By: Kate Doerksen & Wallace Lovejoy

This article is a quick primer of telehealth and telemedicine solutions in the eyecare industry. While there are several other telemedicine reports for eyecare out there, we felt like those reports focused primarily on the eyecare professionals segment only and omitted some important new technology entrants like online refraction tools/smartphone apps that are relevant for online and omnichannel retailers and brands.  

Written in partnership with Wallace Lovejoy, experienced eyecare & optical retail executive. 

Overview

The Covid-19 pandemic drove a significant increase in telehealth adoption in the eyecare industry. Between state mandates and customers not wanting to risk leaving their homes and risking exposure, telehealth became a necessity.  

At the ATA2020 Conference in June 2020, they shared some key takeaways that drove this point home:

• More telehealth visits in 2 months than all of 2019 – 10x growth
• Physician adoption went from 22% to 75% during the pandemic
• 32% of patients would have done nothing if they didn’t have access to telehealth

According to the Review of Optometric Business, 73% of all physicians provided their first telemedicine visits during this time. A variety of platforms were tested due to relaxed restrictions, and telemedicine proved to be an effective way to evaluate the urgency level of a patient’s need.

All data suggests there will be a “new normal” post-pandemic. Two-thirds of those currently using telemedicine plan to continue using it post-pandemic, according to a January 2021 survey by Jobson Optical Research.  The infrastructure is now in place (from technology solutions to processes and workflows to insurance reimbursements) to support telemedicine going forward. 

From a customer/patient perspective, there are clear benefits to telemedicine including increased convenience and accessibility. According to an article in the Wall Street Journal titled “What Covid-19 Taught us About Telemedicine”, 30-40% of visits are still virtual even though practices have resumed in-person appointments, and 75% of patients who completed a video visit report that they are very likely or extremely likely to choose a video consult over an in-person visit.  This shift towards telehealth across all sectors will change customer expectations for care – including eye care. 

To further support the trend, the tech giants are entering the telehealth fray, including Amazon’s recent announcement to launch Amazon Care this summer to all 50 U.S. States. This is their telemedicine offering that includes a smartphone app to connect patients to medical professionals to chat live with a nurse or doctor, via in-app messaging or video; and 2) in-person care, where Amazon Care can dispatch a medical professional to a patient’s home for additional care, ranging from routine blood draws to listening to a patient’s lungs, and also offer prescription delivery right to a patient’s door. Amazon hasn’t mentioned anything specifically to at-home eye exams (yet!) but suffices it to say that this will change customer’s expectations for care.  

Make no mistake, telemedicine is here to stay.

Key Terminology of Telemedicine Broadly

To start, we wanted to layout and clarify some of the commonly used terms broadly in telemedicine as well as the key terms relevant for eye care telemedicine:

Telehealth

The use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. 

Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. Telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

In eye care, telehealth is broad enough of a term to include online appointments, online access to your prescription, text/email communications to doctors asking quick questions about their eye care (dry eyes, something in their eye, etc).  

Telemedicine

Remote clinical health services; the remote diagnosis and treatment of patients by means of telecommunications technology. Telemedicine can be conducted synchronously or asynchronously. 

Synchronous Interactive Services

• This is when the patient and provider can see and/or hear each other in real-time
• Practitioners provide immediate advice to patients who require medical attention
• Phone, online, or home visits to do the assessment similar to that done in face-to-face appointments

Asynchronous Store-and-Forward Services

• The medical practitioner and the patient don’t meet in person
• The patient or the patient’s initial health care practitioner or patient facilitator sends information (like medical images, biosignals, etc) and is reviewed by the receiving practitioner after the fact
• Commonly used in dermatology, radiology, and pathology

Asynchronous Remote Monitoring

• Also called self-monitoring and self-testing
• Uses a range of technology devices to monitor health and clinical signs remotely
• Used extensively in the management of chronic diseases such as cardiovascular disease, diabetes, asthma
• Data may be transmitted automatically to the monitoring practitioner

Key Terminology of Telemedicine in Eyecare

Telemedicine Platform 

A technology platform allows a participating Provider to collect and transmit patient data to a remote location for interpretation by a licensed Optometrist or Ophthalmologist. The platform may or may not require specific brands or models of diagnostic equipment. Integration of the diagnostic equipment and the EMR with the telemedicine software would be the responsibility of the eye care practitioner and may include technical support from the vendor. Arranging for technicians, assistants and licensed Optometrists or Ophthalmologists to perform elements of the examination is the responsibility of the ECP,  group practice or optical retailer. The ECP or group practice would establish the workflow related to the examination protocol and the related sequence of the elements of the examination.

