By Susan Haigh. Updated April 24, 2017.
Some optometrists are pushing back against new technology that allows consumers to get prescriptions for contact lenses and glasses with the click of a keyboard and a smartphone.
While proponents of these limited online eye exams argue they provide both financial savings and convenience, medical professionals contend patients could be put at risk. Without a full, face-to-face exam from a doctor, they argue potential medical problems could be overlooked.
"Our concern is making sure that people get the health of their eyes checked," said Connecticut state Rep. Kevin Ryan, who has a doctor of optometry degree. He has proposed legislation this session that would require in-person eye examinations conducted by an optometrist or a physician who specializes in ophthalmology for contact lens prescriptions.
More than a dozen states have decided to regulate online exams in recent years, according to the American Optometric Association. In Virginia, for example, online eye exam providers must meet certain consumer protection standards, while South Carolina last year barred consumers from getting a prescription for glasses or contact lenses from an online exam.
Ryan said an optometrist will make sure a patient's contact lenses, which he referred to as "a medical device on the eye," are a good fit. Ryan said lenses can cause damage to the eye if they're not properly fitted. Also, he said professional fittings typically include checking the pressure in the eye and basic eye health to make sure no adverse conditions have developed. In contrast, Ryan said the online tests are "unproven and untested" and there have been examples of patients receiving the wrong prescription.
"I'm going to say for like 95 percent of the people ... they can get away with this," he said, referring to the online exams, which typically include a refraction test that measures a person's prescription for glasses or contacts. "But everybody is kind of taking a risk. Another health condition can develop in your eye that you just won't be aware of."
Chicago-based Opternative is one of several companies offering a variation of an online eye test. According to the company's website, their test takes 15 minutes or less to complete. The patient tells Opternative what he or she sees on a computer screen, standing 10 feet away, by using a smart phone as a remote control. The website states how a previous prescription is required "most of the time." An ophthalmologist in the patient's state will review the test results and their prior prescription.
The procedure costs $40 for a prescription for eye glasses or contracts and $60 for both, while a typical exam by an optometrist can cost $127 on average, according to the company. Opternative states how the procedure is not a replacement for a comprehensive eye health examination.
Opternative, which filed a lawsuit last year challenging the South Carolina law banning online exams, is fighting the proposed Connecticut legislation.
"New clinically proven technologies like Opternative would be blocked from providing patients access to safe, convenient and low-cost prescriptions for glasses and contacts," said Dr. Steven Lee, OC, chief scientific officer and co-founder of Opternative, in written testimony. He said state lawmakers should pass legislation that enhances patient access to telehealth, not diminish it.
But Dr. Brian Lynch, a practicing optometrist in Branford, Connecticut, and the legislative chairman for the Connecticut Association of Optometrists, argues such online tests don't meet the benchmark already created in the state's telemedicine laws.
"It will leave patients with serious ocular and systemic issues undiagnosed and delay the care patients should be receiving," he said. "But without a medical history, how could they know?"