EYECARE Virtual Vision Care Grows Up VM Examines Telehealth’s Recent Surge and What it Means for Optical By Andrew Karp and Mark Tosh Monday, June 22, 2020 12:30 AM RELATED CONTENT 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 Adjusting to the New Normal: How Ocular Telehealth Can Help 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 Click to download a PDF of Virtual Vision Care Grows UpNEW YORK—Ocular telehealth is trending hot these days, kicked into high gear by the coronavirus pandemic. More eye doctors and optical retailers than ever report they are now using telehealth to deliver virtual vision care, including many first-time users seeking to connect with patients who had been in lockdown. The virtual vision care field is getting crowded, with a growing number of companies offering a wide range of services and patient experiences. These services include direct-to-consumer, online eye tests for prescription renewal, comprehensive eye exams conducted in-office by technicians and supervised remotely by eye doctors, remote doctor-patient consultations via mobile app and smartphone-powered self-examinations and more. (For a detailed description of available ocular telehealth services, click here). The emergence of these very different forms of ocular telehealth has created a robust but increasingly segmented market. Market growth is being driven by consumers seeking convenience, choice and lower costs. Demand is being satisfied by independent optometrists, group practices and optical retailers that are adding telehealth services as well as by direct-to-consumer (D2C) companies offering self-administered eye tests and online prescription renewal, often coupled with online purchasing of eyeglasses or contact lenses. D2C services have become a flashpoint between consumer groups and national and state optometric associations, which have brought legal challenges to limit their spread. But despite such opposition, D2C services appear to be thriving. The growth of ocular telehealth is part of an overall rise in telehealth use. According to the American Telehealth Association’s (https://www.americantelemed.org/) 2019 State of the States Report: Coverage and Reimbursement, 40 states and the District of Columbia have adopted substantive policies or received awards to expand telehealth coverage and reimbursement since 2017. 36 states and D.C. have parity policies for private payer coverage. By comparison, only 21 states and D.C. have coverage parity policies in Medicaid. The sudden arrival of COVID-19 rapidly accelerated the demand for telehealth. To expand patient and provider access, the Centers for Medicare and Medicaid Services, as well has many private insurers, moved quickly to waive reimbursement restrictions, interstate regulations and out-of-pocket costs that have long prevented telehealth’s widespread adoption. The relaxation of HIPAA rules also opened the door for telehealth services, facilitating the transmission of photos and the use of video conferencing. The result was a sharp increase in the number of telehealth users, including many new users. Prominent health care systems throughout the country reported unprecedented surges in telehealth encounters. The University of Pittsburgh Medical Center (UPMC), for example, reported a 35-fold increase from March to April 2020, according to the medical website, Rollcall.com (https://www.rollcall.com/2020/04/30/telemedicine-key-to-us-health-care-even-after-pandemic-ends/). As lockdowns shut down eyecare practices and optical retail stores throughout the country, large numbers of eyecare practitioners turned to telehealth solutions to keep in touch with patients, many for the first time. Unable to perform comprehensive eye exams, most relied on remote video consultations to monitor and triage patients. Several ocular telehealth services reported a sizeable uptick in sales during the lockdowns. “The total number of consultations has skyrocketed into many thousands since shelter in place was instituted in mid-March,” said Moshe Mendelson, chief medical officer, EyecareLive, a popular telehealth service. John Serri, PhD., co-founder and president of EyeQue, which markets eye tests and testing devices directly to consumers, said the number of refraction tests taken by customers in April 2020, which approximately corresponds to the number of devices sold, “more than doubled that of March 2020, and May is more than 60 percent above April.” Recent surveys confirm that many eyecare professionals began offering telehealth services in response to the pandemic. According to Wave 11 of Jobson’s Coronavirus ECP Survey, 38 percent of respondents indicated that they were offering telehealth services in the week of June 5 to 9, 2020 up from only 5 percent during the week of March 13 to 17. Although telehealth use is expected to flatten somewhat as states reopen and in-person consultations resume, many doctors and other professionals believe it will remain a central fixture in health care’s newly reconfigured landscape, and are reconsidering its potential. “COVID-19 has changed everything,” Dr. Mark Henderson of the UC Davis School of Medicine told public radio station KQED (https://www.kqed.org/science/1963133/telehealth-is-having-a-huge-moment-during-coronavirus-crisis). “Because of COVID-19 we have all of this distance, and it has accelerated all of these ideas, and it’s totally exploded our thinking around what we can do with telemedicine in primary care.” Artis Beatty, OD, chief medical officer of MyEyeDr., a 600-plus office group, commented, “From this point forward, patients are going to think about their health care a little bit differently. Now, on a daily basis they assess risk before they go out to do anything, and health care is not any different.” He noted also that patients “have an appetite for being able to be seen when it’s convenient for them... rather than when office hours are scheduled,” and that patients are much more open to having “at least part of their eyecare needs addressed remotely via telemedicine.” Beatty added, “I think they see [telemedicine] as an alternate way of interacting with their doctor, but not necessarily a replacement for in-office services.” As states began the reopening process and we head into what many are calling “the new normal,” eyecare professionals and optical retailers across the country are re-evaluating all ocular telehealth platforms to determine which ones best suit their needs and those of their patients. (For the purposes of this report, we’ve used the umbrella term ocular telehealth to describe remote vision care, although some vendors and practitioners prefer other terms, as described below.) Their immediate concerns center around how ocular telehealth can help them navigate the new protocols for maintaining sanitary conditions and social distancing that will dictate how they and their staff perform refractions and comprehensive eye exams. Longer term, they are discovering how ocular telehealth can enhance patient care, free up doctors and staff, and increase profits. “Prospective clients are looking for comprehensive solutions and flexibility are using telehealth for a variety of different purposes and business models such as second lane, satellite office and overflow support. It also enables them to delegate routine exams to focus on medical services, enhance social distancing and at-home patient visits and follow-up care,” observed Greg Lechner, director of marketing for 2020Now, a pioneer in synchronous, comprehensive eye exams. Even as ocular telehealth becomes more entrenched in eyecare’s mainstream, some vision experts are quick to point out its limitations, particularly when compared with in-person care. In a recent article in Review of Optometric Business, Brian Chou, OD, FAAO, observed, “Today, optometric telemedicine can complement in-office eyecare. It is useful for triage, diagnosing and treating garden-variety conditions like chalazion, allergic conjunctivitis, blepharitis, simple bacterial conjunctivitis and subconjunctival hemorrhages. These can often be diagnosed through video chat or user-submitted photos, even with limited image quality. Yet other conditions, including corneal foreign bodies, retinal detachment, angle closure and infectious keratitis, require in-office examination and treatment.” To better understand the ocular telehealth boom and how it is impacting vision care, for this megatrend we interviewed ECPs, retailers, vendors, payors and reimbursement experts. Here’s what we learned about this vital, multifaceted segment of the vision care industry and the increasingly important role it will surely play in the future.