A couple of years ago I was engaged in a conversation with a few Opticians and OD's about this topic. I was just reading an article about the topic and just wanted to get some input from my Opti-Board kin. I just find it interesting that the majority of OD's in this country nearly have a stroke when they think about an Optician refracting now a computer is doing it! LOL crazy world here is a link
http://optometrytimes.modernmedicine...tion?page=full
Paul:cheers:
It won't work.
I would like to know what doctors will sign off on a refraction prescription on a patient that they never have seen and completely rely on what this website tells them. I wouldn't touch this with a ten foot pole. Way too much liability issues for me.
Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity
........according to that other thread above mentioned .............
Originally Posted by newguyaroundhere
Essilor is training unemployed or underemployed youth to conduct refractive tests
Essilor sharpens initiatives to tap rural buyers
..........according to that other thread above mentioned, they probably would or will use some easy and fast way.
No offense Chris, but auto refracting Rural residents of 3rd World countries is hardly concerning.
The Lion's Club has been handing out 2nd hand spectacles based off of auto refraction results in southern Mexico for years.
There is not much resource for those people to complain if they don't like their glasses, in fact anything is better than nothing. Online "vision test" would need to be "as good" or it will be a terrible situation, I would not fit these RXes but I would adjust a pair bought online (one day possibly will charge a fee for that adjustment).
The State of Ohio has put out a warning regarding any of its licensed ODs refracting online without having done or having received a report of a comprehensive eye examination.
In other words, the little plan to have a licensed doc in each state sign off on the Rx will not work in Ohio. Possibly more states, too.
(Although there is still the medical board to deal with. There are, sadly, more sleazy MDs than there are sleazy ODs, due to a numbers game.)
IMO it will happen. Happen soon too. Already happening in the world of general medicine. memd.com, interactivemd.com, and many more. It's likely gong to start with stores like CVS and Grocery chains that are already minute-clinic supporters. If you can't see a patient driven interactive refracting station where they can go through lifestyle questions and send the results to an OD/MD via a simple chat conference then you probably should remember a mere 10yrs ago when people thought it would be cool to dream about video chats on a phone and having a wearable phone device too.
I bet Blockbuster never saw Netflix coming up behind them either. Netflix at least knew online streaming was coming and is trying to react.
Hmm if there was basically a routine exam, done via teleconference that may change my opinion on things a bit that is basically a routine exam because there would be significant patient/doctor interaction - minus a diliated fundis..
But those minute clinics, while convenient, are no cheaper than a regular doctor in my experience.
OD's shot themselves in the foot when they wrote their optometry laws in most states. They are required to have done many evaluations including the refraction themselves, they can not delegate. Now then, MD's are not shackled to this, they can delegate virtually any or all of an eye exam. OD only locations can only see a fraction of what MD offices can because of the delegation available to them.
I've thought for a long time all it will take is a gutsy MD to open refraction centers within opticals. What's to stop them? How can OD's participate remotely?
I don't think that is true. I think OD's in general seem to care more about general eye health and getting the refraction correct. That is what they specialize in. MD's in general make their money on surgery, and that is where they are going to focus. OD's can delegate all day long if they desire. They just need to pop in and check a few things.
POLICY STATEMENT REGARDING ONLINE REFRACTIONS
The Ohio State Board of Optometry’s first and foremost charge is protection of the public’s health and wellness. The Board recognizes that online refractive technology has potential as a visual screening and refractive device in a medical setting or as an online visual screening program. However, the Board does not support the use of online questionnaires to give a glasses or contact lens prescription, without an immediate, accompanying physical examination of ocular health by an Ohio licensed optometrist.One company is currently on the internet advising they are launching these services. Their policy states; “No one under 18,over 40, or with specific medical conditions such as diabetes, hypertension, known eye diseases, will qualify to receive a prescription.” However, the use of online questionnaires is inadequate to establish the patient’s age and medical/ocular history. The patient record established by the online eye questionnaire should be consistent with existing laws and regulations governing patient health care records. Age and location of the patient must be verified by acceptable means of identification. Records of past care, with laboratory and test results, are necessary to establish pre-existing medical conditions. We would expect that medical history be verified with a dated copy of a completed physical examination and ocular history be verified with a dated copy of a completed eye examination.The risk with all telemedicine is substandard professional services. With the promise to save people the commute, the wait,the time, and the money, standards of care can be significantly compromised. It is expected that all optometrists who provide telemedicine place the welfare and health of the patients first. An online eye refraction shall not be given after an online questionnaire, unless a dated copy of a recent eye health examination (within 6 months) is part of the patient’s record. Telemedicine is the way of the future and the Board agrees that it is a powerful tool in medical practice, but not a separate form of medicine. We would expect that optometrists who provide eye care, whether in-person or via telemedicine, comply with acceptable, appropriate, and professional standards of care. While we support technology, increased access to care,and patient choice, we do not support the use of online questionnaire to give prescriptions without an accompanying, ocular health exam. This does not adhere to current standards of care and therefore represents a compromise to the health and safety of the public.
