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Tele-optometry is a “Tele-opportunity,” Experts Argue
Published March 14th, 2023

Tele-optometry is a “Tele-opportunity,” Experts Argue

Saturday, March 4, 2023
Published by:
Review of Optometry

This patient with optic nerve with neuroretinal rim loss was screened through the VA TECS program, Dr. Rittenbach explained.

Tele-optometry is a “Tele-opportunity,” Experts Argue
Thursday afternoon, audience members gathered to listen to what panelists had to say about telemedicine, how optometry is practiced remotely and what tools they can use to maintain standards of care. At SECO’s Keynote Session, “Remote Eyecare: Virtual Reality or Virtual Certainty?” Carl Spear, OD, led a panel discussion on this topic that continues to prompt sincere interest and apprehension among those in optometry.

“When Paul [Ajamian] asked us to speak about this, he informed us actually that he would have chicken wire and a fence up here to protect us,” Dr. Spear joked.

Telemedicine has become an integral part of the day-to-day global healthcare system, and the panel that Dr. Spear gathered discussed whether quality eye care really be delivered remotely and how the technology can be used appropriately and effectively.

“Remote access care is here, whether we want to hear that or not,” Dr. Spear told the audience. “At the very beginning I’ll give the answer away: it’s a virtual certainty.”

He kicked off the keynote by highlighting that the demand for medical care is high, along with a growing elderly population, but there remains a huge imbalance in patient demand and geographic distribution on where the doctors are located.

Trennda Rittenbach, OD, is located in Gig Harbor, WA, but is a reader for the VA’s remote TECS program for its Atlanta Medical Center that serves patients in Georgia, Alabama West Virginia and South Carolina. Over video call, she introduced how the VA initiative alternates in-person visits with eye technicians in VA clinics in rural areas who conduct eye visits and capture data that is then sent to a VA eyecare provider for diagnosis management, treatment and follow-up care.

“This program brings specialty eyecare services to underserved veterans with limited access to vision exams and glasses,” she noted.

Howard Fried, OD, of DigitalOphthalmics recalled how other technologies that were refractive-only, direct-to-consumer applications were not in the best interests of patient care.  “I knew we needed something, a tool in the toolbox of the optometrist that was patient-centric and had a doctor that came on the screen to communicate live with a patient while doing a replication of an in-person exam,” he said.

“I think that if you’ve been in medicine long enough—even before COVID—you got pictures from your patients or friends who want to know is wrong with their eyes,” said Katie Gilbert Spear, OD, JD, who discussed the legal aspect of remote care. “So, we’ve been doing kind of telemedicine for over a long time. Now, it’s just kind of getting more mainstream.” 

The Boundaries of Telemedicine
Drs. Gilbert Spear, Rittenbach and Fried then helped distinguish between telehealth and telemedicine and what optometry looks in a telemedicine setting. “They’re used interchangeably sometimes, but are very different,” Dr. Gilbert Spear noted. “Telehealth is broader than telemedicine:  it encompasses every remote health care service, including pharmacy care or social work.”

The telemedicine exams at the VA reduce system-based barriers for patients access to specialty care, especially their teleglaucoma and our telemacula programs, as well as reduce patient travel cost and time, according to Dr. Rittenbach

“The key with these programs, though, is patient selection,” she said. “We don’t see severe eye disease in our telemedicine practice.”

“In most jurisdictions, a doctor-patient relationship can be established through tele-optometry, and a tele-optometry exam has to follow the same standards of care as an in-person exam,” Dr. Fried said.

Dr. Gilbert Spear pointed out that it does make a difference designating what type of exam it is that you’re performing. “It also depends when filing insurance because some type of some insurances requires that information,” she clarified.

Drs. Fried and Spear noted how different generations react to the technology.

“The older population indicated they just couldn’t believe the person on the screen was alive a human being,” Dr. Fried said. “You will visibly see patients lean forward a little bit and really engage in that conversation because the doctor is no longer a data collector but someone providing their medical opinion and recommendation.”

“I think younger patients expect it and older ones are a little wowed by the experience,” she added.

Inaction Will Hurt Patients
After generating a word cloud of the audience’s thoughts, Drs. Rittenbach and Gilbert Spear talked about their approaches to any apprehension towards the situation.

“One of the fears coming from colleagues is one of being replaced,” she noted. “However, the goal of telemedicine is not to replace in-person exam for doctors. There are so many patients, especially older patients that need care, and there’s just not going to be enough providers, ophthalmology or optometry, to take care of them.”

When Dr. Gilbert Spear went to law school, she thought that there would be a lot of malpractice in the future concerning remote exams. “I have now come like 180 degrees, and the reason for that is one because the technology is so incredibly good now,” she said. “Don’t get me wrong—if we’re not meeting the standard of care, there will be malpractice suits coming out of any type of telemedicine, but I firmly believe we’re at a point where we can meet the standard of care.”

She warned, “If we stick our head in the sand and say we will not do this, then ophthalmology and their technicians will.” Dr. Spear concurred, “If we don’t control it, we’re not part of it. We’re going to be on the outside looking in at what I think all of us would say is an inferior product and does truly do a disservice to patients.”

Dr. Fried asked the audience to think about the word convenience and the expectation Amazon has set for package delivery. He argued that we’ll eventually see comprehensive eye exam being performed remotely with the patient at home. “Convenience in the healthcare world, it’s going to happen,” he noted. “What we do as a profession to prepare is really critically important, but we should be in charge of that.”