Q&A: Exploring telehealth through DigitalOptometrics

Telemedicine has been a topic of hot interest for the past few years and most specialties of medicine have explored the ways health care could be digitized. The use of telemedicine to treat our patients became less elective and more prioritized during the spread of the COVID-19 pandemic.

Many practitioners in the field of optometry chose to communicate with and assess patients through video conference, utilizing services such as Zoom, FaceTime, or Skype. Although these techniques were adequate for some diagnoses, they were not nearly sufficient to provide our patients with a comprehensive assessment.

DigitalOptometrics has elevated telemedicine through new developments in its software platform. Patients are able to receive a comprehensive exam with a doctor who is working remotely. All aspects of an eye exam—visual acuity testing, refraction, slit lamp examinations, fundus imaging, etc.—can be conducted in-person while the doctor is able to assess all the information at a different location.

The technology of DigitalOptometrics pioneers a new way for doctors to see patients who may not readily have access to eye health providers. Howard Fried, OD, DigitalOptometrics’s president, speaks more on the concept of telehealth and the company’s technology.

Describe the process of an eye exam performed by a DigitalOptometrics optometrist.

DigitalOptometrics facilitates a remote comprehensive eye exam. The patient enters the practice where a local technician collects their demographic information as well as their ocular and medical history in a tablet, laptop, or desktop computer. That information is pushed up to the Cloud to be reviewed by the remote optometrist.

The patient is then led into the pre-testing room, where they will go through a number of tests including retinal imaging, video slit lamp for anterior segment analysis, glaucoma test, visual field, auto-refractor/keratometer, auto-lensmeter, as well as the recording of ancillary tests such as pupils and extraocular movements (EOMs). DigitalOptometrics integrates into hundreds of devices to keep the capex down for our clients. The information gathered is pushed up to the cloud to be reviewed by the remote OD. The patient is then led into the exam room, where they sit behind a digital phoropter. At this point, a remote technician appears on a 43-inch monitor above the visual acuity chart, takes control of the phoropter, and performs an initial subjective refraction.

When completed, a licensed OD appears on the monitor. The doctor controls the phoropter to refine the prescription, if necessary, that the remote refractionist provided. The OD will put up images of the patient’s retina on our white board technology and point out areas of interest.The doctor will provide recommendations for lenses and any appropriate follow-up or referral necessary for the patient. The OD will answer any questions that the patient might have, at which point they will finalize the prescription for eyeglasses or contact lenses, and the prescription will immediately print so the patient can take the prescription into the dispensary to purchase their eyewear.

How does DigitalOptometrics differ from other telehealth models that have been explored in the past?

DigitalOptometrics has taken a very responsible approach to tele-optometry. Our process is an Optometrist-driven, patient-centric model. We do not cut any corners—it is a comprehensive eye exam performed remotely. We are constantly adding additional features to bring additional value to our clients. Another differentiation is that, by utilizing our technology, exams can be performed every 20 minutes—allowing high volume practices to process 3 patients per hour per exam lane, if needed.

How many ODs are employed by the company? Where are these optometrists located?

We have over 100 Optometrists working for DigitalOptometrics as independent contractors.They are located throughout the United States and work from their home offices.

Where are the current locations of the offices? How many offices are there in total?

DigitalOptometrics has 2 offices: our corporate office is located in Lake Success, New York, and our regional office is located in Cincinnati, Ohio.

What effect did the pandemic have on DigitalOptometrics' growth?

The immediate impact was negative—when our clients’ offices closed in early 2020 for a couple of months. During this period of time, we were busy hiring more installers and trainers, as we knew that the pandemic would push telemedicine to the forefront of everyone’s minds and that we needed to be prepared for the significant increase in business. We were correct in that, prior to 2020, we had the wind behind our back. But as a result of the pandemic, we now had Gale Force winds. The pandemic had positive effects on DigitalOptometrics’ growth by introducing social distancing as another advantage of our technology.

What are the current limitations of a telehealth eye exam with DigitalOptometrics?

The DigitalOptometrics technology is an excellent gatekeeper approach to performing exams.Patients can now be examined when they want to be seen, which then results in reduced wait times and early detection of disease. Having said that, this technology will always be a supplement—not a replacement—to the extraordinary care provided by in-person optometrists.

The potential reach telehealth could have for patients living in areas with a shortage of doctors is one of the most frequently mentioned advantages of the practice. Even in the United States, there are patients in rural areas who must travel a long distance to see a certain specialist. Is this something that DigitalOptometrics has in mind for the company?

One of the primary reasons I developed this technology was to improve access to care and provide eye are to the numerous underserved areas throughout North America.We are currently getting to these underserved communities and will accelerate that initiative over the next few years.

Artificial intelligence (AI) has been involved in the frontier of the future of telehealth, i.e. software that is able to detect various conditions from fundus photos, especially diabetic retinopathy. Is there a place for AI in telehealth eye exams with DigitalOptometrics?

Yes—any technology that permits our doctors to receive additional and clinically relevant information on the patient is something that we are interested in integrating with. Early detection is a critical advantage of our technology platform.

In your opinion, what benefits do optometrists have byworking in telehealth practices?

Optometrists now have the flexibility to balance several quality-of-life events and/or return to the profession by practicing remotely from their home office. They can now eliminate the time and cost associated with travel to optometric practices to perform eye exams and can perform eye exams with social distancing. In addition, they can examine patients in multiple states in which they are licensed within minutes of each other—all from the comfort of their home office.

What do you foresee for the future of teleoptometry, and how will DigitalOptometrics fit into it?

Tele0ptometry will become a higher percentage of total exams performed not only in the U.S., but globally.As the leading platform of teleoptometry, our company will continue to scale and will bring additional value to our clients through new features and integrations that will elevate the experience further for the patient.