UPDATE: Senate VA chairman deals blow to TECS program

February 13, 2017
Experimental VA pilot misses mark by offering screenings in place of comprehensive eye exams.

Rural veterans deserve a standard level of care commensurate to peers living within range of Department of Veterans Affairs (VA) facilities, which is why a prominent U.S. Senator is taking a stand against an eye and vision screening pilot program now in operation within the VA.

Senator Johnny Isakson (R-Ga.), chairman of the Senate Committee on Veterans' Affairs, delivered a letter to VA Acting Secretary Robert Snyder on Feb. 6 that called into question an experimental screening initiative now in operation at the Atlanta VA Medical Center that he—as well as AOA and the Georgia Optometric Association (GOA)—contend subverts the VA's guarantee of "one standard of care."

Although the AOA commends the VA's ongoing efforts to expand veterans' access to eye and vision health care, this "Technology-based Eye Care Services" (TECS) program sidesteps the high-quality care afforded by in-person, comprehensive dilated eye examinations. Senator Isakson penned the letter after a round of meetings with GOA leaders and staff.

TECS identifies rural veterans residing outside the footprint of full-service VA facilities to receive vision and eye disease screenings as part of their local primary care visit. These services are performed by an ophthalmic technician, include an unproven hybrid of eye disease screenings, and may result in the creation of an eyeglass prescription based solely on auto-refractor readings.

"While vision and eye health screenings can be beneficial as an adjunct to regular, comprehensive eye examinations, these limited screenings may be failing our veterans by providing them with a false sense of security, as TECS screenings are no substitute for the one standard of care the VA has always offered eligible vets, and that is a comprehensive, dilated eye examination," Sen. Isakson writes. "I am concerned that the TECS program is offering a disparate, and, in my opinion, a reduced level of care for some veterans, particularly rural veterans, which does not conform with existing VA policies.

"With doctors ready and able, I question why TECS screenings are being deployed in (Georgia), and soon elsewhere, and tested on America's veterans."

AOA President Andrea P. Thau, O.D., notes how the VA supports the vital care role doctors of optometry serve, as reflected by a January 2017 memorandum that exempts doctors of optometry and VA residents from the current federal hiring freeze.

"By exempting doctors of optometry and residents from the hiring freeze, the VA took a vital step to ensure that all of the men and women who serve our great nation have access to quality eye and vision health care," Dr. Thau says. "The AOA applauds the VA's action and looks forward to working with them to continue to implement safe and proven initiatives that help expand veteran access to in-person care."

AOA, affiliates respond to TECS

Working alongside and in conjunction with the GOA and the Armed Forces Optometric Society (AFOS), the AOA continues to communicate concerns to the VA that veterans being offered these TECS screenings may receive substandard diagnoses and care, and may mistakenly assume that they have received a comprehensive eye examination. Furthermore, the AOA voiced concerns that this pilot program could delay timely diagnosis and care afforded by a comprehensive eye examination at a frequency advocated by the AOA and the American Academy of Ophthalmology.

More specifically, the AOA voiced concerns that providing eyeglass prescriptions to veterans based solely on auto-refractor readings is leading to substandard refractive diagnosis and vision correction treatment. This type of substandard care is expressly prohibited in Georgia and nearly a dozen other states; though these laws do not apply to the VA system. The AOA raised concerns that the eye disease screening portion of TECS, which is in the initial phases of study by the National Eye Institute (NEI) for its effectiveness, will catch some eye diseases, but also will miss a wide range of eye health issues common among veterans.

While limited in its current reach, the TECS program is dangerous and poses a barrier for doctors of optometry, both within and outside of the VA, to deliver quality care, Dr. Thau says. "The AOA and the Georgia Optometric Association, as the advocates for our profession and, more importantly, our patients, are taking a stand on behalf of all patients, including those who have served our great nation by fighting for our country. We will speak out against inappropriate uses of telehealth technologies and inferior care to ensure that this program cannot grow or potentially influence policymakers and others outside of the VA."

U.S. House members agree with concerns

The AOA and GOA's message has resonated with other members of Congress, who took up a bipartisan letter and signed on their support last year—a show of force against such a potentially harmful program. The letter—sent to the VA Sept. 27—was signed by Reps. Barry Loudermilk (R), Sanford Bishop Jr. (D), Lynn Westmoreland (R), John Lewis (D), Rob Woodall (R), Jody Hice (R), Austin Scott (R) and Earl "Buddy" Carter (R).

Although these letters don't halt the pilot program, it marks an important step to ensuring this does not become the norm system-wide.

"As soon as we learned about the TECS program, the Georgia Optometric Association took swift action, working with the AOA to quickly educate representatives about the substandard care the program delivers to our veterans," says Ben Casella, O.D., GOA president. "This is a crucial first step, and we must continue to work together to fight for the whole profession and the eye and vision health of all of our patients."

Advocating for veterans' eye care

Eye care clinics staffed by VA doctors of optometry—and residents—are among the busiest primary care settings in the veterans' health care system. In 2014, more than 1.2 million veterans received comprehensive eye examinations and other essential care through VA doctors of optometry.

The AOA has long supported measures that expand veterans' access to timely, quality eye and vision care services offered by in-person, comprehensive eye examinations, including legislation in this current Congressional session.

Passage of the bipartisan "Veterans Access, Choice and Accountability Act of 2014" (Choice Act) created the Veterans Choice Program, a way for eligible veterans to access care via non-VA providers should the veteran face an extended wait time or geographical hindrances. But an AOA-backed provision effectively made it easier for veterans to qualify for this care. Through the Choice Act, non-VA doctors of optometry can provide care to America's veterans when needed.

Read how AOA members serve America's service members—at home and abroad—including via the Veterans Choice Program, in the November/December 2015 edition of AOA Focus.

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