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Refraction is ‘one small part’ of healthy vision
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Who amongst us is not in search of a better way to refract? While our time-honored subjective refraction – a delicate blend of objective measurement and patient commentary – has served patients well for generations, it seems a bit outdated. After all, in an era in which we measure retinal thickness with micron accuracy, should we not be beyond “which is better, one or two?”
It is really for this reason that I have been intrigued by Opternative and EyeNetra. Sure, like every other eye care provider I have concerns as it relates to insuring patient health. But I figure if these technologies take us to the next level, we will find ways to safeguard patients – perhaps even adapt the technology for in-office use.
In taking a good look at each technology, I asked three simple questions: Is it a better way to a more accurate prescription? Is it efficient and cost-effective for patients? Does it provide a safety net for patients? After all, it really only makes sense if it improves patient care.
Is it a better way to a more accurate prescription? While each technique employs a “high-tech” patient interface, both fundamentally rely on subjective refractive techniques, not unlike what is done in-office. Furthermore, aside from the presence of Blink’s visioneer, neither provides OD or OMD supervision during the actual refraction or professional consultation immediately thereafter. This is an important consideration, as we all know phoropter results are often modified to meet patient needs.
Opternative’s results are reviewed by an eye doctor, which, while beneficial, still lacks real-time direct doctor-patient interaction. And while each company is conducting in-house clinical trials, it is with the goal of achieving parity with a traditional manifest refraction. Personally, I was hoping for something more ambitious ... and superior to what already exists.
Is it efficient and cost-effective for patients? The fact that each can be done at home is a positive. The fact that the “process” takes 20 to 60 minutes — not so much. As many patients languish over the subtleties between “1 and 2”, I question whether most will welcome the opportunity to do so for 20 minutes or more. Furthermore, in the case of Blink, patients may have to wait up to 24 hours for their prescription. With costs ranging from $40 to $70, there appears to be little savings for the patient. Especially as both companies are quick to point out this is just a refraction and not a comprehensive eye examination.
Does it provide a safety net for patients? This is a tough one. I applaud both companies for differentiating their services from a comprehensive eye examination and for encouraging patients to seek the latter. However, it is one thing to state such (read: legal disclaimer) and quite another for patients to understand exactly what you are saying. The simple reality is most patients equate their refraction with an eye examination, often presuming an ocular health evaluation is somehow embedded in the refraction. If we all agree periodic eye health evaluations are necessary, why not just do a refraction then?
So, what will I tell patients? I will tell them there are exciting emerging technologies in refractive eye care. Our hope is that they eventually prove more accurate, patient-friendly and cost effective than what we have done for the past 100 years. Finally, I will also tell them that the refraction is just one small part of what is necessary for a lifetime of clear vision and healthy eyes.