Optometrists Push For State Laws Blocking Online Eye Exams

from the no-competition-please,-we're-doctors dept

Tue, Apr 19th 2016 2:07pm — Zach Graves

Billing itself as a sort of Uber-for-eye-exams, telemedicine startup Opternative recently came on the scene offering a quick, inexpensive alternative to traditional optical exams that uses your computer and smartphone. Following a 25-minute online exam, an ophthalmologist will approve your results and issue a prescription for a cost of $40. No doctor visit is required.

Unfortunately, just like Uber, there's a powerful lobby of incumbents who don't want the status quo disrupted. Now they're pushing legislation in several states to shut down online eye exams.

As someone who recently had to get glasses, I like the idea of an online option the next time I need a checkup (and unlike many people, I only have to walk a few blocks from my office to see an eye doctor). Of course, my first question was: "Is it accurate?" But, at least according to its clinical trial, the online version appears to be equivalent in accuracy to its analog counterpart.

The technology is approved in 45 states, and the service is currently available in 33. So, unlike transportation network companies like Uber that had to contend with onerous insurance, safety and liability questions, the regulatory status quo of telehealth services like this is that they are legal in most jurisdictions.

Indeed, telemedicine is nothing new. Through its more than 40-year history, it has shown great potential for cost savings in both private sector and government programs. This potential will only grow, as wearables and smartphones become more sophisticated and ubiquitous. For instance, in Opternative's case, the service is about half as expensive as a traditional eye exam. Future competitors in the space, or economies of scale, could bring costs down even further.

Unfortunately, a powerful lobby of brick-and-mortar optometrists is pushing for legislation to shut them down. In Georgia, a bill (HB 775) was passed by both houses of the state Legislature that would ban these online eye exams. Aptly listed as "restrictions on sale and dispensing of spectacles," this legislation is clear in its purpose to protect licensed brick-and-mortar optometrists from unwanted competition. Now it's up to Gov. Nathan Deal to sign or veto the bill. He has until the first week of May to decide.

Blocking new telehealth applications like this one will only serve to raise prices, reduce the ability of low-income or rural individuals to access care and stifle future smartphone-driven innovations. As former Speaker Newt Gingrich wrote in a column for USA Today:

There are more than 100,000 smartphone apps for health purposes, including one that detects heart attacks and another that helps diabetics monitor their blood sugar....And every day more are invented. Many of these smartphone enabled apps and devices will be better than the methods they're replacing — more convenient, faster, less expensive, and, in a growing number of cases, more accurate.... In healthcare, however, there is a growing effort by the existing, expensive systems to defend old, costly, less convenient, and slower methods by simply outlawing most of the competition.

What's happening in Georgia, Indiana, Nebraska, South Carolina, Oklahoma and elsewhere, is a shameless attempt to capture the regulatory apparatus by a rent-seeking cartel that wants to preserve the status quo at all costs. If these acts of cronyism are allowed to proceed unchecked, they inevitably will contribute to a disastrous chilling effect for innovation in the health sector -- an area already encumbered by a massive regulatory burden.

This will only make us all poorer, and less healthy.

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Filed Under: georgia, indiana, innovation, internet, lobbying, nebraska, oklahoma, optometry, regulators, south carolina, telemedicine
Companies: opternative

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That Anonymous Coward (profile), 19 Apr 2016 @ 2:26pm

"by simply outlawing most of the competition"
Wish sadly has become the tried and true method for maintaining the "free market".
Even as the incumbents make promises they never live up to (and no one with power holds them accountable) they get handed control and use it to raise prices while not innovating. With no real competition, they don't have to get better, faster, cheaper... they can claim how much better they are now while keeping people from being able to see what real progress is.
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Jason, 19 Apr 2016 @ 2:33pm

To be fair, a good eye exam does a whole lot more than simply check your vision and crank out the right prescription for a pair of new glasses or contacts.

The eye doctor will screen for a number of conditions that can affect your sight, or be an early indicator of other problems. (There are medical conditions that can affect your eyesight, so those problems don't even necessarily have to be related.)

