Looking forward: the role of Telemedicine in Eye Care?
Looking forward: the role of Telemedicine in Eye Care?
Radiology was the first branch of healthcare to embrace telemedicine. Yet today remote access to healthcare has spread to all arenas of medicine, eye care included.
Teleradiology found its roots decades ago in the shipment of physical copies of film between hospitals and has been evolving ever since. With rapid transfer of information possible via internet, the hospitals of today can now communicate with a wide net of off-sight specialists. Incorporating technology into how we review medical images has resulted in a dramatic increase in access to care and
Technological advancements continue to improve the ability of doctors to provide care, whether they are interfacing with patients directly or remotely. The pervasiveness of tech in our day-to-day lives is rapidly driving the acceptance of telemedicine. Culturally, the healthcare consumer has grown accustomed to online transactions and to the efficiency and convenience they provide. A
In the eye-care industry our patients are similarly demanding convenience in how they access care. Not blind to the opportunity this demand presents, start-ups pairing cutting-edge optical technology with smart phones are popping up left and right. Online eye exams are becoming increasingly popular and there are now medical devices FDA approved to diagnose diabetic retinopathy (the leading cause of blindness in American adults). All of these developments are outstanding in their promise, yet as a young professional about to enter into a career as an optometrist this movement towards telehealth and remote eye care is as terrifying as it is exciting. We are living in an era of technological revolution and a lot of occupations face replacement, or at least augmentation, by automation. I strongly believe that eye and vision telehealth services are the way of the future, and this is something that optometrists are going to have to adapt to. A recent study conducted by Wakefield Research found that more than 40% of Americans surveyed believe online eye exams are not only a viable means of getting a new glasses prescription, but a suitable replacement for in-office eye exams. This last clause is the source of my professional fear.
To quote the president of American Optometric Association:
“[Optometrist’s] primary concern is that patient health and safety is at risk due to lack of understanding as to what services an online vision test company actually offers and can deliver to consumers… When a patient comes in to the office for an examination we do so much more than just update a prescription for glasses or contacts. Our tests are specialized for the needs of each individual and allow us to check the overall health of our patients. By analyzing images of the back of the eye, for example, we can see how a patient’s blood vessels are functioning which can signify serious conditions like hypertension that often go undetected.”
The simple fact of the matter is that the average American healthcare consumer has no idea what constitutes a comprehensive eye exam. Optometrists do not dilate your eyes out of sadism, honest. We do it to assess the health of the retina and screen for variety of systemic and ocular diseases. Comprehensive eye exams are an important part of general preventative health care, and at the moment remain the best way to get a complete assessment of eye health. A change in your vision could be an underlying symptom of a number of eye or systemic conditions, and many diseases, such as multiple sclerosis and myasthenia gravis are often first detected through a comprehensive eye exam. In 2014 alone, 240,000 cases of diabetes in the US were first detected by an eye doctor. Clearly, there is more to optometry than meets the eye (pun intended).
The debate we face today is not whether the role of the optometrist is important, or even whether telehealth has a role in eye care; it does. The topic of concern is whether or not current remote eye exams are misleading patients and doing their health a disservice. The American Optometric Association (AOA) has released a position statement expressing support for the appropriate use of eye and vision telehealth services to supplement access to in-person eye and vision care. The condition for their support being:
“The standard of care must remain the same regardless of whether eye and vision services are provided in-person, remotely via telehealth, or through any combination thereof.”
At the moment a strong argument can be made that this standard is not currently met by remote alternatives, and most patients do not seem aware of potential limitations in the services that can be provided via telehealth.
Yet, whose fault is this gap in the patient’s knowledge? Is it the fault of the start-up company that sees opportunity in the patient’s demand for increased convenience in how they receive healthcare? Or is it the fault of optometry for not having done a better job in educating the public on what exactly a comprehensive eye exam entails? One of the most controversial and popular online refraction providers, Opternative, actually has a very clear disclaimer on their website stating: “Opternative is not a replacement for a comprehensive eye health examination”. These are difficult questions to ask and difficult questions to answer.
I understand the fear a lot of eye care providers are experiencing in the face of Teleoptometry. Every week, I see patients who do not understand what I have so rigorously trained to do for a living as an optometrist. I will be the first to tell you that at the moment a remote eye exam does not provide the same standard of care as an in-person, comprehensive exam. Yet, technology is continuing to advance. There are a lot of great minds dedicated to improving the quality of remote healthcare and I am far from alone in believing that we are on the brink of bridging that gap. Those companies currently developing tools required for remote healthcare have a lot of work to do, but so does optometry. If we can meet in the middle, a lot of good stands to be done.