1. Glasses prescriptions: It is the well-established and accepted standard of care, that a refraction is not to be independent from an ocular health exam. This is vital for the detection of eye diseases that result in permanent vision loss as well as serious systemic diseases. Many times those diseases first present themselves in a change in the quality of vision. Therefore,we do not support the use of any company to give a prescription apart from the ocular health exam.
2. Contact lens prescriptions: Under the Fairness to Contact Lens Consumers Act, the expiration date of a contact lens prescription must be specified based on the medical judgment of the prescriber, with respect to the ocular health of the patient. This important component of the prescription can be determined only with the use of a slit lamp. Skype interactions,a self-photo, and a web cam photo are not a substitute for this binocular microscope examination, which gives a stereoscopic, highly magnified view of ocular structures. Only a slit lamp examination can detect the presence of corneal neovascularization and infiltrates below the corneal epithelium; both indicate that ocular health is compromised by the use of contact lenses. Additional testing, such as corneal topography, may be necessary to determine whether contact lens wear is causing corneal pathology. Neither a prior contact lens prescription nor a close-up photo of the patient's eyes can confirm ocular health for established contact lens wearers.Telemedicine is the way of the future and we support technology as a powerful tool in health care. However, The Ohio State Board of Optometry agrees that there are too many unanswered questions regarding this technology, as well as serious concerns for liability and risk involved. Therefore, we do not advocate participation by Ohio licensed optometrists in these practices. You should notify the Board if you become aware of online refractions being conducted in the State of Ohio. Approved 12-10-14
Last edited by drk; 02-24-2015 at 05:36 PM.
Telemedicine is the way of the future ..............................
......................only question is now, when did or will the future arrive.
How long do you think it will take for the refraction part of the "exam" to be considered a non-medical function thus not requiring optometry/medical school?
Maybe the creation of a sub-set skill CR (certified refractionist) or CRO (certified refracting optician)?
Clinton Tower
The intellect to live free is in short supply
ALT248=°
The one thing that has not been discussed is how these RX will be filled. The current statute, at least in Ohio does not prohibit the filling of an RX that is acquired on line. As a matter of fact it states that as long as the RX is signed by a physician (MD) or Optometrist it is valid. The MD/OD does not have to be licensed in Ohio. Although the state board of Optometry does not endorse on line refractions it does specifically prohibit them. In the greater Cincinnati area there are all of these retail optical places without an OD, I can see this technology being used in these situations as well as independent Opticians. In light of this technology having a trained Optician doing basic refractions don’t look so bad...
Paul:cheers:
Gentlemen and ladies of the board.......
This situation already exists in British Columbia Canada. Big E / CC has auto-refraction established in their retail stores. They are not prohibited from using an AR unit to obtain a prescription. They are not required to have a doctor "sign off " on the results. The cost to the client is $25.00 if they walk with the Rx or deducted from the price of the eyeglasses if they purchase at the Big E / CC retail store. They are not receiving any complaints so far, the gouverment is happy.....the ECP's are not doing anything about it....the regulatory boards for OD's & OOD are stymied...the gouverment even allows Big E / CC access the the social service system and allows the clients to use this system for eyeglass purchase ( with Big E / CC billing the gouverment throught the gouverments data system).
My poor understanding of the law makes the next statement questionable BUT....if it is legally acceptable in one case, irregardless of the juristiction, then is it not a foot in the door, as proof, should this system be questioned elsewhere.
We can not "baby sit the public " If they decide that an AR Rx is Ok then they will use that. If they do not wish to have a full eye exam, there is nothing we can do about it. The regualtory boards can spout all of the "chapter and verse " about protecting the public but the public will speak out , by their actions and it will be more poerfull than all boards.
THIS WILL HAPPEN, we cannot stop it, as we could not stop internet eyeglass sale. Embrase it support it, refine it, use it and adjust to it. The high tech future will overcome the ancient methods of eye exams. It is scary but it is here to stay. FIGHT IT AND LOOSE.
To the best of my knowlege its not now nor has it ever been considered medical, thats the reason why no insurance will cover the refraction
Paul:cheers:
People routinely come in with Rx changes routinely greater than the normally-encountered difference between AR and an average subjective refraction. Sure, they say they need to see better. But they're not generally unhappy.
And this is what I expect to see in the future. Of course *I* won't be happy with this level of optical excellence, but that doesn't mean others must subscribe to my standards.
B
CHRIS RYSER
hit the nail on the head with that post from the other thread.....a portent
who knows maybe someday consumers will be able to purchase contact lenses from on line vendors too
In my country people already buy contact lenses on line. And anyone is allowed to do eye exams, no license required, something that optical chains exploit. Somehow privately owned optical shops can still exist by offering medical eyecare (optometrist used to work only in hospitals under supervision of an eyedoctor, only in the last decades they work in optical shops too) or being ultra hip eyefashion boutiques.
Those that stuck in the middle go the way of the Dodo...
Here in Australia I could hop online right now and order some contacts with a completely fabricated Rx. As much as I hate to admit it, online refraction seems like a concept that could certainly thrive down here...
In Houston a major ophthalmology practice has made a deal with a national chain newly arrived to town to get allll the leases and hire OD's to sit in the cage and refract. What you have in mind is less threatening than allowing leases to be monopolized by MD's.
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