I appreciate the point the article is trying to make, but I think it's a bit unfair to paint any opposition as strictly trying to keep a captive market. There are legitimate medical reasons to have a regular eye exam. Maybe they don't apply to everyone, but even if they don't I generally prefer not to take medical advice from software developers. Speaking only for myself, I doubt I'd feel overwhelming confidence in a smartphone app to tell me about my health. Ditch your eye doctor if you like, but I'm happy to keep my annual appointment.
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Anonymous Coward, 19 Apr 2016 @ 2:36pm

This goes a lot farther than that... it actually bans buying glasses without a prescription.

"A person shall not dispense or adapt contact lenses or spectacles without first receiving authorization to do so by a written prescription..."

This partially existed before, but the words "or spectacles" would be added by this bill. The definition of "spectacles" is pretty much any corrective glasses.

You can make an argument that people SHOULD be getting eye exams, but it's not the place of government to MAKE them get eye exams.
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Anonymous Coward, 19 Apr 2016 @ 2:42pm

Re:
"At no time, without the direction of a prescriber, shall any changes or substitutions be made in the brand or type of lenses the prescription calls for with the exceptions of tint change if requested by the patient."

This paragraph used to apply to contact lenses, but if this bill is passed, it would also apply to glasses. So now they get to control what BRAND of lens you're allowed to have in your glasses? I'm not sure if they intended this change or not.
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Paul Brinker, 19 Apr 2016 @ 2:46pm

Re: Re:
They specifically did intend this, Otherwise you could go to an independent eye doctor for a proscription then wal-mart for the glasses.

This makes it so your locked into Brand A B or C AND all 3 brands are made by the same firm.
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crade (profile), 19 Apr 2016 @ 2:46pm

Re:
To address your points:

Since as you mention the online version is not replacing checks for other medical conditions, those would still have to be performed on an as needed basis by your regular optometrists. Any opposition would have no cause to complain about any competition on that front.

Fortunately for you, if you or anyone else doesn't like/trust/whatever the online version they have the option of going to a brick and mortar one instead. Yay for competition!
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crade (profile), 19 Apr 2016 @ 2:53pm

Pupillary Distance
I have no experience with online eye exams. However, I am familiar with buying glasses online. Currently buying glasses online in Canada is perfectly legal and like 1/10th the cost of buying them retail. The biggest obstacle to doing so is the glasses retailers attempt to prevent this through a deal with the optometrist that your pupillary distance is never included in your prescription from the optometrist. The pupillary distance is needed to make glasses for you, and because of this collusion, it's only ever measured by the glasses retailers, and they will never give it to you. You can *try* to measure it yourself, but it's not nearly as reliable and you can get headaches and such if you screw up and order glasses with a wrong PD.
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Anon, 19 Apr 2016 @ 2:54pm

Canute strikes again.

What, are they going to have inspectors at every post office and FedEx depot to look for unlicensed glasses? The only thing easier than checking your eyes online is ordering glasses online. I saw a site once, the only thing they asked you to do was put a ruler up to your eyes and measure pupil to pupil, then send the prescription numbers. I suppose for contacts, not even that.

Until the Feds get involved... and interstate transport of eyeglasses for commercial purposes becomes a crime.
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crade (profile), 19 Apr 2016 @ 3:02pm

Re:
I would highly suggest bribing the clerk at the retail store to give you your PD. The little gizmo they use to measure it is much more accurate, and it's quite important to get it right.

If you want to use the ruler method, definitely have someone else measure, since you can't read the ruler and hold your eyes straight at the same time. The ruler method didn't work for me though, I got a bunch of wonky symptoms and had to do the bribe the clerk method :)
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Anonymous Coward, 19 Apr 2016 @ 3:11pm

Re:
To be fair, "Jason," nothing you said is actually relevant to the issue at hand.
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Whoever, 19 Apr 2016 @ 3:57pm

Zenni Optical and Warby-Parker?
It looks like this approach is aimed more at Zenni Optical and Warby Parker than cellphone apps.