Telemedicine System or Network

This combines the data collection and transmission software and some or all professional and technical services and staff that are supplied by a vendor to a participating Provider. The system may or may not include the installation of specific brands or models of diagnostic equipment. In a Telemedicine System, properly licensed Optometrists and/or Ophthalmologists who are contracted with the Telemedicine System vendor will become credentialed Providers, will perform or appropriately supervise elements of the examination, and may be assisted by trained and supervised assistants or technicians (where permitted by state law). Additionally, the Telemedicine System vendor may integrate diagnostic equipment with HIPAA compliant telemedicine software and the Electronic Medical Record (EMR). Typically, the Telemedicine System vendor would establish the workflow to complete the examination protocol including the sequence of the elements of the examination.

Comprehensive Eye Exam

In the US, only a doctor of optometry or ophthalmologist can prescribe corrective eyewear and perform a comprehensive eye and vision examination. The AMA Code of Procedural Terminology defines “comprehensive eye exam” and separately defines “refraction.  This separation also occurs in traditional Medicare (and often private health insurance), where the plans cover reimbursement for a comprehensive eye exam only when there is a sign or symptom of an eye health condition. Routine eye exams are not covered by traditional Medicare, including refractions. However, some preventive eye tests and screenings, such as glaucoma screening and treatment of macular degeneration, are covered by Medicare.

However, there are vision plans that do provide coverage for routine eye exams and refractions (and often, for corrective eyewear) that are available as stand-alone plans and as part of health plans, including Medicare Advantage plans.

These are the typically 10+ elements of a comprehensive eye exam:

Background and Discussion

1. Chief complaint assessment: what’s the reason for getting an eye exam
2. General physical health history: complete health history to screen for physical conditions and medications that may affect eyesight
3. General ocular health history: complete eye health history including family history of eye conditions, disease, or medication
4. Current prescription analysis: evaluation of current lens prescription, if applicable

Evaluations/Tests

1. External and Internal Eye Health Evaluation
   1. Examination for the signs of eye disorders, including cataracts and other eye disorders
   2. Retinal Imagery/Screening 
      1. Equipment is used to take fundus images: pictures of the interior surface of the eye opposite the lens and includes the retina, optic disc, macula, fovea, and posterior pole
      2. This is often where doctors dilate the pupils to get a better look at the entire fundus (often referred to as a “dilated fundus exam” or “DFE”)
2. Visual Acuity
   1. Test for the eyes’ ability to see sharply and clearly at all distances 
   2. Visual acuity measurements evaluate how clearly each eye is seeing. Reading charts are often used to measure visual acuity. As part of the testing, you will read letters on charts at a distance and near.
   3. The results of visual acuity testing are written as a fraction, such as 20/40. The top number in the fraction is the standard distance at which testing is done (20 feet). The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet to see a letter that should be seen clearly at 40 feet. Normal distance visual acuity is 20/20.
3. Refraction 
   1. Refraction determines the lens power needed to compensate for any refractive error (nearsightedness, farsightedness or astigmatism). 
   2. Test for the eyes’ ability to focus light rays properly on the retina at distances and close by
   3. Refractions can be done objectively (measured by a device such as an autorefractor) and/or subjectively (asking for the patient’s preference between two different powers of lenses using trial lenses, a manual or automated phoropter or other device) 
      1. Phoropter: instrument where the doctor places a series of lenses in front of your eyes to determine the preferred correction. For patients who are unable to note subjective preferences, the doctor may measure how these lenses focus light on the retina using a handheld lighted instrument called a retinoscope. The doctor may choose to use an instrument that automatically evaluates the focusing power of the eye. The lens power is then refined based on the patient’s input on which lenses give the clearest and most comfortable vision.
      2. Smartphone app/computer: new technology entrants are creating at-home objective and subjective refraction tests using a smartphone and/or computer. See regulatory and power constraints below.
4. Tonometry
   1. Test to measure internal fluid pressure of the eye
      1. Increased pressure may be an early sign of glaucoma
   2. Can be done with eye drops and a device that touches the eye or with a non-contact tonometer also known as the “air puff test”
5. Visual Coordination
   1. Checking the ability of both eyes to work together as a team. 
   2. Looking for amblyopia, a serious vision condition commonly known as lazy eye. 
6. Other preliminary tests as needed:
   1. Accommodative Ability: Test of the eyes’ ability to change focus from distance to near
   2. Color vision
   3. Evaluations of depth perception
   4. Visual fields: testing peripheral or side vision,
   5. Evaluations of how your pupils respond to light

