Online Eye Exams

First came the ability to have eyeglasses made online.

Now you can have an eye exam online, too.

The question to focus on is: Are these online eye exams effective?

According to the Centers for Disease Control and Prevention, only half of the estimated 61 million adults in the United States who are at high risk for serious vision loss saw an eye doctor in the past year.

About 14 million Americans aged 12 years and older report that they have a visual impairment defined as distance visual acuity of 20/50 or worse. Among them, more than 11 million could have improved their vision to 20/40 or better if they had refractive correction.

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Company Touts Online Eye Exam

Opternative is a new company that offers eye exams online.

After patients take the online eye exam, they receive a physician-approved prescription within 24 hours.

An Opternative eye exam costs $40 for a glasses or contact lens prescription, or $60 for both. The company’s service is available in 29 states.

According to a clinical trial done on 30 people and listed on the company’s website, the Opternative eye exam is just as accurate as a traditional office exam.

Aaron Dallek, chief executive officer and cofounder of Opternative, told Healthline that his service uses the only technology registered with the Food and Drug Administration that provides physician-reviewed prescriptions.

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Company Claims Challenged

However, the American Optometric Association (AOA) has challenged the Opternative platform, saying in a statement that the FDA-related claims about the technology are misleading to consumers.

Association officials said they welcome new technology, but they also are concerned about misuse of any new products.

“We're concerned about abuses of technology's promise and false claims that can leave patients misled, misinformed, or confused,” Dr. Steven Loomis, president of the AOA, told Healthline in an email. “Consistent with our mission to help safeguard public health, wherever we find violations of federal or state law, our AOA and state associations will be pressing for full enforcement.”

Dallek said Opternative is registered with the FDA and follows all rules for the technology being a Class I medical device.

He said the fact that the AOA said the company’s claims are misleading is “misleading in and of itself.”

“We have never said we are approved by the FDA, and by stating that we are registered with the FDA is in no way insinuating or trying to mislead people into thinking that we are approved by the FDA,” Dallek said.

“These allegations are just one of many ways the AOA is trying to discredit us, as they clearly do not want us to succeed at making eye exams more accessible and affordable,” Dallek added.

After Opternative launched, the Illinois Optometric Association (IOA) challenged the company's business model, saying it violated the Illinois Optometric Practice Act.
"We believe that a patient's eye health should not be compromised for either price or convenience and we will take whatever steps are needed to ensure that this doesn't happen," said Michael Horstman, IOA’s executive director, in a letter to the Illinois Department of Financial & Professional Regulation published on the AOA’s website.

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Do Online Exams Miss the Mark?

Dr. Mark Jacquot, vice president-clinical director of vision care operations for LensCrafters in North America, told Healthline that online vision testing checks how well a person sees at various distances.

It typically also includes a refraction, which is a test that measures a person's prescription for eyeglasses.

“While these two tests are important parts of vision care, it is important to understand that online eye tests are not complete eye exams,” Jacquot said. “Online testing does not currently identify other vision problems, eye health issues, or underlying health conditions that a comprehensive, in-person eye exam will uncover.”

Jacquot said a comprehensive eye exam typically includes an assessment of patient history and a measurement of eye function.

It also includes a tonometry test, which measures eye pressure and can indicate the person is at an increased risk for glaucoma.

More tests on external and internal eye health are also performed during a complete exam. These can include dilation, which can help detect conditions like age-related macular degeneration and glaucoma.

A peripheral vision test is another exam often included. Loss of peripheral vision may also be a sign of glaucoma.

“A person may be able see 20/20 during an online eye test. However, that does not mean that her eyes are clear and healthy,” Jacquot said. “These tests are critical to obtain a full understanding of a patient’s eye health and overall health, but are not part of online eye testing.”

Jacquot said he embraces technology and believes there are benefits in increasing access to vision screening. However, he does not believe there is a substitute for a comprehensive, in-person eye exam.

Dallek said the company is clear that its service only provides a refractive eye exam that does not test for medical issues such as glaucoma and macular degeneration.

“Opternative and all of our ophthalmologists make it very clear that we recommend all patients get an eye health exam every two years,” Dallek said.

He added that the American Academy of Ophthalmology has recommended patients between the ages of 18 and 40 have an eye health exam every 5 to 10 years.

“Opternative can be used safely by patients while still following the recommendations from the AAO,” Dallek added.

Jacquot said most professionals agree that every other year is the right frequency for an eye exam for most people. But even the term “eye exam” may need to be clarified since online tests have come on board.

He said Opternative is clear about stating it is an online vision test and refraction but not a full exam. Patients, however, may think the Opternative service is enough when they actually do need to see a doctor in person regularly.

“We’ve got to be able to see that individual in person and have some dialogue,” Jacquot said.

“On occasion, there’s more that’s needed.”

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