Zenni Optical in particular is a far cheaper source of spectacles than any optician's office. Far, far cheaper.
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Anonymous Coward, 19 Apr 2016 @ 4:02pm

Re: Pupillary Distance
If these are driving glasses we are discussing then I kinda agree a smart phone is not a reliable way to make a diagnosis. I don't want other drivers that can't see, I want a licensed optometrist making a diagnosis with the right equipment prescribing the right glasses to the patient before that patient drives on the same road as me.
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zm, 19 Apr 2016 @ 4:18pm

Re: Pupillary Distance
I bought a pair of glasses for my son in Costco last month, and they did print his PD on the receipt.
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Anonymous Coward, 19 Apr 2016 @ 4:23pm

While this is definitely a classic case of governmental interference with the market (funny how politicians are against that till it's their bri... er campaign funds being threatened), there's another side to optometrist services that can't (currently) be performed by online exams. You can't find out if your patient has glaucoma, newly forming cataracts, retinal damage, or many other diseases of the eye just by having someone read out letters on an eye chart.

Georgia is doing the right thing for the wrong reasons. Course doing the right thing for the wrong reasons means you screw up rather than make the correct regulations and cause more problems rather than solving any.

The right way of handling this would have been to require a followup exam by an optometrist who you take your online exam results to for verification along with proper screening for the various eye conditions. Most of the time I take at the eye doctor is to get a new lens prescription (Yes it's that one. No, 1 is better...). This would reduce that down to time needed for verification (a quick setup on the equipment, can you see this?) then the checks for eye diseases. You've cut your visit time down to maybe 15-20 minutes rather than an hour.
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Anonymous Coward, 19 Apr 2016 @ 5:07pm

Re:
"You can't find out if your patient has glaucoma, newly forming cataracts, retinal damage, or many other diseases of the eye just by having someone read out letters on an eye chart."

This is true.

"Georgia is doing the right thing for the wrong reasons."

I don't think they're doing the right thing, though. Yes, people should get proper eye exams. Should we *force* them to get eye exams - but only the people who need glasses?
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Anonymous Coward, 19 Apr 2016 @ 5:13pm

Re: Re: Pupillary Distance
But what if the person decides to just not get new glasses because it's more of a hassle and more expensive, even though they kind of need them? Do you want THAT person on the road with you instead?
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JoeCool (profile), 19 Apr 2016 @ 5:23pm

Re: Re: Pupillary Distance
Doesn't really matter - I went to a licensed optometrist and got a prescription that I took to a major eye glasses store. For just over $300, I got a pair of glasses that only got my vision to 20/40. When I complained to the eye glasses store, they blamed the optometrist. When I complained to the optometrist, he blamed the store. In the end, I'm out $300+ and have a pair of glasses only slightly better than the old pair.
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JMT (profile), 19 Apr 2016 @ 5:28pm

Re:
"I appreciate the point the article is trying to make, but I think it's a bit unfair to paint any opposition as strictly trying to keep a captive market."

It's up to optometrists to convince the paying public that it's worth paying more to get the benefits you describe. That's called competition. Running to the government for a law change that kills off your competitors instead of competing on merit is the very definition of a captive market.
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xtian (profile), 19 Apr 2016 @ 5:41pm

Re:
What you say is true, but making the service "illegal" speaks to much more than a concern about quality of care. The service has already been shown to be accurate, so they can't argue that it's fraudulent or sloppy. There's no basis for pushing laws against it beyond defending their territory. If it were simply an inferior service, they could market their services better and actually compete.

I'll never abandon my optometrist, but back in grad school, the best I could get was a drunk in a mall who worked for some chain. I would have gladly taken a simpler exam rather than spend hours traveling to a doctor who was incompetent.

