Introduction

While it is clear that eye care professionals are concerned about the accessibility of eyewear available for purchase via e‐commerce Internet sites,1, 2 it is also clear that many members of the general public would argue that the Internet dispensing trend supports, ‘consumer choice, fairness and affordability.’3 The push to make eyewear available to purchase online was inevitable, considering the rate at which e‐commerce has taken off in the age of the Internet: there has been an overall shift from traditional storefronts to Internet shopping across products and services.4 Much of the research literature on this subject focuses on topics such as the complex psychology of shopping behaviour,5, 6 the demographics of technology use7 and the impact of website design on shopping decisions.8 Although analyses specific to online purchasing of eyewear are scarce, we know that online purchasing of contact lenses is on the rise: 10%–20% of contact lens wearers in Australia,9 the United States10 and the United Kingdom,11 have considered or researched the possibility of Internet purchasing. This proportion may be greater than 50%, according to a 2013 survey conducted by the Association of Contact Lens Manufacturers (ACLM)11.

There is clearly a gap in communication when it comes to this issue. With the 2010 deregulation of eyewear dispensing in one Canadian province (British Columbia) having impacts far beyond its borders, you could say that the horse has already jumped the gate. Any attempts to corral it back in are challenging because anyone from anywhere in the world can access eyewear online. So we need to ask, what options do eye care providers have?

We conducted a qualitative research study to find out what members of the public know about ocular health and eye care, and have reported on attitudes towards eye care12 as well as motivators for and deterrents to seeking eye care,13 both topics that we set out to understand better. Although we did not explicitly intend to explore attitudes towards Internet purchasing, the topic arose spontaneously in four out of seven focus groups. We believe that the themes raised by our study participants warrant attention.

Defining the problem

Sometimes it is useful to take a step back to define a problem clearly and concisely, if only to ensure that everyone with an opinion about it is on the same page and to clarify which problem we are trying to solve. There is often variability in the way in which problems associated with online eyewear dispensing are posed. It might be helpful to group them into the following categories:

1. Concerns about poor product quality, including prescription errors stemming from either the supplier or the consumer.1, 2, 14, 15
2. Concerns that ordering eyewear online cuts consumers off from access to professional advice ranging from clinical judgement to prescription adjustments.16
3. Concerns that online dispensing sends a message that purchasing eyewear is separate from seeking eye care and that regular eye care is not important.17-20

While the first category, and even the second category, could conceivably fall under the heading of ‘buyer beware,’ in that consumers have every right to make what experts see as ‘poor’ decisions, the third category seems urgent, based on what we know about consumers’ understanding of ocular health and care.

We know that many people think eye examinations are primarily about replacing eyewear12 and that they believe eye problems will be associated with obvious symptoms.12, 21-24 We also know that the general public has a limited understanding of ocular health, particularly with respect to the role of eye examinations, common eye diseases and their treatment,2, 3, 12, 13 and the risk factors for eye disease.3 With these findings in mind, our concerns shift from product reliability to consumer well‐being. Eye care providers want the public to understand that eye care includes attention to, among other priorities:

• Ocular manifestations of systemic disease, such as diabetes, hypertension and rheumatoid arthritis
• Ocular diseases and conditions, from glaucoma to myopia to strabismus
• Ocular health relating to eyewear, such as surface staining and vascularisation that can indicate problems with contact lens wear

Given the obvious draw to e‐purchasing, and given that studies show that the general public does not have a good grasp of the nuances of eye health, what can eye care professionals do to protect the general public‐‐ and do it effectively in a way that holds weight with consumers? We can’t begin to answer that question until we have a better sense of what consumers are thinking.

中文翻译：

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有关在线购买眼镜的患者意见

介绍

显然，眼保健专业人员担心可以通过电子商务Internet网站购买眼镜的可访问性1、2，但也很明显，许多普通公众会认为互联网配药趋势支持“消费者选择，公平和负担能力。” 3考虑到互联网时代电子商务的迅猛发展，促使人们可以在线购买眼镜的努力是不可避免的：从传统店面到产品和服务的互联网购物已全面转变。4关于这个主题的许多研究文献都集中在诸如购物行为的复杂心理学，5、6技术使用的人口统计等主题上。7以及网站设计对购物决策的影响。8尽管很少有针对在线购买眼镜的分析，但我们知道，在线购买隐形眼镜的人数正在上升：澳大利亚，美国10，英国9和英国11中有10％–20％的隐形眼镜配戴者已经考虑或研究了互联网购买的可能性。根据隐形眼镜制造商协会（ACLM）11于2013年进行的一项调查，该比例可能大于50％。

在此问题上，沟通显然存在差距。随着2010年加拿大一个省（不列颠哥伦比亚省）眼镜配饰的放松管制的影响远远超出了其边界，您可以说这匹马已经跨过了大门。将其重新收藏起来的任何尝试都是具有挑战性的，因为世界各地的任何人都可以在线访问眼镜。因此，我们需要问一下，眼保健提供者有哪些选择？

我们进行了定性调查研究，以找出有关眼睛健康和眼部护理公众知道的成员，并已报告了在眼部护理的态度12，以及用于激励和威慑寻求眼部护理，13个这两个主题，我们设置了更好地了解。尽管我们没有明确打算探讨对互联网购买的态度，但该主题自发地出现在七个焦点小组中的四个焦点小组中。我们相信研究参与者提出的主题值得关注。

定义问题

有时，退后一步来清楚，简洁地定义问题是有用的，只要确保对每个问题有意见的每个人都在同一页面上，并阐明我们要解决的问题。与在线眼镜配给相关的问题所产生的方式通常存在差异。将它们分为以下几类可能会有所帮助：

1. 对产品质量差的担忧，包括由于供应商或消费者引起的处方错误。1，2，14，15
2. 在线订购眼镜的担忧使消费者无法获得从临床判断到处方调整等专业建议。16
3. 担心在线配药会发出这样的信息，即购买眼镜与寻求眼保健服务是分开的，并且定期的眼保健并不重要。17-20

虽然可以想象第一类甚至第二类属于“购买者当心”的标题，但由于消费者有权做出专家认为是“不良”决定的权利，而第三类似乎很紧迫。了解消费者对眼保健和护理的理解。

我们知道许多人认为眼睛检查主要是为了更换眼镜12，他们认为眼睛问题将与明显的症状有关。12，21-24我们也知道，公众对眼睛健康的了解有限，尤其是在眼科检查，常见眼病及其治疗，2、3、12、13和眼睛危险因素方面疾病。3考虑到这些发现，我们的关注点从产品可靠性转移到了消费者的福祉。眼保健提供者希望公众了解，眼保健包括以下方面的重点：

• 全身性疾病的眼部表现，例如糖尿病，高血压和类风湿关节炎
• 眼科疾病和病症，从青光眼到近视再到斜视
• 与眼镜有关的眼部健康，例如表面染色和血管形成可能表明隐形眼镜的佩戴有问题

考虑到明显的电子购买吸引力，并且研究表明普通公众对眼保健的细微差别没有很好的了解，眼保健专业人员可以采取哪些措施保护普通公众，并有效地做到这一点。与消费者保持联系的方式？在对消费者的想法有了更好的了解之前，我们无法开始回答这个问题。