How Tariffs May Affect Eye Care

How Tariffs May Affect Eye Care
By Gretchyn M. Bailey, NCLC, FAAO


With the recent change in US leadership, tariffs have become part of day-to-day conversation. A tariff is a tax placed on goods entering or leaving a country by that country’s government.

For many, tariffs belong in macro economic discussions. However, tariffs have the potential to do more than affect multinational companies—effects from tariffs are likely to affect small independent businesses and ordinary people, such as optometrists and their patients.

At Vision Expo East in Orlando last week, in coordination with The Vision Council, attorney F.D. “Rick” Van Arnam, Jr., a partner at Barnes, Richardson & Colburn in New York, discussed how tariffs may affect eye care and outlined how today’s looming tariffs first became part of the landscape.

Tariff origins
In 2018, the Office of the United States Trade Representative opened a Section 301 investigation on intellectual property misappropriation by China that officials believe were adverse to US interests. Specifically, American companies were required to release proprietary technology to Chinese business partners as a prerequisite to the US company manufacturing or distributing in China.

Under Section 301 of the law, the federal government is able to take remedial steps to correct such bad actions. Therefore, a 25% tariff was assessed on merchandise made in China. At the time, the tariff was limited to products negatively affected by the Chinese bad actions, such as machinery. However, many more products were added to the tariff list.

China retaliated by enacting its own 25% tariff on US agriculture, of which China was a big consumer. China also identified other products that were subject to additional tariffs.

In return, the US created an additional tariff of 7.5% on a broader list of products—on top of the already established 2.5% duty on many imported items. That additional tariff increased duty on Chinese goods to 10%.

Note that a Court of Appeals case is challenging Section 301 tariffs. The case will likely be decided in the next few months, and the decision is likely to be appealed to the Supreme Court.

Eye care involvement
Eye care was affected by the additional tariffs by the involvement of things like spectacle lenses, plano sunglasses, over-the-counter (OTC) readers, low vision equipment, and lens finishing equipment.

However, companies were able to petition for relief—or exclusion—from Section 301 tariffs. If one company was granted exclusion, all other companies with similar products were also granted exclusion. For about a year, exclusions were issued for spectacle frames and reading glasses. Those exclusions ended in 2020, and attempts to renew them were not successful.

In February 2025, an additional 10% duty was announced for any Chinese origin product.

Says Van Arnam: “That 10% the eyewear company is paying to import those plastic spectacle frames from China just jumped to 20%. The same frame, if you bought it today from say Vietnam, would be a 2.5% duty; it is now 20% if it's coming from China. China is the biggest by far producer of of optical products, particularly frames.”

Mexico and Canada tariffs
Also in February 2025, a 25% tariff was announced for products coming from Mexico and Canada. This tariff was framed as action taken against the countries for allowing fentanyl and illegal immigrants into the US.

Says Van Arnam: “This was a huge deal because Mexico and Canada are two of our largest trading partners. “They are are border allies and historically have had good relations with the United States. “We have free trade agreements with both of them, which allow the vast majority of products that are made in Canada and Mexico to come into the United States free of duty and for products that are made in the United States to go into Canada and Mexico free of duty.”

Due to both Canada and Mexico making overtures to remedy the problems identified by the US, tariff enforcement was paused for 30 days. That 30-day period expires on March 4.

“Some companies in the eyecare industry who weren’t affected by the China trade were panicking because they would now be impacted by Canadian or Mexican trade,” says Van Arnam. “There is a lot of cross-border trade. You might have a lens processing facility on the Mexican side of the border with lenses sent over for processing and brought back into the United States for distribution.”

He wonders how the US will measure success for the remedies proposed by both countries.

“What metric do you use to measure fewer immigrants coming in or less fentanyl coming across the border?” he says.

Aluminum and steel
Within the past two weeks, a 25% tariff on raw aluminum and steel (and their derivative products) was announced. Most manufacturers in the eyecare space use both metals in their production, from frames to equipment.

Says Van Arnam: “These costs will ripple through the supply chain because I don’t believe any company will be big enough to absorb the cost and say it’s all on us.”

The additional duty will eventually end up in the cost of goods everywhere, including eye care. Van Arnam foresees challenges in the future because costs may not necessarily be passed onto patients or consumers due to negotiated contracts.

