AOA and South Carolina doctors expose and defeat retail lobby group’s influence scheme

For state associations and the AOA, advocating for optometry practices and patients and serving as the most trusted health care policy resource for lawmakers is a round-the-clock undertaking. The importance of these efforts is being reinforced as South Carolina’s doctors of optometry and the AOA are facing off against a lobby group that deceptively implies it represents doctors of optometry when in fact it works on behalf of large optical retailers.

In February, the National Association of Optometrists and Opticians (NAOO), the misleadingly named group known for its claims to represent doctors of optometry, sent a letter to the House Regulations and Administrative Procedures Committee in the South Carolina legislature unilaterally calling for specific changes it wanted to rules affecting optometric practices and doctors of optometry across the state. For instance, it called a portion of practice sanitary standards “impractical” while also seeking elimination of references to monitoring and testing when referring to cleaning and disinfecting office equipment. The NAOO also urged elimination of language regarding recordkeeping of sanitation efforts and deemed “unnecessary” a requirement that optometrists provide parents of minor children “an information sheet” that summarizes services provided during visits.

Although the NAOO cited itself as representing “thousands of employed and affiliated optometrists and opticians,” the letter was not signed by a doctor, nor did it include a reference to any related finding of or view expressed by a doctor.

One legislator at first thought the letter detailed the view of a national organization representing doctors of optometry. Others were facing similar confusion until the South Carolina Optometric Physicians Association (SCOPA) doctors and staff, who actively monitor the state capital and make certain that only doctors represent the profession, learned of the letter and weighed in with accurate information. After rounds of fact-checking meetings in the state capital led by SCOPA, the AOA also took action by renewing its insistence on a government inquiry into the operations of the NAOO through a March 7 letter to the Internal Revenue Service (IRS).

“If massive retailers want to lobby against basic patient health and safety standards, our government agencies must know and respond decisively by requiring that they do so under their own names and not ours,” said AOA president Robert C. Layman, O.D. “As the AOA insists on full accountability at the federal level, we will also make it clear that large retail-focused corporations—especially those with a record of diminishing the doctor-patient relationship—and their paid lobbyists are never recognized to speak for the profession of optometry or any of our doctors.”

According to Dr. Layman’s letter to IRS Commissioner Charles P. Rettig, there must be a comprehensive review of conditions that allow “a 501(c)(6) tax exempt association [misleadingly] claiming to represent licensed professionals when the membership is not made up of those professionals…This is especially important to the AOA in light of the anti-parent and anti-patient positions being taken by the NAOO, which unfairly impugn the reputation of the nation’s dedicated doctors of optometry.”

Dr. Layman adds, “Underscoring the urgency of our request, we were informed that members of the South Carolina House Regulations and Administrative Procedures Committee, to whom the NAOO letter was addressed, were initially under the false impression that the NAOO was affiliated with the AOA.”

The NAOO’s website acknowledges that primary membership is open to “retail optical companies with brick-and-mortar locations where optometrists provide eye care,” with affiliate membership for companies and vendors supporting those retailers. According to its website, the NAOO’s members include:

• America’s Best Contacts & Eyeglasses
• Warby Parker
• Vision Essentials by Kaiser Permanente
• Eyemart Express
• For Eyes
• Walmart Vision Center
• Costco Optical
• JC Penney Optical
• Eyeglass World
• Now Optics (retail brands My Eyelab and Stanton Optical)

Being present

It started out as a casual comment—made to SCOPA’s Executive Director Jackie Rivers and a member doctor at the state house in Columbia, South Carolina—that led to grounds for serious concern. A result of being at the right place to hear the remark and relationships built over the years with SCOPA and lawmakers.

“We found out about the NAOO letter because the chairman of the regulations committee brought up in passing that ‘your national group contacted us about the proposed optometry regulations,’ No doubt their name, National Association of Optometrists and Opticians, was misleading,,” says Johndra McNeely, O.D., legislative director for SCOPA and chair of the AOA State Government Relations Committee, adding that the AOA affiliate reached out to the chair to set the record straight.

“Fortunately he (the chair) is more interested in what our local doctors think than what a corporate interest thinks as far as how we take care of our patients,” she says.

“We knew from previous battles that AOA and numerous states had faced egregious and potentially patient-harming attacks from NAOO, which is why we were armed and ready to inform the chairman of the House Committee on Regulations and Administrative Procedures,” says Jackie Rivers. “We support the request by Dr. Layman. This group and others who are misleading lawmakers and the public need to be held accountable and should be revealed for who they are and what they do.”

A pattern of misleading the public

In late 2020, the NAOO joined with the internet contact lens sales industry in attacking the AOA-backed Contact Lens Rule Modernization Act and sought to undermine optometry’s support in the U.S. Senate. The menacing escalation of the group’s influence campaigns against doctors and patients was further exposed last year by Art Epstein, O.D., chief editor of the weekly e-newsletter Optometric Physician™: “Essentially, the NAOO purports to represent doctors of optometry … while actually representing the interests of [major companies]. [Flying under] the radar for many years, its recent unholy alliance with [online contact lens lobbying interests] has increased their visibility and has made their assertions of professional representation more dangerous.

“For my colleagues in the trenches, if you think NAOO activities don’t affect you, think again,” Dr. Epstein wrote. “The NAOO does not represent optometry.”

NAOO frequently at odds with optometry in the states

The NAOO’s very name implies it represents the interests of doctors of optometry, however it has directly worked against doctors of optometry in favor of large optical retailers.

