requirements such as the type of lens, tints, coatings, polycarbonate, etc. may be included where such requirements may be indicated.
The expiration date should also be indicated on the prescription. The prescriber in his or her professional judgment should consider how long the prescription should remain reasonably accurate. Typically, a glasses prescription has an expiration date of one or two years. If the expiration date is shorter than one year, the prescriber should reference the reason in the patient’s medical record.
The eyeglass prescription should indicate, “Eyeglass Rx Only” or “Not for Contact Lenses” or similar so it is clear the Rx is for Eyeglasses only. An eyeglasses prescription should never say, “OK for Contact Lens.”
Filling the Prescription - Selection and Ordering of Eyeglasses by the prescriber or any other licensed provider.
It is the responsibility of the professional filling an eyeglass prescription to make the appropriate frame selection for the patient’s prescription related to the physical measurements of the patient’s anatomical features to ensure a proper fit of the eyeglasses on the patient’s face. Such measurements include but are not necessarily limited to the intended wearers facial features, the size and shape of the frames selected by the patient into which the lenses are to be mounted, appropriate inter-pupillary distances (distance and near) for the accurate decentration of the lens, and the segment heights when progressive or multifocal lenses are prescribed.
Inter-pupillary distance or PD:
The PD is not considered part of an eye exam, but part of the measurements obtained in the fitting of eyeglasses. If a patient is having eyeglasses fabricated by an outside provider, it would be the responsibility of that provider to take the PD measurement. If a patient is requesting this measurement from the prescriber, the prescriber can charge a fee for this measurement.
Professional Dispensing of Eyeglasses:
In keeping with the above, and before the dispensing of prescription eyewear to a patient, the accuracy of the prescription should be verified by the prescriber or provider as to the accuracy of the lens power(s) and the proper decentration of all variables. In those instances where multifocal or progressive lenses have been prescribed, the height and decentration of the ‘adds’ should be verified, and the eyewear adjusted comfortably to the patient’s face before it can be said that the prescription eyewear has been ‘properly dispensed’ in accordance with the prescription.
On-line purchase of eyeglasses:
It should be noted that fitting eyeglasses by an on-line provider can be a challenge when measurements of the eyes and how the glasses fit to the patient’s face cannot be directly obtained. When the patient receives the eyeglasses in the mail, the patient usually has no way of having the eyeglasses professionally dispensed as is described above in 1. e. unless the provider has made arrangements locally for this service.
If a patient is having problems adjusting to the eyeglasses or the fitting of the eyeglasses purchased on-line, it could be a result of a variety of reasons including but not limited to: the prescription has not been fabricated accurately, fame not appropriate for the prescription or patient’s face, segment height too high or low, etc. When this occurs and the patient returns to the prescriber of the eyeglass prescription, often the prescriber can resolve or tell the patient how to resolve the issue with the on-line provider of the eyeglasses. It is reasonable and appropriate for the prescriber to charge a fee for this service.
CONTACT LENS PRESCRIPTIONS:
Release of Contact Lens Prescription – FTC Contact Lens Rule:
The FTC Contact Lens Rule requires optometrists and ophthalmologists (prescribers) to provide patients with a copy of their contact lens prescription immediately after a contact lens evaluation/fitting is completed and finalized, which often requires two or more visits. The prescriber should not finalize a contact lens prescription until he or she is confident the fit is satisfactory regardless of the number of fitting trials, etc. The Board feels strongly that a determining a satisfactory fit can only be determined by observing a contact lens on the patient’s eye(s).
It is usual and customary that prescribers charge a separate fee in addition to an eye exam for the contact lens evaluation/fitting. This fee can vary greatly based on the time the prescriber spends with the patient in determining the prescription, the type of contact lens being fit, and the difficulty of the fit. It is advisable for the prescriber and patient to discuss financial details of the expected costs prior to the evaluation/fitting.