“Patients may have insurance which is paying only X amount,” he says. “Or maybe you’re selling frames to Veterans Affairs which won’t allow you to increase your price. There won't be a direct line from the 25% paid on the raw material to the finished value of the of the eyewear. Some of it will be absorbed, but at some point, you're going to see price hikes and hear people talking about how these tariffs will be inflationary.”

Tariffs on aluminum and steel were enacted prior to 2020; however, exclusions and agreements with other countries largely mitigated the effects. Those terms expire on March 12.

Reciprocal tariffs
The federal government is looking into imposing a tariff on all imported products, regardless of origin, to match the originating countries’ tariffs.

“There is a perceived injustice that the United States has tariffs that are historically lower than those of other countries while other countries have tariffs that are historically higher,” Van Arnam says. “The federal government is looking at what we charge for an item vs what country X charges for that item. If we are charging 2.5% for a pair of spectacle frames, and hypothetically, India is charging 10%, there is a 7.5% gap. Under the reciprocal theory, you would pay an extra 7.5% duty to import spectacle frames of Indian origin into the United States so the tariff amounts would match.”

Addressing reciprocal tariffs would likely create logistical challenges for smaller companies without the resources to quickly pivot.

Federal agencies involved with international trade are required to report by April 1 where reciprocal duties might apply. For example, will the duty apply to specific countries or specific products?

Upcoming tariff deadlines
• March 4: The 30-day pause on Mexican and Canadian tariffs expires. A 25% tariff may go into effect.
• March 12: Previous exclusions and agreements about raw aluminum and steel expire. A 25% tariff may go into effect.
• April 1: Reports due to identify where reciprocal tariffs might be applied.
 
Last edited by a moderator:
  • Like
Reactions: Cameo Harvey
I don’t think the foreign companies had much choice about leaving or selling. They were mostly confiscated. Like all the airliners the Russians confiscated.
no, they all announced a voluntary withdrawal. include giants like Ikea

problem is they left massive built-out stores and inventory. Coca-cola left and had large manufacturing facilities.
McDonalds now goes by a different name.

they still owned them. and chose to sell to Russian based 'entrepeneurs'

some companies chose to stay.

(btw, to be very clear. a personal friend was driven lfrom his house where bombs were literally landing close enough that I could hear them in the background. he trades forex professionally and said 'eh, its not something I dont expect around here'. he fled to western ukraine then eventually out of the country. another friend of a friend who is russian was forced to leave russia for not supporting the war. newsflash: you go against russia as a russia and you will be silenced. so not saying the russian war is good or bad. saying it had *possibly* and unintended consequence of taking more control of most things within the country)
 
Last edited:
  • Like
Reactions: Alan David
Hang on to your hat and wallet...

Breaking news in the afternoon 4/2/25 New York Times...

Trump unveiled sweeping tariffs on nearly all imports

President Trump announced this afternoon that he would impose new tariffs of at least 10 percent on all goods imported into the U.S. from every country other than Canada and Mexico. He also promised steep additional levies on dozens of countries that he claimed had been unfairly taking advantage of America. Here’s the latest.

Together, the new tariffs are by far Trump’s most expansive to date. They include a 34 percent fee on goods from China — on top of the 20 percent already placed on Beijing — as well as a 20 percent fee on goods from the E.U. Once in place, they are likely to upend global trade and incite retaliation. My colleagues are covering the reaction from around the world.

“Many people had been expecting the president to announce high tariffs today, but the numbers that he just revealed are stunning,” our trade reporter Ana Swanson said. “That will likely force some manufacturing back into the U.S., but also raise costs for American consumers and manufacturers.”

White House officials said that the 10 percent base line tariffs will go into effect on Saturday, and the additional “reciprocal” rates on April 9. Canada and Mexico will not be hit by the new measures, though they will continue to be subject to a 25 percent tariff that Trump imposed on many of their products last month, in addition to separate global tariffs on steel, aluminum and cars.

Trump, who has described tariffs as “the greatest thing ever invented,” seemed to relish detailing the high fees. He described the rollout event in the Rose Garden as one of the most important moments in American history.

Many economists — even those who say Trump has a point about America’s unfair trade relationships — warn that the tariffs could cause substantial collateral damage and backfire on the president’s goals for jobs, manufacturing and the economy. The E.U., for example, could strike back against the U.S. service sector. The early market reaction pointed to a further slide in the stock market and a weakening dollar.
 
