How to get started with Tele-Optometry with Drs. Rothschild, Pandit and Tchang

[AdminWolf]

Click here to book a demo & sign up for a free tele-health consultation with Visionix:
https://landing.visionix.com/en-us/odwire

Program Synopsis:
Are you interested in Tele-Optometry but don't know where to begin?

Are you struggling to find an Optometrist for your team, or do you simply want to serve more patients?

In this ODwire.org Webinar, we highlight Tele-Optometry and address frequently asked questions about understanding and implementing Tele-Optometry.

We explore:

* What does Ocular Telehealth and Tele-Optometry mean?
* Why start Tele-Optometry, and is there a need for it?
* What does a Tele-Optometry exam look like?
* What information can the remote Optometrist access during the exam?
* What is the patient's feedback on Tele-Optometry exams?
* What do ECPs think about Tele-Optometry after implementing it?
* What equipment is required for Tele-Optometry?
* When is Tele-Optometry NOT appropriate?



A live Q&A follows.

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About the Speakers


Mike Rothschild, OD is the Director of Practice Development for Vision Source and the founder of Leadership OD, a practice management consulting company.

Sukumar Pandit, OD is the president of Pandit Optometric Corporation. He is also a tele-optometrist with 20/20Now.

Noelle Tchang, OD is Director of Professional Services at 20/20Now.



About Visionix

Visionix is the global manufacturer and exclusive provider of Optovue OCT/OCT-A devices, multimodal Visionix screening and refraction systems, and Briot and Weco lens finishing equipment.

Our goal is to improve access to a complete suite of advanced visual health solutions that transform the patient experience.

Today, we are proud to offer devices like the Optovue Solix OCT-A and a wide range of multimodal technologies designed to facilitate the diagnosis and management of a range of ocular diseases. Our new Tele-Optometry Program with 20/20NOW introduces more options to grow your practice with Visionix while keeping the doctor in control of the full patient care experience.

We are pioneers in integrating core refractive, screening, and imaging technologies to address the ever-changing needs of eye care professionals. With over 100 years of innovation, as well as a new level of support and clinical education, we are well-positioned to help you unlock your potential.

 

[AdminWolf]

Thanks again to our speakers & to everyone who came to the show live last night! It was a good one -- the Q&A was especially enlightening about the nuts-and-bolts of how it all works, people asked really good questions.

-- ad

 

[Jonovan Ottenbacher]

I wonder in which states ODs can perform these comprehensive remote eye exams; I didn't hear them mention that.

OMDs can perform complete tele-exams in any state and can have techs perform (essentially?) the entire exam for them, whereas ODs are legally much more restricted:

In California, https://www.optometry.ca.gov/lawsregs/opt2020lawsregs.pdf

"§2540. MEASURE OF RANGE OF VISION; DETERMINE PRESCRIPTION OF LENSES No person other than a physician and surgeon or optometrist may measure the powers or range of human vision or determine the accommodative and refractive status of the human eye or the scope of its functions in general or prescribe ophthalmic devices."

"§2544. FITTING OF LENSES; ADDITIONAL PROCEDURES BY ASSISTANT" does not include slit lamp / biomicroscopy.

So techs can't refract or perform slit lamp. Dr. Pandit mentioned having a tech refract and then the OD refining that, but even that doesn't sound legal in California.

In Texas, https://tob.texas.gov/optometry-act/

"Sec. 351.453. EXAMINATION REQUIRED FOR PRESCRIPTION. An optometrist or therapeutic optometrist may not sign, or cause to be signed, an ophthalmic lens prescription without first personally examining the eyes of the person for whom the prescription is made."

also,

"Sec. 351.353. INITIAL EXAMINATION OF PATIENT"
"To ensure adequate examination of a patient for whom an optometrist or therapeutic optometrist signs or causes to be signed an ophthalmic lens prescription, in the initial examination of the patient the optometrist or therapeutic optometrist shall make and record, if possible, the following findings concerning the patient's condition: ... biomicroscopy, internal exam ..."

Does an anterior video count as biomicroscopy, and does a poster photo count as an internal exam? And do those constitute "personally examining" the eyes?

Maybe other states have more relaxed legal requirements for ODs, but at least for patients in these states, it seems ODs couldn't perform comprehensive remote eye exams, if I'm interpreting the laws correctly.

 

[Ciara Guglielmi]

I wonder in which states ODs can perform these comprehensive remote eye exams; I didn't hear them mention that.

OMDs can perform complete tele-exams in any state and can have techs perform (essentially?) the entire exam for them, whereas ODs are legally much more restricted:

In California, https://www.optometry.ca.gov/lawsregs/opt2020lawsregs.pdf

"§2540. MEASURE OF RANGE OF VISION; DETERMINE PRESCRIPTION OF LENSES No person other than a physician and surgeon or optometrist may measure the powers or range of human vision or determine the accommodative and refractive status of the human eye or the scope of its functions in general or prescribe ophthalmic devices."

"§2544. FITTING OF LENSES; ADDITIONAL PROCEDURES BY ASSISTANT" does not include slit lamp / biomicroscopy.

So techs can't refract or perform slit lamp. Dr. Pandit mentioned having a tech refract and then the OD refining that, but even that doesn't sound legal in California.

