Last week we talked about decentralization, specifically how it can be used to disrupt two big, slow-moving industries: healthcare and government. I promise we’ll get to government examples soon, but for now we’re sticking to healthcare. Only this time it’s a little more consumer facing than radiology.
Lucky, or maybe unlucky, for you I’m not going to redefine anything from my previous email. So, if you need that just click here. If not, let’s get to it.
Braces, but Cheaper, Easier, and Invisible
I’m guessing at least some of you also wore braces as a kid, and I’m also guessing that most of you didn’t love the fact that you had them.
After all, they were ugly, fairly intrusive, painful, accompanied with inconvenient monthly orthodontist appointments, and fairly expensive. And back in 08’ when I had braces, my parents were particularly bothered by the cost. Anywhere from $1,700-$9,000, with a lot of that coming out of pocket, even with dental insurance.
Anyway, SmileDirectClub has recently disrupted this industry by taking a direct-to-consumer business model and using it on top of Invisalign technology. They have essentially decentralized organized dentistry if you remember me saying that last week.
It works similarly too. They send a molding kit to you house, which you do and send back, they make a model of your teeth, and then send you a set of retainers that progressively get straighter. Just like braces, only it only costs $1,800 on average.
In 2021, they brought in $638 million dollars, so clearly the demand is there.
SmileDirectClub uses aligners, but it cuts out the orthodontist middleman by selling straight to customers. They are bringing affordable orthodontics to a huge number of people and making teeth alignment both cheaper and more ubiquitous through decentralization.
Not surprisingly, orthodontists are unhappy and fighting back. Similar to cab drivers being unhappy about Uber or lawyers complaining about LegalZoom (examples that I used last week).
As with radiology, I began to see a trend in finding something that was boring, slow, and expensive to improve. So, I started thinking of all the annual doctor visits to see if there was one that this logic could be applied to.
Orthodontics has SmileDirectClub.
A general doctor’s visit would be tough because you can’t really be your own doctor and should be physically present for the checkup.
You can’t draw your own blood, so any sort of blood work would be ruled out.
Optometry seemed like a good fit. It’s recurring, basically just reading one chart, expensive and somewhat complicated with insurance, and often requires you to go somewhere else or have your contacts or glasses shipped to you.
Opportunity = identified.
What About Warby Parker
Warby Parker has built a ginormous brand around part of this concept. Doing a similar $540 million dollars in revenue, they have capitalized on the direct to consumer part of this problem.
Don’t want to go get you’re glasses? Get them shipped to you?
Don’t want to spend hundreds of dollars on one pair? Spend just $90.
Still want to know what they look like on your face? Try the technology on their app.
They have essentially condensed the entire optometrist visit into something you can do online, from your house. Just like SmileDirectClub has done with orthodontics.
Except for one thing: the prescription.
Warby Parker can do everything through the app or website except generate an eye prescription, which is the most important part. When you go to their website, you’ll see this for their “vision test”.
Note the word “renew” your prescription. In other words, “we can’t generate a new prescription for you”. In other other words, “if it ain’t broke don’t fix it”.
And the rest of the internet can’t generate a prescription either. The best online test available is Zeiss, and even that just tells you whether you’re “good” or “bad”. My results were actually pretty good.
So, you’re telling me that with all the technology available (even technology at Warby’s disposal) that we can’t somehow generate an eye prescription online?
I’m not buying it.
What to Do, What to Do
Unlike radiology last week where essentially all you needed was to build a platform connecting radiologist with patients, for this you would have to actually do some research and science.
But the market is way, way bigger. More people need a vision aid than an X-ray (just ask Warby).
It doesn’t seem that difficult to me.
With just an eyephone (i-Phone haha get it?) I feel like you could collect enough information to write a prescription. All you really need to know is a few numbers like how far the glasses sit from the patient’s eye, how far their face is from the screen with the exam information, and maybe the curvature of their eye. Plus a few questions from an optometrist.
Diagrams from, matt incoming.
As well as, of course, their feedback on what they can and cannot see.
Every rose has its thorn, right? Well not really, there aren’t too many downsides. Wearing the wrong prescription can lead to dizziness and headaches, but no permanent eye damage. So, if you get the wrong prescription, just switch it out.
Also, there’s no advantage in the patient lying or trying to game the system. It’s mutually beneficial to find the right prescription, so I would imagine people would just be honest about it. If not, just have an optometrist present virtually.
I Can See Clearly Now
All I’m saying is that we can have people literally moving the teeth inside your mouth in a decentralized fashion, or prescribing medicine that alters your bodily chemistry in a decentralized fashion, but we haven’t figured out how to prescribe basic eyewear over the internet?
Copy the SmileDirectClub for vision. Either yourself or pitch it as a vertical venture for Warby Parker.
I know this doesn’t perfectly fit the definition of decentralization, but the vision is clear (pun intended). Disrupt the annual, boring, but expensive optometrist visit through the ideas of a direct to consumer model and decentralization, and change yet another facet of healthcare that is ripe for disruption.