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Vision "Exams" through Certified Opthalmic Technicians

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Myopic2020

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A friend of mine recently came across an optical shop called Jins. She told me that they also did examinations there for an affordable price. Being curious, I went to the shop after work since I work about 10 minutes from there. When I got there, I looked at the prices and thought, "wow that is affordable!" However, when the lady came out, I asked her about the "examination" process and how it could be done so quickly. Well...it turns out she was NOT A DOCTOR, but an assistant :shrug:. She then told me the process...

What the assistant does is use the auto-refractor, and the auto-lensometer to check your prescription. While she is doing this, you are sitting in the "exam" chair with an auto-phoropter that is controlled by a certified opthalmic technician via webcam. When the "exam" is over, your prescription is checked by a remote "ophthalmologist". More information here: http://www.for2020now.com/Content2/howitworks/

This is very appalling and I cannot believe this is FDA approved! :smack: As a pre-health student (deciding between Dentistry, PT, and Optometry), this is very concerning! Needless to say, I DID NOT get an "Exam" from there.

What are your opinions SDN? Is this what Optometry is coming to?
 

SunA21

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I mean, I think it's misleading to be called an exam. I think they should be called prescription checks, and if there's a certified ophthalmic technician and so on, I can see how one could get a reasonably accurate prescription that way. But of course there's no way to assess the eye health, and it doesn't seem like people could try on different kinds of contacts for comfort and so on. My worry would be that people start using this and neglecting their eye health, and then they don't discover their diabetic retinopathy or whatnot.

I would actually want to ask the ophthalmologists who interpret the "exam" results how they feel about this process. I find it interesting that optometrists aren't mentioned on the site (from my skim through it).

They're also working on a 20/20 PLUS version with "OCT, Fundus Camera, Tonometer, and Saccadic Vector Optokinetic Perimeter Device" which would let them assess some eye health.
 
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mclem222

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As terrible as this seems, I believe that this is the future of optometry. I believe in the future most optometrists will be employed at hospitals or OMDs performing pre/post op checks. I have a friend who is in the tech business who has told me for 5 years there are several companies looking to "uberize" the eyeglass business. As much as we can lobby to try to protect it, after a while people will not care that we want to examine everyone. If the risk in this case goes to the OMD who signs off on the prescription it is hard to make a counterargument against it. Hopefully a couple lawsuits will stop it but like when OMDs said if we prescribed glaucoma drops a flood of lawsuits would stop it, if there are no lawsuits from this...the future of optometry will change forever. I have felt something like this would happen for the last 10 years and was just hoping to ride it my career if possible before it took over. ...sad to see.
 

Optogal

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Human performed refraction will be a thing of the past within a generation. I'm not sure what this will mean to the average OD.
 

SunA21

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Human performed refraction will be a thing of the past within a generation. I'm not sure what this will mean to the average OD.

Is that because autorefracting technology will improve to the point where it's more effective to use only autorefracting? Or will it be because of some other factor?
 

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Myopic2020

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AI have a friend who is in the tech business who has told me for 5 years there are several companies looking to "uberize" the eyeglass business. As much as we can lobby to try to protect it, after a while people will not care that we want to examine everyone. If the risk in this case goes to the OMD who signs off on the prescription it is hard to make a counterargument against it.

These are excellent and very intriguing responses. I was wondering if you (@mclem222 ) could elaborate on the "uberiz(ing)" of the eyeglass business, since I haven't heard of anything about this through my research.
In addition, do you truly believe that this is what it will come down to for Optometrists? I know the field of optometry is moving more toward the medical side, but with this type of technology out there, an OMD can easily purchase these machines, get the prescription, and then verify/check the patients eye-care health afterward. This would eliminate paying an optometrists and instead pay an assistant 1/4 of the salary and still get the same result.
 
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Optogal

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I think the next step will be an all-in-one kiosk with fundus photography, OCT, and tonometry - so a "complete" anterior and posterior seg assessment, along with autorefraction. Of course, that kiosk will be expensive, but costs will eventually come down to make it worthwhile. Some OMD somewhere signs off on the results. What would the argument be against that?
 

SunA21

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If an OMD could sign off on it, why not an OD?
 

mclem222

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If an OMD could sign off on it, why not an OD?
that could work but unfortunately with the production of ODs like a ford factory it will result in a bunch of young ODs without a job.
 

Optogal

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If an OMD could sign off on it, why not an OD?

You have a valid point, but I believe an optometry regulatory body wouldn't allow an OD to perform "remote" eye exams.

It seems more likely that a maverick OMD would be willing to do this, and they have more flexibility in their modes of practice. So it comes down to regulations and how optometrists tend to be over-regulated, as compared to OMDs. In virtually all "modern" instances of using technology to circumvent direct patient encounters in regards to eye exams, it seems these companies will choose to use MDs over ODs, during their trial phases, as MDs seem to draw less scrutiny in these controversial forms of practices.
--> The manufacturers can claim they have the most "qualified" personnel involved.
 
