Patients Trust These Online Vision Tests. Know the Brands, Share the Risks

Dr. Jeffrey Sonsino of Optique Franklin recently spoke to TheNewsFront about the risks of online eye tests. His warning stems from the case of patient Austin Gaydosh. For three years, whenever Gaydosh needed contact lens refills, he relied on app-based renewals instead of visiting an OD, and often slept in his lenses for up to a week at a time. The refill convenience came at a cost: Gaydosh developed a severe corneal ulcer that left him with lasting vision problems. Dr. Sonsino points to this case as one of the hazards of confusing a quick online test with a comprehensive eye exam.

AOA’s consumer health alert

The American Optometric Association (AOA) issued a consumer health alert about this very issue back in 2022, stressing that online vision tests are not eye exams. These services only measure visual acuity to renew prescriptions. They don’t check for glaucoma, retinal disease, corneal health, or systemic conditions with ocular signs. Patients who rely solely on such tools miss out on the early detection and prevention that ODs provide in the exam lane.

Brands and services to know

Even if you don’t endorse online eye exams, it’s worth knowing which companies patients encounter. Some of the most widely used include:

• Visibly (formerly Opternative) was cleared by the FDA in 2021 for online refractions, but still opposed by the AOA as insufficient for eye health.
• Lens.com offers budget-friendly prescription renewals for contacts with only a screen-based acuity check. Strictly refractive-only, no ocular health evaluation.
• 1-800 Contacts ExpressExam provides an online test reviewed by a remote doctor for prescription renewal. Marketed as quick and convenient.
• Warby Parker has an app-based renewal option (Virtual Vision Test) for existing glasses/contact prescriptions.
• Hubble Contacts allows customers to order lenses with minimal oversight. In 2022, parent company Vision Path paid $3.5M in penalties for prescription verification violations; FTC enforcement and consumer refunds continue.
• Simple Contacts offers app-based prescription renewal and contact lens ordering.
• EyeQue is a consumer facing vision screening device + app that lets patients self-test visual acuity and refractive error at home.

Note: These services typically require patients to already have a prescription, then use an online test reviewed by a remote doctor to renew. And state-level regulations impact the availability. To be fair, the companies listed above do share messaging about the limitations of the tests and the need for annual in-person exams, but it’s not front and center compared to the convenience messaging.

Why ODs can’t ignore them

Patients use these services for convenience. Everyone understands the value there. But the problem is, patients often don’t realize these are for acuity checks only, and not a substitute for comprehensive exams.

You should be there to provide better patient education, particularly when it comes to these three facts:

• Contact lenses are medical devices. Proper fit and corneal health still need to be checked annually.
• Online exams can’t spot silent disease. Glaucoma, AMD, diabetic retinopathy, and even keratoconus can progress without noticeable symptoms.
• Convenience can come at a cost, Gaydosh’s case being just one example.

Talking points for patient education

A simple message works best: Online tests only measure how clearly you see letters on a screen. They can’t evaluate your eye health That’s why an annual exam is essential, to protect both your vision and your overall health.

You could offer an analogy: A quick vision check is similar to a blood pressure screening — not the same as a physical exam.

Calling back to the AOA consumer alert (PDF here), there are five important questions for consumers:

1. Can you find the FDA approval statement for the company and its test, and is the company operating within that authority?
2. Do you know the doctor of optometry or ophthalmologist who is prescribing your contact lenses?
3. Are you asked to sign any forms that seek to release the company from liability?
4. Can you ask the doctor who is prescribing the contact lenses any questions when you are using an online vision test?
5. What does a particular online vision test actually assess?

These can also help guide your patient education conversations. Overall, you want to empower patients to make informed choices without feeling judged for wanting convenience.