Start-Up Says It’s Changing Eye Care for the Better. Others See It Differently.

The colorful ads on Facebook and Instagram promise a fantastic bargain: “Stop overpaying for contact lenses. Get 30 contacts delivered to your door for ONLY $1.” Captions like “wow” and “what a steal” splash across images of teal containers and lenses perched on fingertips, urging consumers to act fast.

This social media marketing has been integral to the growth of the online contact lens start-up Hubble since its founding in 2016. It has raised more than $70 million from venture firms and companies like Colgate-Palmolive, which are attracted to its plan to disrupt the contact lens industry by providing a line of low-cost daily lenses through monthly $39 subscriptions. It’s like Dollar Shave Club — for eyeballs.

But Hubble’s early success has been criticized by numerous optometrists and ophthalmologists, who say that its direct-to-consumer model bypasses eye care professionals, that it does not properly vet prescriptions and that it takes advantage of federal regulations to sell customers its own brand of contact lenses. The company, they say, switches people out of their prescribed lens brands and into Hubble’s lenses, sometimes to the detriment of consumers. Those lenses, they say, use a material that some consider to be outdated and can sometimes not fit properly.

The company says its sales are legal. And plenty of customers seem happy with the product. But others have developed eye issues after using the lenses.

CreditHubble, via Facebook

Bailey Brown, a 31-year-old in Dallas, developed a corneal ulcer in June. When she was treated at an ophthalmologist’s office, they asked about her lenses. “I said Hubble and they said, ‘Oh, that’s it. You’re not the first,’” she said.

Dr. Lauren Lodholz, an optometrist who practices in Lexington, Ky., said that she had seen complications in more than half of her patients who say they got their lenses from Hubble.

“They’re just assuming the lenses they get from Hubble are the same thing I prescribe them,” Dr. Lodholz said. “They see it’s a great price and see the bottom line.”

Contact lenses are typically fitted, prescribed and sold by optometrists, who often specify brands from major manufacturers like Acuvue Oasys or Biofinity Toric in prescriptions. Sellers can substitute another brand for the lens on the prescription, but only if the substitute lens is the identical product from the same manufacturer. (Some manufacturers make lenses that are sold under different names at retail chains.) Brands like Hubble can also be prescribed.

Other companies like 1-800-Contacts also sell major contact brands to consumers, filling orders through copies of prescriptions or getting the prescription information and confirming its accuracy with the consumer’s eye care practitioner.

The Federal Trade Commission, which oversees the market, allows what is known as “passive verification.” Under this method, sellers can try to verify prescriptions through faxes and voice messages and, if eye doctors don’t respond within eight business hours, the orders can be filled. The rule was created in the early 2000s, when companies like 1-800-Contacts pushed to sell brand-name lenses and ran up against eye doctors who did not want to work with them.

Hubble — and its founders and co-chief executives, Ben Cogan and Jesse Horwitz — saw an opportunity in the rule.

A sudden jump in Mr. Cogan’s lens prices in 2015 led to the idea for Hubble — monthly shipments of daily lenses that cost roughly $1 a day. (Prices have since increased.) At the time, he was working for Harry’s, the subscription razor brand, while Mr. Horwitz was on the investment team for Columbia University’s endowment fund.

“It was one of three or four or five things I was tinkering around with,” Mr. Horwitz said at a conference in January, “and we said for all of them, anything that I can go actually raise a seed round for and sort of have investors be stupid alongside me, I’ll go do that one. And so that’s why we did Hubble.”

In December 2015, when Mr. Cogan was seeking a lens manufacturer, he contacted Dr. Sally Dillehay, who was then the chief medical officer at a small lens company and has worked in the contact lens industry for more than 30 years. During a telephone call, Mr. Cogan laid out a plan to move consumers from their prescribed brands and into a private label brand through passive verification, Dr. Dillehay said. This would put consumers into a new type of lens that the patient’s doctor had not prescribed, she said.

“I told them I did not want to be involved with such a company and described in great detail why contact lenses are not generic items like socks or razors, how even small micron level changes in something such as the edge design can completely alter the fit and safety profile of a contact lens,” said Dr. Dillehay, who now runs a consulting company called ClinTrialSolutions in Georgia.

CreditDiwang Valdez for The New York Times

Hubble, in a written response to questions sent by email, said, “The suggestion that Hubble is engaging in impermissible contact lens substitution is simply not based on the facts or the law, and does not reflect our business practices or the standards by which we operate.”

Hubble declined to make Mr. Cogan or Mr. Horwitz available for an interview. It said it was no different from other online sellers that “routinely use passive verification” to fill orders. Hubble also noted that the F.T.C. does not require online sellers to ask customers to list the lens brand on their prescription.

“All Hubble customers are required to have a current prescription for the daily disposable contact lenses that Hubble offers,” the company said. “Hubble uses industry-standard policies and procedures to verify that customers who sign up for Hubble subscriptions have such valid prescriptions.” It declined to comment on Mr. Cogan’s phone call with Dr. Dillehay and did not say how many eye care professionals in the United States prescribe Hubble’s lenses.

In the past decade, attention has been heaped on hip new direct-to-consumer brands selling everything from razors to mattresses. Such companies have typically been built through social media marketing, often offering lower prices than established competitors and sometimes selling their products through subscriptions. Interest increased with successes like Unilever’s purchase of Dollar Shave Club for $1 billion in 2016.

When it comes to health care, however, a start-up’s bold ambitions can sometimes collide with regulations, doctors and patients.

