“Let the Buyer Beware”

What regulations guide the use of “tele” services in eye care?

By Robert M. Easton Jr., OD, FAAO

In the May/June issue of AOC, I talked about online refraction (which is not telehealth or telemedicine, it is only a “telerefraction” if that). Online refractions have nothing to do with ocular health or treatment, they are merely a non-US Food and Drug Administration-approved overrated, subjective internet test for vision. Uneducated consumers may spend their hard-earned money on these unregulated tests believing it is cool, convenient, or that they are saving money. Moreover, sites like www.1800contacts.com refer consumers to online refraction sites, bypassing a comprehensive eye health examination by optometrists and ophthalmologists.

Coming to a state near you, telehealth or telemedicine is the use of medical information exchanged from one site to another via electronic communication. Telemedicine can include two-way video, email, and smartphones. Health information technology or HIT, includes electronic medical records and electronic health records (EMR/EHR) and related information systems. On the other hand, telemedicine refers to the actual delivery of remote clinical services using technology. 

Many family practitioners and pediatric physicians may consult with a “tele-eye care provider.” Many primary care doctors image patients using a retinal camera, rather than referring the patient to an ophthalmologist or optometrist for a dilated fundus exam, to rule out diabetic retinopathy, for example. I have always felt that the retinal camera is a great adjunct and an excellent educational tool for patients, but it is not a replacement for a dilated binocular fundus exam. State boards of optometry, boards of medicine, and boards of osteopathy should work together to protect the public in this regard rather than ignore this new technology.

According to the Association of Regulatory Boards in Optometry, only about 10 state optometric boards have telemedicine rules and regulations in place. Unfortunately, until something is worked out that benefits patients first, telehealth/telemedicine/telerefraction will continue to be, as I said in my previous column, a wild west shootout for eye care delivery in America.

It is not “old fashioned” to see a patient, understand his or her history, do a hands-on examination and assessment, and arrive at a diagnosis and treatment plan with a recommendation when to return for further care. Face-to-face encounters are important in the delivery of quality primary eye care.

So, one has to ask, who is regulating the doctor receiving the telehealth/telemedicine/telerefraction information? Is the transmission safe from hackers and does it follow Health Insurance Portability and Accountability Act guidelines? Is the information provided to a licensed doctor, in an interactive, real-time environment? How do telehealth/telemedicine/telerefractions follow the standard of care in this regard? Does the patient understand consent laws? Are there fees for the doctor sending and the doctor receiving information? Are there facility fees, are there imaging fees, and will all of these cost more in the end? Can drugs be prescribed this way? Is that safe? Will insurance companies demand the use of telehealth/telemedicine/telerefraction to reduce their provider list and minimize management costs? Will the so-called big box stores replace ODs with technicians?

Eye care professionals are at a crossroads. We have to adapt or not survive. We have to welcome new technology—of course it is coming one way or the other. However, with new advances in telehealth/telemedicine/telerefraction, we must engage in legal and legislative approaches to ensure that, in this wild west environment, our patients are protected from entrepreneurs who wish to practice eye care without a license. Join associations, join political action committees, and come together to promote good eye health delivery to patients. We have come this far—we cannot give away our profession. n

Robert M. Easton Jr, OD, FAAO
• Easton Eye Care, Oakland Park, Florida
• Past president, Florida Optometric Association; past president, Association of Regulatory Boards in Optometry; former chair, Florida Board of Optometry, and adjunct faculty, Nova Southeastern College of Optometry
• (954) 564-2025; dreaston@eastoneyecare.com