The illusion of choice

There is a lot to be grumpy about in our industry.


If you had to distill down why we have got ourselves into some of this mess, it was when someone decided that an optical prescription was a commodity. Much of what is wrong in our industry comes down to this illusion of patient choice that people still cling to.


Ask yourself, why is patient choice a good idea?


Given a choice of where to access their medical care, people will search out the best services with the best outcomes. The medical practitioners who are good at their job and provide a good standard of care are rewarded with more patients. More patients generally mean that the service will benefit financially and grow, so the best stay in business and the best services grow. Those that don't provide a good service either go out of business or are forced to improve. Giving patients the choice in a service industry should mean that standards within that industry constantly improve and evolve, which ultimately benefits every patient.


Selling a vision


However, this does not work in the optical industry because the financial benefit of dealing with a patient comes mainly from the sale of a pair of glasses. The clinical skill and equipment needed for an eye test are not valued in the same way. This means we have the situation where a very skilled optometrist can go out of business if they don't sell glasses, but a bad DO can become very successful if they can get people to buy their glasses.


Since Covid’s onset, waiting lists have been jam-packed. At my practice we provide a minor eye conditions service for our area but many other optometrists have stopped theirs because it makes more financial sense to concentrate on selling glasses. So, although the public became more aware of patronising independent businesses and ‘supporting local’ during lockdowns, unfortunately it’s the same old problem: our practice’s reputation means it’s seen as the place to get an eye test, but not necessarily to buy glasses. Hence we help lots of people with eye problems, but they will still hop off to some other optician for that 2-for-1 frames deal.


So the incentive is to dumb down with quicker eye tests, undertrained staff and poor quality equipment; to spend on marketing and glossy adverts rather than clinical training and research. We are not rewarded by our clinical outcomes; instead we are graded on our conversion rates and average patient spend. Our industry is not performance related in the way that we as clinicians value it.


Our industry was set up to see the patient as a consumer and not a service user and it’s not evolving in a way that benefits them. Here, patient choice can only lead to a less clinically skilled optometry sector that is detrimental to their care. We shouldn't be surprised to still find in this day and age that we have optometrists who can't fit children with a decent pair of glasses or that patients choose to buy contact lenses online – a patient’s illusion of choice comes from not understanding the consequences of their choices.


The Grumpy Optician is a UK-based independent optometrist whose interests are the industry’s sustainability practices and telling it like it is.


NB: The views expressed by Chalkeyes are the author’s alone and not necessarily the views of NZ Optics, or its editorial team. If you wish to comment on Chalkeyes’ views, please email a brief letter to the editor at for consideration. Letters can be edited for space, style, grammar and clarity.



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