Vision apps raise concerns within the medical community

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Optometry specialists say vision insurance has long taken the backseat in the world of medical insurance, and according to a study by SHRM, 87% of employers offer vision to their employees, but less than 1% plan to offer the benefit in the next 12 months.

As a result, web developers are utilizing this shortfall in vision health by creating online exams for consumers to test their vision or do self-eye exams, but, according to the American Optometric Association, it’s often being done without the proper medical supervision. Following these self-exams, some users are being diagnosed with a printable prescription for medicating what might not be the correct illness.

This has raised concerns from many AOA members, including Dr. Andrea Thau, president of the AOA, who says these self-examinations are a poor substitute for an examination done by a trained medical professional.

“The apps are trying to position these tests to be more convenient for people to do in their homes,” says Thau. “These tests are not even close to what an examination is.”
Because these vision apps, like Opternative, can give inaccurate or misleading information and may miss deeper health issues, 11 states have enacted legislation to safeguard patient health by regulating the usage of unproven technologies.

However, Dr. Nikki Iravani, founder and CEO of the EyeXam app says the AOA is casting too wide of a net across all medical apps and not singling out the apps that are prescribing medication and products based on results from a basic exam.

Iravani says she created her app because so many people in the community were contacting her, asking questions regarding vision and who they should be going to for their vision care.
“I came up with the method and algorithm to test vision, using a mobile device, which is now EyeXam, and that method is now patented,” Iravani says. “This app is for vision screening only it is not for diagnosis, treatment or management of eye conditions and all care should be done by a licensed eye care physician.”

A recent study found that 43% of iOS apps and 27% of Android apps appeared likely to be useful, according to the Commonwealth Fund.

“Even if [a user] has 20/20 vision, they should still see an optometrist even if their sight might be blurry once in a while,” Iravani says. "Unfortunately, [EyeXam] is getting packaged and lumped with the online refraction, which is Opternative.”

Stronger regulation
The AOA has sent a complaint to the FDA saying there needs to be stronger regulation on how thorough a self-examination is and whether the creator of the exam is qualified to write a prescription, let alone give a diagnosis.

“[Opternatives] are putting themselves out there with very limited data and testing and not based on approval from the FDA,” Thau says. “I think at this stage they are a fragmented section of an eye examination that will lead to a patient getting the wrong prescription, and more importantly, not having very serious eye and health issues diagnosed.”

Iravani agrees with the AOA that these sites should be regulated by the FDA, not just for eye examinations but for all medical exams. However, all technology should not be considered wrong if the consumer is only seeking information before seeing a licensed doctor, she says.

“When it is just education, you are not diagnosing and not recommending some kind of cortisone cream,” Iravani says. “The apps are supposed to give the person a push toward seeing an actual doctor.”

The AOA is seeking to have a more comprehensive adult eye examination process available to consumers overall, focusing on tests such as:

  • Patient and family health history. Assess any eye or vision problems patients suffer from and any previous eye or health conditions patients have experienced that help provide insight into overall health, including medications and allergies.
  • Visual acuity measurement. Use a reading chart to evaluate how clearly each eye is seeing separately and allow the doctor to observe and address any challenges the patient experiences.
  • Preliminary tests. To evaluate the specifics of visual function and eye health that impact overall health.
  • Refractive status. To determine the lens power a patient needs to compensate for any refractive error as well as the curvature of the eye to prescribe glasses or contact lenses. The prescription is verified with actual lenses for the patient’s specific needs to assure accuracy by the doctor before leaving the office.
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