Teleoptometry and Teleophthalmology

Teleoptometry is a synchronous interactive telemedicine service by optometrists for comprehensive eye exams or asynchronous store-and-forward eye care telemedicine services. In addition to prescribing eyewear for the correction of visual acuity, it may include primary eyecare for diagnosis and treatment of eye disease when within the scope of the optometrist’s license.

Teleophthalmology is a synchronous interactive telemedicine service by ophthalmologists for comprehensive eye exams or asynchronous store-and-forward eye care telemedicine services that includes the same services offered by optometrists and may including more advanced treatment and management of eye disease by specialists in diabetic retinopathy, glaucoma, macular degeneration and other eye health concerns. 

For both, the patient will typically visit an office or optical location where the exam is conducted virtually using digitally connected diagnostic equipment and the help of an on-site technician or patient care facilitator. The optometrist or ophthalmologist is available over a live video feed for bidirectional communication with the patient and technician/facilitator.

These exams use digital equipment – usually a wide-field or ultrawide-field retinal imaging systems, such as a fundus camera, an Optos camera or optical coherence technology (OCT), an automated phoropter for the refraction plus other diagnostic equipment such as an autorefractor, auto keratometer, NCT, and visual fields testing using an automated device.  The results are typically evaluated by the optometrist or ophthalmologist in real-time.

Teleretinal Screenings

Teleretinal Screenings are screening exams where fundus/retinal images are captured in one location and an eye care provider (sometimes aided by artificial intelligence algorithms) in another location reviews them. Images are usually captured at primary care offices, hospitals, etc. There is a published standard for how to do the retinal screenings published by the ATA Ocular Telehealth special interest group (SIG). See Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition.

These can be conducted as part of a comprehensive eye exam and refraction or can be limited to screening diabetics for retinopathy, without all the other elements of a comprehensive eye exam.  The Indian Health Service and Veterans Administration both actively use teleretinal screenings given the high rate of diabetes and the remote populations they serve.  

Online Refractions and Online Visual Acuity Tests

Online refractions use a smartphone and a computer screen to measure the visual acuity and both spherical and cylindrical refractive errors in healthy individuals. In one approach, users stand 3 meters/10 feet back from the computer and follow the on-screen process using their smartphone as a remote.  They also usually take a few images of the eye. The online services transmit the data to a licensed optometrist or ophthalmologist, who reviews the results of your online test and, if warranted, will transmit a prescription for corrective eyewear, usually within 24 hours.  

Today online refractions are regulated in the U.S. (FDA) and Europe (CE).  There are solutions for both prescription glasses and contact lens renewals but these exams are not typically used for a new glasses or contact lens wearer.   Currently, companies offering these services may limit prescription renewals by age (e.g., 18- 55) and for a limited prescription range between Sph -3.0D to +2.0D, cylinder up to -2.0D. For contacts, the spherical power range appears to be wider: Sph -10D to +10D, with similar range limitations on cylinder for astigmatic contact lens wearers. 

The FDA loosened restrictions on the use of devices to perform remote refractions during Covid-19. They had previously restricted use of some devices for online refractions until safety and efficacy tests had been reviewed, allowing only visual acuity tests. During the pandemic, they paused this restriction.  We don’t yet know if they will continue to allow online refractions or if they will move back to visual acuity only post-pandemic. Companies are actively collecting safety and efficacy data to make their case to the FDA and CE.

Online Lensometer

Online lensometers verify the prescription of an existing pair of single vision eyeglasses using a smartphone and a computer screen. Users hold their glasses between the smartphone (with the app) and the computer screen. Using unique technology, the app can determine the power of the existing pair of glasses.  Multifocal and progressive lens measurements are more difficult and do not appear to be available through the app at this time.

