What you should know before getting eyeglass prescriptions and other vision checkups online.
Advertisements can be seductive. For the millions of people in the country who decide not to visit the eye doctor due to the pandemic, getting eye exams remotely thanks to telemedicine seems to be the perfect solution: a way to renew or update prescriptions for glasses or lenses from the comfort of their home, or to be evaluated for possible eye disease.
The pandemic has accelerated the use of tele medicine, which has increased by as much as 700%, according to some estimates. This trend has been fueled by increased patient acceptance of the effectiveness of video visits, the easing of regulatory restrictions on its use, increased payments healthcare providers receive for remote visits, and the continued need to practice social distancing. And it can allow people with mobility or health problems to safely receive the care they need.
But in many cases, such as emergencies or the diagnosis of serious eye conditions, or even something that seems as simple as refilling your eyeglasses prescription, telemedicine is not a substitute for in-person exams.
In a few situations, however, remote exams can be helpful:
1. Initial assessment of symptoms
Some patients have received care from their healthcare providers via video conference or even over the phone to assess symptoms. If you wake up one morning with extremely reddish eyes, swollen eyelids, or “floaters” in your line of sight, which can be a sign of retinal detachment, for example, on a video call you can quickly assess whether the problem is A vision condition is effectively an emergency, it can wait until you see an eye doctor in person, or it can be treated with prescription antibiotic eye drops (as in the case of eye infections, such as conjunctivitis).
A good rule of thumb: ask yourself, is the problem in the front or back of the eye? Any symptom you can see in the mirror is a good candidate for a telemedicine visit, says William Reynolds, an optometrist in Richmond, Kentucky, and president of the American Optometric Association (AOA). “We can perfectly visualize the back of the eye if you have a style, an abrasion, or conjunctivitis,” he explains. “But anything that occurs in the front of the eye — cataracts, macular degeneration, glaucoma — has to be evaluated in person. The technology doesn’t exist that allows us to examine the inside of the eye at the level that we need to truly track these diseases.” Does Warby Parker Take Insurance?
2. Routine follow-up appointments
You may not always need to see your doctor in person for follow-up appointments for more serious conditions, such as glaucoma or macular degeneration. “Because we’re able to have higher magnification, with images and video, we’re able to look at the eye a little bit better and make an assessment with a lot more confidence,” says Sophia Salem, MD, an ophthalmologist at Mount Sinai Health’s New York Eye and Ear Infirmary. “However, while these tools are useful for screening and priority purposes, they have not been approved by the FDA for diagnostic purposes.”
Remote follow-up appointments can also be helpful for people with diabetes, who must be closely monitored for diabetic retinopathy, a disorder that can cause blindness if left untreated.
Why You Shouldn’t Get Your Glasses Prescription Eye Exam Remotely
It’s almost impossible for a remote eye exam to get a correct eyeglass or contact lens prescription, experts say, because so much of the intangible goes into making sure you get the right corrective lenses. Even when a certified technician does the refractory evaluation in person, only 5% of prescriptions are correct, according to the AOA’s Reynolds, because many factors must be taken into account before making the final determination. Only an in-person exam can detect potential depth perception issues or undiagnosed eye disorders that could affect vision, or determine if patients can tolerate significant changes to their eyeglass prescription.
In August 2019, the FDA (US Food and Drug Administration) took strong action against Visibly, which offered a refractive eye exam, for its misleading claim that it was, at best, what same as visiting the doctor (AOA believes there are similar problems with the 1-800-Contacts app). Both apps rely on consumer reporting of compliance with instructions without testing by an eye care professional, and online visual acuity charts are not the same as those found in eye doctors’ offices. As a result, no one is making sure that the test is done properly or, in the case of contact lenses, that they fit well.
However, last April, the agency eased guidelines for remote eye exams to be expanded during the pandemic, and some online apps made a comeback. But even apps like Warby Parker or Quick Renew, an online contact lens renewal tool that CVS launched last October, are problematic, experts say, despite having prescriptions reviewed by an ophthalmologist or optician. While both apps simply refill people’s current prescriptions and don’t do online eye exams, experts caution consumers to be cautious anyway. Even if you don’t think your prescription has changed, it may have, and for serious reasons.
“When a patient has blurred vision, new glasses may not always be the right solution, as the change in vision could be due to other disorders,” says Diane Calderon-Villanueva, MD, chief of primary care at the University SUNY College of Optometry Eye Center in Manhattan. “None of these apps will tell you,” she adds. “Even if the patient manages to have 20/20 vision, they still have to see a professional to have their eye health examined.”