V.I.S.I.O.N. links technology, veterans’ eye care

Patient-centered innovation that maximizes the medical eye care already provided by the Department of Veterans Affairs' (VA) doctors of optometry could streamline veterans' access while also eliminating costs associated with other screening programs.

Presented during the VA's Innovation Demo Day on Aug. 17, the Veterans Innovate Sight in Optometry Nexus (V.I.S.I.O.N.) project would "create an initial or ongoing encounter that eliminates the need for a remote screening process," reduce veterans' wait times, and accelerate their access to full-scope eye care and sub-specialty services on a same-day basis.

Based on conversations with patients, private sector and VA Optometry Service providers, the project determined that not only do patients and doctors prioritize access to vision and medical eye care equally, but also patients preferred a "one-stop" visit for comprehensive services where the patient will receive both comprehensive medical care and optical services.

These responses influenced design of the V.I.S.I.O.N. model, which revolves around the introduction of a high-efficiency, ophthalmic imaging technology suite—provided by Optos^® and Marco Ophthalmic—into the current eye examination space. A detailed refractive and anterior/posterior segment ophthalmic imaging, as well as a patient history, are collated by an ophthalmic technician and put into the VA's computerized patient record system (CPRS) for a more efficient review and examination process by a doctor on-site.

Currently, a pilot program is underway to test the model, and already doctors have been able to see up to 36 additional patients per month/per provider, says Dorothy Hitchmoth, O.D., chief of optometry for VA New England Healthcare in White River Junction, Vermont.

"The pilot program is going very well," Dr. Hitchmoth says. "Patients are happy that they are getting same-day service with a technician, optometrist and optician. The overall goal of V.I.S.I.O.N. is to provide veteran patients with timely care that is meaningful to them, and optometry does this well."

V.I.S.I.O.N. an improvement on TECS

Notably, the V.I.S.I.O.N. model differs from another VA eye care pilot program, called Technology-based Eye Care Services (TECS), in several distinct ways. Primarily, the V.I.S.I.O.N. model offers patients streamlined, comprehensive care in one appointment, as opposed to TECS, which requires a remote vision screening and subsequent follow-up visits.

The V.I.S.I.O.N. program also costs only half of the TECS' price tag, which incurs added costs for hiring eye surgeons to complete telehealth image readings. The V.I.S.I.O.N. program, on the other hand, makes use of the existing VA Optometry Service structure that provides the majority of veterans' eye care nationwide.

To ensure veterans receive only the best care, using the latest technology, Dr. Hitchmoth called for collaboration with Gerald Selvin, O.D., VA National Director of Teleretinal Imaging, and April Maa, M.D., TECS program lead.

"I hope this collaboration will move both optometry and ophthalmology in one direction where patients remain at the center of their care," Dr. Hitchmoth says.

Launched as a pilot program in late 2016, TECS identifies rural veterans residing beyond the footprint of full-service VA facilities to receive vision and eye disease screenings as part of their local primary care visit. These services, 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 autorefractor readings. That prompted Sen. Johnny Isakson (R-Ga.), chairman of the Senate Committee on Veterans' Affairs, to rebuke the program earlier this year.

"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 wrote in a Feb. 6 letter to VA Acting Secretary Robert Snyder.

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

Sen. Isakson wasn't the only member of Congress to take issue with TECS. Following initial concerns raised by the AOA, the Georgia Optometric Association and the Armed Forces Optometric Society (AFOS) in 2016, eight Congressional leaders signed a bipartisan letter to the VA that waved red flags about the standard of care.

Roundtable spotlights 'one standard of care'

These concerns came to a head with a meeting of the minds, June 21, in Washington, D.C. During a roundtable discussion, titled, "Veteran Vision: A Discussion on The Importance of Eye Health Care for America's Veterans," and hosted by AOA, AFOS, the Association of Schools and Colleges of Optometry, AMVETS, the Blinded Veterans Association, the Vietnam Veterans of America, Sen. John Boozman, O.D., (R-Ark.) and Rep. Julia Brownley (D-Calif.), the importance of preserving veterans' high-quality, comprehensive eye care was discussed with Sen. Jerry Moran (R-Kan.), Senate VA appropriations committee chair.

"Trying to shortcut the care provided by doctors of optometry to more than 1.5 million veterans a year places their eye health and vision care at risk," said AOA President Christopher J. Quinn, O.D., at the roundtable. "Our veterans have earned and deserve dedicated and quality vision care—and the AOA will fight for them."

Eye care clinics staffed by VA doctors of optometry, and residents, are among the busiest primary care settings in the veterans' health care system. The VA Optometry Service provided primary eye care services for about 1.8 million veteran visits in 2016 alone.

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 landmark legislation, such as the Veterans Access, Choice and Accountability Act of 2014.