Key Considerations When Determining your Telemedicine Strategy

There are a number of key questions to answer when evaluating the scope of the offering you’d like to provide:

• What are you solving for?
  • Improved doctor utilization
  • Addressing a staffing issue where you can’t hire optometrists for every location
  • Geographical expansion
  • Improved safety for patients and team
  • Improved convenience for patients and team
  • Expanded hours of operation for patients
  • Increased eCommerce purchases

• Where are you located? What are the local laws and regulations?
  • Depending on your jurisdiction, there could be very different regulatory limitations. 
  • In the United States, telemedicine laws vary state-by-state. 
    • Some don’t allow telemedicine at all for glasses, contact lenses or both. Some only allow ophthalmologists where others allow optometrists too. The standard rule is that the doctor needs to be licensed in the state the patient presents (not where the patient is from). 
    • Ophthalmologists can be easily licensed across 30 states through the Interstate Medical Licensure Compact. Optometry has nothing similar although some optometrists are licensed in multiple states (but can be expensive for them to do so limiting how many optometrists are licensed in multiple states).
    • Online refractions need to be FDA-approved. They are currently allowed due to pandemic-related easing of restrictions but it’s uncertain if this will hold. 
    • You will also want to make sure that any telemedicine platform or tool used is HIPAA (Health Insurance Portability and Accountability Act) compliant. 
    • You will want to ensure that any telemedicine solution complies with the patient’s rights to access medical records and get their prescription.
      • Healthcare apps or information exchanges have to be able to allow patients to access their records as of April 5, 2021. These records have to be able to be shared at the patient’s request. 
      • The FTC has two rules:
        • Eyeglass Rule: You have to give the eyeglasses prescription at the time of the exam. Later after the exam, under HIPAA requirements (not the FTC Eyeglass Rule) you have to respond and give the prescription within 30 days if the patient requests it. 
        • Contact Lens Rule: The prescriber has to give the contact lens prescription to the patient once the exam and fitting are complete and paid for.  A recent Rule update now requires the prescriber to keep a record to confirm the patient received the Rx with a written or electronic acknowledgment from the patient. If an eCommerce seller of contacts requests the prescription for a patient, the Dr/retailer can either respond or ignore the request. However, if there is no response within eight business hours and the seller has provided the prescriber with a reasonable opportunity to communicate, the seller may complete the sale as if the Rx has been directly verified (passive verification). This makes it easier to buy contacts online. 
      • There are also some obligations of eCommerce sellers.  To request verification, the seller must provide the prescriber with:
        •  The patient’s full name and address;
        • The contact lens power, manufacturer, base curve or appropriate designation, and diameter when appropriate;
        • The number of lenses ordered;
        • The date of the patient request;
        • The name of a contact person at the seller’s company, including facsimile and telephone numbers;
        • And, if the seller is using the prescriber’s regular business hours on a Saturday for purposes of the “8 business hour” time frame for a response, a statement of the prescriber’s regular business hours.
      • Additionally, if a seller uses automated telephone verification messages, the seller must:
        • Record the entire call;
        • Commence the call by identifying it as a request for prescription verification made in accordance with the Contact Lens Rule;
        • Deliver the required information to request verification in a slow and deliberate manner and at a reasonably understandable volume; and make the information required to request verification repeatable at the prescriber’s option.
      • Sellers in the US may not alter a contact lens Rx, including changing brands (with the exception that private label lenses that are identical to the requested brand may be substituted.)
      • E-commerce Sellers must provide a prominent method for the patient to present the seller with the Rx.
      • Sellers must keep a record for all direct communications regarding receipt of an Rx or a request for verification, including detailed logs of telephone communications.  Records n=must be kept for at least three years and must be available for inspection by the FTC.
      • In the US, contact lens prescriptions must be valid for at least one year unless there is a medical reason documented in the patient record that a shorter time is appropriate.
      • In the EU, telemedicine laws are similar across EU countries.  Online refractions need to be CE-approved. To our knowledge only Easee is CE-approved.
    • Companies in EU countries also need to be aware of the European Medical Device Regulation (MDR), a new set of regulations that kick in this May 2021, that governs the production and distribution of medical devices in Europe. Anyone wanting to sell their products (including an online refraction) will need to comply.
    • You will also want to make sure that any telemedicine platform or tool used is GDPR (General Data Protection Regulation) compliant. 
  • Some countries like India have very limited regulatory limitations on telemedicine, online refractions, etc. 
  • Make sure to check out the regulatory limitations and laws in your jurisdiction early in your planning process.

