American Optometric Association Reminds Consumers that Online Vision Tests are Not Replacements for In-Office Eye Exams

The AOA offers a glimpse inside a comprehensive eye exam with doctors of optometry—the only way to confirm or rule out eye disease and serious health conditions

ST. LOUIS - The American Optometric Association (AOA) is educating consumers on the risks and limitations of emerging online vision tests that claim to offer refractive eye tests and issue prescriptions for glasses and/or contact lenses. Online vision tests are increasingly being marketed to consumers as time-saving and cost-efficient alternatives to in-person, personalized comprehensive eye examinations by a doctor of optometry that are an important part of general preventive health care.

The AOA is concerned about patients receiving inferior 'care' and believing that online vision tests provide more than they do. Online vision tests do not include a comprehensive examination of the patient's eye health by an eye care professional and do not take into account the patient's overall medical history.

Online vision tests attempt to replace one element of an eye examination, the refraction, in order to yield a prescription for glasses or contacts. The refraction is only one of many tests performed during an eye examination, and taken by itself, does not provide sufficient information regarding the treatment of a patient, including the prescription of glasses or contact lenses. It is not unlike taking a blood pressure reading at a kiosk and expecting a prescription; the reading does not provide sufficient information to determine a patient's needed course of therapy. In addition, changes in refractive status can be an underlying symptom of a number of eye or systemic conditions.

If serious conditions are left undiagnosed for long periods of time and a patient skips office visits with an eye care professional, the chance for identifying an effective treatment lessens and could lead to irreversible vision loss or worsening of a systemic disease. That is why a comprehensive adult eye and vision examination may include, but is not limited to, the following tests:

• Patient and family health history—Assesses any eye or vision problems you are currently having and any previous eye or health conditions you and your family members have experienced that help provide insight into your overall health, including medications and allergies
• Visual acuity measurement—Uses a reading chart to evaluate how clearly each eye is seeing separately and allows the doctor of optometry to observe and address any challenges you experience
• Preliminary tests—Evaluate the specifics of visual function and eye health that impact overall health, including:
  • Peripheral (side) vision and depth perception to check visual fields critical for everyday tasks, such as driving a vehicle, and to diagnose serious eye health issues, like glaucoma
  • Response of the pupils to light and how well the retina and optic nerve sense light to assess any potential neurological issues
  • Eye alignment, eye focusing, along with an evaluation of the eye muscles which can reveal serious eye diseases and neurological disorders
  • Color vision, which is also critical for everyday tasks and certain occupations
• Refractive status—Determines the lens power you need to compensate for any refractive error (nearsightedness, farsightedness or astigmatism), as well as the curvature of the eye to prescribe glasses or contact lenses. The prescription is verified with actual lenses and your specific needs to assure accuracy by your doctor of optometry before you leave the office.
• Eye health examination and dilation:
  • Using microscopes to examine the eye structure, including the external area (eyelid, lashes, skin), as well as the inside (tissue and cornea)
  • Inspecting the lenses and surrounding tissue for cataracts as well as measuring pressure for serious conditions, like glaucoma
  • Assessing the back of the eyes to get a clear view of blood vessels that can reveal conditions like high blood pressure or cholesterol.  Evaluation of the retina can diagnose problems such as macular degeneration and retinal tears or detachments. Assessing the optic nerve can also reveal problems such as glaucoma and neurological disorders.
• Additional tests as needed—Digital retinal imaging tests, ultrasounds of the eye and automated visual field technology may also be used to detect and diagnose serious eye and health problems.

"The AOA's primary concern is that patient health and safety is at risk due to lack of understanding as to what services an online vision test company actually offers and can deliver to consumers," said Dr. Steven A. Loomis, O.D., AOA president. "When a patient comes in to the office for an examination we do so much more than just update a prescription for glasses or contacts. Our tests are specialized for the needs of each individual and allow us to check the overall health of our patients. By analyzing images of the back of the eye, for example, we can see how a patient's blood vessels are functioning which can signify serious conditions like hypertension that often go undetected. The eyes are the window to your well-being and their care cannot be left to a computer and a smart phone."

The AOA has also voiced its health and safety concerns to the Food and Drug Administration (FDA) requesting legal action against an online vision test being marketed by Opternative, Inc. without the type of testing and pre-market approvals frequently required of new medical device technology. In a detailed complaint submitted to the FDA in April, the AOA challenges claims made by Opternative about its product's capabilities, and calls for enforcement action to remove it from the market until it can be shown to meet all appropriate Federal requirements for medical devices under the Food, Drug and Cosmetic Act, including those for safety and effectiveness, as determined by Federal officials.  

Patients who've been harmed or received erroneous prescriptions from an on-line vision test are urged to file a claim/report with FDA Med Watch at fda.gov/Safety/MedWatch.

To find a doctor of optometry near you to schedule a comprehensive eye exam, please visit the American Optometric Association at aoa.org. 

About the American Optometric Association (AOA):
The American Optometric Association, a federation of state, student and armed forces optometric associations, was founded in 1898. Today, the AOA is proud to represent the profession of optometry, America's family eye doctors, who take a leading role in an individual's overall eye and vision care, health and well-being. Doctors of optometry (ODs) are the independent primary health care professionals for the eye and have extensive, ongoing training to examine, diagnose, treat and manage disorders, diseases and injuries that affect the eye and visual system, providing two-thirds of primary eye care in the U.S. For information on a variety of eye health and vision topics, and to find an doctor of optometry near you, visit aoa.org.