Last edited:
Markets are not happy. SP500 is down 2% and Nasdaq down 2.7% at this time in after hours trading. Huge spike in selling volume.
As a resident of Ontario how do you think will be the Province Government reaction?

On March 11,2025 this almost happened...

Here are the U.S. states that get electricity from Ontario, as Trump’s trade war gets new twist

Ontario’s leader imposed a 25% tariff on electricity exports to the U.S. and threatened to cut them off entirely — but then suspended the surcharge Tuesday afternoon

 
How Tariffs May Affect Eye Care
By Gretchyn M. Bailey, NCLC, FAAO


With the recent change in US leadership, tariffs have become part of day-to-day conversation. A tariff is a tax placed on goods entering or leaving a country by that country’s government.

For many, tariffs belong in macro economic discussions. However, tariffs have the potential to do more than affect multinational companies—effects from tariffs are likely to affect small independent businesses and ordinary people, such as optometrists and their patients.

At Vision Expo East in Orlando last week, in coordination with The Vision Council, attorney F.D. “Rick” Van Arnam, Jr., a partner at Barnes, Richardson & Colburn in New York, discussed how tariffs may affect eye care and outlined how today’s looming tariffs first became part of the landscape.
At the end of February the lead on this topic has led to some great discussion.

No need to be a PhD Economist or an MBA to understand ramifications

Time to become proactive assuming no less than 10% inflation in the short term.

Will Vision Care Plans increase their payments? Can you add a surcharge on to your fees. Some Auto dealerships will be placing a surcharge on to the sticker price of their Autos.
 
1743633639841.png
 
Markets are not happy. SP500 is down 2% and Nasdaq down 2.7% at this time in after hours trading. Huge spike in selling volume.
Well,

We are about to see trillions of dollars of American’s wealth wiped off the books and trillions more in market capitalization of American companies vaporized so………it’s going to be interesting times.
 
  • Like
Reactions: Jenifer Ambler
Looks like he's already issued an exemption for semiconductors. I suspect if we have a blood red day in the market tomorrow that suddenly more and more things will find themselves exempted.
 
Well,

We are about to see trillions of dollars of American’s wealth wiped off the books and trillions more in market capitalization of American companies vaporized so………it’s going to be interesting times.
You mean literally "wiped off/vaporized" as if they sold their positions? :rolleyes: Hmmm.....maybe they should just ( I know I'm crazy but just hear me out) I don't know.......BUY MORE AT A DISCOUNT!
 
  • Like
Reactions: William R. Hall
As a resident of Ontario how do you think will be the Province Government reaction?

On March 11,2025 this almost happened...

Here are the U.S. states that get electricity from Ontario, as Trump’s trade war gets new twist

Ontario’s leader imposed a 25% tariff on electricity exports to the U.S. and threatened to cut them off entirely — but then suspended the surcharge Tuesday afternoon

I don’t expect a response from Canada right now (beyond what has already happened) because Canada wasn’t really targeted today. Looks like it’s the same for Mexico.

1743636130459.png
 
  • Like
Reactions: Joe DiGiorgio O.D.
You mean literally "wiped off/vaporized" as if they sold their positions? :rolleyes: Hmmm.....maybe they should just ( I know I'm crazy but just hear me out) I don't know.......BUY MORE AT A DISCOUNT!
A stock is supposed to represent the value of all future cash flows.

So if the price is dropping it is because the fund managers (who control much of the market) feel underlying equities are fundamentally worth less. It won't be the same across all equities.

Take Wal-Mart for example -- if a 34% tariff against China is enacted, Wal-Mart is absolutely and thoroughly screwed, possibly for years or decades, since basically everything they sell is from China, and their typical consumer simply can't afford to pay more.

Their cash flows will necessarily drop. If my job as analyst is to decide whether or not to "hold" or sell, I know what I'm doing in the face of that data ...
 
A stock is supposed to represent the value of all future cash flows.

So if the price is dropping it is because the fund managers (who control much of the market) feel underlying equities are fundamentally worth less. It won't be the same across all equities.

Take Wal-Mart for example -- if a 34% tariff against China is enacted, Wal-Mart is absolutely and thoroughly screwed, possibly for years or decades, since basically everything they sell is from China, and their typical consumer simply can't afford to pay more.

Their cash flows will necessarily drop. If my job as analyst is to decide whether or not to "hold" or sell, I know what I'm doing in the face of that data ...
You’re cherry picking to prop up your argument & ignoring many market factors & how often in history stock price doesn’t follow any of these rules.
 