• What is the scope of the services you’d like to provide?
  • Online appointments 
    • Good for all brick-and-mortar eyewear businesses with exam services
  • Online check-ins
    • Enables patients to fill out the necessary registration paperwork online
  • Online access to their prescription
    • This is a best practice for all groups who sell eyewear online or in stores.
    • It’s particularly useful for online retailers of eyeglasses and contacts.
  • Prescription verification support
    • See the detailed requirements of the FTC Contact Lens Rule.  Also, the FTC expects to begin a proceeding in 2021 to update the Eyeglass Rule.  There are likely to be requested by e-commerce eyeglass sellers for a similar approach to Rx verification as taken in the Contact Lens Rule.
  • Consultations with your doctors or staff
    • This is a nice way to have your patients connect with your existing doctor and staff either through asynchronous store-and-forward communications or synchronous real-time communications
  • Comprehensive eye exam
    • This provides prescription to new eyeglasses or contact lens wearers and those who need a renewal.
    • This requires the patient to do an in-person visit to an optical location and along with a remote optometrist or ophthalmologist.
  • Online visual acuity test
    • Good for omnichannel retailers and ECPs who want to use an online acuity test to allow their customers to see if they need an appointment. 
  • Online refraction
    • These are a great fit for online retailers who want to reduce the friction of the eye exam renewal for healthy adults wanting glasses or contacts.
    • There are usually different exams for glasses and contacts.
  • At home refraction
    • These are companies that provide hardware for at-home use by patients.
    • This can supplement online retailers or doctors who want to remotely monitor acuity and refraction for patients over time. 

• Do you want to provide your own doctor network or do you want to partner with a group that has built out its own network of optometrists and/or ophthalmologists?
  • Groups who provide their own doctor network typically have a doctor network in place and want to leverage them across more locations. This can be a great option for retailers who have a hard time staffing optometrists in every location every day or for want to improve utilization for the optometrists on staff. 
  • Groups who have their own doctor network but want to expand the services, expand their geographical reach or provide some services 24/7 can consider supplementing their existing on-site location with online services.
  • Groups who don’t have their own doctor network can leverage an existing network of doctors using a platform. 

• Do you want to work with an existing system or network,  build your own network, using another’s platform or build both?
  • Some optical retailers and other groups are choosing to build their own telehealth platform that works with their existing equipment and doctor network. One example is Now Optics, operators of Stanton Optical and MyEyeLab. 
  • Most groups are selecting from existing telemedicine platforms such as 2020Now and Digital Optometrist that also offer system or network services.  Such platforms are also able to coordinate a hybrid approach with an already established network of on-site practitioners affiliated with an optical retailer.

• Do you want to work to use existing equipment or rent/buy new digitally connected equipment to support your telemedicine services?
  • Some telemedicine platforms provide equipment if needed. 
  • There are some limitations to the types of equipment that can work with their platform so make sure you check out whether your equipment will work.

• How important is Managed Vision Care (MVC) reimbursement to your business?
  • Most MVC plans reimburse only if the exam includes a wide field or ultra wide field retinal image.  The vision plans may also require the telemedicine practitioners to have the ability to refer the patient for in-person care in a reasonable time for a dilated fundus exam or other in-person care when medically indicated.  See the NAVCP Policy on Ocular Telemedicine.
  • At this time, there is no MVC reimbursement for online refractions or online visual acuity tests. 
  • Health plans may reimburse for broader telehealth care beyond comprehensive eye exams like consults. 
  • Most MVC plans only cover comprehensive eye exams with refraction and eyewear (glasses and contacts).

Telemedicine Solutions in the Eyecare Industry

There are a lot of broad telemedicine platforms that don’t focus specifically on the eyewear market. If the scope of the services you’d like to provide are limited to consults, you might want to consider a general telemedicine platform. Here is an article with the top 11 telemedicine platforms here. Another one we’ve heard some eye care professionals using is Doxy.me, a general use telemedicine platform with a free package. 

We have focused our list below on the companies offering various telemedicine solutions specific to the eyewear industry. These are the ones that have hit our radar and is likely not a comprehensive list. If you see any that are missing, please let us know in the comments section and we can add them in a revision.

