Online eye examinations are currently allowed in 37 states, but some of those states are moving toward limiting or banning them under pressure from optometric associations.
For instance, under heavy pressure from the Kentucky Optometric Association (KOA), the state attorney general (AG) alleged that online, eyeglass retailer Warby Parker violated the state’s KOA-backed Consumer Protection in Eye Care Act. Specifically, the AG argued that 69 Kentucky residents were “improperly given” the company’s online eye exam. As a result, the company agreed to pay a hefty fine and to remove the online test from its site.
Telemedicine Not for Eyes
Telemedicine is increasingly an option for patients who prefer to be treated in their homes or who live in areas where doctor visits may be impractical. And yet one form of telemedicine—online vision examinations—is opposed by the nation’s optometric professional associations.
KOA President Leslie Cecil, O.D., defended the organization’s advocacy of market limits. “We were met with a lot of pressure from outside companies and public concerns that we were thwarting technology,” said Cecil. “The KOA had to educate our legislative leaders about the concerns of patient safety, while also making sure that Kentuckians had appropriate access to technological advancements.”
Optometric associations in other states have also sought to shut down online tests. Indiana took similar action against Chicago-based Visibly. Visibly sued the state and sought Food and Drug Administration approval of its online vision test.
On August 12, 2022, the company became the first online test provider to gain “510(k) Clearance” from the FDA for its Visibly Digital Acuity Product (VDAP), after successfully arguing that its product existed to augment, not replace, in-person exams.
Health Risk?
The Health Policy Institute (HPI) of the American Optometric Association (AOA) posted a policy statement in 2019 warning of the risks of the Visibly (at the time called Opternative) online exam. Ultimately, the health risks cited were not related to the outcome of the exam, but rather to the idea that a quick and easy home exam would allow patients to avoid a comprehensive eye exam in-clinic.
“Ultimately, the AOA HPI found there is a high and unacceptable likelihood that doctors relying on data self-generated by consumers using the Opternative device will misdiagnose the user’s refractive correction and importantly, the patient misses professional in-person eye care that could identify serious ocular and systemic disease requiring treatment before eyesight is permanently impaired or lost,” said the statement.
Consumers Without Glasses
The statement does not address the fact that these “health risks” would be no greater than for the large number of Americans who do not use vision correction or else use only off-the-shelf reading glasses, or whether HPI is suggesting that such persons’ failure to obtain regular eye exams with an optometrist should be subject to governmental intervention.
While there may be a legitimate need for full in-clinic exams, that shouldn’t preclude less comprehensive services, says Matt Dean, senior fellow for health care policy outreach at The Heartland Institute, which publishes Health Care News, and a former state legislator.
“Optometrists look for melanoma, glaucoma, and other issues,” said Dean. “They do catch certain conditions that can be referred to specialists, but the question is, should this preclude people from getting eyeglasses? The answer to that question is probably not.”
Health care regulations are often designed for the benefit of existing providers, says Dean.
“Professional associations heavily influence state laws,” said Dean. “Specialists do have an interest in protecting public health, but providers in competing specialties often use state laws to ‘fence’ other professions by mandating such things as how often patients must be examined, and who can perform which procedures,”
Medical Boards Dominated by Industry
“Rulings like (the one in Kentucky) accomplish little more than protectionism,” said Devon Herrick, a health care economist. “Over time, professional medical boards become captured by the interests of their profession. They begin to view their mission as one to protect their profession, protect the status quo and they do so in the name of patient protection.
“Claims that convenient, in-home vision tests are not comprehensive enough are making the perfect the enemy of the good. The result is fewer patients getting vision tests of any kind. Although in-home vision tests may not be as comprehensive as in-office optometrist visits, they expand access to vision care for many who would never set foot in an optometrist’s office.”
Kevin Stone (kevin.s.stone@gmail.com) writes from Arlington, Texas.