You’re cherry picking to prop up your argument & ignoring many market factors & how often in history stock price doesn’t follow any of these rules.
No, over time the market cap of a company (the share price x all outstanding shares) is supposed to represent the value of all future (discounted) cash flows. This is finance 101, it is how stocks are valued. Short-term fluctuations may be due to psychology or other factors, but in the long run, all that matters are discounted cash flows. This is what analysts will look at when making long-term investments.

The massive drop today isn't some sort of conspiracy - it reflects a consensus of business analyst's best reflection of reality in the light of a rapidly worsening economy.

---
https://finance.yahoo.com/news/live...ng-tariffs-rip-through-markets-000611007.html

Stock market today: Nasdaq futures lead stock plunge, Dow drops 1,000 points as Trump's punishing tariffs rip through markets

US stock futures plunged after President Donald Trump announced 10% tariff on all US trading partners, sending shockwaves through markets and the global trade order.

Futures attached to the Dow Jones Industrial Average (YM=F) tumbled 2.4%. Futures attached to the benchmark S&P 500 (ES=F) plunged 3.6%. Futures attached to the tech-heavy Nasdaq Composite (NQ=F) sunk 4.5%.

---
This was as of 1 hour ago, I am really not looking forward to what happens tomorrow morning.
 
Out of all the policies, the Tariff/Trade war situation seemed like the most likely to flop for these reasons:

1. Above all, Americans are pure consumers. We like to buy, and we like to buy things cheap. The "Buy American" slogan/model has shown again and again not to work. As a society now we just don't value it. If you give an American a choice of a being able to buy a Samsung for $400 and a foreign made couch for $400, or only buy one $800 American made couch they choose the 2 cheaper things almost every time. Also, the tariffs/duties that these other countries have are protectionist and only harmful to their residents as consumers and are the reason places like Canada, Europe etc have such higher prices on goods compared to the United States. Americans almost burn down the White House now if gas prices go up $1.00, we are used to prices being a certain way and have very little threshold for rising prices. Also our bi-partisan media loves to just hammer these price type things, with Fox showing inflation numbers every day when Biden was in office, and some places already have started "Tariff pricing" signs and graphs to hurt Trump.

2. With how much flip flopping, changing of minds, and influence is going on 3ish years is not long enough for these companies to make Billion dollar decisions by bringing back manufacturing. The amount of times which items are being tariffed and by what % has already changed multiple times. The market seems to be sinking because of the uncertainty of it all, no one seems to know what to do. Should I buy a Toyota? Should I not? Should I wait? These companies are probably either frozen in uncertainty or just plan on waiting it out. Also, if the market continues to tank the Congress/Senate could turn on the administration. The Senate just passed a bi-partisan resolution to not Tariff Canada, but most likely won't get past Congress and definitely not signed by Trump.

3. Even if they plan on brining back all of this manufacturing do we have the future workforce to do these jobs? Whether it is right or wrong we are purposefully making it difficult for these type of workers to enter the country. It sounds romantic to build up American manufacturing, but do you really think that the up and coming younger generation will want to be standing on an assembly line working every day for the next 30 years? We all here can barely get competent people now to want to show up and work at our offices, and our work isn't as hard as a manufacturing company. There is a reason my small town has 22 languages in our school system, they are unable to find white working class folks to do the blue collar work in our two largest plants.

Out of all of those reasons I really just don't think it is a long enough time frame to really take any effect. All it takes is the next President to start signing executive orders on Day 1 to just reverse everything, or have one of the next candidates campaign that they are reversing everything back to free trade. Anyways, just some macro-level thoughts from a random nobody in middle America.
 
Is anyone considering buying some crypto as a hedge against a downside.

BTW on the ODs on Finance page, many are talking about DCA'ing into this market to pickup things on sale.

What would be good targets to buy during a tariff response market drop?
 
You mean literally "wiped off/vaporized" as if they sold their positions? :rolleyes: Hmmm.....maybe they should just ( I know I'm crazy but just hear me out) I don't know.......BUY MORE AT A DISCOUNT!
If the stock market goes down 50% (I know...not likely) in order for it to go back to where it was, it has to go up 100%.

People at or near retirement are not going be buying more at a discount. They aren't looking to contribute. They are looking to withdraw.
 
Is anyone considering buying some crypto as a hedge against a downside.

