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Telemedicine—and specifically Online Eye Exams by Dr. Piatt

online eye exam

Why I’m excited:

Having gone on medical mission trips to under-served groups, with significantly less access to eye care, I’m thrilled when technology comes out that can improve their quality of life by improving their vision.  On our trip to Guatemala, we were in a small village and there was a mother who was so incredibly far sighted, after fitting her with glasses, she looked down at her baby’s face and had the biggest smile.  I don’t think she had ever seen her child clearly.  It’s always a very moving and rewarding experience to fit people with glasses who have never worn them before.

The idea of having an online eye exam is amazing because even in third world nations, most people at least know someone with a smart phone or computer access.  If an area was able to do online eye exams, a group working with the Lion’s Club or other organizations, could go down with the specific glasses for this group of people.  Normally you’re bringing down hundreds of glasses, doing the exam there and hoping you happen to have a fit in your collection of frames that you brought, often times, just giving the best option even if it’s not perfect.  You could be more specific in what you bring.  You could also just mail them with their names attached.

Why I’m concerned:

The concerns I have so far, is that I’m not sure who’s regulating the online eye exam industry.  They don’t claim to be an eye exam, so they haven’t registered through the FDA.  Therefore, it isn’t FDA approved.  It’s not approved by the state.  Who’s testing the technology and ensuring patient safety?  They’re claiming not to be a replacement for an eye exam, and yet call it an online eye exam.  The attorney general doesn’t look into them unless there have been concerns reported to them.  An autorefraction isn’t the same thing as a refraction and a retinal or external eye photo isn’t the same thing as a comprehensive eye exam.

So although I love that we could be bringing SOMETHING to an underserved population that doesn’t have access to anything better, is this something I would recommend to American citizens who do have access to something better?  Increased access to an inferior exam isn’t progress.  It isn’t a step in the right direction for Americans.  It isn’t (at this time) equal to the care you would receive seeing an eye doctor in person.

Case Studies

Off the top of my head, I’m thinking of a couple case studies that could have slipped through the cracks.  Two individuals had similar experiences in our office; one was a long term patient who came for annual eye exams.  She was healthy with glasses, had no other complaints besides wanting to update her frames and make sure her eyes were healthy.  When she came in her eye pressures were incredibly high and this was not normal for her.  She had never measured that high.  She ended up having narrow angle glaucoma, was ultimately referred for surgical intervention and is currently using glaucoma drops.  Had she not come in for her annual eye exam, she likely would have progressed to some vision loss before she realized there was a problem.  It was easily caught and taken care of and at this time has no measurable visual field loss from her glaucoma.

A similar problem occurred with a new patient who came in our door.  He was complaining of a vision change and wanted to update his glasses.  His pressures were the highest I’d ever seen.  He also was referred out for surgical intervention and his sight was saved because of a regular eye exam.  You cannot check intraocular pressure online.

A very different case study involved a twelve year old boy who presented for a regular eye exam.  He had no complaints about his vision, headaches, or general eye comfort.  His sibling wore glasses and his parents wanted his eyes checked.  He could see 20/20.  His intraocular pressure was great.  During the health exam, a flame shaped hemorrhage was observed on his optic nerve head in his retina.  In an adult if you saw that you would think glaucoma (likely normal tension glaucoma), but in a kid that’s pretty unlikely.  I referred him out because it didn’t look normal and ultimately he was found to have elevated cerebral spinal fluid pressure.  That can cause optic neuritis and damage the optic nerve.  In the exam it wasn’t swollen at all.  It was caught early enough that it was addressed before his vision was ever affected.

Conclusion:

I think telemedicine can be utilized very effectively.  I would enjoy using it especially if it’s a patient I already have a relationship with. I don’t believe it’s a replacement for a full eye exam, but I think it could be utilized for some office visits.  Allergic conjunctivitis, for example: you’re out mowing the lawn and your eye gets incredibly swollen with an acute reaction.  If you’re able to send a picture to your doctor, you’re able to dialog through a series of questions and answers and then an antihistamine or whatever remedy is most appropriate could be called in.  I also think it could be life changing in a third world application.

It’s an exciting world.  I’m eager to see what technological advances are around the corner. What I do not want to see happen is a patient hurt because they trust in technology that is unregulated by anything other than a business desire to make money off of the convenience that an online “exam” provides with no recourse when things go wrong.

#telemedicine #onlineexams #eyehealth