2020 Now is a technology company based in New York, NY, USA. They have a comprehensive eye exam platform.  Groups can use rent diagnostic equipment or provide their own as long as it meets their interoperability standards. Groups using 2020Now provide the technicians to administer the tests.  2020Now provides a doctor network with both optometrists and ophthalmologists or works with the doctor network of the clients. This expanded optometrist and ophthalmologist network gives them slightly broader state access.  They can return a prescription within a matter of minutes to the patient and location (upon the patient’s request). 

Digital Optometrics is a technology company based in Lake Success, NY, USA. They have a comprehensive eye exam platform.  Groups can use rent diagnostic equipment or provide their own as long as it meets their interoperability standards.  Groups using Digital Optometrics provide the technicians to administer the tests. Digital Optometrics provides a doctor network with only optometrists or works with the doctor network of the clients.  They can return a prescription within a matter of minutes to the patient and location (upon the patient’s request) 

Eyecare Live is a technology company based in Santa Clara, California, CA that is partnered with ABB Optical. They have a wide range of products including a telemedicine platform for eyecare professionals and retailers, online refraction for glasses and contact lens renewals, and app-facilitated tests for visual acuity, dry eye, contact lens comfort and macular degeneration.  They do not provide the diagnostics hardware.  You can use your own doctors or their network. 

Topcon is a technology and equipment company based in Tokyo, Japan. They sell the eye exam diagnostic equipment and a software subscription primarily to eyewear retail chains. It appears their platform only works with their equipment.  

Zeiss Vision is a division of Zeiss, a large German manufacturer of optical systems and optoelectronics. Their teleoptometry platform includes connected equipment and the software to support telemedicine targeted to eye care professionals and eyewear chains. It appears their platform only works with their equipment.  

AOS Advanced Ophthalmic Solutions is a technology company based in London, UK.  They have software for eye care professionals including mobile imaging apps for both patients and clinicians for both iOS and Android devices and software to do objective image grading and analytics. They also support live video calls and patient reports.

Easee is a technology company based in Amsterdam, Netherlands. They have the only CE-certified (European regulatory agency) online refraction and acuity test tool and are used by many of Europe’s top online retailers.  They also provide these tools to eyecare professionals and retailers. 

Visibly (formerly known as Opternative) is a technology company based in Chicago, Illinois, USA.  The FDA (USA regulatory agency) relaxed restrictions during Covid-19 so they were able to expand their offering from an acuity test to include an online refraction. 

6over6 is a technology company based in Tel Aviv, Israel and was recently acquired by 1800Contacts.   They have the only known Lensometer tool and have announced an online refraction coming soon. 

1800Contacts is a leading online retailer of contacts and glasses based in Salt Lake City, Utah, USA. They developed an online vision test for contact lens renewals called Express Exam. This app is not available for other eyewear retailers or eye care professionals at this time.  

Eyeque is a technology company based in Palo Alto, California, USA.  They have made several handheld, low-cost devices (some which use your smartphone) to do at-home do-it-yourself vision tests. The results are fed into algorithms that produce Eyeglass Numbers that can be used to order glasses from some online retailers. These results are not reviewed by an optometrist or ophthalmologist. 

Warby Parker is an eyewear brand based in New York, NY, USA.  They built their own iOS app for online refraction and acuity tests specifically for their customers who already have a prescription but need a renewal. This app is not available for other eyewear retailers or eye care professionals. 

Spect is a technology company based in California, USA. They have not yet launched their product but they are developing a telemedicine retinal screening smartphone app for use by patients outside the office, guided by a facilitator with the patient. 

OcuDoc is an early-stage technology company based in Ohio, USA. They also have not yet launched their product, which they intend to be able to perform objective refraction using a smartphone without the need for additional hardware.  One likely approach will be for the company to license the technology to ECPS and to optical retailers for use by their affiliated ECP network.  

Smart Vision Labs has a proprietary vision testing device that attaches to a smartphone. It’s sold to opticians and optometrists and used in in-store optical locations or in the field. They also have a doctor network that can review the results or you can provide your own doctors.

Eyenetra is a technology company based in New York, NY, USA. They have built a proprietary device that attaches to a smartphone. This is sold to optical retailers and eye care professionals.  Currently, they do not have its own doctor network so an optical retailer would have to use its own.

If there are telemedicine companies that offer either platforms or systems/networks for eye care that we are missing, please let us know in the comments section and we can add them in a revision.

Conclusion

We hope this article helped you understand the importance of telemedicine, the distinctions between offerings, and a framework to consider which option is best for your business.