BTW on the ODs on Finance page, many are talking about DCA'ing into this market to pickup things on sale.

What would be good targets to buy during a tariff response market drop?
Crypto is NOT an equity risk hedge. Its is very correlated to the movement of the stock market.
 
  • Like
Reactions: Stephen McDaniel
If the stock market goes down 50% (I know...not likely) in order for it to go back to where it was, it has to go up 100%.

People at or near retirement are not going be buying more at a discount. They aren't looking to contribute. They are looking to withdraw.
I would respond but it would be censored. So.....eff it say what you want IDC. I'm pretty damn fed up.
 
Day end...SP500 -0.67% & Nasdaq -0.87%...been much bigger days this year.
The tariffs weren't announced until just after the market closed - for obvious reasons, they knew it would be a catastrophe. The lower numbers you're seeing now are post-closure, which may portend not-so-great things tomorrow morning.

As an individual, it is difficult to know what to do with such instability. Consumers are already pretty well pushed to the edge -- defaults on car loans are at the highest level at least since the great recession, and price increases could cause that market to topple completely. I guess that means shorting the car dealers might not be a terrible idea ....

But bringing this back to eye care -- if there is hyperinflation (and if these tariffs on asian goods are enforced, there will be, there is no way around it.) What does this mean for your practice? I don't see people going for a "second pair" with AR when they are worried about ... "food" or an iPhone which now costs $1,500.
 
I moved my IRAs to a 30% cash/gold plus 15% mostly T and FHL bonds. Wish I did more cash. The rest of my portfolio I diversified into international x-USA equity index funds and dividend stocks paying 5%+. And, of course, BRK/B. :) Even sold off some of my AAPL. It will be interesting to see what happens tomorrow and going forward. Trusk has already cost me a couple of retirement years income which I wont likely recover. Hopefully I wont loose too much more.

I believe people who are living on retirement IRAs/401-Ks or plan do so in the next couple of years are going to be royally screwed. The youngins' with a couple of decades to build their wealth are going to make out like bandits, if they have cash to invest when the smoke clears, becasue there is surely going to be a giant fire sale! If they have jobs. If the coming hyper-inflation doesn't wipe them out.

So who will be the winners of the global trade war. Or how long before Trusk "re-adjusts" the tariffs?
 
Stop the political rants plese, they will be deleted.

Again, this is a thread about tariffs and eye care. We know -- from literally all of recorded economic history -- that tariffs ultimately pass price increases onto consumers.

As a retailer [which 50% of you are], what are you doing to plan for an environment where people may have less discretionary cash to spend on non-essentials? Are you going to change your product mix?
 
Stop the political rants plese, they will be deleted.

Again, this is a thread about tariffs and eye care. We know -- from literally all of recorded economic history -- that tariffs ultimately pass price increases onto consumers.

As a retailer [which 50% of you are], what are you doing to plan for an environment where people may have less discretionary cash to spend on non-essentials? Are you going to change your product mix?
This "environment" has been here for awhile now in the form of inflation.

From what I have heard from frame reps and what I have seen in my own office, patients have been cutting back on spending for the last few years, well before any tariffs, due to the cost of literally everything being so expensive. As a result, in April 2024 we made the decision to bring in more low to middle end frames and draw back on the high end stuff.

Crazy thing is our net increased significantly because of the higher mark up on the cheaper frames. I honestly don't expect the tariffs to have much impact on my practice because we make a big effort to keep things affordable for our patient base to begin with.
 
  • Like
Reactions: AdminWolf
This "environment" has been here for awhile now in the form of inflation.

From what I have heard from frame reps and what I have seen in my own office, patients have been cutting back on spending for the last few years, well before any tariffs, due to the cost of literally everything being so expensive. As a result, in April 2024 we made the decision to bring in more low to middle end frames and draw back on the high end stuff.

Crazy thing is our net increased significantly because of the higher mark up on the cheaper frames. I honestly don't expect the tariffs to have much impact on my practice because we make a big effort to keep things affordable for our patient base to begin with.
I think the difference is going to be if goods from China are tariffed at 30% or more, people who rely on Wal-Mart or Amazon to make their daily purchases are going to be squeezed more heavily than ever.

The question as always is where consumers make their cuts.
 
Hey, Adam.

What's 30% of "$169 frame and lens complete"?

I can't do the math.
 
Stop the political rants plese, they will be deleted.

