Will optometry’s fear of disruptive technology backfire?

Eye care has been a magnet for new-and disruptive-technology. In the past few years, the industry has seen the birth of companies such as Smart Vision Labs, Opternative, and EyeNetra, just to name a few.

“I'm not sure eye care is any different than any business,” says Optometry Times Chief Optometric Editor Ernie Bowling, OD, FAAO. “The opportunity for technological advancement is present everywhere, and there are venture capitalists willing to take a risk on the technology.”

But what is it about eye care that is attracting so much attention in the startup community? Opternative CEO Aaron Dallek tells Optometry Times it’s not just eye care but health care as a whole that is ripe for disruption. But there are aspects of eye care that make it a particularly appealing niche market.

Related: How your practice can learn from successful companies

First, Dallek says health care has been slower to adopt new technologies compared to other industries. Second, there is an eyecare accessibility problem internationally and in some areas of the U.S. Third, there’s a lot of money to be made.

“When it comes to disruption, you have to make big changes,” says Dallek, “and that’s what we’ve done and what other people are looking to do in eye care and in health care in general.”

How should ODs respond to new technology?

Many ODs have been vocal in raising their concerns about disruptive technology companies like Opertnative and EyeNetra misleading their customers and ignoring ocular health.

“The question with any of these products is: does it meet a need and how is it placed in the market?” says Dr. Bowling. “I could definitely see this technology meeting a need in third-world countries where there’s little access to health care. But to position it in this marketplace as an ‘eye exam’ willfully neglects the ocular health aspect and is deceptive advertising at a minimum and raises public health concerns.”  

Some ODs are equally as concerned that waging the battle against this new technology is damaging the profession’s image.

“I'm afraid that optometry's current all-out assault on online refraction and telemedicine runs the risk of defining our profession more by what we are against rather than what we are for,” says Optometry Times Editorial Advisory Board member and blogger Michael Brown, OD, FAAO. “It will be seen as old-fashioned professional protectionism by a growing demographic of patients for whom managing their lives online is as natural as breathing.”

From Vision Expo East: How ODs fit into the future of online refraction

Dr. Brown says that organized optometry’s calls of an impending public health crisis remind him of the frantic-and eventually debunked-arguments that ophthalmology used against optometry during the great therapeutic wars of the past.

“If the technology doesn't work, most patients will figure that out-give them a little credit,” says Dr. Brown. “If it does, look for ways to use it to your advantage. I believe that shrewd and progressive ODs are doing this. Unfortunately, not all ODs-nor the organizations that represent them-are shrewd and progressive.”

American Optometric Association (AOA) President Steven Loomis, OD, says that the AOA’s fight against Opternative shouldn’t imply that optometrists are anti-technology.

“I don’t know of a profession that is more pro-technology than optometry,” Dr. Loomis says. “Right now in my office, I have an OCT, a new topographer, LipiFlow. To suggest that just because we don’t embrace an inferior technology means that we’re not pro-technology is kind of silly.”

Some ODs are taking these new technologies as a challenge.

Next: Find out how ODs are accepting the challenge

Optometry Times Editorial Advisory Board member Dori Carlson, OD, FAAO, says disruptive technology isn’t necessarily a bad thing-but it should make ODs reevaluate the care they provide. Can you do it better?

“That said, any technology that tries to circumvent the doctor-patient relationship can be misleading,” she says. “Technology is a tool-nothing more. It can’t replace the individualized care provided through a conversation and examination.”

Essilor Senior Vice President of Customer Development Howard Purcell, OD, FAAO, says optometry is a very traditional profession, and change can be difficult.

But Dr. Purcell predicts even bigger things on the horizon. He believes artificial intelligence and virtual reality will bring big changes to the exam room in the very near future.

“Imagine having everything you learned from your first day of optometry school to a study that was published 10 minutes ago at your fingertips,” says Dr. Purcell of the future of artificial intelligence.

He says it’s a technology that will likely scare many ODs. Don’t worry-it won’t replace you. But it will allow practitioners to make the best decisions for their patients.

Dr. Purcell predicts virtual reality will enter the exam room within five to 10 years, replacing many of today’s refractive tools. He imagines a world in which an OD utilizes virtual reality to immerse a patient into her everyday activities-driving, working on a computer, playing tennis-in order to optimize her vision solutions.

“These are technologies that will significantly change and disrupt what we do, and we need to embrace them,” he says. “It’s going to really enhance the experience for the patient.”

When asked whether optometry as a whole should be more open to new technology, Optometry Times Editorial Advisory Board member John Rumpakis, OD, MBA, FAAO, says we are asking the wrong question:

“I would submit that it is not a question of should-the survival of the profession means that we must not only participate, but we should be leading the way,” he says. “That means having leadership at the national, state, and local levels that can drive change effectively and guide us to having a seat at the table for healthcare delivery in the future.”

