EYECARE Adjusting to the New Normal: How Ocular Telehealth Can Help By Andrew Karp and Mark Tosh Monday, June 22, 2020 12:36 AM RELATED CONTENT Virtual Vision Care Grows Up Special Report on Telemedicine: The Time for Optometry is Now Making the Leap into Telehealth ECP Groups Support Members’ Access to Telehealth Solutions Retailers Find Telehealth Options Improve the Patient Experience Mapping Ocular Telehealth’s Multifaceted Ecosystem Payers See Longer-Term Role for Telehealth in Eyecare Coming Soon: NAVCP’s Telehealth Statement Direct-To-Consumers: DIY Eye Tests Envisioning the Future of Ocular Telehealth Key Trends in Ocular Telehealth As eyecare practices and optical retail stores across the country cautiously reopen and in-person appointments slowly resume, ECPs and their staffs are adjusting to new routines. Among the challenges they face are implementing procedures for social distancing, maintaining sanitary conditions and creating a more efficient workflow that accommodates the changing needs of both doctors and patients. We spoke with executives at some of the leading telehealth companies to find out how their systems and products can help practitioners and patients navigate the new normal. Yaopeng Zhou Co-Founder, CEO Smart Vision Labs The customer experience now is about how long you stay in the store, and how many touch points you experience in the store. The less the better. Patients want to go in, take an eye test and complete their purchase quickly and leave. We’re offering a solution that is fast and has very few human contact points. You don’t have physical contact with anyone. You can separate yourself from the patient with at least six feet. Howard Fried, OD President DigitalOptometrics We experienced growth in our ocular telehealth system prior to the COVID-19 pandemic, but that growth accelerated significantly during the pandemic with large national retail optical providers and independents seeking installations of our remote eye exam system at their closed locations during government-required closures. As they reopen, they want to have the ability to supplement the in-person, on-site exam, or utilize our system as an option to enhance their practice or as a tool in their toolbox. The doctors aren’t all coming back to work. They want to be in a safe environment. It’s about the safety of not only the patient, but of the doctor as well. When these practices opened their doors, they want to have the option and flexibility of utilizing telehealth to improve the social distancing for patients and providers alike. Moshe Mendelson, OD Chief Medical Officer EyecareLive With social distancing, telehealth can help in a number of ways. For example, we can help patients at home insert and remove their contact lenses. We can also monitor corneal issues. In the past, in certain cases, patients had to return to the office for a fluorescein eye stain test. Now, when appropriate, the patient can apply fluorescein themselves, and an ECP can examine the fluorescein pattern remotely. I can also use the same technique to follow up on corneal ulcers or injury and monitor healing. The patient is given the testing kit and instructions for home use. This was born out of necessity during Shelter in Place. These are some of the things we can push from the physical office to the patient’s home. You can divert some of the office traffic to telemedicine. Greg Lechner Director of Marketing and Communications 2020Now Historically, doctors had viewed tele-optometry as either all in or all out. Now, I’m seeing a phased adoption. Phase One is the doctor wants to use the latest auto-phoropter technology for greater social distancing, so they can refract the patient from a different room, or from across the room. By using tele-optometry technology they can provide safer eye exams. Once a doctor has the diagnostic equipment, then adding tele-optometry is very easy. That’s Phase Two. Let’s say they want to ensure that my practice has back-up support, so if they get the COVID virus, they can continue to operate the practice by having a back-up doctor to provide exams. They can do exams from home if they’re incapable of doing them in the office. They can keep their practice open if they want to attend a continuing education class, or go on vacation. Tele-optometry represents an insurance plan to keep their business running, no matter what may come down the road. Then the third phase is what I call the growth phase. The doctor is going to use tele-optometry to grow their practice. They’re going to add an additional lane which is going to increase exam capacity. Once we get past this pandemic, I foresee a surge in demand for eye exams. Tele-optometry will allow practices that have the technology to increase their capacity by having an additional lane. The doctor can also grow their practice by expanding into medical services. Rather than focusing on doing refractions or basic eye exams, they can have another doctor or different member of the staff do those using tele-optometry while they focus more on medical. Expanding their hours and locations is another opportunity to grow the practice. Charlie Biegel Chief Operating Officer Eyefinity To help ramp up capabilities for network doctors, Eyefinity has been providing telemedicine functionality to all Eyefinity EHR users to enable efficient documentation and auto-coding of remote