Walmart has optical centers in 47 states, but none in the goliath retailer’s home turf of Oklahoma. It’s not for lack of trying. The Oklahoma Association of Optometric Physicians (OAOP), having been early adopters of the medical model for optometry, has long challenged big box chains’ attempts to move into the optometric space. Part of that included supporting “two-door laws” in the Sooner State—which would require companies such as Walmart to entirely separate doctors from their stores.1 That includes different phone lines and websites, different marketing and a physically walled-off locale.

“That doesn’t fit their business model,” explains OAOP President Jason Ellen, OD. “Walmart wants control over the medical portion of the eye exam so they can profit from increased glasses prescriptions,” he believes.

Having failed to tear down that wall legislatively, Walmart has backed a state ballot question—which will appear before voters in November—that would alter the state’s constitution. This change would go even further than any of the 47 other states where ODs practice in stores by cutting out the state board’s oversight altogether. The language, as it is set to appear on the ballot itself, states that the measure “does not prohibit optometrists and opticians from agreeing with retail mercantile establishments to limit their practice.”

Potentially, this provides the opportunity for Walmart or any other employer to dictate that their ODs only generate prescriptions and do not perform comprehensive eye exams, a state board requirement. If the question is approved, patients who seek prescriptions at a Walmart could get a refractive exam, but skip a dilated fundus exam, a visual fields test and a measure of intraocular pressure.

However, Anne Hatfield, Walmart's director of communications, denies that any such changes to a comprehensive ocular exam will be made and says that any patient who visits an optometrist in a Walmart in Oklahoma will receive the same diagnostic services as any other patient in the state, including front and back of eye exams and screening for diseases such as diabetic retinopathy and glaucoma, from a doctor who passes the same licensing as any other OD in the state. She does note that, due to space issues, Walmart optometrists will not perform some of the surgical procedures that other ODs in the state can provide under Oklahoma’s scope-of-practice laws.

“The state board says that no commercial entity (especially Walmart) can dictate what constitutes the standard of care for an eye exam,” Dr. Ellen says. “This is going to create a massive legal quagmire of who is in control of how your doctor's practice. Physicians will lose their independence, and that puts an undue non-medical stress on the doctor.” Meanwhile, Ms. Hatfield says Walmart is taking its cues from customers who, she says, are seeking convenience.

Fighting Back

In an effort to defeat the proposed constitutional change, the OAOP must take on a financial powerhouse. Walmart remains the world’s largest retailer and employer.2

“They traditionally spend between $5 million and $8 million on a campaign like this,” says Joel Robison, the Association’s executive director and CEO. “We are going to put forth a campaign of approximately one and a half to three million dollars.” A lot of that money, he says, comes from contributions from other state associations. He says the OAOP wouldn’t be able to inform the public without the donations it’s received from 14 different state optometric associations, ranging from $1,000 to $10,000 (plus aid from Vision Source and EyeMed Vision Care). California’s Optometric Association is the latest to join the battle, pledging a $10,000.

Dr. Ellen says these other groups are contributing so much because this sets a precedent for all states. “No other state has the scope of practice of optometry mentioned in the state constitution. In every state, the state board still has authority to protect the public with oversight of the optometrist. 793 would change that,” he explains.

Oklahoma’s state question 793 “puts at risk the public’s health and welfare by limiting the independent clinical judgment of our proud profession,” says Ranjeet Bajwa, OD, president of the California Optometric Association, in defense of that group’s contribution.

But while it could never match Walmart’s wallet, optometry does have a secret weapon. “What we have that Walmart doesn’t is patients in every county of Oklahoma,” Mr. Robison says.

The OAOP is encouraging its members to speak to each patient individually about the harm and cost of the proposed constitutional change and reaching out to voters online.

“Walmart hopes people care more about cheap glasses than eye exams. Getting cheap glasses is not hard to do in Oklahoma. What’s important is getting a comprehensive eye exam,” Mr. Robison says.

1. Certain practices in mercantile establishments prohibited. Justia US Law Accessed July 19, 2018.
2. Walmart. Fortune 500. Accessed July 19, 2018.