Next: Disruptive technology is here to stay

Disruptive technology is here to stay

Despite the strong opposition, Dallek says Opternative and companies like it aren’t going away. Disruption and innovation are inevitable, but how industries respond to those changes can predict their future success, he says.

“I think it’s important for ODs to think about how they adjust their business practices and how they adjust to the new reality where innovation and disruption just becomes part of the industry,” he says. “You can pass laws to hold back innovation for only so long.”

Dallek says Opternative is willing to talk to and work with doctors-both ODs and ophthalmologists.

“We’re not here to take over the industry,” he says. “We’re always willing to work with doctors-it’s just a matter of if they’re willing to work with us. There have been doctors who have been willing to work with us, but the establishment would not necessarily let them.”

“What I do see is that every optometrist is very scared about the future,” says EyeNetra founder, CTO, and co-CEO Vitor Pamplona, PhD. “I don’t think they should be, but they are because they don’t know what’s coming in terms of technology, and they think that technology can replace everything they do-which is completely false.”

Technology can provide eyecare providers with more information so that they can do a better job, says Dr. Pamplona, but it will never replace the optometrist. He says that there will be more technology coming out within the next year or two that will continue to shake up the field, but he does not believe it will impact how optometrists practice or make a living.

“I think it’s fair to say that it’s very hard today for private practice ODs to be profitable in their practice without giving up something else,” says Dr. Pamplona.

Dr. Pamplona makes the analogy that optometry will not go the way of typists, disappearing completely as technology evolved. Instead, he sees it going the way of photographers.

Photographers used to be chemists who knew how to mix the chemicals needed to develop a photo. Then, the profession moved to those who had the most expensive equipment. Now, everyone has devices with cameras, and yet photography is a bigger industry than ever.

“People pay for the artist-they’re not paying for the device or the mechanism,” he says. “This is exactly what optometrists are-they are artists. Even with refraction, they will always be better than any machine out there.”

Next: Opternative takes the heat

Opternative takes the heat

Since launching in July 2015, online refraction company Opternative sat firmly in the crosshairs of organized optometry.

The company recently raised $6 million, bringing its total $9.5 million since its inception, Dallek says. He says the funding will help the company grow its team and make its program easier for patients to use.

Although the company has attracted negative attention within optometry, ophthalmology has embraced the company, as seen in an article featured in our sister publication Ophthalmology Times.

Related: Eyecare community raises red flags over Opternative

Dallek says that Opternative’s experience hasn’t been much different than that of other disrupters such as Uber or Airbnb. The difference, he says, is that Opternative has faced industry backlash much earlier in its maturity than Uber or Airbnb received from the taxi or hotel industries, respectively.

“There have been many supporters in the industry who want to see innovative technology like ours succeed,” says Dallek. “There’s also some people and industry groups who have made it their mission to essentially stop innovation in eye care and prevent patients from gaining access to affordable, safe, convenient eyecare services like ours.”

One of those organizations is the AOA, which filed a complaint against Opternative with the U.S. Food and Drug Administration (FDA) on April 4 (click here to see “AOA files FDA complaint against Opternative” for more information on the complaint.)

In less than a year since its launch, Opternative has faced numerous legal battles across the country.

One recent case was in Georgia where Dallek says Opternative hired lobbyists to help fight HB 775, a bill that would outlaw Opternative’s services within the state. When the Opternative team talked to Georgia legislators, Dallek says most of them had a positive response to the company’s technology.

“We’re protecting the rights of all doctors and all patients to use technology-whether it be ours or any other innovative disruptive technology that comes after us,” says Dallek. “That’s what legislators-most of them-get.”

However, according to Dallek, politics got in the way.

“But the legislators said, ‘We can’t vote for it because the sponsors of the bill are too powerful,’” he says. “These bills aren’t going to pass on their merits-we have clinical trials that prove our technology works, and we have a satisfaction rate with our prescriptions that is far above industry standards.”

Opternative says its satisfaction rate is more than 99 percent.

Ultimately, however, the bill was passed in the Georgia legislature and was sent to Governor Nathan Deal’s desk, although it has not yet been signed into law.

Opternative is facing similar challenges in other states. Indiana enacted a law effective July 1 that prevents providers from issuing prescriptions for glasses or contact lenses via telemedicine. Michigan’s Department of Licensing and Regulatory Affairs issued a cease and desist order in February 2016. Other legislative challenges are in the works in states like Nebraska and South Carolina.

Dallek is adamant that the claims made by organized optometry-like the company has misled patients-have no merit.

“We do everything we can to make sure our patients understand what our technology is and there are no misunderstandings on what we do and what we don’t do,” he says. “We don’t serve every patient who comes to us. And yet there are bills that are being presented and potentially even being passed that are designed to stop us specifically and any technology like us.”

