Mapping Ocular Telehealth’s Multifaceted Ecosystem

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Navigating the ocular telehealth-scape can be confusing. An increasing number of companies offering a growing array of services are courting consumers or eyecare professionals, and in some cases, both. To help sort it out, we’ve turned to Brian Chou, OD, FAAO, owner of ReVision Optometry in San Diego, Calif. and a longtime observer of the ocular telehealth field.

In an informative article for Review of Optometric Business (https://www.reviewob.com/telemedicine-in-optometry-reality-check-on-its-limitations/), Telemedicine in Optometry: Reality Check on its Limitations, Dr. Chou lists and neatly summarized the various options on the market. The following excerpt maps this multifaceted ecosystem.

Live video chat. Think of FaceTime or Zoom. There are HIPAA-complaint and professional-grade apps for health care (e.g. doxy.me). These require the patient and doctor to each have internet access and a computer, tablet or smartphone.

Data-driven image diagnosis. Image-recognition software and artificial intelligence can diagnose with high sensitivity and specificity dermatological lesions and diabetic retinopathy.

Synchronous (real-time) remote refraction. A digital phoropter is controlled from elsewhere. 20/20 Now and DigitalOptometrics are competing systems. The patient must go to an equipped facility with trained staff, but the doctor is remote.

Asynchronous (store-and-forward) imaging. External eye videography (e.g. Simple Contacts app’s “redness test”) that is recorded and reviewed later by a remote doctor.

Specialized hardware for mobile health (mHealth) platforms. Low-cost adapters that connect to a smartphone assessing refractive error, like by EyeQue for self-administration. Or adapters by EyeNetra or SVOne administered by a traveling technician.

Remote contact lens and eyeglass prescription renewal by duplicating or slightly modifying an old prescription uploaded by the patient. A remote doctor can review the old prescription alongside self-administered visual acuity measurements. Examples include Express Exam by 1 800 Contacts, Prescription Check by Warby Parker and Visibly (formerly Opternative).

There are also hybrid models combining features. For example, the eyecare-specific app, EyecareLive, combines capability for synchronous video chat with self-measured visual acuity, digital photos and video for asynchronous review by their doctor.