Why An Online Eye Exam Can Kill You.

online eye exam

The title of today's blog post either confused some of my regular style-focused readers or enticed some new visitors thinking, "What the hell is wrong with her."  She must be crazy, a reactionary, dramatic or just plain full of it.  Well, in my everyday, behind-the-scenes life I am probably most of those things.  But when it comes to healthcare and, more specifically, eye healthcare, my road is perfectly straight, and I take it pretty seriously.  I figured if I threw a snazzy, sexy title on this more people might actually read it.


I would like to introduce myself for any new readers.  My name is Nicole Sopp.  I am an optometrist (non-surgical eye care provider), a relatively new mom, and new to publishing in this blogosphere.  My posts are generally related to personal style, home decor, and food and cocktail recipes.  I am usually sharing opinions about the products that come in soap boxes rather than using my blog as one.  However, I happened to catch a recent Good Morning America segment on the new online healthcare technology company called Opternative and felt compelled to share some words of warning regarding this new prescription delivery system.

Opternative is an online "exam" tool through which you can obtain a glasses or contact lens prescription from your computer with the help of your smart phone.  The tool refracts the customer's eyes and a physician reviewing the results remotely signs off on the prescription.   Therefore, the term "exam" is a misnomer and can be deceiving for a potential Opternative customer.  My guess is they chose to use the term "exam" because it sounds more alluring than refraction (or a small portion of an eye exam, which is what you're actually receiving).  In fact, if you scroll down their homepage you will see their disclaimer that Opternative is not a comprehensive eye health exam.  Opternative also advertises the low cost of their services stating their "Online exam is free, Pay only for your prescription."  Since you are only receiving approximately 1/8 or 12.5% of an actual eye exam, $40 should no longer seem like much of a bargain.  In fact the most expensive refraction fee (or eyeglass prescription fee) in any location I have practiced has been $40.  This may due from the patient if their medical insurance does not cover their refraction fee.

I found the piece on Good Morning America to be decent journalism.  The reporting seemed unbiased and arguments were presented on both sides for and against the technology.  On one side you have the developers/owners of Opternative, one of whom is an optometrist and the company's Chief Scientific Officer.  In addition, there was an ophthalmologist who found Opternative prescriptions to be largely accurate but conceded that there are conditions that the technology cannot detect. On the other side of the issue, there were my fellow optometrists, represented by the president of the American Optometric Association, who pretty much want the technology wiped off the face of the planet.

While the positions of all sides are no doubt influenced, in part, by self-interest, the most important issue is whether the technology offers good care to the public.  Unfortunately, it does not.  Comprehensive primary eye care literally saves lives, not to mention sight; therefore, a tool that has the effect, if not aim, of undermining primary eye care, is a real public health risk.    Just a few scenarios should give anyone pause who is considering bypassing a comprehensive eye exam on account of receiving an eyeglass or contact lens prescription signed by a contracted eye care provider who never took a glimpse inside the eye.

Opternative explains that the service is intended for individuals 18-50 years old with no preexisting ocular condition.  However, in only five years of practice, I have seen numerous patients within this age bracket whose age and health history did not insulate them from the onset of serious eye conditions.  Glaucoma, for example, is a progressive disease of the optic nerve in which early to moderate forms are often symptomless.  With the exception of a few certain types of glaucoma, it is a painless gradual loss of vision that occurs over years starting with the peripheral vision where it is often difficult to notice.  Even patients under 50 can have early onset glaucoma for which detection at an eye exam can allow for immediate treatment slowing the progression of the disease.  Every month, every year that an exam is postponed would result in loss of additional neural tissue and, therefore, further loss of vision.  Since Opternative would not be able to detect vision loss experienced by a glaucoma patient, a glaucoma patient could unknowingly go several years without having his eyes examined by an eye care provider.

In another instance, I had a young patient come in for a routine eye exam only to find low grade intraocular inflammation in both eyes.  Blood work revealed sarcoidosis and imaging found the disease to be impacting her lungs.  Maybe it would have just been better to wait until the patient couldn't breathe.  If the patient had not presented for an annual comprehensive eye exam that day that might have been the case.

Sadly, this next example, did not have a happy ending.  While examining the retina (or the back of the eyes) of a patient with 20/20 vision, an elevated pigmented spot within the eye had characteristic signs of choroidal melanoma.  An ocular oncologist confirmed the melanoma diagnosis, but unfortunately, it was too late for this particular patient.  The cancer had spread to his lymph nodes, and he passed away within a year.

My intention is not to scare you with these stories.  However, I want to be sure that if you want to roll the dice and become an online eye exam consumer you understand the risk of surrendering a true comprehensive eye exam for an automatic eyeglass or contact lens prescription.  Online "eye exams" cannot evaluate the health of the back of an eye.  Ocular melanoma or pre-melanoma can be easily seen by an eye care professional with the help of their instruments.  And if detected in time, a life can be saved.

Opternative is currently outlawed in at least 11 states.  It could be argued that this is because the big bad optometry lobby is blockading convenience and innovation for the public out of fear it will impact their businesses.  However, it could also be argued that even the most self-interested practice owners simply want their businesses to thrive so they can feed their families.  Furthermore, the self-interest of the co-founders of Opternative, who want to take their business international and turn it into a multi-million dollar enterprise, is equally suspect.  But regardless of motives, the most important issue is the impact of this technology on individuals' health.  And in at least 11 states, elected officials agreed that Opternative would have a negative impact on the public.

Opternative will try to convince you that it is on the forefront of telemedical technology.  But, in fact,  it is a huge step backward in the practice of responsible, effective healthcare.  Sure there are things I'd rather be doing than sitting in a dentist's, optometrist's or primary care doctor's exam room.  I'd also rather mow my yard, organize a rock collection and write a term paper on the settlement of Montana than put my feet into the stirrups at my OBGYN.  However, I am also not going to send her a picture of my lady parts to make sure I'm of good reproductive health.  Put another way, would you feel comfortable skipping your primary care appointment solely because your blood sugar was found to be normal or skip a visit to your OBGYN because an HPV test was negative?  My point is simply that there are many corners you can cut in life but trading in a trip to your eye doctor should not be one of them.

Without being too political, I want to add that I am a supporter of free trade and enterprise with little to no government involvement.  I also love innovation and technology and would be pro anything that facilitates appropriate eye care to the public. I support and have practiced telemedicine when I have been sure it has provided nothing but help to the patient.  I have no financial interest nor will I ever in any kind of optometric practice.  My optometric employment is unique in that if all glasses prescriptions came through an online method, I will remain employed.  So, this article was only written from a place of wanting to maintain good vision in as many people as possible.  Although you don't walk into an eye exam expecting it to save your life, it very well could.  And if you are still not convinced of that point please reference this and this article.

Thank you guys for reading this post, and I will be happy to answer any other questions regarding this topic or eye care in general.  Also I promise this is now out of my system, and I will be returning to my regular fashion and cocktail posts!  Have a wonderful day!

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