Again, this is a thread about tariffs and eye care. We know -- from literally all of recorded economic history -- that tariffs ultimately pass price increases onto consumers.

As a retailer [which 50% of you are], what are you doing to plan for an environment where people may have less discretionary cash to spend on non-essentials? Are you going to change your product mix?
Political rants is what this entire thread is.

You just won't admit it. It's a stealth political rant.

This thread is ONE SIDED in it's conception: how tarriffs are NEGATIVE.

What about the positive effects? "No, that's poltics."

How about how this is a "deal" or "negotiation". "No, that's politics."

I applaud you keeping this thread "open", but it's not "really open". It's heavily censored to present a narrative. It's a tired, tired technique that those in control use when facts or even opinions don't agree with them.

I'm out.
 
I think the difference is going to be if goods from China are tariffed at 30% or more, people who rely on Wal-Mart or Amazon to make their daily purchases are going to be squeezed more heavily than ever.

The question as always is where consumers make their cuts.
Again, those cuts in spending by patients have been made for quite some time now due to inflation. Can't get blood from a stone so those that have needed to cut their budget already have for the most part.

The vast majority of my patients are low income and rely heavily on Walmart as it is the only place to shop around here but many of them are on Medicaid, Medicare Advantage plans, or some other type of assistance that covers their exam and glasses. The tariffs will impact their discretionary spending in other places but they pay virtually nothing for exams and glasses so I don't expect the tariffs to impact our practice much.
 
Crypto is NOT an equity risk hedge. Its is very correlated to the movement of the stock market.

This is true.

Glad you guys weighed in on this. I know a very savvy trader that was making some crypo buys last night. So I thought at least I should ask.

Here was their chart. Admitted I do not at all follow it, and I am not a crypto owner.

1743684985893.png
 
I did not have time to go back and listen to yesterday's 1+ hour speech. So these are all "reciprocal tariffs" What if China responds and cuts their tariff to zero. Will they still be subject to a 10% minimum tariff? What do we really sell to China that they can not source elsewhere? If they go to zero does that instantly open our market to that at low or no tariff?
 
Political rants is what this entire thread is.

You just won't admit it. It's a stealth political rant.

This thread is ONE SIDED in it's conception: how tariffs are NEGATIVE.

What about the positive effects? "No, that's poltics."

How about how this is a "deal" or "negotiation". "No, that's politics."

I applaud you keeping this thread "open", but it's not "really open". It's heavily censored to present a narrative. It's a tired, tired technique that those in control use when facts or even opinions don't agree with them.

I'm out.
Jeff, you seem to misunderstand the purpose of this thread. It is to discuss the economic impact of these tariffs on optometric practice. So people can proactively handle their business appropriately.

Even if you believe these tariffs are "good" because they will bring manufacturing back to the US, it does not matter. Any positive effect on manufacturing will take literally DECADES - you will be long retired or dead before you see any positive impact in your community, if there is one to be had at all.

So again, the focus in this thread is on the impact of these tariffs and what people can do now to shore up their businesses in the face of unstable economics.
 
The vast majority of my patients are low income and rely heavily on Walmart as it is the only place to shop around here but many of them are on Medicaid, Medicare Advantage plans, or some other type of assistance that covers their exam and glasses. The tariffs will impact their discretionary spending in other places but they pay virtually nothing for exams and glasses so I don't expect the tariffs to impact our practice much.
So in your case, you have what economists call inelastic demand in your office -- it doesn't matter what the price actually is or becomes, your patients will pay it (because they aren't the ones paying it)

But what about everyone else -- what happens to the average 30 year old with a middle-class job who is paying out of pocket? Adjust the product mix downward to keep things affordable?

I know that for years people have tried to make "in-office specs" a thing, and it seems to fail every time for most people (Qspex etc). I wonder though with advances in polymer science, and advances in 3D printing, will we get to a place where it makes sense manufacturing the whole kit and kaboodle on site.
 
But what about everyone else -- what happens to the average 30 year old with a middle-class job who is paying out of pocket? Adjust the product mix downward to keep things affordable?
Honestly these type patients (ie cash paying 20-40 year olds) around here went the way of the Dodo bird after COVID. Most of them don't go to the eye doctor unless their glasses break or they have steel in their eye because their bank accounts are already stretched to the limit.

Money has been tight for many Americans for quite some time now so changes in spending habits are somewhat already "baked in" even before the tariffs. Now some of your higher end practices with ridiculously high markups will probably be affected.