As it has with countless other businesses and medical fields, new technology will continue to enhance and grow optometry. And the hottest tech button in optometry right now is the growing use of technology for telemedicine purposes.

But the concept isn’t completely devoid of controversy.

Many corporate opticals have expressed interest in adopting a telemedicine model to enhance the patient experience—and to provide access in areas that have minimal doctor coverage. Some corporate opticals have successfully incorporated it into their business model, while others have decided that a traditional in-person exam remains the best model for their practices and patients.

What is telemedicine in optometry? Telemedicine harnesses advancing technology to provide refractions and even full exams outside a traditional optometrist-controlled exam lane. Some of the telemedicine models are performed via an on-site ophthalmic tech. The measurements and tests are done by an ophthalmic tech, and a remote doctor evaluates and signs off on a prescription, if appropriate. If the tests indicate (or if certain age and health requirements are not met), the patient is required to return or seek an optometrist for an in-person eye exam.

[For the purposes of this article, we are defining telemedicine as providing an eye exam that contains more than just a refraction.]

Recently I asked members of the @Corporate Optometry Facebook group for their thoughts about the use of telemedicine in corporate optometry. Some of the concerns included:

All are valid concerns and questions that need to be answered in order to modify the model and have O.D.s accept it. O.D.s should be involved in these discussions in the industry and set rules and regulations.

Here, we ask three corporate O.D.s to examine the good, the bad, and the future of telemedicine in optometry.

THE GOOD

Telemedicine has several positive uses that can be beneficial in certain areas of optometry.

It can be incorporated into models for mission trips and used in underserved areas. Technology such as Optos and OCT will provide images that can be taken by a tech and reviewed by an optometrist remotely, providing a medical exam to remote areas and access to care to individuals who need it.

Many insurance companies have adapted this method of care and will reimburse O.D.s for the telemedicine eye exam. This can increase revenue for optometrists who are seeking other streams or for the entrepreneurial O.D. who can’t find coverage for their sublease or is looking to expand to multiple locations.

Dr. Eller sees the positive side of telemedicine.

“Let’s properly define telemedicine. It’s not an online refraction that is not nearly as accurate as even the basic autorefractor found in an office. The exam must include eye health, external and internal, with IOP,” he notes. “Now, the patient could certainly schedule this and come in for an office visit and the measurements could be taken by a tech and information relayed to an O.D. Standard of care would need to change to allow this, but I think the imaging technology is good enough to compete with in- person assessments. I have doubts about the online refraction, however.”

Dr. Carlson says he sees the potential for telemedicine putting a practice at a competitive advantage.

“I want to use telemedicine as a service after an in-person baseline exam is established for those who are having office-visit-type problems to really triage and/or treat. Many, I assume, would be directed in for an in-person exam based on signs and symptoms. But some could be treated (as they are now through the medical tele-sites),” he notes. “I can also see it being used for diabetes monitoring, glaucoma, and macular monitoring. Retinal photos, OCT scans, visual fields, etc., can be done on days with no doctor in the store, or they can be forwarded to an optometrist for review and treatment plan.”

THE BAD

The main criticism regarding telemedicine is whether it upholds the industry’s standard of care. That a remote exam, or tests done by a non-O.D. tech, may miss a significant eye health issue or diagnosis is often the first fear raised in a telemedicine conversation.

On a practical level, some O.D.s are also concerned about malpractice if something is missed during a telemedicine exam.

Although Dr. Tasripin thinks that liability insurance will cover O.D.s who want to provide a telemedicine service, it may come at the cost of much higher malpractice premiums (despite the fact that most tele-exams would be routine in nature).

“The ophthalmology liability insurance underwriters have done a cost benefit analysis, and that’s why they limit who can have these ‘exams’ to statistically healthy age groups. The chances of missing something significant are small and the cost of an out-of-court settlement is far less than what can be made off of all the healthy individuals,” he says. “I think that malpractice will be quicker to cover ophthalmologists because they already pay much higher rates than we do, rather than cover O.D.s for telemedicine, and that is why I think that O.D.s’ malpractice premiums will increase.”

THE FUTURE

My own view is that telemedicine will become an addition to corporate optometry practices, but it will not replace the O.D.s in this setting.

The results of my recent poll on the @Corporate Optometry Facebook page indicated that many O.D.s in corporate optometry agree that the future of corporate optometry will not be telemedicine alone. They feel there will need to be a partnership and involvement with O.D.s for the patient interaction and to handle difficult clinical cases. Also, they believe telemedicine could be an added value to corporate optometry, for use during low-volume hours or vacation coverage when an O.D. cannot or does not need to be present. COT!

MARIA SAMPALIS, O.D., is the founder of the Corporate Optometry group on Facebook and corporateoptometry.com . Currently, she is owner of Sampalis Eye Care in Cranston, RI, and has a sublease at For Eyes by Grand Vision in Rhode Island.