They probably try to make a public health argument, but I'd say that the ability to get proper glasses easily is many times more important to the public than checking for signs of glaucoma.
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Anonymous Coward, 19 Apr 2016 @ 6:33pm

Re: Re: Re: Pupillary Distance
The DMV should do periodic eye exams on people (and in California I believe they do every so often, they make you read that chart to the examiner).
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Anonymous Coward, 19 Apr 2016 @ 6:34pm

Re: Re: Re: Pupillary Distance
Pretty much the same thing happened to my dad. That's a separate issue though.
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Anonymous Coward, 19 Apr 2016 @ 7:06pm

Re: Re: Re: Re: Pupillary Distance
Yeah, where I'm from you need to go in every 8 years or so and show that you have at least 20/40 vision. (Or 20/100 at minimum, but that gets you extra restrictions.) But 8 years is a long time.

Unless there's going to be a rash of people getting glasses that are somehow *worse* than the glasses they currently have, it's still better that they use this technology than go without new glasses.
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Anonymous Coward, 19 Apr 2016 @ 7:12pm

Re:
It should be up to the individual to decide if they want the additional screening or not. Otherwise, I would ask you if you think everyone, not just those needing corrective lenses, should be legally required to have periodical eye exams.
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Anonymous Coward, 19 Apr 2016 @ 9:23pm

Re:
This argument almost makes sense. Trouble is that people who don't need corrective lenses never get all those necessary services you're talking about. If you really want to solve the massive problem of people wandering around with glaucoma, there's only one option: force everyone to go in for an eye exam. I think maybe random traffic stops, force everyone to show their eye exam certificates or face heavy fines. That would fix it.
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toyotabedzrock (profile), 20 Apr 2016 @ 12:02am

If someone has astigmatism how in the world do they intend to detect that?
Further many phone screens use nontraditional pixel arrangements and the ability to actually put the lense in front of your eye is the only way to get it right.

This seems like another scam that will be skiming off Medicare and Medicaid since people will have to go back for real exams.
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Zem, 20 Apr 2016 @ 12:30am

I don't see the problem with this.
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Wendy Cockcroft, 20 Apr 2016 @ 2:37am

Re:
This is why I'm constantly bashing the "free market." As soon as someone gains an incumbent position they are loathe to give it up. They then use "government" to maintain the status quo. I really can't be dealing with it. Either create and maintain a market that's as free and open as it's possible to be or stop pretending there is such a thing as one.
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Padpaw (profile), 20 Apr 2016 @ 4:21am

better people die to easily treated medical problems than we lose a single cent
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LAquaker, 20 Apr 2016 @ 4:30am

glaucoma, Never use Visine
In California, i would NEVER trust a passing cop to decide whether i 'should' be wearing glasses, but that's a ticket if 'correction' is marked on your DL, and in his computer.
Amblyopic my whole life, the DMV forces me to get a sign off from a 'professional' every time.
I! will decide according to the driving situation; Rain, long stretch of dark road, dense city traffic daytime?
Last time the DMV insisted, i obtained 3 full exams; Cosco, an old Beverly Hills optometrist (since retired) and the VA.
Each was 1 to 3/4 diopter different and placed the axis of astigmatism 10-20 degrees different. PD? the dispenser MIGHT get it close:(
DO NOT EAT before an exam, carbs will badly effect the outcome. This is something i have been explaining to Drs since the 1990's (NoWay!!) and just this last year or two, everyone now believes.
Millions of low-class Americans need glasses, this new law will condemn them to partial blindness. In Monoply, three players starve and have no place to live.
THIS JUST IN: 3D movies can correct lazy-eye, even for oldsters.
Disclaimer; My USArmy MOS was 91-U20 (EENT)
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Alan Edwards (profile), 20 Apr 2016 @ 4:43am

Normally I'd agree with you, that the established people are trying to crush competition, but I'm not sure it's a good idea to do eye tests with a smartphone app.

It's certainly not something I'd do.

The optician's tests do a lot more than just see whether you can focus right, the tests will give advance warning of conditions that will affect your eyesight.
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LAquaker, 20 Apr 2016 @ 4:50am

astigmatism or cataracts
Your axis of astigmatism can be discovered by studying the distortions of the moon on a dark clear night; this will correlate to the addition of cylinder in glasses held away from the face and pivoted.