Prescribers can require patients to pay for their eye exam and contact lens evaluation/fitting before giving the patient a copy of the prescription, but only if they also require immediate payment from all patients for their professional services at the time they are rendered. Proof of insurance counts as payment for eye exam fees, but many insurance policies don’t cover contact lens fitting fees.
The provider cannot charge a fee for providing a patient the actual prescription once finalized and the prescription must be provided even if the patient does not request it.
The provider cannot require the patient to sign a waiver to provide a copy of their prescription.
A patient and secondary contact lens seller can request an additional copy of a valid and unexpired contact lens prescription. A contact lens seller must show the prescriber they have the patient’s permission to request the prescription. The prescriber has 40 business hours to provide it to the patient or seller.
As long as the patient has given permission to the prescriber to release his or her prescription to a contact lens seller or business, there would be no violation of HIPAA.
Issue of compliance
While the FTC has rules prohibiting the illegal sale of CL, sales of CL without a valid and current prescription have soared as evidenced by reports from optometrists to the Board. With increasing numbers of patients purchasing contact lenses through alternative sources, primarily on-line sellers, a large percentage of patients are not returning for follow up appointments or not returning in an appropriate time period. The Board wants to emphasize that providers have the authority to discharge these patients from their practices due to lack of compliance and the risk these patients have of developing CL complications and serious infections while under their care.
It is further recommended that in the event a seller of contact lenses requests confirmation of an expired or otherwise invalid contact lens prescription, the prescriber should promptly respond to such inquiries within an 8 business hour period. Not responding could result in “passive permission” and the contact lens seller can legally sell contact lenses to a patient that was not generated from a valid contact lens prescription.
All issues related to a patient not being compliant with contact lens wear instructions, schedules, etc. should be documented in the patient’s medical record. If a patient is discharged for noncompliance or any other reason, he or she should be discharged in an appropriate manner.
Contact Lens Prescription Must Include:
Rx issue date and expiration date ( expiration period explained below)
Provider’s name, address, phone number and fax number
The type of lens and all specifications necessary for the ordering or fabrication, type and quantity of lens to be dispensed, number of refills authorized, all lens parameters as appropriate including name, power, base curve, diameter, material and/or manufacturer
The name of the manufacturer, the brand name, and the name of any identical lens from the same manufacturer, if that applies. If for a private label brand or store brand contacts (often sold by large eye care practices or optical chains) that also should be included.
If a patient requests a different brand of contact lens than you prescribed, you can require a refitting and charge for this service.
Contact lens expiration date - The Contact Lens Rule says that contact lens prescriptions should be good for at least a year. However, the provider can indicate a period of less than one year if in his or her professional judgment a medical reason suggests a shorter period and is documented in the patient’s medical record.
The FTC warns against a patient trying to buy glasses or contact lenses with an expired prescription. They state, “Your eye health changes over time, so it’s important to have regular comprehensive eye health exams.”
Trial contact lenses, so designated by the manufacturer, should never be sold to a patient.
A prescriber, prior to fitting a patient for contact lens should review his/her office policies with the patient including the cost of services and follow up expectations. If a patient does not accept and agree to these policies, the prescriber should not agree to accept this patient as a contact lens patient. Having the patient initial his/her acceptance of the policies is a good idea to prevent misunderstandings. When giving the patient his or her finalized CL prescription, a follow up appointment should always be scheduled.
Writing a Contact Lens Prescription:
A contact lens prescription should never be written for a year’s supply of contact lenses. Instead, it should be written like a prescription for a medication with a 1-month or 3-month supply. As an example, a XYZ brand one-day 90 pack should say: OD -3.00 D, 9.0 BC, 1 pack of 90 lens with 3 refills and OS …
COSMETIC CONTACT LENSES
Cosmetic contact lenses are contact lenses that can at a minimum change the color of a patient’s eyes to reshape the apparent configuration of eyes, such as cat-eye contact lenses or similar. Cosmetics contact lenses can have no prescription (plano) or contain a corrective prescription. Some cosmetic contact lenses are medical in that they actually correct the appearance of an ocular defect.
