Why you should care

Because this might mean one fewer doctor’s office and waiting room to endure. 

I’ve closed the blinds, turned off the lights and lined up cushions to block out errant flashes of sunlight. One hand covers my right eye, the other grips a phone, chirping with a voice asking me to identify when triangles on my laptop start to blur together. I’m staring at the future of optometry, and I’m scared I’m doing it wrong — did I measure exactly 12 steps, heel to toe, away from my screen? Should I have said I wear size 9 shoes instead of 8.5? Not sure, but an optician-validated prescription for glasses for $40 in 30 minutes flat? Yup, there’s actually an app for that — and it’s too good to pass up.

And for many, it might be their only way to access an optician. A staggering 285 million people are visually impaired, according to the World Health Organization, and fully 90 percent of them reside in developing countries, which have a major shortage of ophthalmologists. And the consequences amount to far more than blurred vision when, for example, undiagnosed cataracts — a highly treatable condition with an 80 percent success rate in America — can lead to blindness. In response, several startups including oDocs Eye Care in New Zealand, Opternative in the U.S. and D-EYE in Italy are working on visionary solutions — and the trusty iPhone (to start with) is their tool of choice.

oDocs Eye Care, for one, makes clip-on optometry tools for smartphones to combat blindness. Its portable visoClip ($225) maps corneal lesions, while its visoScope ($299) captures retinal images for detecting macular degeneration, macular edema and retinal detachment. Both snap onto an iPhone and cost a fraction of what you’d find in your doctor’s office (the professional equivalent of a visoScope is around $25,000, says Lifetime Eyecare in Maryland). “Mobile technology will level the playing field of developing and developed,” says Hanna Eastvold-Edwins, CEO of oDocs Eye Care. “Health is a human right.”

So far, 80,000 people have taken Opternative’s eye exams, and Dallek reports a 99 percent customer satisfaction rate.

 

Eastvold-Edwins believes blindness can be prevented, and that her company’s tools can help push that mission forward in developing countries. An admirable goal, but the for-profit company has to adhere to legislative accuracy standards, which vary from country to country and involve a time-consuming certification process. To speed things up, oDocs has focused on regulatory, rather than medical, approval. “We don’t want to compromise patient care,” she says. “But we need to investigate the potential — even if it upsets some people.”

And some people are definitely upset. Opternative, the Chicago-based startup that provided my $40 web-based prescription, has been the target of complaints filed with the FDA from opticians questioning the company’s business model, and some state legislatures are enacting “telemedicine” laws that prohibit it from operating. Opternative is currently banned in Indiana, Georgia and South Carolina but operates in 36 other states.

Aaron Dallek, CEO of Opternative, thinks that’s unfair. They aren’t trying to replace eye doctors, he says — you should still visit them for regular checkups — but he wants to offer consumers a more convenient and affordable way to get prescriptions. Dallek compares his company to Uber and Airbnb — startups that followed tumultuous paths as they disrupted their respective fields. So far, 80,000 people have taken Opternative’s eye exams, and Dallek boasts a 99 percent customer satisfaction rate.

Which isn’t enough to satisfy Andrea P. Thau, president of the American Optometric Association. “By getting a prescription via an online ‘exam,’ a person could be putting both their eye health and overall health at risk,” she emailed.

“I’d be worried about whether the test would be accurate,” adds Natasha Johnson, a designer from Portland, Oregon. “What if I set it up wrong?” Human error is always possible, but Dallek insists the test is designed to correct for it.

For some consumers, there may be an attraction to the cost of these offerings. Besides the below-market pricing of the new devices, where both oDocs and Opternative products cost significantly less than their professional-grade equivalents, the $40 prescription fee becomes even more attractive when you compare it to your copay (they don’t take insurance yet) and factor in the costs of time and travel to your doctor’s office. And for those without insurance, these companies are 60 percent cheaper than the $90 people spend on average to visit an optician for an exam and prescription — another reason opticians are protesting.

This pushback may explain why competing products, like Peek Vision’s clip-on cataract checker, are still in beta following years of development — with no launch date imminent. A spokesperson for Peek Vision didn’t respond to a request for comment. And those that have gone to market, such as the SVOne autorefractor and the D-EYE clip-on retinal imager, carry price tags that may be competitive for a Western market but are way out of range for the developing world.

The preferred solutions from oDocs and Opternative aren’t complete, yet. oDocs require trained optometrists to use their products — a patient’s eyes must be dilated to take a reading, so they only sell them to professionals — which slows their footprint in developing countries. And while Opternative provides prescriptions for glasses, if you’re a contact lens wearer, you need to have an existing prescription before it can evaluate you anew. But Dallek says they’re working to remove the contact lens hurdle, and oDocs is designing a device that makes dilation obsolete.

White-coated opticians are not going away, but neither is this new technology — in fact, Opternative just inked a contract with 1-800 Contacts to provide tests through its website, and 6over6, an Israeli mobile app that uses light to take optical measurements, won the innovation category at the mHealth conference. And then there’s EyeNetra, which offers eye exams through a virtual reality interface. The future may still be coming into focus, but “optometrists shouldn’t be scared of what’s happening — there will always be a need for them,” says Eastvold-Edwins. “This won’t take jobs — but it will save sight.”

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