Like the AOA, several state affiliates have faced NAOO attacks and lobbying efforts.

About a decade ago, Thomas R. Cheezum, O.D., a longtime advocate for the profession, remembers an appearance by the NAOO during a scope expansion battle by the Virginia Optometric Association (VOA). To legislators at the time, in a subcommittee hearing, the NAOO’s very name implied that it represented doctors of optometry, Dr. Cheezum says.

Yet, when asked to produce a membership list or to have an optometrist testify on its behalf in the hearing, the NAOO representative was unable to produce either, he says.

“They’re taken at face value at first, but it is a very deceptive name,” says Dr. Cheezum, who was on the VOA’s board at the time. “We made it very clear to the legislators that it was not an organization that represented optometrists in our state in any way and that it was run by corporations to benefit the corporations.

“Their motivations are whatever benefits them,” he adds. “It’s an organization that purports to represent all these folks. But it doesn’t.”

Jim Zieba, J.D., executive director of the Indiana Optometric Association (IOA), noted its active lobbying in an attempt in 2020 to repeal vision health protections in the state’s telemedicine law.

“Online contact lens companies used NAOO in an effort to give the appearance that there was a split within the profession to counter the efforts of the IOA," Zieba says.

"NAOO serves the interests of big-box sellers of glasses and contact lenses over efforts to protect and promote full-scope optometry," he adds. “NAOO was thwarted from achieving its goals, but its involvement did confuse some legislators. NAOO did not hide its relationship with big-box stores, but its involvement had an adverse impact on the position of organized optometry.”

Similarly, in Rhode Island, the group has attempted to undermine the legislative agenda of doctors of optometry.

Paul Zerbinopoulos, O.D., a member of the Rhode Island Optometric Association (RIOA), called the NAOO’s intervention “deeply troubling.” The NAOO has been repeatedly mentioned in legislative testimony and written materials in a number of states proposing safeguards for comprehensive vision care legislation, as representative of optometry when there is no apparent optometric representation in the organization, Dr. Zerbinopoulos says.

“They state that the slit lamp examination of contact lenses is not required and that there is little medical benefit to an annual contact lens evaluation,” he says. “This is stated in testimony (by NAOO) despite the fact that a slit lamp exam is accepted as the standard of care by optometry and ophthalmology alike to ensure best practices in contact lens wear and eye health.

“The NAOO in Rhode Island has worked specifically to undermine the doctor-patient relationship,” he adds. “They actively oppose legislation seeking to ensure medically accepted standards of care for telemedicine. Alternately, they propose acceptance of technology clearly not meeting the definition of the standard of care for telemedicine in any state in the country. In my opinion, it is antithetical for an organization to proclaim they represent optometry in any fashion and then seek to undermine clinically accepted standards of patient care and telemedicine.”

Wanting to explain the position of the RIOA on telemedicine, Stephen Montaquila, O.D., RIOA past president, AOA Federal Relations Committee member and former AOA Third Party Center Executive Committee chair, reached out to the group because he was “deeply disappointed and disturbed” by its approach to legislation.

Not only had the NAOO lobbied against consumer protection legislation supported by local optometrists in Rhode Island, but the group also was giving the impression that it represented optometrists, not the optical retailers it truly represents, he says.

“I wanted to discuss both the misrepresentations and also I was happy to further discuss our bill in detail but quickly learned that they did not want to discuss telemedicine; rather, they just want to oppose regulation,” Dr. Montaquila says. “They don't advocate for the protection of the patient and didn't want to discuss the intent of the legislation.

“My primary concern with this group is its misrepresentation to our legislators,” he says. “They give the impression that they are representing the profession. This is, of course, not true. They do not in any way clearly state in their communications that they represent the optical retail industry and not doctors of optometry or ophthalmology; rather, they mislead suggesting that they do in fact represent doctors in some way.”

AOA presses the IRS to take action

In the March letter to IRS Commissioner Rettig, the AOA expressed its concerns over the deceptively named NAOO. It has charged that, despite its name, it actively works against the interests of doctors of optometry, as it said in the earlier correspondence with the federal agency.

“Recent actions by the NAOO highlight the need to address the issue of a group co-opting the name and respect accorded the profession of optometry in order to promote an agenda that is opposed by the actual members of the profession and their legitimate professional associations,” Dr. Layman says. “As a reminder, the NAOO, which describes itself as representing, ‘the retail optical industry and its thousands of employed and affiliated optometrists and opticians,’ does not in fact have any individual optometrist members. The NAOO is actually funded by a small group of large optical retailers, which take positions opposed by practicing doctors of optometry.

“In a recent letter to the South Carolina House of Representatives, the NAOO argues against improved standards for cleaning and disinfecting equipment and instruments used in providing optometric care to patients,” he continues. “The group (NAOO) also opposes a rule that would require providers to provide parents of minor children an information sheet outlining the care provided to their children by the children’s physicians. Needless to say, actual doctors of optometry, as represented by the American Optometric Association (AOA), the largest and most representative professional association for practicing optometrists, support the highest standards of cleanliness and safety in the office as well as full transparency for parents of their patients.”

Through earlier contacts with the IRS, the AOA has been notified that the agency maintains an ongoing audit program to ensure compliance with the Internal Revenue Code and that it will consider the information the AOA had submitted under the program.

AOA's State Government Relations Committee volunteers and staff are working side by side with state associations to ensure that doctors of optometry are heard loud and clear as health policy decisions are being made. For more information on how to get involved in advocacy, please connect with AOA staff at stateadvocacy@aoa.org.