Our annual technology issue comes at a time when the tools and techniques of eye care are being rethought—sometimes radically—out of sheer necessity. Even before the pandemic, meeting the needs of an aging population was already an uphill climb. We’ve all seen projections of ever-increasing rates of AMD, diabetic retinopathy, glaucoma and cataracts. But a two-month shutdown of practices and a drastic reduction in capacity due to safety measures has upped the stakes.

Understandably, interest in telehealth among optometrists soared in the early days of the pandemic. It was a bit of a shotgun wedding—and has aged about as well as one. 

In mid-March, just 22% of eye care practitioners surveyed by Jobson said they were thinking of offering telehealth services; one month later, it jumped to 54%. However, the percent of respondents who said they actually planned to integrate telehealth in practice on a regular basis started high and then dropped precipitously, from 90% in May to 58% in August. Billings for telehealth peaked at 70% in late April at the height of the shutdown but have since dropped to 39%.

But telehealth can succeed if done correctly; just look at the model created by the Dept. of Veterans Affairs. “The COVID era may have highlighted how useful and profitable this technique is under different circumstances,” one VA optometrist told us, noting that the VA’s Technology-based Eye Care Screening (TECS) program expanded this year. “There was, and still is, a lot of pushback from optometry, and I’ve personally been plenty resistant; however, now that COVID has set us back months, we’re latching onto it to help us with the backlog of routine exams.”

TECS has an infrastructure that most optometry practices can’t replicate, including robust IT support, evidence-based protocols for provision of care and a widely dispersed network of primary care practices staffed and equipped to conduct remote screenings. 

VA docs had a solid telehealth foundation to build on; the rest of the profession is largely winging it. Many have developed their own ad hoc exam techniques that rely on phones and laptops instead of medical-grade equipment. “We use telehealth for our soft contact lens follow-ups,” one OD told us. “I have the patient send me pictures of their eyes closed and open: up, down, left, right and straight ahead.” Is that good enough? Time will tell.

Others worry a rush to telehealth may degrade optometry. “In a backhanded way, we’re validating some elements of the 1-800 model,” one noted. Another cautioned, “We need to make sure optometry does not end up practicing like urgent care GPs—antibiotics for all red eyes.”

Insurers, of course, will have the final word. If actuaries determine telehealth increases their costs, that’ll be the end of that.

ODs are to be commended for improvising new methods in a time of need. Let’s hope the lessons learned under battlefield conditions foster a discussion among policy-makers that yields long-term solutions.