About 45 million Americans wear contact lenses and an estimated 35 percent wear daily disposables. The market is dominated by brands from Johnson & Johnson, Alcon, CooperVision and Bausch & Lomb, and is tough to crack without support from optometrists. That was part of Hubble’s motivation — lenses, especially daily disposables, can be expensive, and the major manufacturers have been accused of anticompetitive practices in recent years. Many optometrists make money by selling contact lenses.

“This incentivizes eye care providers to both prescribe expensive lenses and thwart the efforts of online sellers to offer more affordable options, neither of which are good for consumers,” Hubble said.

Industry groups like the American Optometric Association, which have long been at odds with sellers like 1-800-Contacts, have been more critical of Hubble. Optometrists have complained that Hubble’s messages seeking verification can be difficult to understand, arrive at odd hours and refer to patients that they have never seen. A December 2017 report on the business news website Quartz detailed multiple instances of Hubble sending lenses to people who had entered fake prescriptions and made up doctor names.

Hubble’s website states that prescriptions “must be tailored to Hubble’s lenses” and that they are made by St. Shine Optical Company, a manufacturer in Taiwan whose products have been cleared by the Food and Drug Administration. Multiple Hubble customers told The Times they simply entered the strength of the lenses they needed and a doctor’s name and received their boxes.

As Hubble’s business has grown, its founders have been feted at advertising industry gatherings in New York and Cannes, France, where executives are keen to learn the ways of brands built on Facebook and Instagram. Hubble has appeared on “disrupter” lists with companies like the direct-to-consumer eyeglasses company Warby Parker and Harry’s and its marketing tactics have been described glowingly in a Harvard Business School case study. Its founders were on Forbes magazine’s 30 Under 30 list of leading young entrepreneurs in manufacturing and industry in 2017. And the company was mentioned prominently in an article in The New York Times Magazine about successful start-ups that built their business through advertising on Facebook.

Last year, Colgate-Palmolive took what it described as a “very small, passive stake” in the company. Hubble is providing marketing support to Colgate’s direct-to-consumer “oral care efforts” in the United States.

Investors have viewed Mr. Horwitz and Mr. Cogan as bright entrepreneurs taking on an entrenched industry — and with the law on their side. A 2017 review of Hubble by the venture firm FirstMark Capital, which was obtained by The Times, noted that the company’s dependence on passive verification was a risk but that the rule was likely to stay in place despite “constant attack by optometrists and sympathetic politicians.”

In May, the F.T.C., which has been reviewing its contact lens sales rules, made public a proposal to modify its regulations. It expressed concern “with what appears to be the use of prescription verification to change consumers from their prescribed lens to another brand of lens entirely.” It specifically referred to the rise of new companies reaching consumers through ads on Facebook. If a seller knows or should know that the verification request includes a different brand and manufacturer than what a patient was prescribed, that request is not valid, the agency said.

The F.T.C., which did not mention Hubble, said it believed that this type of “illegal substitution” was growing quickly and acknowledged anecdotal reports of eye injury from patients wearing lenses that weren’t prescribed for them. When contacted for this article, the agency said it did not comment on specific companies. Hubble said that the F.T.C. has never “specifically claimed” that an online seller using its allowed verification methods “is nonetheless engaged in impermissible contact lens substitution.”

Some contact lens fitters and industry experts say that the hydrogel material used by Hubble is outdated and could cause particular discomfort for lens wearers with dry or sensitive eyes. Hubble, in its statement, referred to a recent study of daily disposable lenses that said there were “no clinically significant differences” between hydrogel lenses and ones made with silicone hydrogel, which is used in more expensive lenses.

Dr. Dillehay said that complications could emerge from the absence of fittings and doctor involvement. “If this lens was never seen on someone’s eye, regardless of material, it may never have been the proper lens for that patient,” she said.

The Times interviewed eight people who complained of eye problems after ordering Hubble’s lenses online and the mother of a teenager who wore the lenses. One Hubble user, Ashley McCormick, 20, of Hackensack, Minn., said she woke up one morning in January, barely able to open one eye and seeing flashes of light. Doctors at the emergency room told her that Hubble’s lens material was problematic for her sensitive eyes and that the situation had worsened over several months of daily use. She was diagnosed with uveitis, an inflammation inside the eye.

CreditAshley McCormick

“By the time I put them in the following morning, even if it was a new pair, my eye wasn’t healing fast enough,” Ms. McCormick said. She said that she had not been aware that the lenses were significantly different from what her eye doctor previously prescribed and estimated that the problem cost her $1,000 in doctor visits, prescription eye drops, gas and lost wages.

“The convenience and affordability of Hubble’s subscriptions encourage customers to engage in healthy practices, instead of overwearing lenses to save money or to avoid the inconvenience of obtaining additional lenses if they run out,” Hubble said in its statement. “Hubble believes that patients should not have to choose between their eye health and their wallet.”

The F.T.C. has received 279 complaints about Hubble and Vision Path, its parent company, since 2016, according to a Freedom of Information Act request. Some of those complaints came from consumers who struggled to stop their subscriptions after signing up for an advertised free trial.

An investor presentation in January 2017 by Hubble outlined several new “retention initiatives.” The company said it switched to phone-only cancellations from 9 a.m. to 6 p.m. on weekdays and suspended emails, like notifications about a customer’s first paid order following a free trial, that were “reminding” people to cancel their subscriptions.

Critics, like the American Optometric Association, say this is another example of Hubble putting profits before patients.

“When you go to Hubble’s website, they’re not promoting good eye health and frequent eye exams and all the things necessary for good vision, they’re only promoting sales of what they do,” said Dr. Samuel Pierce, the former president of the industry group. “Every doctor I know, their goal is to make sure their patients have healthy eyes and the best vision possible.”

Email Sapna Maheshwari at or follow her on Twitter: @sapna.

This article is from NYT – go to source

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