En español | The ads are seductive. For the millions of Americans who are skipping eye doctor visits because of the pandemic, remote telehealth eye exams seem to be the perfect solution: a way to renew or update eyeglass or contact lens prescriptions from the comfort of home, or have a potential eye condition assessed.
The pandemic has accelerated the use of telemedicine, which has increased by as much as 700 percent, according to some estimates. This trend has been fueled by greater patient acceptance of the efficacy of video visits, the relaxing of regulatory restrictions on its use, increased payments to health care providers for remote visits and the ongoing need for social distancing. And it can allow people with mobility or health issues to safely get the care they need.
But in many cases, such as emergencies or to diagnose serious eye conditions — or even something as seemingly simply as renewing your eyeglass prescription — telemedicine is no substitute for in-person exams.
In a few situations, however, remote exams can be useful:
1. Initial assessments of symptoms
Some patients have been receiving care through videoconferences or even phone calls with their health care providers for assessments of symptoms. If you wake up one morning with eyes that are flaming red, swollen eyelids or “floaters” in your line of vision, which can be a sign of a detached retina, for instance, a video call can quickly evaluate whether an eye problem is a genuine emergency, can wait until you can see an eye doctor in person or can be treated with a prescription for antibiotic eye drops (as is the case with eye infections like conjunctivitis, or “pink eye").
A good rule of thumb: Ask yourself, is the problem happening in the front or the back of the eye? Any symptoms you can see in the mirror are a good candidate for a telehealth visit, says William Reynolds, O.D., an optometrist in Richmond, Kentucky, and president of the American Optometric Association (AOA). “We can get a good view of the front of the eye — if you have a stye, an abrasion or conjunctivitis,” he explains. “But anything that occurs in the back of the eye — cataracts, macular degeneration, glaucoma — has to be analyzed in person. There is no technology that allows us to look inside the eye at the level we need to really follow those conditions."
2. Routine follow-up appointments
You may not always need to visit your doctor in person for follow-up visits to track more serious conditions, like glaucoma or macular degeneration. “Because we can get high magnification — with photo images and video — we're able to look into the eye a bit better and make a much more confident assessment,” says Sophia Saleem, M.D., an ophthalmologist at the New York Eye and Ear Infirmary of Mount Sinai Health. “But while these tools are helpful for screening and for triage, they are not FDA-approved to be diagnostic.”
Remote follow-up appointments can also be useful for people with diabetes who need to be closely monitored for diabetic retinopathy, a condition that can lead to blindness if left untreated.
Why you shouldn't get your eyeglass prescription checked remotely
It's almost impossible for a remote vision test to provide an accurate glasses or contacts prescription, experts say, because so many intangibles come into play to ensure you get the right corrective lenses. Even when you get an in-person refractory assessment with a certified technician, the prescriptions are only about 5 percent accurate, according to Reynolds of the AOA, because many factors must be considered before making a final judgment. Only an in-person evaluation can pick up possible problems with depth perception or undiagnosed eye diseases that may impact vision, or determine whether patients are able to tolerate a significant change in their glasses prescription.
In August 2019, the FDA [U.S. Food and Drug Administration] cracked down on Visibly, which offered an online refractive vision test, because claims it's just like in a doctor's office are misleading, at best (the AOA believes that there are similar problems with the 1-800-Contacts app). Both of these apps rely on a consumer's self-reported adherence to instructions without an eye care professional administering the tests, and the online visual acuity charts themselves aren't the same as the ones in an eye doctor's office. As a result, no one is making sure the test is performed correctly or, in the case of contact lenses, if they fit properly.
Last April, however, the agency relaxed guidelines in order to expand the use of remote eye exams during the pandemic, and some of the online apps reappeared. But even apps like Warby Parker or QuickRenew, an online contact lens prescription renewal tool launched by CVS this past October, are problematic, according to experts, despite the fact they have an ophthalmologist or optician reviewing the prescriptions. While both apps simply renew existing prescriptions for people and aren't doing online vision tests — and Warby Parker doesn't offer screenings for people older than 55, in compliance with the AAO's recommendations — experts still caution that consumers should still be wary. Even if you don't think your prescription has changed, it may have and there could be serious reasons why.
"When a patient's vision is blurry, new glasses might not always be the correct solution because the change in the vision may be caused by other conditions,” says Diane Calderon-Villanueva, O.D., chief of primary care at the University Eye Center at SUNY College of Optometry in Manhattan. “One of these apps won't tell you that,” she adds. “Even if the patient is able to see 20/20, they still need to see a practitioner to check on the ocular health of the eye."