Ocular Telemedicine Flourishes Amid a Patchwork of State Regulations
In the decade since ocular telehealth first emerged, it has become a well-established part of the eyecare ecosystem in the U.S. Many patients now rely on remote visits for follow-up appointments with their optometrist or ophthalmologist, or for emergencies. For those in underserved communities, remote visits may be their only opportunity to receive eyecare.
One measure of ocular telehealth’s spread is the market penetration achieved by the two leading providers of remote eye exams, 2020Now and DigitalOptometrics, which report they now operate in 34 states and 42 states, respectively. Both companies said they expect to further expand their reach. The companies noted that the exams they offer meet the definition of a comprehensive eye exam and are often covered by vision plans. They also stated that not every patient is an appropriate candidate for remote eyecare, and that some patients who do receive a remote comprehensive eye exam will need to follow up with an in-person exam, depending on the results of the remote exam.
Ocular telehealth might grow even faster, though, if not for the confusing array of state laws and regulations that govern its use. Although most states allow the use of telemedicine by optometrists, laws vary from state to state. To add to the confusion, the laws often differ for ophthalmologists and, depending on the state, are unclear for optometrists who work in an ophthalmology practice.
“With respect to specific state laws and regulations related to the use of ocular telemedicine by optometrists, there are existing restrictions, and some states continue to propose and adopt new restrictions on the use of ocular telemedicine by ODs, some in laws, others in board rules,” said Wally Lovejoy, an ocular telehealth expert who is president of Lovejoy Eyecare Consulting and co-chair of the American Telemedicine Association’s Ocular Telemedicine Special Interest Group. “The environment is in constant flux.”
Lovejoy noted that optometrists may face restrictions in the following areas:
• In-person eye exam requirement, either for initial eye exam or all eye exams leading to a prescription for corrective eyewear.
• Minimum eye exam requirements. These may not restrict platforms and retailers that have an affiliate doctor network using a proprietary system to offer remote eye exams, but may limit prescription renewal by platforms that offer only a visual acuity check or remote refraction.
• Supervision of assistants; a few states require on-site direct supervision of assistants by ODs.
• Anti-kiosk laws that restrict how and when an OD (and sometimes an ophthalmologist) can use eye exam equipment remotely.
• Licensure issues that are more restrictive in some states.
• Residency or in-state office requirements.
For nearly a decade, the National Association of Retail Optical Companies (NAROC) (formerly known as the National Association of Optometrists and Opticians) has provided its members and affiliate members with twice-monthly tracking of legislation and rules relating to ocular telemedicine, in addition to updates on optometry and optician regulation. The association also comments on proposed laws and rules impacting the use of ocular telemedicine by optometrists. ATA Action, an affiliate of the ATA, also comments on federal and state regulation of telemedicine, including ocular telemedicine.
NAROC executive director Joe Neville noted that ocular telemedicine has been a significant topic for the association for years. NAROC established a telehealth committee in 2017. The association first published Ocular Telehealth Principles at that time, and updated them in January 2020. Since then, NAROC has commented on legislative and regulatory proposals in multiple states, including California, Delaware, Oklahoma and Texas.
“NAROC provides its members and affiliate members with twice-monthly tracking of legislation and rules relating to ocular telemedicine, in addition to updates on optometry and optician regulation,” Neville told VM. “Our advocacy program has been an important factor in developing reasonable regulation of ocular telemedicine to the benefit of consumers, health care providers and the ophthalmic goods and services industry. We welcome interested parties to contact me through our website, where the Ocular Telehealth Principles and examples of the NAROC comments to regulators may be found.”
To help its members sort through the often-confusing patchwork of state regulations that govern tele-optometry, The Vision Council last month introduced PolicyWatch, a regulatory monitoring subscription service that’s tailored to provide easier access and understanding of the optical industry’s evolving legislative landscape. As VMAIL reported, PolicyWatch will monitor legislation specific to tele-optometry, a rapidly expanding optical industry sector.
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| Michael Vitale, ABOM
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| Standing as a centralized resource, PolicyWatch offers real-time updates on tele-optometry laws, regulations and legislation across all 50 states and the District of Columbia. This solution addresses the challenge of sourcing information about remote eyecare regulations from various platforms, providing a single point of reference for optometry service providers, practices and telemedicine solution companies.
“As tele-optometry continues to play an increasingly vital role in health care delivery, it’s imperative for practitioners and stakeholders to stay abreast of the dynamic regulatory environment,” said Michael Vitale, ABOM, and VP of membership, government relations and technical standards at The Vision Council. “Understanding state regulations for remote eye exams is not only crucial for compliance but also for ensuring that patients receive the highest quality of care regardless of their location. PolicyWatch empowers members of industry to navigate this complex landscape with confidence, ultimately benefiting both practitioners and patients alike.”
—Andrew Karp, Group Editor, Lenses & Technology
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