Editor’s Column September 2026
Save as PDFConflict of interest: The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Several months ago, I found myself waiting in a long line to get through security so I could get into a nondescript building on Capitol Hill in DC. It was cold, I had my hands full with papers, and we were being told we had to take our belts off, so I was wondering how I was going to hold everything without my pants falling down. I was at the “AOA on Capitol Hill” event. Ostensibly, I was there to advocate for modernizing eye care for Veterans, but in truth, I was curious. I’ve been in eye care for 25 years now and have benefited from the modernization of the optometry profession, but never really participated in that change. I wanted to see how it was done.
How it was done was flying down to DC on a Sunday night. Meeting in a big conference room all day Monday to learn about the issues we were to advocate for the next day. And finally meeting with staffers and members of Congress on Tuesday, then flying out on Tuesday night. It was fun but tiring. I was part of a three-person delegation from my state, and we met together with people from eight different offices that day. I spoke about the importance of allowing Veterans to have better access to modern treatment, especially for glaucoma. But the biggest push that day was to have stronger regulation of Vision Benefit Managers (VBMs).
Many in our audience are familiar with VBMs. The two dominant ones in the US are VSP and Eyemed. In most states, one of these two companies owns over 75% of the market. They own the vision insurance companies to which your patients belong; they own a huge amount of frame choices from which your patients choose; and they own most of the optical labs from which your patients get their lenses. That vertical integration allows them to set prices without the fear of patients going elsewhere because there isn’t anywhere else to go. They can push lopsided contracts onto eye care practices because, without accepting the contract, the practice will lose access to over 75% of potential patients in their state. Eyemed is owned by EssilorLuxotica, which owns Lenscrafters, Pearl Vision, Target Optical and Sunglass Hut. VSP owns Visionworks and Eyemart Express. They require sales quotas of VBM-made frames and lenses; they require doctors and patients to use VBM-owned optical labs.
It seems like a cause perfectly designed for Congress to take action on: large corporations using market dominance to increase profits at the expense of American citizens. And I do think Congress will take action. There are bills in both the House and the Senate (the ‘DOC Access Act’ in the House and the ‘Vision Lab Choice Act’ in the Senate) which aim to combat VBM abuses. When my delegation was explaining the VBM situation to some Congressional staffers, we drew a lot of attention by noting that this is the eye care equivalent of what Dr. Glaucomflecken talks about when he lampoons Pharmacy Benefit Managers (PBMs) in his videos. Turns out even Congress likes Dr. Glaucomflecken! Here’s a great one where Jimothy learns about PBMs and here’s one where Elizabeth Warren guest stars to shine light on the Senate’s anti-PBM bill.
The reason I’m bringing this up in this column is not only to create action against VBMs but to say that it felt satisfying to be acting to help a cause. Many of us who read journals like this one have a voice in our workplaces, within our families, and in our communities. We’re all very busy, but it can feel good to put our voices to work for the greater good. Find something you can do in your community to give power to your voice. Perhaps one way to do that is to write up that case report you’ve been meaning to do. Harriette Canellos, Sherry Bass and Inwhan Lee did just that in our Featured Article this issue. They present a fascinating but sad case of a child with Kearns-Sayre Syndrome, who they followed for over six years. The article describes how the disease progressed in their patient, then explains the disease’s pathophysiology and how these things can happen. It’s a necessary read to be the person who can catch this disease in a patient who shows up in your chair. Thanks to them and to all the authors of this issue.
Dr. Rett is the Editor-in-Chief of the Journal of Medical Optometry and the secretary for the American Board of Certification in Medical Optometry. He is the Chief of Optometry at VA Boston and sits on the national Field Advisory Board for Tele Eyecare at the VA. He is adjunct clinical faculty at several optometry schools, lectures nationally and enjoys writing about eyecare whenever and wherever.