Regardless of the type or purpose of a cosmetic contact lens, they require a prescription which is written only after a prescriber determines the fit is satisfactory and will not harm the eye(s). Therefore, anyone selling these lenses without a valid and current contact lens prescription is selling them illegally.
VIOLATIONS OF THE FAIRNESS TO CONTACT LENS CONSUMERS ACT
What constitutes violations of this Act. A contact lens seller:
sells contact lens without a valid prescription or has not appropriately verified a valid prescription as required by the Rule
fills a prescription that the prescriber tells the seller, by direct communication within eight business hours after getting a complete verification request, is inaccurate, expired, or otherwise invalid
alters a prescription. If the seller submits a verification request for a brand that is not the customer’s prescribed brand, the seller may be violating the Rule by altering the prescription. The only exception is if the seller has submitted a verification request for a brand that the customer expressly told the seller is listed on their prescription. To qualify for this exception, the seller must ask the customer to give the seller the name of the manufacturer or brand listed on their prescription, and the customer must have told the seller that information. For private label lenses, however, the seller can substitute identical contact lenses made by the same manufacturer and sold under a different name
suggests or states that customers can get contact lenses without a valid prescription either in their possession or on file with the prescriber.
fills additional shipments of lenses once the prescriber has let the seller know that the prescription provided in the verification request was inaccurate, expired, or invalid, without re-verifying the request or getting a copy of the patient’s valid prescription
How to report a violation of provisions of the Fairness To Contact Lens Consumers Act (Public Law164.108) relating to the unauthorized filling of an expired or otherwise invalid contact lens prescription to the Federal Trade Commission.
Click the link that takes you to the Report Fraud Section on the FTC’s website. https://reportfraud.ftc.gov/#/
Complete the form skipping those questions that are applicable to your complaint. When you get to the place on the form that asks you to describe the complaint, indicate you are an optometrist reporting a violation to the Fairness To Contact Lens Consumers Act. Then supply all pertinent information about the complaint in an exact and factual manner including the company or seller’s name and the specifics about the violation of the Act. Make sure you include your contact information.
The Board has directed several optometrists to the above site to report obvious violations of the Fairness To Contact Lens Consumers Act. Following filing of the complaints, these optometrists indicated that the FTC neither acknowledged their complaint or followed up with how the complaint was investigated or resolved. This led the optometrists to believe their complaint was not investigated.
The Board would hope this was not the case. Reviewing the FTC’s website, the Board discovered reports of how a couple of violations of the Act were settled.
If you file a complaint and do not hear back from the FTC you can try to contact them by phone at 1-877-FTC-HELP (Consumer Response Center).
The Board would suggest if you do file a complaint with the FTC as directed above, to send a copy to our Board with any follow up communications from the FTC or results of your outreach to them by phone.
Finally, if a patient is harmed or injured by the illegal sale or filling of an invalid contact lens prescription:
please have the patient complete the following form: https://drive.google.com/open?id=1QvRTMAn29bVCeByOppAsW9UazR5PrpXpvseYfvQPqGc
Alternatively, if the patient is unwilling to complete the above form, please report the incident describing the violation and injury to the patient redacting the patient’s name and any identifying information. The patient’s age and race would not be considered identifying information.
FAIRNESS TO CONTACT LENS CONSUMERS ACT
Public Law 164.108 (December 6, 2003)
Information is believed to be accurate but not guaranteed.
The State of North Carolina and the North Carolina State Board of Optometry disclaims liability for any errors or omissions.
To verify any information please contact: North Carolina State Board of Optometry
521 Yopp Road, Suite 214 #444, Jacksonville, NC 28540
Phone: (910)-285-3160 Fax: (910)-285-4546,