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August 24, 2015

New telemedicine technology aims to disrupt eye exam business

PHOTO | Pablo Robles Dr. Erin McCleary, a Greater Hartford optometrist, worries that a new online vision test will hurt both optometry practices and patients' eye health.
HBJ PHOTO | Matt Pilon Dr. David McCullough, a Northeast Medical Group ophthalmologist in Fairfield County, tried Opternative's online vision test last week. Looking on is Dr. David Emmel, a Wethersfield ophthalmologist.
HBJ PHOTO | Matt Pilon Opternative does not accept health insurance for its test, which costs $40 for a single prescription.
Contributed photo Aaron Dallek, CEO, Opternative
By Matt Pilon

Some experts believe technology will continue to displace workers, particularly those in lower-skilled jobs, but one professional group that has unexpectedly found itself in the automation crosshairs is optometrists.

Last month, a Chicago startup launched an online eye exam service in Connecticut and 26 other states that provides patients with a glasses or contacts prescription without ever having to leave the house.

The venture-backed company, Opternative, says its 25-minute test (which costs $40 for a glasses or contacts prescription or $60 for both) can generate a prescription that a 30-patient clinical trial determined is just as accurate as one written in any eye doc's examination room. Prescriptions, however, must be signed by state-licensed doctors who contract with Opternative's doctor network.

Connecticut optometrists and their more advanced counterparts, ophthalmologists, say they're approaching Opternative's launch with caution. The service is not a full eye health exam, both say (and Opternative readily admits), and can't detect diseases such as diabetes or autoimmune conditions like a doctor could in person.

But it's optometrists who have the most to lose, because Opternative is going after their bread and butter eye exam business and leaving them out of the process. The company is recruiting only ophthalmologists to review and sign prescriptions its test generates, which are then emailed to the customer to use at any online or brick-and-mortar retailer.

Optometrists have pushed legislators in several states to ban or inhibit services like Opternative's. The biggest example so far is Michigan, which passed a bill last year banning automated eye-exam kiosks. But that hasn't stopped Opternative from offering its services in that state.

The Connecticut Department of Public Health has already received a complaint about Opternative, but the nature of the complaint or identity of who filed it was not publicly available at press time, said DPH spokesman Christopher Stan, who cited an “investigatory process underway.”

Greater Hartford optometrist Dr. Erin McCleary, who is a Connecticut Association of Optometrists (CAO) board member, said her organization didn't file the complaint.

McCleary, who works for Solinsky Eyecare and her own private practice, said optometrists may feel threatened by Opternative, but she insists that she and her peers are more concerned about patients believing the online test — which is just the eyesight or “refraction” portion of a full eye exam — is a worthy substitute for an eye doctor visit.

“It is but a sliver of the complete examination,” said McCleary, who stressed that CAO members support the use of technology that improves health care. “If we separate the two, we start to have substandard levels of care for our patients.”

Opternative CEO Aaron Dallek said in a telephone interview that his company has chosen not to recruit optometrists because of liability concerns. He said the company believes laws in many states forbid an optometrist from signing a prescription based on a test conducted by somebody else.

McCleary said her understanding of Connecticut law is that optometrists can't delegate certain key parts of an eye exam, such as refraction, to others.

Ophthalmologist: Jobs likely safe for now

Dr. Steven Thornquist, a pediatric ophthalmologist in Trumbull and an officer of the Connecticut Society of Eye Physicians, said he has mixed feelings about Opternative, which he sees as “the tip of the iceberg” for the disruptive telemedicine technology that will come down the pike in the future.

He shares some of McCleary's concerns about missed diagnoses, but said the company's refusal to accept patients outside of the generally healthy 18-to-40 age group, or those who have a history of diabetes or other diseases, reduces much of the risk. He thinks it's worth it to wait and see how the online service works.

That limited customer base — and the fact that Opternative requires customers to get an in-person eye exam at least every two years — could blunt the economic impact on optometrists, he said.

“Yes, there will be an impact,” Thornquist said. “I don't think it's ready to take anyone's job yet.” Would he consider becoming one of Opternative's contracted doctors?

Possibly, if he was convinced he wouldn't face additional liability for doing so and the test is accurate.

“It sounds like they've got data to back it up,” he said. “It'd be nice to see more studies.”

Dallek says Opternative's own malpractice insurance will cover doctors who sign its prescriptions.

Opternative is eager to answer doctors' questions and become accepted by the medical community, said Dallek, who is planning to attend the Connecituct ophthalmologist society's January meeting for a demonstration and Q&A session. He has visited several other states for similar reasons. The company also provided a free trial of its test to the society last week, so that its officers could try it out.

“We care deeply about the concerns of the eyecare community,” Dallek said. “And we recommend that all of our patients get an eye exam [in person] every two years.”

He's also hoping his visit will hook a few Connecticut ophthalmologists interested in signing on as contractors.

“It's an opportunity for them to service additional patients they might not be able to otherwise,” he said.

Sidebar story: Opternative co-founder settles suit

By the Numbers

656

The number of active optometrist licenses in Connecticut at the end of last year, which has remained virtually flat over the past decade. 

$169,380

The mean annual wage of a Connecticut optometrist. 

Sources: CT DPH and U.S. BLS, May 2014

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