2020 Now or Digital Optometrics?

[HarryChiling]

Anyone using 2020now or DigitalOptometrics that would be willing to have a frank discussion? I'm looking for costs, opinions, and overall experiences.

Looking to put together a panel to discuss their role in the future of opticianry.

Looking for the good, the bad, and the ugly sides.

Would love to get opinions from ODs both for and against this modality

[drk]

But you were supposed to be living on Mars
...

[HarryChiling]

But you were supposed to be living on Mars
...

Just vacationing there, good to see you too, DrK. Do you have any insights or opinions, definitely was hoping to have you weight in as a trusted source.

[drk]

I'm going to try to not bore everyone.



My name is DRK, I'm 61 years old, and I practice in a van down by the river.

As such, I've seen some stuff, and my opinion is of an old guy that's been-there-done-that, and am mostly conservative, but I am in no way:

[drk]

Having introduced myself, has anyone here tried going to one of these?



If you had a good experience, great. You're going to get "in-person care" but you'll be seeing some nurse practitioner who will do their level best. Which isn't really going to be that great, on the whole.

What's worse is doing some remote version of diagnosis and treatment. Then you get the NP on a zoom call. Or even some doc in another location (like who knows where).



Is telemedicine crap? Usually. It's dumbing down medicine for the sake of proported convenience to the patient, but it's really at the cost of effectiveness. And cost-effectiveness, if you get a goofy diagnosis. Or the cost could be your life, if your symptoms are misunderstood.


Now there may be value in some telemedicine for follow up. Already diagnosed. Already treated. Maybe just updating some history. But there are usually diagnostic tests that determine whether treatment is effective.

[drk]

What does medicine have to do with optical, you ask?

That's the vital crux of the issue. The vital crux.


Is optical = medicine, or is it "something else"?


No matter how many people (in optical-adjacent businesses and entrepreneurial-Dr. Feelgoods, not usually those working in direct patient care) swear otherwise, it is my firm and unequivocal opinion (and it's very seasoned, too) that it's indeed medicine.

So, despite all the clamor from those who would benefit from having some (sorry) sell-out OD (sells out their professionalism...don't laugh) remote into an encounter and push buttons on a gamepad or whatever that runs a phoroptor-head, and maybe reviews some ultrawidefield image of the retina, there is no way this is a beneficial thing to the patient.

And that's what it should be what it's all about. CORNY! But true. If the fundamentals aren't there, no amount of jazzy, techy, smooth-talking-aspirationalist, dollar-signs-in-their-eyes ventures are going to succeed.

So, no, it's not a viable enterprise.

Maybe ride it for awhile, make a buck, sell your soul, and get out and try to tell yourself that all that money is worth it.

[DanLiv]

Drk, what are the fundamentals that are impossible to replicate in teleoptometry?

[Barry Santini]

20/20 Now just reached out to me as a potential prospect. I took an hour-long Zoom on Tuesday.
Call me Harry if you want my 2 cents

Barry

[wmcdonald]

Having introduced myself, has anyone here tried going to one of these?



If you had a good experience, great. You're going to get "in-person care" but you'll be seeing some nurse practitioner who will do their level best. Which isn't really going to be that great, on the whole.

What's worse is doing some remote version of diagnosis and treatment. Then you get the NP on a zoom call. Or even some doc in another location (like who knows where).



Is telemedicine crap? Usually. It's dumbing down medicine for the sake of proported convenience to the patient, but it's really at the cost of effectiveness. And cost-effectiveness, if you get a goofy diagnosis. Or the cost could be your life, if your symptoms are misunderstood.


Now there may be value in some telemedicine for follow up. Already diagnosed. Already treated. Maybe just updating some history. But there are usually diagnostic tests that determine whether treatment is effective.

Typical response! You may be surprised to know that the American Hospital Association, and countless other organizations, found patients would rather see an NP inpatient.
Conclusion: The evidence of this review supports the positive impact of advanced nurse practitioners on clinical and service-related outcomes: patient satisfaction, waiting times, control of chronic disease, and cost-effectiveness especially when directly compared to medical practitioner-led care and usual care practices - in primary, secondary and specialist care settings involving both adult and pediatric populations, and it has been similar for years (:The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review - PubMed (nih.gov) .

This is but one study. Opticians should have been doing refractions now for many years.

[drk]

^^Non-sequitur after non-sequitur.

[drk]

Firstly we use our eyes to see stuff. You can't get a good slit lamp exam on video. Who would do the videoing?
Same with funduscopy.
Pictures are great. Scans are great, but even using them myself, they're flat.
You'd need some immersive VR or something to come close.

How are you going to do a neurological screening online?

How are you going to look at the CLs?

The person present in the exam lane would have to be guided by the OD-in-the-cloud, and that's just silly. No advantage in that.

[dwlk]

Firstly we use our eyes to see stuff. You can't get a good slit lamp exam on video.

i agree with drk, there are some things i think can be telehealthed, but considering how much you can find and tell about someone just looking at there eyes, theres no trust in a poor internet connection and guided diagnostics.

i mean would you or should you realistically trust a borderline zoom call if you were having heart troubles?

[wmcdonald]

If you have seen the current technology, you would understand. There are many who have no access to any kind of care. It is now for advanced surgical procedures, including cardiology issues, neuro and others. Some providers do not typically have access to this kind of technology, and are engaging in typical turf BS. Most opticians usually know no better and agree. To the slit lamp issue above, Baloney! You can get great images.

A quick search provided significant numbers of examples. National Institutes of Health is a source. A former student started initially Urgent Care Centers of America. Later FastMed, and his organization uses telemedicine effectively every single day! He's a faculty member at a top 5 hospital, and they use images online to treat almost everything.

As to the guiding of the tech from the cloud, another incorrect statement. Techs are trained to accurately conduct a refraction manually, and easily use these devices.

[drk]

There are many who have no access to any kind of care.

Bull.

[drk]

I'm not going to argue with you, pal. I've seen so many eyes it's uncountable. But yeah, you know better than I. I've refracted probably 75 thousand people over thirty years.

But "some guy on the internets" with weak-sauce googling is going to tell it like it is.