1930s – 1950s

A number of optical retailers, often owned and operated by optometrists, began bringing modern marketing and retail operations to the ophthalmic goods and services industry.  These entrepreneurs introduced innovations to the market for eye examinations and corrective eyewear.

The optometrists and their business partners saw that there was public interest in having an alternative to the traditional approach of a single optometric office with a limited selection of frames on display.

These entrepreneurial optical retailers

  • Offered a broad selection of products, including a wide selection of frames and quality guarantees and warranties on eyewear
  • Opened during extended days and hours of operation
  • Welcomed prescriptions from any eye doctor
  • Advertised the availability and price of eyeglasses and eye exams
  • Used a brand or trade name (e.g., Lee Optical, Sterling Optical, Pearle Vision, Royal Optical, Texas State Optical, Wall & Ochs)
  • Located both eye exams and the optical dispensary together in a retail setting such as a retail area, shopping center or a host department store such as Sears, JC Penney’s and Montgomery Ward, rather than a medical building or private office

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1959

The National Association of Optometrists and Opticians (NAOO) was founded by entrepreneurial Doctors of Optometry (O.D.s/optometrists) and vision industry leaders to:

  • Foster the trade, commerce and interests of all members of the industry
  • Promote enlarged and friendly relations between those engaged in the various types of optometry and opticianry

Founders and early members included: Joe Cole; Clint DeWolf, OD; Don Golden, OD; Robert Hillman; Larry Kohan ; Stanley Pearle, OD; Galen Roe, OD; the Rogers brothers (Ben, Vic, Sol (OD) & Nate (OD)); Gene (OD) and Ted Schanbaum; Eli Shapiro, OD; and Sid Weinrib, OD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1960

NAOO incorporates as a 501(c)(6) not-for-profit business association

The NAOO founders formally established an organization to among other things:

  • Actively support efforts to make high-quality, cost-efficient eye care widely and conveniently available to all people
  • Aggressively defend the public’s best interest by promoting fair, vigorous competition and alerting lawmakers and the general public to the dangers of special interest attempts to restrict or inhibit vision industry competition
  • Affirmatively promote education programs to constantly improve the association members’ ability to deliver superior levels of care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1970s

NAOO supports Federal Trade Commission (FTC) efforts to promote the right of optometrists to use truthful advertising related to their eye exam services and dispensing practices. The association also promoted and supported efforts to empower consumers with the automatic release of prescriptions for eyeglasses, thereby allowing consumers to comparison shop.

This FTC investigation commenced in September 1975, a proposed rule was issued in January 1976 and the Staff Report was released May 1977.

The purpose of this FTC action was to increase the availability of material information about price and quality of eyewear and eyecare.

The second broad issue addressed in the FTC investigation and rulemaking leading to the Eyeglasses I Rule related to prescription release.  The FTC found that if consumers were to be able to choose where to buy eyewear and to take advantage of the information that advertising would provide, the consumer had to be given the prescription by the prescriber without having to request it and without charge or waiver requirements.[1]

These actions combined to increase the availability of material information about price and quality of eyewear and eyecare and spurs market growth for eye care and eyewear.  History will make clear that the ophthalmic goods and services market has grown significantly as a result of the ability of optometrists and opticians to advertise.[2]

During the FTC Eyeglasses I rulemaking, the NAOO supported FTC efforts to end public and private restraints on truthful advertising about ophthalmic goods and services. The NAOO submitted comments and testimony, which the FTC considered significant. The FTC listed the NAOO comments as one set of evidence that it referred to frequently.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1980s – 1990s

NAOO supports reduction in state law restrictions proposed by the FTC relating to restrictions on business relationships between optometrists and opticians, opening up business opportunities for both. The Association also encourages expanded marketing efforts to promote certified opticians.

During the rulemaking proceedings in 1976, a number of witnesses brought other restrictions on competition in the market for ophthalmic goods and services to the attention of the Commission. As a result, a second rulemaking process was authorized. The NAOO was also a participant in this rulemaking.

The evidence assembled in that proceeding showed that many regulatory and legislative restraints on commercial practice had harmful effects, including higher prices to consumers, reduced frequency of vision care and decreasing the overall quality of care provided in the market. The Association supported the reduction in state law restrictions proposed by the FTC relating to business relationships between optometrists and opticians, opening up business opportunities for both.

Ultimately, the DC Circuit Court determined that the FTC lacked the statutory authority to promulgate the rule because Congress did not authorize the Commission to regulate “state action.”[3] In essence, the “state action” principle protects the ability of the states to pass and enforce anticompetitive and anti-consumer laws.

A more recent Supreme Court case has made clear that the state action defense to federal antitrust laws has limits. If control of a state board is in the hands of decisionmakers who are “active market participants” in the regulated occupation (as is each state Board of Optometry), the state must meet a requirement of active supervision of the board.[4]  The FTC Bureau of Competition staff has provided guidance regarding how this impacts enforcement efforts.[5]

After the Eyeglasses II Rule, the FTC continued to examine anticompetitive and anti-consumer activities in the market for eye care and eyewear through research, cases (for example, against the Massachusetts Board of Optometry for unreasonably restricting truthful advertising)[6], consent orders (for example, with the Oklahoma Optometric Association)[7] and comments to regulators[8] about the potential impact of proposed regulation.[9]

Following the decision ending the Eyeglasses II rulemaking, NAOO worked with multiple state boards and associations to support the ability of optometrists to be able to choose a variety business structures, including leasing and franchising, implementing many of the relaxations suggested by the FTC. Some of the states include: CA, GA, OK, TX, NM, OH, NC, VA, NJ, WY, IL and FL.