Opternative recommends its customers get a full ocular health exam once every two years, and it restricts customers form using the service more than four times within a five-year period without getting an eye health exam, in accordance with the American Academy of Ophthalmology’s recommendations.

Next: EyeNetra fights for Blink

EyeNetra fights for Blink

EyeNetra has created a series of smartphone-based refractive tools-such as Netra, Netrometer, and Netropter-which can be used to provide eye care outside of the practice. Dr. Pamplona founded the company as a part of his PhD thesis because he saw an opportunity to create new options for common refraction tools that he describes as “archaic.”

What attracted the ire of optometry was the company’s launch of its Blink service. The company utilizes non-doctor technicians called “visioneers” to conduct refractive testing in a patient’s home, an ophthalmologist reviews the data, and the patient receives a spectacle prescription within 24 hours.

(For more information, check out our story on Blink HERE.)

In July 2015, the New York State Optometric Association (NYSOA) and the New York Board of Optometry challenged the company, calling the refractive testing illegal. (Click HERE to read that story.)

EyeNetra also offers a similar service to Blink in India called Nayantara. Utilizing EyeNetra’s tools, local rural youth are trained to be visioneers. The visioneers provide doctor-supervised refractive testing and affordable glasses in their villages and towns. The company also refers patients out to partner eyecare institutions for those needing advanced eye care.

Dr. Pamplona says Nayantara provides eye care in underserved communities while also allowing young members of the community to become entrepreneurs.

“The whole system is very sustainable-it is not a mission trip,” he says. “We can keep it going because everyone on the chain is making enough money to sustain themselves, which is really important.”

EyeNetra sells its tools and software to eyecare providers so that they can provide their own version of the Blink service under their own brand-an at-home, on-demand refraction test. Dr. Pamplona says he knows of eyecare providers in the U.S. who are charging patients up to $500 for an at-home visit, and patients are paying.

“In many cases, because this is a premium service, the providers don’t care so much about selling glasses because in the practice, you undersell on your time in the chair and oversell on the glasses,” he says. “It’s highly profitable for them.”

Optometry Times requested to speak with one of those eyecare providers-many of whom are opticians, not optometrists, says Dr. Pamplona-but the providers did not wish to be interviewed.

Next: Smart Vision Labs enters eye care

Smart Vision Labs enters eye care

Another company that recently entered the eyecare space is Smart Vision Labs, maker of the smartphone-based autorefractor SVOne Pro. Smart Vision Labs also offers a patient-guided refraction test through its SVOne Enterprise service. The patient uses the SVOne to collect refraction data, which is reviewed by an ophthalmologist, and the patient receives a digital copy of a glasses prescription.

Eyecare providers can also use the SVOne Pro in their offices or to provide services outside of their practices. You can see SVOne Pro and how test is conducted HERE.

Smart Vision Labs CEO and cofounder Yaopeng Zhou, PhD, says that since launching the SVOne Enterprise service, the company has received negative feedback from optometrists.

“We understand where they’re coming from. When you have technology like this, some optometrists are thinking, ‘Is this going to replace me?’” says Dr. Zhou. “But it’s not like that at all. Optometrists do a lot more than just refraction. They do a lot of things that we can’t do. We just want to offer some help with the refraction piece of the equation.”

Next: AOA files FDA complaint against Opternative

AOA files FDA complaint against Opternative

The American Optometric Association (AOA) filed a complaint against Opternative with the U.S. Food and Drug Administration (FDA) on April 4. AOA President Steve Loomis, OD, says that the primary complaint is that Opternative did not receive what the AOA believes is the proper premarket approval from the FDA.

“When a medical device yields a diagnosis, like a refractive error, it needs to go through premarket approval by the FDA,” Dr. Loomis told Optometry Times. 

The complaint brings that and other concerns to the attention of the FDA, he says.

“We looked at Opternative ourselves and went through the testing and found a number of areas in which we think it falls short, especially in the area of contact lenses,” says Dr. Loomis. A number of fundamental aspects of a contact lens prescription cannot be completed online, including K readings, tear film assessment, or the actual lens fitting itself.

In the complaint, the AOA detailed each of the problems it identified with Opternative’s program and marketing. AOA members can access the complaint here: http://www.aoa.org/news/advocacy/aoa-files-expansive-fda-complaint-against-opternative?sso=y.

Opernative responded to the AOA’s filing with a statement:

“Opternative strongly disagrees with the American Optometric Association (AOA)’s plea to the U.S. Food and Drug Administration (FDA) to take legal action against the Company. The AOA’s claims are false and mischaracterize the proven safety and effectiveness of Opternative’s technology.”

This is not the first time the AOA has raised its concerns about Opternative to the FDA; however, this was the organization’s first formal complaint. Dr. Loomis sent a letter to the FDA on behalf of the AOA in October 2015 stating that Opternative’s doctor locator tool on its site implies that the doctors listed endorsed the company’s program.