Optometry is a really weird business... Some of my readers know that I was once part of that business – not as an optometrist myself, but as a software provider for them. Veronique de Rugy has an (characteristically) excellent piece at Reason.
One weirdness she doesn't mention, as it wasn't relevant to her point, is that optometrists routinely under-price or even give away their exam services. This is unlike any other medical provider that I know of. It's as if all their training, experience, and specialized equipment was worth almost nothing. Why? Because their business model typically depends on giving away their services in order to attract customers for the “dispensing” side of their business: selling glasses and contact lenses. This makes them particularly sensitive to competition from discount sources for glasses and contacts, of course.
The solution would seem to be obvious: the optometrists should start charging a fair price for their services, and stop selling glasses and contacts at high markups. The problem is that many optometrists have tried exactly that – and failed miserably. Why? Because not all optometrists (even in a particular area) have switched models, and as long as there's even a single optometrist offering discount (or free) exams, that's of course where patients will go. Then they'll buy their glasses and contacts from a discount source.
As de Rugy points out, this is difficult today for contacts. It's not difficult at all for glasses, though: there are about 50 sources for discounted glasses on the Internet. I've used two of them myself. The glasses I got certainly aren't the best ones I've ever purchased – but – they are both properly constructed, the prescription was accurate, and they work fine. And they cost about a tenth of what I'd pay for the equivalent glasses at an optometrist ($76 vs. $850 for my last pair). They're made in China (of course!), and took about a week to get here. That's not really much different than the optometrist! I had occasion to use one of those glasses (which I purchased as spares) a few weeks ago when I had to get my prescription re-done for the glasses I purchased from an optometrist (as that pair had been mis-manufactured). The cheap spare worked fine...