One form of 'cataract' is yellowing of the vitirus to protect the fovia from UV with ageing.
Just saying
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Anonymous Coward, 20 Apr 2016 @ 5:21am

Re:
"While this is definitely a classic case of governmental interference with the market "

Looks more like industry whining at the feet of government whilst begging for favors.
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Mason Wheeler (profile), 20 Apr 2016 @ 7:12am

Of course, my first question was: "Is it accurate?" But, at least according to its clinical trial, the online version appears to be equivalent in accuracy to its analog counterpart.

Wait, wait... what?!?

How can an online eye exam possibly be accurate? How can it even hope to be accurate?

When you go to an optometrist, they make sure you're seated at the right distance from the chart--something vitally important that you can't do alone on an app. Then if they're trying to determine a prescription, they'll have you look into a machine and flip the lenses around, choosing one thing and another, sometimes even for each eye individually. You can't do that on an app. They might even put eyedrops in your eye to dilate it to get more accurate test results--I've had that happen. You can't do that on an app.

Sure, they might show some blurry images and check to see which one looks better, but that's in no way a real eye exam. I would no more get a prescription for eyeglasses online without a physical exam than I would buy shoes without going to a store to try them on, or purchase a car online without a test drive. It's one of those "how can anyone be stupid enough to think this could even possibly work?" sort of things.
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Mattmon (profile), 20 Apr 2016 @ 7:30am

Re:
"If someone has astigmatism how in the world do they intend to detect that?"

For the specific things that an online exam can't detect, you can still go to an regular optometrist.
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Anonymous Coward, 20 Apr 2016 @ 7:41am

Re: Re:
This is NOT a problem with the free market assholes!

This is a problem with government regulation backed monopolies! Only the government can outlaw shit not a fucking company! And this means that a free market is BEING DESTROYED!

get your fucking facts straight. I see a lot of people blaming free market for the problems that a free market would actually solve.

You might be thinking Capitalism instead which would be closer but not correct either.
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Mattmon (profile), 20 Apr 2016 @ 7:47am

Re:
So your claim is that an optometrist does the test differently than an online app? That doesn't speak to whether the test is more accurate, or at least significantly more accurate, just that the test is done differently.
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BentFranklin (profile), 20 Apr 2016 @ 7:58am

"a shameless attempt to capture the regulatory apparatus by a rent-seeking cartel that wants to preserve the status quo at all costs"

This is my new favorite phrase
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Mattheus (profile), 20 Apr 2016 @ 7:59am

Re: Re:
There is no such "thing" as a free or freed market. It's a concept. There are markets *more free* or *less free* than other markets (broadband industry is a case in point here), but no such thing as a genuinely free market. There COULD be freed markets if government were abolished, but since it is not, all currently existing markets are to some degree controlled.

The problem is that a lot of people think that our current society is half-and-half "free markets" and necessary government regulation. That's not possible. The "free markets" of today are highly controlled, corrupt, crony industries.
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Mason Wheeler (profile), 20 Apr 2016 @ 8:07am

Re: Re:
Of course it speaks to whether the test is more accurate. You can't possibly hope to have any sort of reliable accuracy if you have a person alone looking at a screen, because the person will naturally, instinctively lean closer, or back, to get a better focus. (Especially if they do have existing vision problems that they aren't already wearing corrective lenses for, as this will be a natural compensation strategy they've learned over the years!) That's why the optometrist makes you stay at a specific distance from the chart, far enough that leaning forward won't make any difference, and they can watch what you're doing with your face to see if you do things like squinting.

A test like this might be a good first approximation to determine if you need to go in and see an optometrist, but without a controlled environment, I don't see how it could ever be reliable in its final determination, because people will naturally sabotage the results without even meaning to.
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Mattmon (profile), 20 Apr 2016 @ 9:00am

Re: Re: Re:
"You can't possibly hope to have any sort of reliable accuracy" According to the clinical trial, apparently you can.

