As a result of the changing face of medicine, in general, and optometry, in particular, I have found myself in the unique position of practicing remotely for Luxottica from my home in Kansas. I am proud to be at the forefront of practicing remote optometry and using technology to provide comprehensive care to our patients without compromising exam quality.
During a remote optometry exam, a highly trained technician takes the patient through a series of tests including, but not limited to, visual fields, ultra-wide field retinal photos, detailed slit lamp videos, autorefraction/keratometry, intraocular pressure measurements, pachymetry, topographies, lens retroillumination, color vision, stereopsis, and blood pressure. All of this information is then gathered and sent to me for review prior to speaking with the patient.
When I start my video consultation with the patient, I am fully armed with all of this data and ready to conduct their exam with confidence. I then take control of our digital phoropter remotely, and I perform the refraction including any ancillary near testing. I am in full control of the experience and can monitor the patients responses through the in-office camera. I then discuss all of my findings and any recommended treatment plans.
What to expect from a remote optometry exam
Remote optometry is both similar and different compared to an in-person comprehensive eye exam. With remote optometry, patients still receive a comprehensive eye exam that assesses overall eye health with refraction, including the ability to perform Contact Lens exams on existing wearers. The review of information and documentation requirements are the same. Additionally, the consultation with the patient is just as detailed and personal as an in-person exam.
The main difference compared to an in-person exam is that it is a purely digital experience. The comprehensive testing required for remote care is held to a higher standard due to state and other healthcare regulations. For example, instead of doing confrontational visual fields, we use the Oculus Easyfield or a Humphrey visual field to gather the necessary data. In addition to autorefraction, pachymetry, and topographies to fully assess the visual function of the eye, the tech also acquires Optos retinal imaging for every patient. All of these scans and images result in a variety of pertinent data to analyze.
Because of the technology we leverage and the level of detail and information we are able to obtain throughout our virtual appointment, I am able to confidently determine when a referral is necessary. On the occasion that I see something suspicious that warrants further evaluation, I will speak with the in-person doctor from that store to coordinate a follow up visit, or make a proper referral to another doctor in the area.
Advantages of remote optometry
One of the prime advantages I see in remote optometry is directly linked to patient care. I find, with this model, I actually have more time to spend with patients because I spend less time data-gathering. Amassing accurate data quickly through technology allows me to get back to the basics and to fully focus on the patient and what they're saying. Instead of splitting my attention between all the equipment, tools, and EHR that I'm utilizing during a traditional exam, I can address their concerns directly with no distractions.
Additionally, I think remote optometry has benefited me as a clinician by instilling more confidence in my patients. They see that we’re not only gathering all the necessary data but spending more time in a quality consultation. And, by having the data prior, it allows me the time to decide exactly what I want to discuss with the patient, formulate any additional questions that need to be asked, and devise a potential treatment plan. Overall, it makes me more efficient.
Patients gain unique efficiencies
On the other hand, what patients seem to like most about the remote optometry exams is that their valuable time is not wasted. Every single minute of the exam is taken by some type of data gathering or in discussion with either me or my tech. During these conversations, we can focus on glasses, contacts, and any other issues that may have.
Patients often express their surprise at how comprehensive the remote optometry exam actually is. For those patients who approach this with skepticism, it is usually because the extent of their remote optometry experience has been an auto-refraction or app-based refraction without any other testing. They find the use of the latest technology “cool,” as they've never experienced anything exactly like it. Patients have also voiced how much easier and more convenient remote optometry was than what they expected.
Optometrists gain work-life balance
Remote optometry has improved my work-life balance in a way that I didn't expect. Most importantly, I have found the time and energy to focus on my health and eating better. I find it's allowed me to focus on my family as well, which after the COVID-19 crisis and the quarantining has become even more important to me.
Currently, I work four days a week with shifts ranging from 7-9 hours. The number of patients I see in a day depends on the number of stores I am covering, which on average is two. On an average day, I will see between 8-10 patients and will typically spend about 15 minutes with each after they’ve been screened and their information sent to me, depending on complexity of course.
These appointments consist of both routine exams and contact lens checks. Typically, contact lens exams take longer because after the patient puts the contacts in, the technician will perform and record another slit lamp exam and provide me with the video that I need for proper evaluation. Our goal is to examine a new patient every 30 minutes; we haven't quite reached that point yet, but we are working towards it in order as we improve our efficiencies.
Of course, with this 4-day schedule, I spend a lot more time at home, which results in getting more done. Without commuting and being in an office all day, I accomplish more around the house. I get to spend more time with my dog and take her on regular walks—so, I suppose, even she has benefitted from remote optometry!
Ultimately, this increased sense of balance and well-being translates into my being a better eye care provider to my patients as a whole.
Remote optometry has brought me back to the reason I got into the field of optometry in the first place—to help patients and really listen to them. Listening to the patient, instead of just gathering all the data that insurance needs from us, can be very challenging in a bustling office setting. But listening is crucial, not just for optometrists, but for all healthcare providers, and remote optometry lends itself to critical listening.
I am grateful to Luxottica for providing the state-of-the-art technology and forward-thinking mindset that have allowed me to practice remotely and am proud to continue to give my patients top-quality, comprehensive care through remote optometry.
