iExams: The Rise of Online Vision Tests

Seeing the Problem Clearly-4

In the last five years, a multitude of websites have popped up offering “at-home eye exams”.  Convenient, affordable, and accurate, they promise the curious consumer.

Some have suggested this as the modern, or even improved, alternative to optometry—  all the benefits, without any of the hassle.

But others warn that this is a dangerous and misleading concept.  Lawsuits against some of these companies have made national news, recently. And some states have even gone as far as to outlaw the practice.

So what’s at the bottom of this commotion? Are optometrists merely threatened by this seemingly helpful option?  Or are there valid concerns expressed from the vision care community?

Dr. Dean Brown, O.D., at Central Point Eyecare, explains the growing resistance to these tests: “For the most part, it’s a disservice, because they’re promoting them as an eye exam… And they’re only doing a small part of the eye exam- what we call the refraction.  Which is the determination of the prescription for glasses.”

Furthermore, he warns, “They don’t even do that very well, basically.  So it’s convenient, but you’re sacrificing accuracy and having a full eye health exam- which is important.”

What’s so important about having a full eye health exam?  One main reason is the ability of optometrists to spot health or eye problems, even beyond the need for vision correction.  Through the course of these routine exams, significant health issues are revealed on a daily basis.   In 2014 alone, 240,000 cases of diabetes were first detected by an eye doctor (1).

Glaucoma, macular degeneration, cataracts, neurological problems, aneurisms, brain tumors, and strokes are among some of these health discoveries that optometrists would be unable to detect through a computer screen.

Dr. Brown compares the online screen tests to the blood pressure machines, set up inside local grocery stores and pharmacies.  Anyone who would replace their doctor appointments with these machines, he points out, “I think they know they’re not getting an in-depth evaluation.”

He worries that those ready to jump online for their vision care do not understand the shortcomings of these self-purported exams: “That’s misleading in and of itself, saying it’s an eye exam.  It’s not an eye exam.”

The American Optometric Association shares his disapproval, going so far as to file a complaint with the Food and Drug Administration (FDA), asking them to remove these services off the market, “until such time that the FDA has reviewed the product’s claims, safety and efficacy.”

As safeguards and laws emerge to protect consumers from these online tests, the companies promoting them have begun crafting their advertising more carefully.   So while some have gone so far as to label these sellers “corporate equivalents of snake oil salesman” (2), they would argue that they never claim to replace routine eye care.  They offer prescriptions, they profess, in an accurate and affordable manner.

So what if these tests were merely treated as a stand-in to provide accurate prescriptions, for the busy vision patient?  Christopher S. Wolfe, O.D., an AOA Committee member, would argue that its prescriptions are far from accurate.  After taking an online vision test himself, he was shocked to find that not only did his results completely miss his astigmatism, but his prescription measurements were inaccurate as well.   (3)

Concerning the “affordable pricing”, Dr. Brown explains that it is unable to deliver on that promise either: “It’s really not true. I only charge 30 dollars for that part of the exam- they’re charging more than that and not doing it as well.”

There are additional reasons to think twice about purchasing one of these send-in tests— they cannot offer the expertise and personal guidance of your local eye doctor.

“Do you need computer glasses?  What tints do you need? What types of lens or frame material? What do you do when you have a problem with your glasses?”  Dr. Brown mentions just a few examples.

Impersonal, digital results are incapable of providing the necessary answers and assistance specific to each patient.  The convenience, therefore, of these tests is called into question, along with its accuracy and affordability.  And ultimately, the health of the individual is put at risk.

As Atlanta optometrist Minty Nguyen emphasizes, “It’s not for me to make any more money as an optometrist. It just kind of encourages patients to neglect the health portion of their exam, which is key…  You don’t want to go blind. It’s one of your most important senses.” (4)

Across the board, these online prescriptions prove to be no substitute for routine visits with eye care professionals.

As for those left skeptical, Dr. Brown extends an invitation: “Come in for an eye exam and see what we do.  We do a good job and take care of people.”


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