Online refraction panel: Keep your patients by providing telehealth
LAS VEGAS – “Digital eye exams are a huge opportunity for the industry,” Aaron Dallek, CEO and co-founder of Opternative, said during a panel discussion on remote refractions here at Vision Expo West.
“This is an opportunity for you to take ownership of your relationship with your patient and provide them with the service they’re looking for and the quality of care that you feel is appropriate,” he said. “The best situation is if you were the doctor providing the telehealth. You know when they can do the refraction at home or when they should come in. If they move, you can still keep that relationship with them and work with their local doctor.”
Opternative: At-home refractions
Opternative offers a service that allows users to conduct their own refractions at home for glasses and contact lenses using their computer and smart phone.
“The risks are that a company like ours can come in with a convenient solution if you don’t start thinking about how to use technologies like ours in your practice,” Dallek added. “We are not trying to be the Netflix to your Blockbuster. We want to work with you.”
Dallek explained that customers go to www.opternative.com and answer questions regarding their health and age to help determine if the service is appropriate for them. Those with diabetes and hypertension, those who are pregnant are nursing, and those younger than 18 years and older than 50 are disqualified. Those who are eligible are sent a text message that turns their smart phone into a remote so they can operate the test from a distance.
Customers are instructed to turn down the lights in the room and use a credit card to calibrate their computer screen. They are asked for their shoe size and told to walk a certain number of steps to get 10 feet away from the computer screen.
“We worked with people from MIT to find the most accurate way to get users a specific distance from their computer screen, and it’s worked great,” Dallek said.
“We provide images to test the just noticeable difference point where you can no longer see the letters on your screen,” he continued. “There’s more to it, but that’s the core.”
The medical history and test data are sent to an ophthalmologist in the customer’s state for review and, if appropriate, a glasses and/or contact lens prescription is sent in 24 hours.
“We do refer a lot of patients to an in-person optometrist or ophthalmologist,” he said. “Online refraction is not appropriate for all patients. If someone has flashes and floaters, we stress that they must get to someone immediately. We try to get them on the phone.”
Dallek noted that any customer who cannot see at least 20/40 or better in one eye in the best-corrected visual acuity test is not permitted to proceed.
“We only do renewals of prior contact lens prescriptions and keep same base curve,” he said. “We don’t do new fittings.
“This is not an eye health exam, and we make sure our patients know that,” he continued. “We are focused on making sure we take very good care of our patients.”
More than 100,000 people have signed up for Opternative’s service, Dallek said.
“We did a pilot with 1-800 CONTACTS, and prior to launch we had over 5,000 people run through that and receive a prescription,” he said.
Dallek noted that a number of states ban any telehealth providing glasses and contacts, and some states have passed legislation specifying that an eye exam is not solely based on an objective refraction.
He said that Opternative works with ophthalmologists only.
“ODs have a lot more restriction on what they can and can’t do in many states,” he said. “We also feel that if we did work with ODs there might be some pushback on any optometrists we work with. We don’t want any doctor we work with to have issues.”
MyVisionPod: Refractions in retail stores
MyVisionPod is being developed for implementation primarily in high-traffic retail environments, CEO Hal Wilson said.
The 5-foot by 7-foot unit contains typical refractive equipment with retail displays for eye wear on the outside.
“We’re trying to remove the barrier for buying eyeglasses,” he said.
Users create a vision history profile on the company’s website and must indicate that they understand they will only be receiving a refraction. Those indicating they are first-time wearers are told they should see a doctor and are provided with a list.
At the pod, a trained technician remotely shows a video explaining the process, and the seated customer reads the lowest line possible on an eye chart.
“There’s a monitor on the wall with a high-definition camera,” Wilson explained. “The tech leads the patient through the exam remotely and operates the autorefractor. It’s a telemedicine application.”
A customer’s existing lenses are remotely read by the technician in a lensmeter. The refraction package, which includes the vision history, autorefractor and subjective phoropter results, and prior prescription are reviewed by an off-site ophthalmologist, who will provide a prescription.
“We’d love to work with optometrists,” Wilson said.
The doctors also provide referrals if necessary, he said. Glasses can be purchased from MyVisionPod or anywhere else.
Wilson said the technology is still in the prototype stage, with plans to enter production in November.
“We’ll start in more controlled environments, such as corporate customers with safety wear,” he said.
EyeNetra: Mobile refracting
EyeNetra Inc. offers refracting equipment in a suitcase so optometrists and ophthalmologists can provide eye exams anywhere.
Vitor Pamplona, PhD, the company’s chief technology officer, said the case contains an autorefractor, a smart phone-powered lensmeter and a phoropter that the patient can operate themselves.
The company conducted a pilot program called Blink in New York City where remote exams were provided by trained staff to 900 people.
“We have had no complaints about exams or glasses 1 year later,” Pamplona said.
He said EyeNetra’s products are being used in 56 countries.
“It increases access,” Pamplona said. “The more we can get those folks who are not already coming to regular practices the better.”
An audience member commented: “I don’t think this is a bad thing. You can all be an asset to us. You create an entry point; patients still need their medical exam. I see no competition with you.”
“This is a part of what technology is doing to health care,” Dallek said. “It is happening in every area of medicine. We in eye care need to realize it’s something we have to embrace, and it’s an opportunity. It’s about doing it with intention and doing it intelligently and with patients’ best interests at heart.”
Dallek said he saw one study indicating that 22% of people have never had an eye exam.
“This is a significant group,” he said. “If we can’t get access to these people to even just take a survey asking about redness or flashes and floaters and have an opportunity to tell them to go see a doctor ... 70% of people who came to our site did not get a prescription from us and chose to do nothing instead of seeing an eye doctor. That is the problem. We are trying to solve it by getting them in and educating them. We all need to work together to figure out how we can send you the right patients at the right time.” – by Nancy Hemphill, ELS, FAAO
DeGennaro E, et al. What’s the future of online refraction? Presented at: Vision Expo West, Las Vegas, Sept. 14-17.
Disclosures: Dallek is CEO and co-founder of Opternative. Pamplona is chief technology EyeNetra Inc. Wilson is CEO of MyVisionPod.