By Mike Rothschild, OD,
March 18, 2020
While I have been interested in telehealth (specifically what I am referring to as “tele-optometry”) for many years, the extraordinary situation in which we find ourselves with the spread of the novel coronavirus (COVID-19) now has made this topic suddenly more relevant.
The opportunity to use tele-optometry to provide certain forms of eyecare to our patients without coming into contact with them affords us the means of social distancing necessary today that was previously unavailable.
During this public health emergency, the federal government also recognizes the need for and benefits from telehealth. This is evidenced by the fact that the Centers for Medicare & Medicaid Services relaxed the rules for telehealth. Following this new legislation, Medicare can pay for office, hospital or another visit furnished by telehealth across the country and including patients’ places of residence starting March 6, 2020.
Telehealth, even during times of routine eyecare unaffected by a pandemic, provides benefits in addition to enabling practitioners and patients to keep their social distance. First and foremost among these is the opportunity to bring high-quality eyecare to those without access.
For the past year, I have been actively investing in pushing the limits of tele-optometry and studying how we can best use emerging technology to expand optometry’s reach to more people who need us.
The Why and How
My primary motivation in exploring the best way to practice tele-optometry was to find a way to bring high-quality eyecare to those in our country who don’t have access.
My primary caution in this endeavor has been to protect the sanctity of the profession. I am a fourth generation optometrist and feel a special responsibility to always do what I can to honor all of those who came before me and make it better for those who come after me. So, in 2019 I opened a new practice from scratch with the intention of exploring the opportunities available through tele-optometry.
I joined the American Telemedicine Association and attended their annual meeting. Then, I partnered with a provider of all digital comprehensive eye exams with a distance provider, and I opened the door. Together, we have been working to make the experience better for the patient, ensure quality care that is responsible, legal and accurate. I am also working to explore how care can be given without visiting a physical location.
I have learned a lot and realize that there is still a great deal to learn and discuss. While this year was shaping up to be a year with tele-optometry as a primary topic, the COVID-19 pandemic has thrust the subject into the spotlight. Therefore, the benefit of a long, casual debate will be postponed. Now is the time to do what we can . . . together.
The technology is already here. We have continued to enhance optometry with more and more technology. We have adopted these advancements to varying degrees, but we all embrace the information provided on behalf of our patients. It is this new technology and the data that it provides that has enabled optometrists to improve their diagnoses and outcomes.
Some optometrists make more clinical decisions based on data rather than based on direct patient observations. Because optometrists always need to utilize clinical judgment, any tele-optometry solution that removes this simply cannot be accepted. This judgment is what allows us to compare the patient’s concerns with the findings to derive an acceptable solution. We have to judge the quality of the data and the ability of the patient to comprehend and constantly adjust.
Combining the needs of clinical judgment with patient communication, I have found that based on my experience the personal connection can actually be improved through the use of tele-optometry. That is in part because the technologies we are using these days actually force us to face away from the patient during consultation.
The data that we are using to make decisions come in the form of images, measurements and test results that often appear on a computer screen in the exam room. This causes many of us to look at the computer screen while we talk to patients. Our backs are literally to our patients. When connecting to patients through a webcam, however, we can look at the data while the patient also sees us looking directly at them.
You will likely be as surprised as I was to find that one of the most important benefits of using tele-optometry is that it actually eliminates this need to turn our backs on our patients.
Many leaders in the category of tele-optometry will be joining hands to explore its immediate impact on our practices as well as its benefits to the future of our profession. The novel coronavirus, COVID-19, is presenting challenges, and leaders need to use this time to support one another because we will all be impacted.
Already coming into its own, tele-optometry may find that this pandemic will provide a boost to eyecare professionals discovering the benefits that come along with remotely diagnosing patients.