Telemedicine, Teleoptometry, Telehealth

When is it time for the old to embrace the young?  It is an opportune time to address that question due to controversies in Optometry that have arisen regarding the use of Telemedicine.


Speaking of controversies, I thought twice about using the graphic above to introduce this topic, because grandma’s teeth look a bit creepy.  Then again, in the spirit of Halloween I hope you’ll forgive me.  (Believe it or not, when I put “embrace” into my search box for PresenterMedia images, this was the least creepy of the choices!)

With that intro aside, my former SUNY Resident and good colleague Dr. Tim Petito wrote a nice chapter on the Evolution of Telemedicine for our annual Elsevier volume on Advances in Ophthalmology and Optometry.   Tim’s chapter sets the stage for a closer look at the looming emergence of Telerefraction as a “disruptive technology”.  The American Optometric Association has issued cautions about online refractions in the context of comprehensive eye examinations.  Given that background, it will be worth your while to take a look at the marketing strategy of a fast-moving player in the field, Smart Vision Labs.  Smart Vision’s prototype product is the SVOne Autorefractor/Aberrometer, selling for $7,000.  Here’s what it looks like in operation.

With that background, I’d encourage you to register for a free webinar by Smart Vision Labs called How to Incorporate Telemedicine into Your Optometry Practice.  It features a presentation by Tihomira Petkova-Vamvaka, OD, PhD, a clinician-scientist practicing in a private setting in Houston, TX.  Here’s a screen shot from the Webinar that you’ll likely find controversial right off the bat, in particularly the statement about delivering precise Rxs without a doctor present.  The speaker during the Q & A at the end does advise that it is necessary to check with one’s state practice laws regarding use of the device particularly for remote refraction, but also in what constitutes establishing a professional relationship with the patient.

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But alas, don’t take aim at the messenger!  For I’m about to show you a couple of other interesting slides that you might not have expected to find on a presentation about telerefraction/teleRxing.

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You can access a copy of the full article above, from Rosenfield and Ciuffreda at SUNY in Optometry and Vision Science here.

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Well, I’m not sure that I would ever want to eliminate which is better 1 or 2, but I could do without the 3 or 4, 5 or 6, and 7 or 8.  That having been said, many of the patients we see in VT need at least an astute refractionist to help decide which lenses optimize the way things look and feel, not just which letters they read.  In other words, we know the price one pays for over-reliance on “objective” refraction with our populations!

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Putting issues surrounding school vision screening aside, there’s a comment above worth noting:  that offloading refraction to a technician can maximize the doctor’s time for doing binocular evaluation.  For the intended audience of this webinars, it’s interesting to see binocular evaluation as positioned ahead of DFE, and all else listed as etc.

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The linkage of offloading refraction to adding VT services is intriguing.  We’re used to the drive toward technology, efficiency, and delegation as part of the package in focusing on “more medical care”.  But is the prompt to add binocular vision therapy as the example of additional services a harbinger of re-prioritizing how the O.D. spends time in the office?  If the answer is yes, expect what you and I do everyday to become a hot commodity in Optometry.


One thought on “Telemedicine, Teleoptometry, Telehealth

  1. Technology is here to stay. It should be used to benefit the patient. Removing investigation of more than just an accurate retinoscopy is needed to prescribe lenses for a patient AT ANY AGE. Patients have need for more than just a compensating Rx at a single point in time. Think of the diabetic, anisometrope, strabismic, progressive myopic, and a host of other patient conditions. The best lens type should be determined by the Dr. This also puts aside the detection of eye and neural visual conditions. Rx, treatment, management, and proper prompt referral to the correct specialist can prevent a host of bodily disorders BEFORE they develop into a “catastrophic” condition.

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