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Industry expert: Online refraction will lead to remote eye exams
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NEW YORK – New technology is being used to explore ways to provide eye care outside the traditional means, Ed De Gennaro, MEd, ABOM, said here at Vision Expo East.
De Gennaro moderated a panel discussion on the future of online refraction, with Aaron Dallek, co-founder and CEO of Opternative; Hal Wilson, president of MyVisionPod; and Vitor Pamplona, PhD, chief technology officer, co-CEO and founder of EyeNetra.
Each panelist described his company’s technology.
Aaron Dallek
Ed De Gennaro
With EyeNetra’s portable refraction system, “You can use your cell phone to take a refraction; the patient does it themselves and gets final results just like with an autorefractor.”
Axis and pupil distance are also measured, he said. Patients use their cell phone with a lensmeter to read single vision and progressive lenses.
“Anyone can take the kit anywhere and perform refractions,” Pamplona said. “Blink is a service based on technicians taking this device into patients’ homes to provide refractions only for glasses prescriptions.”
EyeNetra has also served more than 20,000 people in rural villages in India he said.
“Technicians become self-sustaining in villages,” Pamplona said. “We’re looking forward to adding more instruments, taking a full practice on the road with tonometry, topography, slit lamps, etc.”
He said that 3,000 devices have been sold, 700 of which have been shipped to the public.
“Most of our customers do not have a practice anymore,” Pamplona said. “It saves time and money and provides a premium service. You will see more mobile refraction clinics based on devices like this.”
Wilson explained that MyVisionPod uses an autorefractor and phoropter in a remote pod in a grocery store, corporate environment or clinic that can be operated remotely.
“The doctors and technicians are in another location and communicate on teleconference,” he said. “Patients are asked questions and educated on refraction. The patient reads the chart looking through different lenses, and the doctor writes a prescription and uploads it to the patient’s account.”
“We’re a vision care telehealth platform that is focused on the refractive eye exam,” Dallek said of Opternative. “We provide prescriptions for patients for glasses and contacts.
“It’s a subjective refraction; we educate patients about this and we recommend all patients get an eye health exam every 2 years,” he continued. “We do that multiple times and print that on every prescription. We talk to patients on the phone.”
Vitor Pamplona
Hal Wilson
Dallek said to think of the computer as a digital eye chart. Opternative sends patients a text message that turns their smart phone into a remote control. Patients are advised on how to use their shoe size to measure out 10 feet from the computer screen.
“It will also allow you to measure with measuring tape,” he said. “We’ve done this thousands of times and have gotten accurate prescriptions, even using shoe sizes. We’ve proven it’s an accurate method for subjective refraction.”
The patient is questioned about medical history and tested for color vision, and the information is sent to an ophthalmologist in their state to write the prescription for glasses.
“Contact lens prescriptions are just updates of prior prescriptions,” Dallek said. “It’s the same base curve, brand and diameter of the previous contact lens.”
He noted that Opternative calls the patient’s doctor to get the contact lens prescription and vision history; the company does not accept passive verification.
Opternative has had a 99.9% satisfaction rate in the first quarter of this year, he said.
“Only 0.1% have asked for a refund, and 1% came back for adjustments (we do free re-checks),” Dallek said. “We are far above the industry standard of a refraction done in a clinic.”
He said Opternative conducted a clinical trial that showed that 100% of patients who went through the Opternative refraction got to 20/25 or better, and when the subjective refraction was done in those same patients by an eye care professional, 95% got to 20/25 or better.
“That’s not statistically significant,” Dallek said. However, “the objective measurement is satisfaction.”
De Gennaro asked the panelists what precipitated the idea that a refraction should and could be done outside of a doctor’s office.
“If you’re in the eyeglass business, the biggest obstacle is not having a current refraction,” Wilson said. “We wanted to remove that obstacle and provide unparalleled access to convenience and advice. It’s an underserved market.”
“We saw how many people were unserved worldwide,” Pamplona said. “There are 2.4 billion people who need some correction. They are worse than 20/25. They have not seen a doctor. They don’t know they have a refractive issue. We have 6 billion cell phones out there today, and that’s an easy way to do this. They just need the add-on to conduct the refraction test on themselves and their neighbors and provide access to people who usually don’t have it.
“It’s not just for the developing world,” he continued. “Americans sometimes have to travel 5 or 6 hours to see an optometrist. The highly educated doctors prefer to live in big cities. In Brazil, 90% of doctors are in the 12 biggest cities. Telemedicine empowers patients to take their own data and send it to the doctor. It brings the doctor into the discussion. They can see if there’s something going on with the eye and get them to a center to be evaluated.”
