Blink in-home vision test worries ODs

New York City-EyeNetra's new sevice called Blink has begun offering at-home, on-demand vision tests in New York City.

How it works

Blink offers appointments seven days a week from 9 a.m. to 9 p.m. The company will come to a patient’s home and perform the testing in about 20 minutes. The test costs $75 and is performed by a “visioneer,” not an optometrist.

“We’ve shrunk a bunch of equipment that used to fill up an optometrist’s office into a briefcase,” says Blink co-founder David Schafran, who is also part of the team behind EyeNetra, a company that creates smartphone-based refractive tools. Mr. Schafran spoke exclusively to Optometry Times.

Click here to check out the tools Blink uses during in-home tests

Blink visioneers use a variety of tools created by EyeNetra during an in-home vision test. Those tools include:

• Netra, which acts as an autorefractor, but utilizes a smartphone

• Netrometer, which acts as a lensometer, but also utilizes a smartphone

• Netropter, which acts as a phoropter

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According to the company, an optometrist will remotely supervise and review the data collected by the visioneer-including the patient’s eye health and medical history and lifestyle and vision needs. If the OD confirms the prescription, Blink will send the patient a digital prescription for glasses within 24 hours. Blink does not provide a contact lens prescription.

Visioneers are background-checked and must undergo training that was designed with the help of optometrists. Their role is to collect the information and provide good customer service.

“They’re not optometrists-it’s not their job to analyze or interpret any information, it’s about collecting information,” says Schafran.

Blink is currently available only in certain neighborhoods in New York City, but the company has plans to expand further into New York City and other major cities in the U.S. 

Currently Blink is not covered by any vision plans, but Schafran says the company plans to pursue vision plan coverage. VSP Vision Care President Jim McGrann has joined EyeNetras’s Board of Directors. 

Next: Not a comprehensive eye exam

Not a comprehensive eye exam

Blink emphasizes that its test is not a comprehensive eye exam, but the company does offer to refer its clients to local eyecare professionals for a full exam.

“At no point is any patient led to believe that Blink testing is a comprehensive exam, and in fact, we advocate strongly for full eye exams with an optometrist,” says Adam Deutscher, OD, a Blink partner optometrist.

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Dr. Deutscher says there are many criteria that can lead to a referral to an optometrist for a comprehensive eye examination. For example, if it has been over two years since the patient’s last full eye exam, then she is referred for an exam. If there is a history of ocular health disease or if visual acuity is not improved to acceptable levels, those patients are also referred.      

If a patient is flagged for a referral, she is given a $25 discount on the Blink test and a discount for the exam conducted by a Blink-affiliated optometrist.

Next: Concerns from the eyecare community

Concerns from the eyecare community

Despite Blink’s repeated assertions that its test is not a comprehensive exam, much of the optometric community is expressing serious concerns that the public would not understand the difference.

"ODs are rightfully concerned that patients will bypass their annual exams and substitute a refraction for it," says Optometry Times Adivisory Board member Justin Bazan, OD, of Park Slope, Brooklyn. "Many ODs may also be currious to see how it all plays out. They know that a prescription is much more than just a refraction. It would be hard to incorporate all of the aspects that go into the final prescription. Blink appears to have identified several key components, but there is an inherent disconnect without the doctor and optician being there with the patient." 

Schafran says he understands why the eyecare community has questions. 

“I totally get that concern, and we want people to be very clear about the difference between what we do vs. eye health,” says Schafran.

Throughout Blink’s interactions with patients-from its website to scheduling to the visit-he says patients are repeatedly informed that the test does not address eye health.

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“Many optometrists have not looked deeply into the Blink process and erroneously think that Blink ODs are merely signing off on an auto refractor’s prescription,” says Dr. Deutscher. “Like most ODs’ refractions, the Blink process is a hybrid of subjective and objective testing, and it has been developed with ODs to ensure quality refractive care. Optometrists control every patient-care decision, including the writing-or not writing-of glasses prescriptions and referrals for comprehensive eye exams.”

Next: Questions on patient perception

Questions on patient perception

“Our concern is solely based on the general public understanding that having a refraction is not having an eye examination for their eye health-that solely seeing clearly whether you have an eyeglasses prescription or not doesn’t address the comprehensive health of your eyes,” says New York State Optometric Association (NYSOA) President Christopher J. Colburn, OD, speaking exclusively to Optometry Times.

“Determining the refractive state of the eye doesn’t have any ability to determine whether a patient’s eye is healthy,” he says. “It’s one of a vast breadth of tests that we do to determine eye health. Our concern at NYSOA is does the public understand that having one single test is completely inadequate to determine if their eyes are healthy.”

