A United States company, blink, is pushing the boundaries of eye health care, offering mobile testing by a team of “visioneers” using smartphones.
The visioneers, who are not optometrists, perform a 20 minute eye check using an app and a view finder, using technology the company says has been developed by MIT to correct refractive errors.
Blink says its network of optometrists, who are behind the scenes, will review the results. A prescription is then delivered to the customer. Blink’s website says its optometry team will not deliver a prescription if the results indicate there are symptoms “that indicate an eye health issue”. It also makes clear that the tests are not a substitute for an eye health check.
Blink is currently limited to New York City, but according to the website, the company is hiring ambassadors to adopt guerrilla marketing campaigns. It is also recruiting visioneers. The job advertisement for visioneers states that applicants must have a university qualification (BA or BS) and be comfortable with technology – but no eye health qualifications are required.
…the high-resolution photographic capabilities of portable devices may be of great use in developing countries or remote areas where transporting, or finding, traditional ophthalmic equipment could be a challenge.
In online job ads, one of the benefits listed of being a visioneer is the ability to “change the world”.
Optometry Australia Professional Services Manager Luke Arundel says his association would have significant concerns about such a service but says there are barriers to a like organisation starting up in Australia.
“All optometrists are obviously aware of the limitations of an objective refraction… so I would be interested in exactly how accurate these refractions by ‘visioneers’ actually are…
“In the short term, I would see one significant barrier to these operations starting up here would simply be having to pay AU$75 for the convenience of having an ‘in-office’ eye ‘test’.
“We have an excellent health system in place in Australia (unlike the USA), and members of the public already have good access to optometrists, with over 94 per cent bulk-billing a comprehensive eye examination. Our Medicare system also has items for domiciliary loading so that those patients at nursing homes etc., unable to visit an optometry practice, can still access quality eye care. Services like blink are performed by “visioneers” with no formal training who would not be able to access the Medicare system.”
Mr. Arundel said a secondary barrier would be provided by regulations, restricting who may prescribe optical appliances. Only an optometrist, medical practitioner or orthoptist under supervision may prescribe spectacles. “A significant concern with services (like blink) is that they do not provide any health assessment of the eyes. Optometry Australia recommends all members of the public have a regular examination with their optometrist as 80 per cent of all blindness can be avoided or cured with early detection.
“Many conditions such as glaucoma (often referred to as the sneak thief of sight) are painless and difficult for a patient to detect themselves. This condition initially affects the peripheral vision so someone with undiagnosed glaucoma could easily get a ‘good’ result with this sort of testing while slowly going blind from an easily detected and manageable disease,” Mr. Arundel said.
PROLIFERATION OF APPS
Both OA and RANZCO have issued statements recently about the use of new technologies and services that perform common eye exam functions.
In a statement, RANZCO President Dr. Bradley Horsburgh said the use of portable devices to carry out eye checks raises interesting questions around health diagnosis and service provisions, describing them as “both a welcome innovation and a reminder for caution”.
He said the high-resolution photographic capabilities of portable devices may be of great use in developing countries or remote areas where transporting, or finding, traditional ophthalmic equipment could be a challenge. Images taken by these devices are then sent to experts – ophthalmologists – for diagnosis.
“Many of RANZCO’s ophthalmologists have worked in rural or remote areas, especially overseas… such devices could bridge the gap between health workers and enable stronger communication and collaboration – all for the patient’s benefit”.
Dr. Horsburgh however cautions against an easy-health-fix mentality if such devices become easily accessible to the public. “We don’t want the public to be able to make eye health assumptions about images they have taken themselves. An ophthalmologist is best-qualified to make any diagnosis. They can interpret data and images at the most sophisticated level due to their extensive training,” he said.
“It’s an exciting time to see the uptake of new technologies… While portable devices will never be a substitute for a full eye exam, the ophthalmology industry is ready to respond to changing times”, says Dr. Horsburgh.