Last week’s debate in the House of Lords on a possible amendment to the Opticians Act 1989 has brought British manufacturer Adlens back into the optics spotlight.
Lord Richard Newby, Liberal Democrat chief whip in the Lords, proposed to allow the sale of adjustable focus eyewear ‘over the counter’ like reading glasses. Explaining the concept of adjustable focus glasses, he said: ‘They achieve the desired focus for each eye by turning a dial located at the side of each lens. The quality of definition achieved is extremely good, and to demonstrate this I am wearing a pair of these glasses this evening.’
The glasses that Newby was sporting were Adlens’ ViewPlus (formerly Emergensee) spectacles, featuring an Alvarez-style lens design which moves on rotation of a dial permanently located at the front of each temple. The company also produced spectacles named Hemisphere, with a fluid-based membrane which fills and changes the power of the lens when a barrel dial on the side of the frame is turned.
Once the correct refraction is achieved, the barrel is removed and the fluid chamber in the glasses sealed. Unlike the Alvarez design, the power cannot be continuously changed.
Adlens said the older fluid-based spectacles had now been phased out because manufacturing them in large volumes was difficult and costly. Dr Graeme MacKenzie, the company’s director for regulatory and industry affairs, added that the Alvarez style lens sign was more reliable, produced better optics and could be manufactured in greater volumes. ‘Alvarez technology has been used in phoropters in the past, so the optical performance is there,’ he said.
To his fellow peers Lord Newby outlined the statistics for the worldwide sales of Adlens’ products: ‘They are sold in some 57 countries worldwide, but the largest markets are Japan, where some 650,000 units have been sold, and the US, where some 500,000 units have been sold, many without a prescription.’
He added that they were particularly useful for patients with diabetes and cataracts, as well as in emergency situations.
‘The logical next step for Adlens would be to sell its glasses in pharmacies and supermarkets in the UK in the same way in which reading glasses have now been sold for 27 years. In order for this to happen, an exemption needs to be specified under the Opticians Act 1989 to allow them to be sold without a prescription,’ said Lord Newby.
An exemption required
Getting an exemption would mean using the Deregulation Act 2015. Newby said he had already contacted the minister in charge of the bill, Oliver Letwin, who referred the matter to the General Optical Council last year.
The talks between Adlens and the GOC took place last June and a report was commissioned and subsequently delivered by Dr William Neil Charman of the University of Manchester in the autumn. On the GOC’s standards committee’s response to the report, Newby said: ‘It turned a very balanced and positive assessment into a litany of objections, some of which were, frankly, ludicrous.’
There were two primary objections, he said. Firstly, if sold over the counter, the product would reduce the number of people who have eye tests and therefore a number of eye diseases would go undiagnosed. Secondly, if used for driving, they would be unsafe.
‘The GOC basically believes that restricting access to eyewear will force the public to have their eyes tested more regularly,’ said Lord Newby. ‘However, this approach has failed in almost every public health initiative to which it has been applied, whether for the management of hypertension, obesity, diabetes and alcohol abuse.
‘If I were a cynical type, I would think that some of the arguments put forward by the GOC and the Optical Confederation were designed to maintain the current rules in order to require people to go to an optician who did not need to’, he said.
It was suggested that awareness initiatives such as National Eye Health Week and Think About Your Eyes were better methods of ensuring more frequent eye tests.
Lord Faulkner of Worcester, a former researcher for the Labour Party, backed Lord Newby’s stance. ‘It seems to me that the arguments used by the General Optical Council in blocking the change and repeated in the briefing it has sent us for this debate are examples of protectionism of the very worst kind. I understand that they are similar to the arguments it employed when it attempted to block the removal of restrictions on the sale of reading glasses in supermarkets and pharmacies nearly 30 years ago.’
Lord Faulkner and Lord Newby have both previously visited the Adlens headquarters. Lord Newby told Optician he was very impressed by the company’s work and raised the matter in the Lords because he was appalled by the attitude of the GOC. ‘Instead of being willing to support this innovation, it seemed determined to prevent the sale of these glasses.
Opting not to respond to the criticisms levelled at it in the Lords, the GOC said: ‘Any change to the law would be a matter for government, not for the GOC. To help inform the government’s view we commissioned an independent report from Professor Charman, and also sought the views of our statutory standards committee.
‘Throughout the process we have made clear that no change to the law should take place without thorough public consultation, including with the optical sector. This would allow government to consider the widest possible range of expert opinions in deciding whether to amend the Opticians Act to allow for non-prescription sales of over the counter spectacles.’
[CaptionComponent="2248"]Scientific evidence
Professor Josh Silver, an Adlens co-founder and former board member, has queried whether Lord Newby, whose background is corporate affairs and corporate social responsibility, was motivated by the right reasons in raising the question in the House of Lords
He questioned whether there was proper scientific justification for his advocacy or if the matter was raised on commercial grounds. ‘In an area as important as vision, one must only work from a proper scientific research base, especially with a new clinical procedure such as self-refraction,’ he said.
‘Adlens has also pointed to my own published clinical research with my original Adspecs fluid-filled variable power membrane lenses as some form of “evidence” that self-refraction with their newer Alvarez-Lohmann lens glasses will work as well as with the Adspecs. But the Adlens Alvarez-Lohmann lens glasses have not been clinically tested, and are optically very different from the Adspecs, especially with regard to peripheral vision. Even without a proper clinical trial there is even already some evidence emerging that self-refraction with the current form of Alvarez-Lohmann lens simply does not work well for everyone, so that clearly significantly more research is needed.’
He added that he was no longer associated with Adlens in any way, having resigned when the board voted to stop working on eyewear for the poor in the developing world.
Dr MacKenzie admitted that the study, conducted in 2010 with children from America and China on their ability to self-refract, did use the fluid-filled lenses as pointed out by Silver. However, he said it wasn’t practical to carry out a clinical study when each different type of adjustable focus was developed or refined.
Adlens is no stranger to litigation. In November last year, the company won a ‘landmark case’ which permitted the sale of its products in the state of Arizona. The Arizona State Board of Dispensing Opticians had argued that readymade glasses could only be used for near vision correction, unlike Adlens’ product, which corrected both distance and near vision.
The company commissioned a consumer trial in Phoenix to demonstrate that many hyperopic individuals used conventional over-the-counter reading glasses to correct their distance vision, even while driving, which it said offered a precedent for the sale of over-the-counter eyewear for the correction of both distance and near vision. The original objection was abandoned after taking advice from the assistant attorney general.
In the UK, the matter looks set to rumble on. Responding on behalf of the government, Lord Prior, the parliamentary under-secretary of state for the Department of Health drew a clear distinction between reading glasses for a specific task and self-adjustable glasses which were for wider use and could potentially lead people to think their vision needs have been met.
An independent review was tabled during the House of Lords debate, but Lord Prior proposed that further dialogue should take place between Adlens, the GOC and the Lords. However, he added that the government was not minded to consult on this issue in the near future.