State association challenges mobile refractive service

A new commercial venture that uses unlicensed individuals to perform smartphone-based refractions is being challenged by a state association, underscoring efforts by affiliates and AOA to actively safeguard patients from misleading claims.

"AOA is not opposed to cutting-edge technology.  The AOA is opposed to bad patient care."

Known as Blink, the mobile refractive service was called into question by the New York State Optometric Association (NYSOA) for a business model that not only walks the line on state regulations, but also potentially jeopardizes patients' eye health.

Currently operating in New York City, the company sends minimally trained, unlicensed "visioneers" on 20-minute house calls for refractive services. They use smartphone-based tools to collect patient information that is transmitted to an off-site doctor of optometry. A prescription is then provided to the patient via email.

After a presentation by Blink before the New York State Board of Optometry, the NYSOA concluded that Blink's business model was fundamentally inconsistent with state law and, accordingly, sent a letter to the state's Education Department and its Office of Professional Discipline.

The letter identifies several potential breaches of state law and regulation, including:

• Potential breach in the scopes of practice of optometry and ophthalmic dispensing;
• Potential professional misconduct by delegating professional tasks to unlicensed and unsupervised employees; and,
• Potential illegal fee-splitting between an unlicensed referral service and a licensed practitioner.

But foremost among the concerns highlighted by NYSOA is the potential harm to patients.

"We are concerned, regardless of whatever disclaimers Blink might make, that patients who receive mobile refractions from unsupervised and unlicensed 'visioneers' will assume that they have received a comprehensive eye health examination," says Michele Lagana, O.D., NYSOA president.

No substitute for an in-person examination

The AOA firmly stands behind its position that there is no substitute for an in-person, comprehensive eye exam performed by a doctor of optometry. The  comprehensive eye exam is the only reliable way to not only detect refractive errors, but also the full range of eye health and vision conditions, many with no obvious signs or symptoms.

This position was underlined by a 2014 study by UnitedHealthcare that detailed how doctor of optometry play a crucial role in identifying chronic health issues, while a separate UnitedHealthcare study released in May reported that comprehensive eye exams are effective in engaging patients into care for chronic conditions.

Anyone claiming to perform an eye exam without physically examining a patient is offering insufficient, ambiguous information and is contributing to a patient believing—incorrectly—that his or her eye health needs have been met.

"AOA is not opposed to cutting-edge technology. But AOA is opposed to bad patient care," says Steven A. Loomis, O.D., AOA president. "When technology is abused in a manner that undermines the critical doctor-patient relationship, AOA will speak out and act to insure patients receive the care they deserve.

"The notion that eye care can be delivered by an iPhone and minimally trained technicians is not only a bad idea, it's dangerous. Patients will be harmed. Misleading patients into believing mobile refractive services result in adequate care is egregious in any venture, but in a large metropolitan city in which proper eye care is readily available, it highlights the truth that these services are not coming into existence to provide 'care' to an underserved population. In fact, it's about nothing but generating huge profits to huge companies at huge risk to patients."

The AOA and affiliates continue to be proactive in addressing claims made by online services and smartphone apps, and ask doctors to report any claims to the AOA or state association.