In Texas, https://tob.texas.gov/optometry-act/

"Sec. 351.453. EXAMINATION REQUIRED FOR PRESCRIPTION. An optometrist or therapeutic optometrist may not sign, or cause to be signed, an ophthalmic lens prescription without first personally examining the eyes of the person for whom the prescription is made."

also,

"Sec. 351.353. INITIAL EXAMINATION OF PATIENT"
"To ensure adequate examination of a patient for whom an optometrist or therapeutic optometrist signs or causes to be signed an ophthalmic lens prescription, in the initial examination of the patient the optometrist or therapeutic optometrist shall make and record, if possible, the following findings concerning the patient's condition: ... biomicroscopy, internal exam ..."

Does an anterior video count as biomicroscopy, and does a poster photo count as an internal exam? And do those constitute "personally examining" the eyes?

Maybe other states have more relaxed legal requirements for ODs, but at least for patients in these states, it seems ODs couldn't perform comprehensive remote eye exams, if I'm interpreting the laws correctly.

Hello Dr. Ottenbacher,

Thank you for your reply. You are completely right, this is very complex, with 50 states there are 50 different rules and regulations on telehealth exams for ODs.

Including details for refraction, who can be seen via tele-optometry, what can be delegated, etc...

20/20NOW's regulatory and legal teams continually evaluate those and their sales team will discuss all restrictions and details in your state and if/how these exams are possible.

For example, as you noted, in California one of the additional restrictions is that the OD has to perform the entire refraction and there they do. They will also let you know if your state is a hard no for this like in Oregon.

To explore if and how tele-optometry is possible in your state you can reach out and we will connect you with their team to discuss it https://landing.visionix.com/en-us/odwire

Thank you for watching and for your questions.

 

[Lloyd Pate]

I wonder in which states ODs can perform these comprehensive remote eye exams; I didn't hear them mention that.

OMDs can perform complete tele-exams in any state and can have techs perform (essentially?) the entire exam for them, whereas ODs are legally much more restricted:

In California, https://www.optometry.ca.gov/lawsregs/opt2020lawsregs.pdf

"§2540. MEASURE OF RANGE OF VISION; DETERMINE PRESCRIPTION OF LENSES No person other than a physician and surgeon or optometrist may measure the powers or range of human vision or determine the accommodative and refractive status of the human eye or the scope of its functions in general or prescribe ophthalmic devices."

"§2544. FITTING OF LENSES; ADDITIONAL PROCEDURES BY ASSISTANT" does not include slit lamp / biomicroscopy.

So techs can't refract or perform slit lamp. Dr. Pandit mentioned having a tech refract and then the OD refining that, but even that doesn't sound legal in California.

In Texas, https://tob.texas.gov/optometry-act/

"Sec. 351.453. EXAMINATION REQUIRED FOR PRESCRIPTION. An optometrist or therapeutic optometrist may not sign, or cause to be signed, an ophthalmic lens prescription without first personally examining the eyes of the person for whom the prescription is made."

also,

"Sec. 351.353. INITIAL EXAMINATION OF PATIENT"
"To ensure adequate examination of a patient for whom an optometrist or therapeutic optometrist signs or causes to be signed an ophthalmic lens prescription, in the initial examination of the patient the optometrist or therapeutic optometrist shall make and record, if possible, the following findings concerning the patient's condition: ... biomicroscopy, internal exam ..."

Does an anterior video count as biomicroscopy, and does a poster photo count as an internal exam? And do those constitute "personally examining" the eyes?

Maybe other states have more relaxed legal requirements for ODs, but at least for patients in these states, it seems ODs couldn't perform comprehensive remote eye exams, if I'm interpreting the laws correctly.

Photos do not count in Texas

 

[Steven E. Nelson]

Photos do not count in Texas

It's funny, I was just discussing this with another OD friend of mine. Texas Board aside, I think the only way you COULD do it is to have both an Optos for peripheral viewing (and a tech capable of actually giving a good image) AND a camera that does 3D imaging. My old Nidek AFC did that and it was great, but you'd HAVE to have both. You can't even remotely count on color to judge c/d ratios and see elevations in the posterior pole and you're still taking a risk with the peripheral retina given how hinky Optos can be.

We're also talking about a LOT of "refract and refer" because it'd be challenging to discuss complex medical issues with patients as a doctor from a hundred miles away...that's not even discussing simple things like assessing contact lens fitting, more complex refractions, binocular vision issues, specialty lenses like RGPs and sclerals....I mean, it's really kind of a mess and it only "works" (using the term loosely) on simple patients.

I wasn't able to log on, but I'm genuinely curious how it works. The implications concern me as I've seen companies like Digital Optometrix push REALLY hard in corporate locations to get THEIR foot in the door (ostensibly putting the existing doctor's foot out unless they add the hours the retail outlet wants).

 

[AdminWolf]

I wasn't able to log on, but I'm genuinely curious how it works. The implications concern me as I've seen companies like Digital Optometrix push REALLY hard in corporate locations to get THEIR foot in the door (ostensibly putting the existing doctor's foot out unless they add the hours the retail outlet wants).

I am hoping someone from the company can give you a better explanation (ie, like Dr. Pandit who was on the call), but the way they described it at the show, it seemed very much like a collaborative process. (you can watch the archive of the entire event in the first post of this thread.)

But it looked to me like if you needed coverage at certain dates and times you'd work on a schedule with them for when it would happen [remember they have to staff this with ODs licensed to practice in whatever state they are working with, so I'm sure there's some complexity on their end as well.]