Also during the 1990s, NAOO encouraged organized opticianry to undertake marketing campaigns to urge consumers to seek out certified opticians for their vision care.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2000s

NAOO continues to support efforts to empower consumers related to the required contact lens prescription release later imposed by Congress. It also supports and promotes direct to consumer marketing about the importance of regular eye examinations.

In 2003, Congress passed the Fairness to Contact Lens Consumers Act, which became effective in February 2004.[10]  That legislation required the FTC to adopt a rule to oversee the release of contact lens prescriptions, which had not been addressed in the Eyeglasses Rule.  The Commission promulgated the Contact Lens Rule in July 2004.

The Association’s work has, to date, resulted in a balanced rule that:

  • Provides greater flexibility in the manner in which prescribers can secure the patient’s acknowledgment of receipt of their prescription, which protects prescribers.
  • Imposes reasonable requirements on contact lens sellers to ensure the ease and completeness of the verification process for the prescriber by requiring sellers to make such requests in clear, legible, plain language, and (for oral communications) delivered in a cadence and volume that a reasonable person could understand.

Throughout the 2000s, NAOO was Instrumental in organizing and coordinating efforts around the “Think About Your Eyes” program. The program aimed at successfully educating consumers about the need for regular eye care to support good vision and general health and increasing the number of eye examinations performed in the US each year.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2010s and Beyond

NAOO continues its advocacy efforts both inside and outside the industry to foster access to high quality, cost-efficient eyecare and promote fair, vigorous competition for the public’s best interest. It also prioritizes useful, cost-effective continuing education for optometrists and opticians.Over its history, the NAOO has provided comments to federal and state regulators on a host of issues beyond support for the ability of optometrists to be able to choose a variety of business structures. Additionally, it has actively worked to educate licensed optometrists and opticians, as well as numerous optometry students. This work continues to this day.

Issues in support of optometry, opticianry and the industry include:

  • Rulemaking in GA (2019) – ability to supervise non-licensed assistants who were employed by another person
  • Optician licensing issues in multiple states, and in federal review of the consumer and professional impact of optician licensing
  • Ongoing participation as a member of the ANSI Z80 Committee for Ophthalmic Optics) along with the AOA, AAO, OAA & others
  • Developing a program for voluntary certification of on-line optical retailers
  • Offered numerous optician and optometrist continuing education programs, often at no cost to the attendees
  • Promoting diversity and inclusion in the professions of optometry and opticianry
  • Comments on the safe harbors under federal anti-kickback statutes
  • Issues related to privacy and security relating to patient health information, and providing free HIPAA training materials and tools
  • Coverage of eye care by vision and health plans
  • Use of telemedicine that meets the standard of care by optometrists
  • Support, as requested by state optometric associations, for scope of practice legislation. At no time has the NAOO ever opposed such measures

During the mid- to late-decade years, NAOO actively participated in the Optician Collaboration Forums and worked with several opticianry groups to develop and roll out the Model Optician Mobility Act of 2016. Those groups included:

  • American Board of Opticianry
  • National Academy of Opticianry
  • National Commission of State Opticianry Regulatory Boards
  • National Contact Lens Examiners
  • National Federation of Opticianry Schools
  • Opticians Association of America
[1] “If con­sumers are not guaranteed access to their prescriptions, any Com­mission action permitting truthful advertising would be a futile gesture.” https://www.ftc.gov/system/files/documents/reports/staff-report-advertising-ophthalmic-goods-services-proposed-trade-regulation-rule-16-cfr-part-456/r611003_-_staff_report_on_advertising_of_ophthalmic_goods_and_services_and_proposed_trade_regulation.pdf
  1. 280.
[2] The market in 1975 was only 52.6 million pairs of lenses, and the wholesale value of the frames and lenses sold was under $600 million.  Consumers paid optometrists an estimated $1.75 billion in 1975 for eye examinations, lenses, and frames.  Id. at p. 20.  In today’s dollars, that equates to $8.78 billion.  In 2019, the value of frames and lenses sold was actually almost $25 billion. U.S. Optical Report Card, The Vision Council “VisionWatch”, Sept. 2020.  Advertising and retailing clearly helped grow the market for all.
[3] California State Board of Optometry v. FTC, 910 F.2d 976 (D.C. Cir. 1990), reh'g denied, January 8, 1991.
[4] N.C. State Bd. Of Dental Exam’rs v. FTC, 135 S. Ct. 1101 (2015).
[5] https://www.ftc.gov/system/files/attachments/competition-policy-guidance/active_supervision_of_state_boards.pdf
[6] https://www.ftc.gov/sites/default/files/documents/commission_decision_volumes/volume-109/ftc_volume_decision_110_july_1987_-_june_1988pages_549-end.pdf
[7] Docket 9191. Complaint, Feb. 1985-Decision, Nov. 1985
This consent order requires the Oklahoma Optometric Association, among other things, to cease prohibiting any member optometrist from: affiliating with or operating franchises; operating branch offices; or truthfully advertising the prices, terms and availability of optometric services or optical goods.
[8]  In Letter to Virginia State Delegate, FTC Staff Supports Continued Competition in the Provision of Optometric Care to Consumers, https://www.ftc.gov/news-events/press-releases/2005/03/letter-virginia-state-delegate-ftc-staff-supports-continued
[9] For examples of FTC activity prior to 2006, see Statement of the FTC to Subcommittee on Commerce, Trade, And Consumer Protection, U.S. House Of Representatives, on Consumer Protection and Competition Issues Concerning the Contact Lens Industry;  https://www.ftc.gov/sites/default/files/documents/public_statements/prepared-statement-federal-trade-commission-health-care-competition/060915_v040010cpcicontactlensindustryhouse.pdf
[10] https://www.congress.gov/108/plaws/publ164/PLAW-108publ164.pdf