Online vision test receives failing grade from doctor of optometry
An online vision test, which is being billed as an "eye exam" by its makers, touts ambiguous claims that could mislead patients into choosing convenience at the expense of proper eye and vision care.
Doctors don't have to look much further than one such company's homepage for an example: "Opternative is as accurate as an in-person refractive eye exam," it states. The question is—does it deliver on that assertion? Christopher S. Wolfe, O.D., AOA State Government Relations Committee member, was eager to find out.
"After Opternative made an announcement about their online vision tests, I decided to take it and see what it was all about," Dr. Wolfe says. "Once I received my prescription, I was shocked to see how different it really was."
Opternative's prescription came back OU -1.00 DS. But Dr. Wolfe's actual prescription? It's OD -0.25 D -0.75 D x 010; OS -0.25 D -1.00 D x 015. Essentially, Opternative's prescription was slightly more minus than his spherical equivalent—Dr. Wolfe's astigmatism was completely missed.
"Just to visualize how I would see out of a -1.00, I put it into a trial frame," he says. "Uncorrected visual acuity in my right eye is 20/25 and my left eye is 20/30. Through the -1.00 prescription it was almost exactly the same."
Concerned with these findings, Dr. Wolfe reviewed the clinical study that Opternative uses to back its claim comparing its vision test to an in-person refractive exam. The 30-person trial compared patients plano to -4.00 using spherical equivalent data for both exam modalities, determining a correlation.
Despite that test range, the company will assess myopic participants with spherical power between -0.25 and -5.50, hyperopic participants with spherical power between +0.25 and +2.50, and astigmatic participants with cylinder power between -0.25 and -2.50.
"There are the eye health concerns that are obviously misleading, but the fact that the study they cite is so small and their claims that it points to accuracy and correlation to traditional refraction techniques is misleading at best, since it only accounts for spherical equivalent data," Dr. Wolfe says.
Most importantly there is a significant opportunity to miss an asymptomatic patient with an eye disease via this online modality, Dr. Wolfe says. The refraction is only 1 of 12 parts of the comprehensive eye examination, and within that refraction are numerous objective and subjective measures that can't rely solely on patient responses.
But furthermore, there is potential for costing consumers more time and money. Although Opternative will recheck eyes if participants are unsatisfied with their prescriptions, the company has no way to refund the cost on eyeglasses or contacts if purchased with the wrong prescription.
AOA 'will be an advocacy force'
The AOA and state affiliates continue to safeguard consumers against the misleading claims made by online vision tests by working with the public, news media and government officials—including state legislators and attorneys general, members of Congress, and federal agencies—to highlight the dangers of separating refractive tests from annual comprehensive eye exams performed in person by an eye care professional.
Already, the Federal Trade Commission (FTC) has taken action against one mobile app for publicizing unsubstantiated and misleading claims about its product. Carrot Neurotechnology Inc., creator of the 'Ultimeyes' app, agreed to cease making unsupported claims that their app improved users' vision, and paid $150,000 to settle FTC charges that the company was deceiving consumers with false product claims.
The action received national news, and further underscores the work AOA and state affiliates do to bring public awareness to misleading claims made by such services.
"Wherever we find similar violations of Federal or state law, our AOA and state associations will be pressing for full enforcement," AOA President Steven A. Loomis, O.D., says. "Where laws may need to be updated to better protect the public, we will be an advocacy force."
The advocacy collaborative fighting for patient safety and the doctor-patient relationship reports on a productive 2020, despite COVID-19 challenges, and recently welcomed Alcon as its newest member.
At Nov. 17 FDA workshop, doctors of optometry warn of a lack of communication regarding the safety of online vision tests. The AOA, which continues to educate the public on these mobile apps and to hold them accountable, offers its expertise.