Dr. Colburn says NYSOA is learning all it can about Blink, the services it offers, how it is being promoted to the public, and whether there are adequate protections in place for the public.  

“If we become aware of activities that involve providing services without a license, then we see that as a public health risk and would advocate on behalf of the public to ensure that doesn’t continue. That’s where NYSOA fits into this type of activity,” he says. “We don’t intend to hamper the use of technology and cutting-edge care provided to patients in appropriate manners to protect their eye health.”

Dr. Colburn says that at this point, it’s not clear whether there’s a problem that needs to be addressed, but he has concerns.  

“It appears to us that there may be a perpetuation of the misrepresentation of refractive determination being equivalent to an eye health examination,” he says. “NYSOA also wants to make sure our members understand what their obligations are to their patients with respect to ensuring comprehensive eye health.”

Kelly Voltz, a second-year student at SUNY College of Optometry, agrees with Dr. Colburn. Voltz recently circulated a petition at her school asking other companies to not offer their support to Blink. While she understands the appeal of the cost and convenience, she was concerned when she saw the patient warning about what the Blink test does not cover.

“Among those were different diagnoses that optometrists would pick up during a regular exam,” she says. “What baffled me was how they assumed that patients knew what these diseases and diagnoses were. That’s where the optometrist comes into play.

“No technology will ever replace personal care from a doctor. We worry that Blink is driving patients in the wrong direction,” she says.

Next: NY state board to investigate

NY state board to investigate

The board of optometry in New York state has recently learned about Blink’s launch in New York City and plans to conduct an investigation.

According to Frank Pirozzolo, OD, chairman of the New York board of optometry, state boards in New York serve only in an advisory capacity to the Department of Education. The board does not make regulations or pass laws.

“When complaints start coming in about this, and I assume they will, we will poll our members,” he says. “Our next meeting is in early June.

“Two of the concerns we will be looking at are whether a refraction can be separated from a comprehensive eye exam, and can unlicensed persons be sent out to do testing without a doctor’s direct supervision.

AOA weighs in

“It seems like every few days there’s a new product being announced that’s based on claims that a remote or self-administered vision check can eliminate the need for a regular comprehensive eye exam and care provided by a doctor of optometry,” says American Optometric Association (AOA) President David Cockrell, OD, FAAO, speaking exclusively with Optometry Times. “Of course, there is no substitute for a comprehensive exam, and confusing or potentially misleading alternatives to seeing an eye doctor for eye care can give patients inaccurate information or a sense of false security that could threaten sight and overall health.”

Dr. Cockrell says that thanks to the advocacy successes of the AOA and our state associations, there are federal and state laws in place to safeguard patients from false claims and substandard care. He says the AOA is committed to pressing for full enforcement and even strengthening public health protections as needed. 

Next: The importance of informed consent

The importance of informed consent

Craig Steinberg, JD, OD, of Agoura Hills, CA, says optometrists frequently separate refraction from medical visits. While many states have either laws or board regulations that may require a complete examination-the performance of a number of specific tests-with a refraction, many patient encounters don’t necessarily rise to the level of being a complete examination and don’t include refraction, he says.

“With that in mind, I do not see how or why performing a refraction without also performing a complete examination cannot be equally reasonable and appropriate patient care,” says Dr. Steinberg. “Just as there can be an office visit or exam without a refraction, it makes sense that there can be a refraction without a complete examination. Moreover, patients generally have the right to decline tests, even tests you believe are necessary.”

Dr. Steinberg says that as long as this kind of test or business is not in violation of any laws or board regulations, the eyecare community’s primary concern should be that of informed consent.

“If the patient understands, after being properly informed, that by receiving a refraction only, he is not receiving a complete exam and there can be no opinion about the health of his eye offered-just as he would if he is having a corneal foreign body removed or an abrasion treated, and tests such as tonometry, dilated fundus examination, and visual field screening are not being performed-that the refraction does not substitute for an eye health examination, and with that information the patient consents to the stand-alone refraction, I do not think it is ‘unprofessional conduct,’ and I think it should be legal,” he says.

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Click here to check out the tools Blink uses during in-home tests

The Blink Netrometer, which acts as a lensometer, but also utilizes a smartphone. (Photo courtesy of Blink) 

The Blink Netra, which acts as an autorefractor, but utilizes a smartphone. (Photo courtesy of Blink) 

The Blink Netropter, which acts as a phoropter. (Photo courtesy of Blink)