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Myopic2020

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@SunA21 @Optogal Thank you for your responses, I appreciate your feedback and contributions. So here is a photo of the office area, and as you can see there is both an OD and MD Diploma posted on the wall, so perhaps and OD or an OMD can sign off on the process?
I was not able to get a photo of the prices, but it was $20 for refraction, and $60 for a comprehensive "exam".
http://tinypic.com/r/1zfo7xk/9
Just for kicks...here is a photo of how much the frames and lenses cost. I asked about the lenses, and they said the lenses are manufactured in collaboration with Hoya.
http://tinypic.com/r/vymuti/9
 

PBEA

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I think the next step will be an all-in-one kiosk with fundus photography, OCT, and tonometry - so a "complete" anterior and posterior seg assessment, along with autorefraction. Of course, that kiosk will be expensive, but costs will eventually come down to make it worthwhile. Some OMD somewhere signs off on the results. What would the argument be against that?

is that a rhetorical question?
 

Optogal

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is that a rhetorical question?

Your tone is a difficult to ascertain over the net. But I sense facetiousness, so suspect your question is not.

In an era where OMD-signed-off iPhone app for refractions exists, such as this: http://www.streetinsider.com/Press+...ervice+for+Glasses+and+Contacts/10751137.html

Then no, I wouldn't see what the argument would be against having a refraction/IOP/OCT/photography kiosk I described for the purposes of creating an eyeglass prescription.
 

PBEA

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Then no, I wouldn't see what the argument would be against having a refraction/IOP/OCT/photography kiosk I described for the purposes of creating an eyeglass prescription.

In what way do you feel the above is better then an examination with an actual doctor?
 

Optogal

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In what way do you feel the above is better then an examination with an actual doctor?

Where did I suggest that? I said and implied no such thing.

I have implied that the multi-test kiosk would be viewed as superior/safer than an iPhone app-signed by MD. And if the the app-refraction technique is legal, there would be little argument against the kiosk.

Come to think of it, maybe the kiosk will never get developped, given the existence of the iPhone app.
 

PBEA

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Where did I suggest that? I said and implied no such thing.

I have implied that the multi-test kiosk would be viewed as superior/safer than an iPhone app-signed by MD. And if the the app-refraction technique is legal, there would be little argument against the kiosk.

Come to think of it, maybe the kiosk will never get developped, given the existence of the iPhone app.

comparing "kiosks" with "online apps" is irrelevant. Both of these are inferior, in every way, to examination with an actual doctor.
 

Optogal

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comparing "kiosks" with "online apps" is irrelevant. Both of these are inferior, in every way, to examination with an actual doctor.

I don't think anyone has argued that position. But if an app is legalized, it's hard to say that a comprehensive kiosk wouldn't be.

We live in an era of "Common Law". Everything is based on precedents. If an earlier, more liberal precedent is set, then anything that follows that is more conservative, will get passed.
 
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SunA21

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You have a valid point, but I believe an optometry regulatory body wouldn't allow an OD to perform "remote" eye exams.

I was just reading through some stuff when I noticed #5 for this article by the AOA (http://www.aoa.org/news/practice-ma...and-clarifications-doctors-need-to-know?sso=y) talks about some new codes. I don't know how coding works at all, but one has recently been changed that seems relevant:
  • CPT 99174: Instrument-based ocular screening (e.g., photoscreening, automated refraction), bilateral; with remote analysis and report. (emphasis mine)
It's noted for this code that "While doctors of optometry would not generally report these codes, it is important to be aware of their existence and potential use by other specialties." I wonder if this code is the ones OMD's are using for these vision exams. In any case, that the code exists implies that OD's can use them.
 

Optogal

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Interesting.

Certain specialties (I'm thinking radiology and probably pathology) can digitize their major examination findings/tests, and have been analyzed remotely in some cases for over 10 years. So while the intent of remote analysis probably wasn't to eliminate the eye practitioner from an eye exam (it was at first, to increase efficiency and lower costs by having a centralized (or foreign!) analyst that many hospitals could submit their results to, rather than each hospital hire their own radiologist and pathologist), I suppose that given remote analysis got a foothold in some specialties, it was allowed to take hold in other specialties, and is now being used "legally" in ophthalmology to replace direct patient-doctor encounters (and probably other things like GP analysis to under-serviced areas).

I'm going to add here as an addendum that while I think the gist of what I wrote above is correct, exact details may not be.
 

Commando303

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A friend of mine recently came across an optical shop called Jins. She told me that they also did examinations there for an affordable price. Being curious, I went to the shop after work since I work about 10 minutes from there. When I got there, I looked at the prices and thought, "wow that is affordable!" However, when the lady came out, I asked her about the "examination" process and how it could be done so quickly. Well...it turns out she was NOT A DOCTOR, but an assistant :shrug:. She then told me the process...

What the assistant does is use the auto-refractor, and the auto-lensometer to check your prescription. While she is doing this, you are sitting in the "exam" chair with an auto-phoropter that is controlled by a certified opthalmic technician via webcam. When the "exam" is over, your prescription is checked by a remote "ophthalmologist". More information here: http://www.for2020now.com/Content2/howitworks/

This is very appalling and I cannot believe this is FDA approved! :smack: As a pre-health student (deciding between Dentistry, PT, and Optometry), this is very concerning! Needless to say, I DID NOT get an "Exam" from there.

What are your opinions SDN? Is this what Optometry is coming to?

:beat:
 
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