In 2016, the American Optometric Association (AOA) issued a press release in response to the growth of online eye tests that attempt to determine the refraction, or lens power needed to compensate for nearsightedness, farsightedness or astigmatism.
“Online vision tests are increasingly being marketed to consumers as time-saving and cost-efficient alternatives to in-person, personalized comprehensive eye examinations by a doctor of optometry that are an important part of general preventive healthcare,” stated the online release. “The AOA is concerned about patients receiving inferior ‘care’ and believing that online vision tests provide more than they do. Online vision tests do not include a comprehensive examination of the patient’s eye health by an eye care professional and do not take into account the patient’s overall medical history.”
Chelsea Johnson, OD, an optometrist with Primary Eyecare in Charlottesville, couldn’t agree more.
“Online vision tests appeared probably two years ago,” she says. “That’s when optometrists were starting to become aware of them. Patients began asking about them and I saw ads for them on Facebook and Instagram. I went online and took the test for fun. It was comical from my point of view.”
Dr. Johnson is emphatic that she would never recommend online vision tests to family or friends, noting that an algorithm is no replacement for a doctor who has years of experience to detect even the slightest change in vision.
“An app can’t detect that,” she says. “It can’t differentiate between pluses or minuses in prescriptions.”
In-person eye exams reveal more than vision issues
Dr. Johnson tested her own eyesight with an online vision test to see what the experience was like for users. She has a minimal prescription with an astigmatism, or curvature of the cornea, something the testing did not note.
“When you hold a phone at a certain distance, it is only to test nearsightedness and farsightedness,” Dr. Johnson explains, adding the prescription provided to her from the online test would have given her severe headaches.
In addition, a full, comprehensive exam is not just a visual acuity test. Some conditions, such as glaucoma, which can lead to blindness, do not even present any signs or symptoms.
“Glaucoma sneaks up on you,” Dr. Johnson notes, adding that in-person eye exams cover more than eye health. “Recently, I had a case with a young gentleman in his early 50s. He had no complaints. I noticed a freckle called a CHRPE (Congenital Hypertrophy of the Retinal Pigment Epithelium) on the back of his eye, which could be a sign of colon cancer.”
Through further investigation, Dr. Johnson discovered the patient had a family history of colon cancer. After seeing a gastroenterologist, who found and treated polyps on his colon, the patient returned to Dr. Johnson with open arms.
Are online exams appropriate for anyone?
According to Dr. Johnson, online tests are popular among late teens and people in their early 20s who don’t have an astigmatism. Even so, this doesn’t meet the standard of care, which includes an annual exam that most insurers cover, understanding the importance of even subtle changes of prescriptions.
Her assessment of the industry is that people risk trading health for convenience. Still, Dr. Johnson does believe that online testing will become part of the continuum of care in the optometric industry.
“Optometry has been around for 200 years,” she notes. “Optometrists take technology and turn it into something better. At our practice, we use top technology practices.”
Nothing, however, will replace the human factor, needed, for example, to read different types of tests and to rule out medical conditions, such as glaucoma and stroke.
“Technology continues to increase, but in terms of an app, it won’t ever meet the level of seeing a medical provider in person.”
–Chelsea Johnson, OD
Article reposted with permission from OurHealth Magazine