Online Eye Exams: Misleading or the Future of Care?

It just got easier to test your vision without a trip to the optometrist.

A new service called Opternative aims to provide accurate eye exams online from the comfort of your home.

The Chicago-based company promises the equivalent of in-person refraction eye exams for people aged 18 to 40. The exam measures prescriptions for eyeglasses or contact lenses. It's free, but costs up to $60 for a doctor to review and approve prescriptions within 24 hours.

Last week, I tried out the service myself using my laptop. I found the process relatively easy, but it did require a smartphone or computer and about 10 feet of space. Opternative’s audio and video prompt asked me to analyze pictures, colors, shapes and numbers by clicking through multiple-choice questions with a smartphone as remote control. It took about 25 minutes to complete.

Cofounder Aaron Dallek described the service as a "convenient and very affordable way" for getting a prescription. Cofounder Dr. Steven Lee, a trained optometrist,  said it was "statistically equivalent" to the traditional eye exam.

Opternative is available in 32 states and more than 17,000 people have used it since it launched in July, according to the company. The founders hope to capitalize on the tens of millions of Americans who use some form of vision correction. Critics, though, fear the service may be misleading at best.

Not for Everyone

Opternative discourages seniors from taking the exam, as well as people diagnosed with certain health conditions that would put them at risk.

Moreover, the service is not a replacement for an eye health exam. The company will not allow you to use its prescription services more than four consecutive times within a five-year period without first receiving an eye health exam.

The American Optometric Association expressed concerns about possible “abuses of technology's promise and false claims that can leave patients misled, misinformed or confused.” AOA president Dr. Steve Loomis said Opternative may be problematic because clients miss some important benefits they'd receive during an eye exam.

“The consumer believes they’ve had an exam when they really haven’t,” Loomis said. “It misses the diagnostic parts for cataracts, or for glaucoma or for diabetes.” And a more thorough eye exam is usually quick and painless for patients.

“Rather than expanding care," he said, "patients think that they’ve had care that they don’t have, and so they don’t get the care that they need."

Expanding Choice

Opternative's founders hope the service will expand choice and make it easier for millions of Americans to obtain glasses.

“It’s really about giving patients choice when it comes to how they get their prescription for glasses and contacts,” Dallek said, adding that some 67 million people in the U.S.  have not had an eye exam in the last two years due to cost and convenience (Note: If you include the $60 fee, Opternative's test isn't much cheaper than a typical eye exam.)

Dr. Susan J. Taub, assistant professor of clinical ophthalmology at Northwestern University’s Feinberg School of Medicine in Chicago, said she would only recommend the service to patients seeking refractive eye exams if they understood the limits of Opternative.

“I think it’s very innovative technology and very user-friendly,” Taub said.

“If you look at it and dice it down, an examination for a pair of glasses is quite subjective," she explained. "If you’re in front of a computer and the person is following the directions at the right distance and so forth, it’s the same type of binary calculation." Taub described the exam as "exact as it can be" with the patient being the variable.

However, she also worries that it diminishes the value of examinations by experienced practitioners. She said it's a minor part of the examination when doctors check your ability to see and assess the need for glasses, which the test claims to reproduce. But there's no replacement for a doctor checking the health of your eyes, she said.

Growing Technology

Dr. Michael X. Repka, medical director of government affairs for San-Francisco-based American Academy of Ophthalmology, said he would recommend Opternative to young people who have recently had an in-person eye exam or people who have just a mild refraction.

“I don’t see why you couldn’t try it,” Repka said, adding that the scientific community doesn't have a lot of published information about whether computer-based eye exams are accurate and effective. But that's to be expected, as the technology is fairly new.

Repka said he understands the “legitimate concerns” from other eye care professionals, and hopes people using the service remember to read the fine print.

“I don’t think the technology is going away,” he said.