"I don't see how it could ever be reliable", but the clinical trial shows that it can be reliable.

If you want to dismiss the results of the clinical trial, go ahead. You still have the choice to go to a regular optometrist.
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Anonymous Coward, 20 Apr 2016 @ 9:13am

The fact is, I wouldn't go to see an optometrist at all if I used this online eye test. I doubt many people would. They would just get their new prescription, order new glasses or lens and go on with their life.

Then possible serious eye conditions would go unchecked.
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Anomynuos Crowad, 20 Apr 2016 @ 10:01am

Re: Pupillary Distance
I buy eyeglasses online in the US all the time. If I want the PD I just ask the optometrist to put it on the prescription. They've never refused.
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Anomynuos Crowad, 20 Apr 2016 @ 10:10am

"reduce the ability of low-income or rural individuals to access care"

Ehh... bit of hyperbole there. Online services don't really come to mind when you're talking about these demographics. More like it reduces the convenience that urban hipsters have come to expect.
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Anonymous Coward, 20 Apr 2016 @ 11:06am

Re: Re: Re:
Sit down, take a deep breath ... and try to control yourself.

Now rethink your silly assertions.
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Anonymous Coward, 20 Apr 2016 @ 6:11pm

Re: Re: Re:
The problem is that a lot of people think that our current society is half-and-half "free markets" and necessary government regulation. That's not possible.

There are those who argue that true freedom means the freedom to own slaves. I think that's bullshit.
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That Anonymous Coward (profile), 20 Apr 2016 @ 11:44pm

Re: Re: Re:
You do understand that the law makers love to tout the alleged free market while enacting laws keeping any competition from entering the market.

In a free market you don't have laws passed to keep the outdated in business, adapt or die off. The problem is these old businesses can afford to pay (what often is small potatoes, and we should be insulted our representatives are so fucking cheaply bought) to protect their market.

We do not have a free market, free market is a buzz word used to rile people up, disengage any critical thinking, and support plans that actually actively harm them. Its a common thing you can see across all sorts of issues, say the hot button and the brains go limp and fall into line.

Note I put "free market" in quotes when I used it, because I know it doesn't exist. The truly wonderful thing that someday might happen is people learning to get past the brain disengaging hot button things and see how fucked we all are, and demand better.
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LAquaker, 23 Apr 2016 @ 3:08am

Re:
Gosh, does anybody here study the people around them?

I 'checked eyeglasses' of thousands of young men in the 1970's, 95% replied that 'they didn't wear glasses' including hundreds that had glasses ON THEIR FACE.
The poor and rural have pride just like the rich and snotty.
Many adults will avoid 'glasses' for decades after they could use them, and never spend the money or time for an appointment.

TechDirt sells a modern solid-state 'camera' that records EVERY possible plane-of-focus, Google gives away a cardboard box that splits it's cellphone into separate images for each eye, and is building a contact lens that monitors blood sugar. Great.

I own a full set of optometrist's diopters, my Father had patents on stereo vision, but i would trust these new evolving APP technology's that integrate personal feedback LONG before trusting a frustrated human operator on a device invented in the 1940's.
We used to put a dozen electrodes on the patents head and READ BRAINWAVES to get around the pride and social stigma of defective hearing. Self-test? Great news, and statistically a much better result.

With eyeglasses, 'The central meaning of justice, perhaps the most common is – efficiency'. Judge Robert Bork was correct:)
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denise, 20 May 2016 @ 5:35am

You can get a full eye exam at Walmart for around $55.

The article states that the online exam of $40 would be half of what it would be not online. So..that's not true.

The online exam is just a refraction only. Refractions can come close to your actual prescription. Nine times out of ten a refraction number will be different that your actual prescription because a doctor tweaks it based on your answers during the exam.

Refractions can be WAY off if the patient is over focusing while doing the test.

So, you can still get a full inexpensive eye exam at a Walmart AND inexpensive glasses. And who doesn't have a Walmart near them? LOL....not many.
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