Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

Can you be replaced by a kiosk?

The buzz on optometry Internet channels this week is all about a major pharmaceutical chain that has opened a “vision center kiosk.” With improvements in autorefractor technology, is it possible to test and deliver wearable glasses without the assistance of a health care provider? If the goal of your optometric practice is to evaluate refractive error and provide eye glasses, then the answer to my title question should have you very worried about the future.

In my role as a medical director for a health plan, I spend a fair amount of time reviewing optometry medical charts. There are cases where after my review I think to myself that this exam could have been done at a kiosk. Skipping the eye history and the health history, the family history and the medicine/allergy review does not just make it a bad optometric eye exam, it is a “nonexam.” Likewise, in the age of new health care reform, having identified chronic health risk factors, such as smoking, obesity or substance abuse, or chronic illnesses such as diabetes and hypertension and not addressing these issues in the patient assessment and management plan is also a poor eye exam.

In one of my previous blog entries, I discussed the “doctoring of the eye exam.” Although technology can provide many of the resulting elements of the eye exam, and the Internet can supply many of the products, only you can provide the “doctoring.”

The U.S. Department of Health and Human Services established the “Healthy People” program 3 decades ago during the term of President George H.W. Bush. If we examine today’s version, “Healthy People 2020” (http://www.healthypeople.gov/2020/default.aspx), we can see that some of the objectives of this program can be addressed by kiosk-based programs:

  • V-1: Increase the proportion of preschool children age 5 years and under who receive vision screening.
  • V-5.1: Reduce vision impairment due to uncorrected refractive error.

The effective use of kiosk programs can be a good thing in improving the nation’s health and can assist eye care professionals by extending our reach. In the overall scope of the vision objectives, however, the vision goals of Healthy People 2020 require active participation by optometry.

The Healthy People program is excellent tool in our quest for American health care reform. I encourage all optometrists to study the program and look for ways to integrate the principles into your practices.

However, do not just look at the vision objectives. This outdated and narrow-minded view of optometry is why our colleagues fret about the title of this blog. It may even be the reason you are reading this. The following overall objectives are the ones that should be the target of the primary care optometrist in his or her review of this program:

  • access to health services
  • diabetes
  • educational and community-based programs
  • health communication and health information technology
  • hearing and other sensory communication disorders
  • heart disease and stroke
  • injury and violence prevention
  • nutrition and weight status
  • occupational safety and health
  • older adults
  • physical activity
  • tobacco use

These are the areas where optometry, with its current position as a trusted and frequently encountered health care provider, can make a real difference in health care reform.

So, fear not the kiosk; find a way to use it to reach a wider population base. Concentrate your efforts on sharpening your doctoring skills, changing your practice to broaden your scope of health care problems and providing more comprehensive patient care.