Eye Doctors Worry About New Apps & Ocular Telemedicine
HARTFORD, CT—Technology is great when it comes to the practice of medicine, but a group of eye doctors is warning that new phone and online applications can’t deliver on their promise to examine the eye.
The technology does what’s called a refraction, which can determine if you’re near-sighted or farsighted and produce an eyeglass or contact lens prescription, according to Dr. Brian Lynch, the legislative chairman of the Connecticut Association of Optometrists.
Lynch, who has been practicing for 35 years, said doing an eye exam requires much more than a refraction.
“Assessing the health of a patient’s eye means examining the blood vessels, and checking for ocular diseases, which can’t be done without a face-to-face encounter,” Lynch said.
That’s why Lynch is supporting legislation that would require the state to implement certain standards of care when it comes to ocular telemedicine. He said the current technology for ocular telemedicine just isn’t able to deliver the same level of care as a face-to-face exam.
“We live in a world where we are accustomed to purchasing goods and services online. The appeal of convenience and low cost are hard to resist,” Dr. Steven Thornquist with the Connecticut State Medical Society told the Public Health Committee three weeks ago. “Add to this situation the fact that many Americans are still without insurance that covers a proper eye health examination, and we have a situation that places the ocular health of some of our most vulnerable citizens at risk. Yet the desire for good vision is universal and studies have shown that the fear of blindness is often second only to the fear of death.”
He said the risk of harm from an incorrect refraction is low, but the true risk “comes from the fact that someone who chooses to use this type of service may believe that they have had an eye exam, no matter how clearly and often they are warned throughout the process that a refraction is not an eye examination.”
Lynch and Thornquist are worried about the consequences for low-income individuals who may see the online exam as a more affordable option.
Lynch said often times those who have vision insurance have access to one eye exam per year. Some online services will accept the insurance and will count it as an annual eye exam. If that person ends up getting the wrong prescription they end up in his office seeking help and are unable to use insurance to cover the face-to-face exam, Lynch said.
Thirteen states have passed similar legislation and several more are looking to restrict this type of activity, Lynch said.
Dr. Kathleen Maloney, an optomestrist with Warby Parker Eyewear, said telerefraction services will help low-income individuals in rural areas, who often don’t have access to eye doctors.
She said when used in conjunction with an optometrist, telerefraction services are “extremely safe.” She said no one is arguing that telerefraction services are a replacement for a full in-person eye exam.
She said Warby Parker Eyewear currently doesn’t use these telefraction services so she can’t say how accurate they are, but she wants to be able to use them if they prove to be accurate and she can’t do that if states like Connecticut ban the service.
Derek Brown, who represents 1-800-Contacts, said the legislature shouldn’t get involved with ocular telemedicine.
“Whether one approach meets the standard of care or not is, indisputably, best left to the medical discretion of the physician,” Brown said. “We would recommend that any language adopted by this committee take care to provide the physician with the discretion to decide which of the many available technologies are appropriate for each patient.”
He said the legislature shouldn’t dictate what technologies physicians can use.
Lynch said the legislation is not trying to obstruct new technologies, but he insisted the technology currently doesn’t exist to do a comprehensive eye exam.
“They’re modern day snake oil salesmen,” Lynch said.
Brown said there have been no reports of injuries related to the use of these technologies.
Dr. Steven Lee, founder of Opternative, submitted testimony that says new clinically proven technologies like Opternative would be blocked from providing patients access to safe, convenient, and low cost prescriptions for glasses and contacts if the legislation being debated moves forward.
As an optometrist, Lee said he was “tired of sitting through industry sponsored seminars teaching us how to maximize the cost to our clients.” He said that’s why he founded Opternative.
He said Opternative saves a patient on average 68.5 percent on a typical optometrist visit for an eye exam which cost $127 on average.
The Public Health Committee has until the end of this month to decide whether to move forward with the legislation, which isn’t specific about how it would apply the standards of care to this new technology.
Sen. Terry Gerratana, D-New Britain, who chairs the Public Health Committee said the legislation and its public policy implication is still being discussed. She couldn’t say with any certainty Thursday what would happen to the legislation.