Technological developments in the past 10 years have created ‘new normals’ in nearly all aspects of our lives. Many of us now shop, communicate with our friends and consume media in the comfort of our homes via the internet. The coronavirus pandemic has intensified these online lives by shuttering us indoors, adding working to the list of activities carried out from the home for millions of people. Already used to shopping from Amazon and watching Netflix, millions of us are now becoming used to working remotely. As this new normal begins to quickly solidify it begs the question; will sight tests survive the coronavirus disruption?
Standard, pre-coronavirus, procedures for an eye test would place the patient and optometrist in close proximity to each other, potentially putting both parties in danger of infection. Recent Office for National Statistics data confirmed this, ranking optometrists 17th out of 359 jobs for exposure to disease. Teleoptometry is one way to minimise this contact; allowing patients to test their own eyes at home with the help of technology seems the perfect solution here, but safety concerns abound.
Teleoptometry in practice
Brent Rasmussen is the CEO of Visibly, a Chicago-based teleoptometry company that boasts customers around the globe. The company fields some of its own optometrists to interpret results but, for the most part, works with practitioners that utilise its software to triage patients. Rasmussen explained: ‘If you’re an independent optician in London then the results for any test that your patients took through our services would be sent to you. You continue to control the doctor-patient relationship.’
Visibly, formerly known as Opternative, has faced opposition from the American Optometric Association (AOA). The AOA reported Visibly to the US Food and Drug Administration (FDA) over what it called ‘significant health risks to the public’, arguing that online eye testing had not been sufficiently regulated. In the UK, the College of Optometrists’ clinical advisor, Daniel Hardiman-McCartney, voiced concerns about the lack of published evidence and validity of how safe online contact lens assessments or eye examinations could be.
Brent Rasmussen
Rasmussen was clear in his opposition to these claims: ‘In no way, shape or form is our eye test a replacement for a comprehensive eye exam. It tests how well you see, so should be interspersed between comprehensive eye exams.
‘I’ve actually never seen a situation where someone’s been hurt taking a test. Safety is not an issue in terms of being hurt while taking a test, it’s the idea that we’re missing diseases that’s a big concern. But the reality is that if someone skips their appointment, then they’ll be missed anyway. I make the argument that we’re actually creating more access; people take more vision tests when they can do it at home.’
Asked why he thought the AOA had opposed Visibly’s online eye test, Rasmussen said: ‘We invented the online eye test, which was unique and different at the time. That caused some issues. The other point they [the AOA] made was that the technology wasn’t accurate, which through time and testing we’ve proved not to be true.
‘The main issue though, was that they believed this test was going to change or disrupt the way optometry does business. I understand that, but the reality is that when I talk to an individual optometrist, even an AOA member, and explain how they could use the test in their practice they love the idea. It gives them an opportunity to compete at a higher level, and as the world evolves and consumers understand there are choices, opticians are going to have to compete at that higher level.’ Visibly provides its software for free to independent opticians, drawing revenue from large companies that it provides its technology to.
Covid-19
Alongside the number of factors Rasmussen believes will influence a move towards more teleoptometry is the coronavirus pandemic. He explained: ‘Right now the market is exploding for telemedicine and we’re right in the middle of it. Once the consumer understands that these technologies exist and that they can do things in an easier way, they will. Especially over the last 60 days we’ve had a lot of interest and a lot of use.’
Teleoptometry potentially provides benefits for the practitioner, allowing them to triage patients and prioritise those who may have more serious problems while checking the sight of patients more regularly than once every two years. Rasmussen commented: ‘I think the effect of teleoptometry is that you’ll see practitioners operating at a much higher level, engaging patients that need more care rather than just renewing prescriptions and refracting. I think refraction as part of the comprehensive eye exam in practice is essential, but maybe in future you can do an online vision test prior to going in to give the doctor an idea of what to look for.’
Online refraction is just the beginning of teleoptometry’s growth, with the future sure to produce increasingly effective methods of remote health monitoring. Rasmussen shared: ‘Not the entire thing, but significant portions of the entire eye exam will eventually become possible via telemedicine as smartphone camera quality improves. It’s difficult to dilate the eye without medicine but other aspects will 100% become remote and electronic.’