Any good doctor will tell you that the key to helping their patients is having good information.  The doctor needs to research a patient’s medical and family history, consider their symptoms, and then diagnose the most likely causes for the problem before suggesting a remedy.  A similar method of problem solving is supposed to happen in Washington, D.C.  Members of Congress and officials in the federal government are tasked to collect facts on problems that can be solved by government and then use those facts to help guide an appropriate response. 

At the present time, incorrect and misleading information is being disseminated in Washington, D.C. to promote a bill introduced by Senator Bill Cassidy (R-La.) that will be used to restrict the sale of contact lenses by online retailers and other retailers selling lenses outside of an optometrist’s office. In pursuing the Cassidy bill, The Coalition for Patient Vision Care Safety, a group representing the interests of contact lens manufacturers and the American Optometric Association (AOA), has claimed that buying lenses from alternative retailers, such as online vendors, can have an adverse effect on eye health, yet this claim is not supported by the vast majority of scientific literature on eye care. 

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For example, a 20-year epidemiologic study of contact lens related-keratitis published in 2007 by the medical journal Eye & Contact Lens found no increase in the incidence of microbial keratitis since the advent of online sales.  The study further found no significant difference in the incidence of keratitis from one geographic region to another (e.g. United States, Scotland, India, Sweden, Netherlands, Australia, and the United Kingdom), regardless of the varying extent of online sales in those regions.  Importantly, the study concluded that the principal risk factor for keratitis has remained “overnight wear of contact lenses.”

A 2012 study published in the medical journal Eye similarly found no difference in the incidence of keratitis between countries that require a prescription to purchase contact lenses and those that allow the purchase of replacement lenses without a prescription. The source of the contact lenses, whether online, a retail store such as Costco, or a doctor’s office, was also not listed as a risk factor in the report.  It is also notable that Sweden and the Netherlands, which had a lower incidence of keratitis for both daily and extended contact lens wearers compared to the United States, have online sales of contact lenses in the 25% to 35% range, while in the United States online sales are less than 20% of all contact lens sales.  As in the 2007 study, the major risk factor for keratitis was found to be overnight wear of contact lenses. 

Other studies also seem to confirm that hygiene behaviors are the same regardless of where contact lenses are purchased.  For example, a Centers for Disease Control and Prevention report from 2015 included a long list of risk behaviors for contact lens-related eye infections including overnight wear, but made no mention of where the lenses were purchased. 

Notably, the abstract of a yet-to-be-released study conducted by the CLAY Group, an optometric research organization formed by the Academy of Optometry and the AOA, and funded by a grant from Alcon, a leading contact lens manufacturer, also found that “the purchasing location of soft contact lens wearers showed limited association with known risk factors for soft contact lens-related inflammation.”  The abstract further noted that “closer access to the eye care professional by in-office soft contact lens purchase did not improve soft contact lens habits or reduce the prevalence of risk behaviors, leaving the relationship between proximity to eye care providers and the risk of complications unclear.” 

Members of Congress and officials in Washington, D.C. should take note that based on these authoritative scientific articles, it appears that online sales of contact lenses have not contributed to any increase in the incidence of contact lens-related microbial keratitis or other eye health problems.  In fact, it appears that, in many cases, countries with less restrictive regulations compared to the United States actually had lower incidences of contact lens-related infections.  Policymakers should consider these facts and reject the Cassidy bill or any other legislative or regulatory changes impacting the contact lens market that are based on biased, unsubstantiated health claims.


Paul B. Donzis, M.D. is Associate Clinical Professor of Ophthalmology, Cornea Division, UCLA School of Medicine.