Like many emerging technologies, online eye exams have advantages and disadvantages. The primary advantage is convenience: patients can complete the exam in their own home without going to a medical office.
Stop a minute and think about that decision in relation to other medical care you seek out. In any other field of medicine, would you be content to substitute care over the internet for a visit to a doctor who could examine you fully and address any health issues that you may or may not have been aware of?
While eye exams might seem like something that is safe to farm out to computers, apply that same standard to other areas of your health: would you be comfortable getting care from an allergist, dermatologist, or audiologist over an electronic device, let alone a pediatrician, endocrinologist, or cardiologist?
Doctors in those medical specialties also use tests and scans to measure data points about your health, just as the online eye exams do.
But the other specialists don’t stop there.
Your cardiologist has detailed records that your pacemaker transmits automatically, but they still want to see you in person from time to time. Your endocrinologist has the results of your blood sugar tests, but you go for one-on-one consultations to see what’s working well and what isn’t. Your audiologist uses technology to assess your hearing, but you come in for check-ups nevertheless to address a range of factors that may impact your hearing.
Online eye exams provide another option to residents of remote rural areas in the U.S. and around the world. Filling glasses and contact prescriptions can be more of a hardship in areas with less access to routine healthcare.
This is the reason behind the development of the telemedicine trend—which online eye exams are part of.
But while they are option for the rest of us, they may not be the best option.
Disadvantages Of Online Eye Exams
You still have to see your eye doctor. Even the online testing companies tell you that you have to see your eye doctor in person regularly. While you can get a quick test of your visual acuity, it takes an eye care professional like an optometrist or an ophthalmologist to conduct a check of the health of your eye, not just how accurately you can see. Your eyes are part of your body systems just like your other organs, and a comprehensive eye exam in person is the only way to see if they are healthy and in good medical condition. In fact, the visual acuity test that determines your prescription is only a small fraction of the examinations your doctor will make during a comprehensive eye exam.
Comprehensive exams catch diseases early. The American Optometric Association (AOA) points out that “systemic diseases can also be detected through comprehensive eye exams” and cites a figure of 240,000 cases of diabetes first detected by an eye doctor in 2014. Diabetic changes in the eye can show up before other warning signs, and damage to the optic nerve, once done, cannot be undone. Total blindness can result from uncontrolled diabetes, so it is something to take seriously.
Online tests can only assess certain issues. Anyone with eye conditions other than simple refractive error is also an inappropriate candidate for the online exam. In fact, a screener questionnaire will filter out anyone with an existing eye issue. But the online exam has no way of picking up on any eye issues other than those simple refractive errors. It can’t test for infection, cataracts, glaucoma, or macular degeneration.
In a recent CNN investigation, side-by-side comparison showed that the online test missed a degree of astigmatism that an in-person visit to the eye doctor detected. Astigmatism is another type of refractive error besides nearsightedness and farsightedness that can cause blurry vision.
According to the editor’s note in the same CNN article, the FDA has intervened in the case of one company offering online vision tests, issuing a warning letter in 2017 to the company Opternative, “requesting that the company cease activities that result in the misbranding or adulteration of its test as an ‘eye examination’ mobile medical app device. A company spokesperson replied to CNN that “we responded to the Warning Letter and we are working closely with FDA on this matter."
Other health issues can be detected in a full exam. For this reason, it says on the website of at least one company that the online exam is "not a replacement for a comprehensive eye health examination." Retinal damage, eye pressure, inflammatory conditions, fluid leakage, and diabetic changes are some significant aspects of your eye health that cannot be detected during online vision tests. In addition, there are many health conditions affecting the rest of the body that rule out the online alternative. These include high blood pressure, diabetes, and allergies.
Untreated conditions can cost you more in the long run. The cost of treating eye conditions later in their development is enormous, both in terms of the resulting damage to vision and the financial cost. Saving money with an online exam must be weighed against these potential costs. This is why the AOA warns, “If serious conditions are left undiagnosed for long periods of time and a patient skips office visits with an eye care professional, the chance for identifying an effective treatment lessens and could lead to irreversible vision loss or worsening of a systemic disease.”
Only patients who already have a stable prescription can use the online test. If your prescription has changed in recent years, then you aren’t a candidate. In addition, severe refractive errors cannot be addressed with online alternatives. These drawbacks position online tests as more of a place holder than anything.
Only those between ages 18 and 39 should consider the online alternative. While the computer-based companies use age 50 as the upper limit, the American Academy of Ophthalmology considers people 40 and over to be inappropriate for the online test.
Medical and vision insurance typically do not cover online eye tests. In addition, 10 states have laws to limit how much online eye exams can serve in the stead of a doctor’s office visit until more evidence is provided that they have health value.
Finally, user error is a possibility with the online test in a way that it is not in a doctor’s office. The online test relies on the patient using their computer screen and smartphone in conjunction at specific distances and self-reporting visual information. There is no trained professional at home to let you know if you’re doing something wrong.
Skip the online test and schedule an in-person exam today.