Online vision testing has long been a doomsday scenario for opticians.
However, development of technology has been slow and the thought of consumers opening an app to get a prescription has always been that little bit too far off to worry about... in the UK at least.
Visibly, formerly known as Opternative, has been causing ripples in the US since its introduction in 2015, but its partnership with online retailer 1-800 Contacts made the news last week (Optician 26.04.19) after the American Optometric Association (AOA) appealed to the Federal Trade Commission (FTC) to investigate the use of the digital
technology because it could be ‘misleading patients’.
An online health care terminology survey of just over 1,000 people commissioned by the AOA in February looked at the ExpressExam vision test used by 1-800 Contacts in an effort to judge patient perception. Data showed over half (56%) thought an ExpressExam was the same exam or test that an ECP would provide during an in-person practice visit, but in less time. A further 49% thought that an ExpressExam would afford them the opportunity to talk about their eye issues with an optometrist or eye doctor, that the test did not provide, said the AOA.
‘We believe that the use of the term “exam” by 1-800 Contacts is a material misrepresentation that could affect a consumer’s choice to
obtain an in-person, comprehensive eye examination,’ said AOA president Samuel D Pierce in a letter to the FTC’s Bureau of Consumer Protection.
He added: ‘Other companies offering the same services take steps to ensure that the term “exam” is not used to describe the service provided.’
Two sections of the FCT Act have been violated, said the AOA: Section 5, which declares unlawful acts or practices that are unfair or deceptive and Section 12, which prohibits false ads likely to induce
the purchase of food, drugs, devices or cosmetics.
In its letter, the AOA also pointed out that Visibly itself had previously stated that its test was limited and not a substitute for a comprehensive eye exam.
‘Even Visibly’s founder has stated that, “We’re definitely not a comprehensive eye exam, and we’re not a replacement for optometrists,”’ said the AOA.
In a hard-hitting rebuttal to the allegations, 1-800 Contacts told Optician the AOA’s claims were predictable and borne out of
protectionism. ‘The AOA is making unfounded claims that we mislead
customers with the marketing language about ExpressExam,’ said
a spokesperson for the retailer.
‘We see their complaint for what it is: a desperate attempt to preserve the past and limit the impact to their pocketbooks, at the expense of customer choice, affordability and accessibility. The AOA also has a long history of making unfounded medical claims all in the name of protecting status quo.
‘Our view on telemedicine is consistent with the FTC’s view. The
FTC stated that if online eye tests are limited by undue regulations it
“may reduce competition, access and consumer choice in eye care
and might also raise costs for consumers.”’
The protected?
The AOA said it had longchampioned patient safety and public health priorities, including repeatedly pressing federal agency officials and Congress to crack down on illegal internet contact lens sellers, that the AOA said put health and vision at risk.
In 2016, the AOA lodged a complaint with the Food and Drug Administration (FDA) over Opternative’s noncompliance with federal medical device and patient safety laws. In its complaint, the AOA raised concerns about product safety and efficacy regarding its mobile app. Following intense pressure by the AOA, Opternative (now Visibly) began taking steps to correct its online
messaging.
The AOA said its efforts were further vindicated after an FDA ruling last year said Opternative had violated federal law by illegally marketing its app-based vision test without prior government approval.
‘These efforts are supported by the public,’ said the AOA. The association’s survey also found that more than half (55%) of respondents supported laws or regulations that prohibited online vision tests that did not comply with existing standards for in-person eye care.
‘The AOA will continue to ask regulators to hold online vision test companies accountable when it believes that consumers’ vision is potentially in jeopardy,’ said the organisation.
1-800 Contacts told Optician it also acted in the best interest of patients: ‘The company has always pushed for better access to and alternative choices in vision care for contact lens customers. We
literally exist because we continue to look for ways to make vision care
convenient, simple, and affordable, even though the optometric
industry continues to fight against these goals. ExpressExam is wildly
popular with customers as well as the eye doctors who issue the
prescriptions.
‘In the meantime, we have to get back to work innovating on behalf
of our customers. Affordable and accessible vision care is not going
to happen by continuing to do the same things over and over – and
won’t happen at all if the AOA has their way.’
Visibly has taken a less confrontational approach to its own dealings with the optometric sector, it even changed the company name from Opternative late last year because it ‘positioned the brand as an existential threat to optometrists.’ Despite this, it is still engaged in legal disputes with several US states and retail businesses, including the online behemoth Warby Parker.
Crossing the pond
The development of online refraction in the US may have been litigious, but it is gathering momentum and some now think it is just a matter of time before patients in the UK will be able to get their prescriptions online.
Specsavers director of professional advancement Paul Morris was the
latest to issue a warning that Visibly was coming to the UK in some way, shape or form.
In a wide-ranging interview with Optician last month, Morris cited the relationships the company had developed with retailers such as
1-800 Contacts as one of the reasons why Visibly had increased its user base from 200,000 to over 1,000,000 in less than a year.
‘It might be illegal in the UK, but you could set up in the Isle of Man or take any fine from the GOC as a business expense,’ he said.
Online refraction formed part of The Optical Confederation and
College of Optometrists commissioned Foresight report in 2016 and its analysis offered an ironic glimmer of hope for the UK market – the low cost of eye tests in some parts of the sector.
‘The global market for Opternative (or its like) could be significant if user feedback endorses online refraction, but in the UK, given the availability of cheaper, comprehensive eye exams, and with people situated less remotely than in the US, online pay refraction may struggle to make inroads,’ said the report.
Visibly plans to roll out its ‘whitelabel’ vision testing, like that of
1-800 Contacts’ ExpressExam, in Germany later this year, with other
EU countries to follow. Given how contact lens retailers in the EU circumvent UK legislation to fulfil transactions, it could already be too
late for British healthcare regulators to act in the best interests of the public.