The following is a letter I have written to Mr. Michael Stenhouse, in response to his foundation’s video and testimony OPPOSING Rhode Island’s attempt to regulate tele-optometry in that state. The foundation is a political think-tank known as the Rhode Island Center for Freedom and Prosperity. Mike is an old college baseball opponent of mine, who went on to play in the major leagues. He now leads a life of great public service and consumer advocacy in Rhode Island. For conciseness, the letter is not all-inclusive of telemedicine issues.
Perhaps these comments can help us, as we deal with telemedicine on a state by state basis?
The Rhode Island bill died in committee last March, but one must believe it will surface and resurface around the country. Knowing our ODs on FB readers, you will have plenty to add.
I suggest viewing the video before reading on:
On to the letter:
You would likely not remember me, but I pitched middle relief for Penn in a game vs. Harvard in April of 1979. We gave your great pitcher Larry Brown a pretty good beating. In turn, you guys knocked our future pro, Timmy Timlin, out early so the game had a big score. Harvard turned the game around, thanks in part to the home run you hit off yours truly, a cartoon-like shot that is probably still traveling. That experience, among others, led me to believe that I would be better off practicing optometry, vs. continuing to play baseball!
I am writing on a matter of concern to those of us who practice optometry here in the United States. While I appreciate that Rhode Island’s legislative committees dealt with the tele-optometry issue last year, we all know that these technologic and regulatory issues will go on beyond our lifetimes.
Our profession is very concerned by the proliferation of telemedicine and how it applies to us, and more importantly, to our patients. In your video opposing last year’s RI Bill #S2404/H7608, you correctly noted that telemedicine is upon us, and can be used for the benefit of all. However, there are still many details that need to be worked out in order to ensure patient safety, confidentiality, and transparency of the process. Here are a few points that remain sticky for ethical optometrists and their patients:
*You emphasized that tele-refraction is not a substitute for a regular eye examination. Health professionals know that this is true, but our patients do not. A refraction-only exam is illegal in many states, including New Jersey. This type of exam is equivalent to an internist checking diabetic patients by measuring fasting blood sugar only. We know that patients with a new eyeglass Rx in hand will often skip proper examination.
*Eye disease is often very silent. Sight-threatening conditions are regularly found by examinations in which the patients were only desiring a new eyeglass prescription. Glaucoma is a classic example.
*Scanning devices for eyeglass prescriptions are notoriously inaccurate. Children and teens cannot control their focus in the way that the test requires. While many of us use these scanning devices in our offices, it is inappropriate to use the results as sole criteria for prescribing.
*Eyeglasses are best prescribed when a professional (optometrist or ophthalmologist) reviews current findings and compares them to a patient’s prior prescriptions and needs. Many books and articles are written on the art of prescribing glasses, and our patients are best served when the “art” is applied to the science.
*Telemedicine cannot yet begin to accomplish the contact lens examination that leads to safe, effective prescribing. The surface features of the eye need a thorough, in-person examination to help avoid infection, allergy, dryness, and toxicity.
*The South Carolina governor’s veto of a similar bill was almost unanimously overridden last year, so tele-optometry is not permitted in that state.
Mike, I hope you will weigh these comments in with any future consideration on tele-optometry. I would enjoy the possibility of dialogue with you, perhaps over a bucket of balls in the cage. I suspect I’ll need a helmet and a screen.
William B. Potter, OD
Penn Baseball ’79, Board Co-Chair
Millennium Eye Care, LLC
President, Optometry on West 44th, LLC
(I provided Mr. Stenhouse with my e-mail address for potential response.)