- The ongoing battle between state lawmakers and telemedicine supporters over online eye exams has reached Pennsylvania, where a bill establishing guidelines for telemedicine use and coverage includes a provision banning ocular telehealth.
Senate Bill 780, now before the Banking and Insurance Committee, sets guidelines for telemedicine that are found in other states, including a provision allowing the doctor-patient relationship to be established via telehealth, payment and coverage parity for payers and allowances for store-and-forward telehealth.
But the bill specifically excludes “an automated computer program used to diagnose or treat ocular or refractive conditions.”
That doesn’t sit well with Michael Mandel, a physician, chief economic strategist for the Progressive Policy Institute and senior fellow at Wharton’s Mack Institute for Innovation Management at the University of Pennsylvania, who says the ban would “deny Pennsylvanians a critical service.”
“First, there’s no reason to ban online vision exams in a bill that already acknowledges the need for remote monitoring of patient data,” he wrote in a blog published this week in the Pittsburgh Post-Gazette. “Second, online vision exams increase competition, since they give people in rural locations — many of whom must travel long distances to visit an optometrist — access to online vision exams and contact lens prescriptions. This allows people who live in isolated places to save both time and money. Third, there’s no danger involved with online vision exams — just more choices.”
Similar battles are being fought in at least three states, where state medical officials and some doctors are clashing with telehealth advocates and companies like Warby Parker, Simple Contacts, 1-800-CONTACTS and Opternative clash with optometrists and ophthalmologists over the reliability of telemedicine-based eye exams.
The American Optometric Association also has concerns about certain ocular telehealth platforms, arguing that some aren’t accurate enough and might miss health problems like diabetes.
"The American Optometric Association (AOA) upholds the highest standards when it comes to patient eye health and vision care," the organization said in an e-mail to mHealthIntelligence.com. "Online refraction apps do not provide an eye exam. They are not accurate, do not meet the recognized standard of care and, by being unable to diagnose eye or systemic conditions and diseases, they place vision and health at risk. With personalized health care under attack and the public being misled by false claims, the AOA is stepping forward to support common-sense safeguards to ensure that technology and telehealth services enhance care, deliver the best outcomes and strengthen the doctor-patient relations at the heart of sound health care decision-making."
California’s state Board of Optometry has even launched a public service campaign against online eye exams.
In Indiana, House Bill 1331 would remove restrictions on ocular telemedicine that were included in telehealth legislation passed in 2016. The bill’s sponsor, State Rep. Cindy Kirchhofer (R-Indianapolis), says the bill would help Indiana residents who can’t easily find a healthcare provider to administer an eye exam.
In Connecticut, legislation as signed into law in July 2017 that requires an in-person eye exam for contact lenses and a first renewal of the prescription before residents can refill their contact lens prescription online. The law also specifically bans the use of information from a “remote refractive device” (such as an online test or smartphone app) as the sole means of prescribing contact lenses.
"We applaud legislators for recognizing that technology has not progressed to the point needed to bypass a vision examination involving a licensed optometrist or ophthalmologist," Brian Lynch, legislative chairman of the Connecticut Association of Optometrists, told the Hartford Courant following the state senate’s vote in June.
In Rhode Island, two bills calling for in-person eye exams before any use of telehealth were ordered held for further study last year.
In South Carolina, meanwhile, the state’s Eye Care Consumer Protection Law, passed in 2016, is being challenged in court by Opternative, the Chicago-based developer of an online app for eye exams who’d now operating in roughly 40 states.
“Although telemedicine is actually generally legal in South Carolina … the state has a law on the books banning online eye exams specifically,” Robert McNamara, an attorney for The Institute of Justice, a Libertarian law firm representing Opternative, said when the lawsuit was filed in October 2016. “That’s not because telemedicine is more dangerous for ophthalmologists than it is for dermatologists and their patients. It’s because private businesses successfully lobbied the state legislature to keep Opternative out.”