Dallek said: “220 million people in the U.S. need some form of vision correction. It’s about accessibility, affordability and convenience. We should focus on making it as convenient as possible to get an eye exam. Everyone here probably makes more money on selling glasses and contacts than on doing the eye exam. [This technology] will get more people involved in the eye and vision care space and sell more contacts and glasses.”
“It will also result in more eye exams, Wilson added. “People will have more awareness of vision issues.”
De Gennaro asked the panelists where they see the biggest need and demand for this type of refracting technology.
Pamplona said he believes the biggest demand is in the U.S. and Europe, to capture Millennials who want a new experience and like using their smart phone to get it. It is a way to get people back into the system, he said.
“The concept behind our telehealth platform is to be the optometric infrastructure for the world in whatever area optometrists and ophthalmologists can’t or won’t be available,” Dallek said, “whether the rural areas of the U.S. or areas in the world where it’s not economically or physically feasible to have the infrastructure or equipment.
“Even where the infrastructure exists, we have patients who say they have two kids and had to take the test while they were sleeping,” he added.
Dallek also addressed compliance issues.
“If you look at Sweden and Germany where contact lenses are easier to get and less expensive, you’re seeing a lot fewer instances of diseases that happen when you’re not taking care of your contacts,” he said. “If you’re forced to get an eye health exam just to get your prescription, you may do things that would cause a lot more health issues than if it’s easier to do the renewal.”
An optometrist in the audience applauded the panel members, saying they are ahead of the curve, and asked where optometrists and opticians fit in.
“For most doctors, they just want to provide the right care in the exam,” Pamplona said. “In the past they had to sell glasses to sustain themselves. It doesn’t make sense to sell glasses anymore. From a non-OD, I say focus on the exam.”
Wilson said MyVisionPod provides an opportunity for optometrists to join a referral network.
“We can provide names and addresses for doctors’ offices,” he said.
“I would much rather everyone in this room use our technology and we just provide the infrastructure,” Dallek said.
He noted that optometric regulations in about 19 states require a comprehensive exam.
However, “In the ideal world, I would rather you own the patient, and your goal as an optometrist is to keep a relationship with this patient,” Dallek continued. “Engage with them on a yearly basis, whether it be online or in person.”
He explained that the clinician could use the Opternative exam as a way to communicate with the patient and encourage them to follow up with comprehensive exams.
“You’re using this as a tool in your toolbox that keeps that relationship strong and gives patients the convenience they want,” Dallek added. “The American Optometric Association and other societies are trying to pass laws to restrict these technologies, but they’re only going to hold for so long. Convenience and demand, like with Uber and AirBnB, inevitably win, so the question is how you get ahead of it.
“We as a company are not going to build a solution if only a few optometrists want in,” he continued. “But when they’re ready for that, we’re ready to build it so you keep the relationship strong [with patients] and you sell the contacts and glasses.”
Dallek noted that those who are disqualified from the Opternative refraction are referred to a page listing doctors.
“We’re happy to help if you want to send us your information,” he said.
Wilson noted that customers of MyVisionPod are sent to EyeWeb.com.
“We can also provide information based on your zip code,” he said.
De Gennaro asked the panelists to comment on how they envision the future of their technology.
“There will be a comfort level established with people going through our process,” Wilson said. “We’re not going to close the market down. We’ll get 5% of 10% of the market space. It will be slow.”
“You will see the number of eye exams and glasses and contacts sold will be higher,” Dallek said. “The number of eye exams will far surpass 4% growth rate over the next 5 to 8 years. We’ll be able to go after the 67 million people in the U.S. who said they haven’t had an eye exam because of cost and convenience in the last 2 years. My hope is that some forward-thinking optometrists will start using technologies like ours, EyeNetra and others to participate in that.”
“Our future is tied to the future of refraction itself,” Pamplona said. “There will be additional technologies that will be used to provide refractions through smart phones.”
De Gennaro summarized: “This is in its infancy. You’ll see refraction not only occur online, but the entire eye exam being done remotely. This is all going to evolve. It likely will affect you in a positive way. And maybe in a negative way. Your life will be different.” – by Nancy Hemphill, ELS, FAAO
Reference:
De Gennaro E, et al. What’s the future of online refraction? Presented at: Vision Expo East. April 14-17; New York.
Disclosures: De Gennaro owns Infocus Optical Consulting. Dallek is CEO and co-founder of Opternative. Pamplona is chief technology officer, co-CEO and founder of EyeNetra. Wilson is president of MyVisionPod.