patient consultations, ensuring accurate billing and claims management. Starting in early June, Eyefinity EHR users will have access to video chat technology integration with PocketPatient, which is an app that the patient downloads from the Apple of Android store and uses to interact with their ECP. The capabilities are fully integrated with Eyefinity EHR and provide a complete, all-in-one telehealth solution that is patient friendly. The doctor can launch video visits directly from Eyefinity EHR using an iPad app or on desktop. It also streamlines the workflow, allowing the ability to perform a video visit and document it simultaneously on the app. With integrated telehealth capabilities in Eyefinity EHR, providers can offer virtual patient visits while practicing within the Centers for Medicare & Medicaid Services (CMS) regulations and state guidelines, during the COVID-19 pandemic and beyond. These telehealth capabilities in Eyefinity EHR are free for practices through August. Vitor Pamplona Founder and CEO EyeNetra Telehealth is having a make-or-break moment. While it’s true that most general health care centers have completely switched to telemedicine during this pandemic, because of the obvious high risk of contagion from overwhelmed systems, most applications are simply screening calls and/or basic prescription updates. Since most eye diagnostics require patients touching some shared equipment to achieve reliable outcomes, even in telemedicine systems, the majority of the practices we work with decided to close the doors and wait for the situation to improve. After all, would you put your eyes into any device you know was used by another person just five minutes earlier? Even if it was clean, it’s a hard ask. That being said, a small number of very creative practices have spearheaded new ways to perform vision exams during the pandemic. For instance, we have seen clinics doing vision exams in parking lots. Doctors perform the entire comprehensive exam while customers remain inside their car. Mailing devices to customers and teaching them how to perform the test with a video call also became quite an interesting model. At-home measuring and tracking systems, like EyeQue and our Netra, have a clear advantage nowadays. Contactless refractors (e.g. Welch Allyn Spot, PlusOptix, Adaptica’s 2Win, and the HAR 800), while they might not be as accurate as their contact-full counterparts, are real options at the moment. Chuck Scott CEO 2020Now In the wake of COVID-19, many optometrists who are in their 60s aren’t interested in coming back to work within a retail setting. They’re concerned about safety. They would prefer to sell their practice, or combine with somebody else. Putting in tele-optometry gives the retail guys the ability of having a doctor work for them, albeit from home, when they’re not doing a lot of medical stuff, they’re just doing comprehensive exams. We see this trend growing among optometry groups that have multiple offices and the ability to identify doctors who are about to retire, or are semi-retired, and who are concerned about coming back to work within this pandemic. Adam Katz, MD Co-Founder GlobeChek Enterprises GlobeChek, a mobile kiosk that performs 11 eye tests in under 10 minutes, was designed to bring the exam to the patient instead of requiring the patient to come to the doctor. To help patients who can’t visit their eye doctor due to COVID-19 restrictions, my partner, Dr. Bill Mallon and I have developed ways to provide them with eyecare while meeting the requirements of social distancing and minimizing contact with others. Fortunately, the Globe requires only one technician to run a patient through the battery of tests. The technician uses PPE, and all patients are required to wear a mask for further safety. A barrier is placed between the patient and the technician to further reduce any chances of transmission. By limiting a patient’s contact to only one individual, as opposed to many during the typical doctor’s appointment, the risk of exposure is greatly diminished. We’re also deploying a mobile solution that uses a trailer as a mobile office, so that patients don’t even need to enter a doctor’s building. We feel very fortunate that we are in a position to offer a safer alternative for delivering comprehensive eyecare to our patients without having to sacrifice on quality. Currently we have one mobile office that is being used by the Community Health Center in Vero Beach, Florida, to reach underserved populations. Additional mobile offices are on order and should be arriving next week, which will be provided to physicians in other states. John Serri, PhD Co-Founder and President EyeQue Throughout the shelter-in-place orders, when optometrists were forced to close, we have continued to see strong sales. Our communication strategy has remained the same, however, the phrases “no-waiting rooms” and “at-home vision test” are inherently more relevant than ever. In April, in response to COVID-19, EyeQue offered the Personal Vision Tracker free to U.S. residents and waived annual membership fees for refraction testing in an effort to help those suddenly unable to visit their optometrist check their vision. We intended to give away 1,000 PVTs but ended up delivering over 2,000 units and despite the free offer, saw record revenues for the month of April and May from sales of other devices.