Guest post by Michael Evans MD (Practicing Ophthalmologist)

Editors Note: This review was done prior to recent actions that have been taken to try and stop Opternative from providing their online refractions, we have detailed these actions at the end of this article.

If you have a fear of visiting your local optometrist or ophthalmologist for a full dilated exam to examine your retina, optic nerves and the vascular supply of your inner eye, but just need an updated refraction for prescription glasses and/or contacts, then a new option called Opternative is an alternative you may want to try.

Opternative is available for the public to use in 33 states, and can provide an online vision exam for healthy patients, ages 18-40. It is important to note, as Opternative does many times on their website, that this exam is not evaluating your ocular health, or screening for any potential blinding conditions which are discovered during full eye exams, such as glaucoma or diabetes (among others). They simply have a platform that allows the user to interact with the software to determine their refractive error, then provide a prescription for either glasses, or for both glasses and contact lenses. One must have had an eye exam in the past two years in order to obtain a prescription from Opternative, and they have to be able to access a record of your glasses and contact lens prescription in order to complete the process.

Overview

First, the website itself is slick, extremely user-friendly, and clean (see the photos of the refractive exam from start to finish). You’ll need a desktop/laptop computer, a cell phone, and about 12-15 feet of space where you can back away from the main computer to interact with the vision screening software. Once you register, a link will be sent via SMS to your cell and it will connect remotely to allow you to proceed with the vision test, using your phone essentially like a remote to answer questions and move through the refraction process. This process was easy, had no connection issues (with either WiFi or cell data for the phone connection) and ideal for taking the vision test.

The refractive portion of the experience takes about 25-30 minutes, and starts after you answer questions about your health, such as any medical conditions (e.g. diabetes) or medication(s). If you have underlying health issues, then the chance of being able to use this service diminishes, likely due to the fact that systemic illnesses can affect a refraction, which could result in variable results and increased rates of needing to use the “money-back guarantee” which they list on their website. This is one of the reasons people return to their eye care providers when they get an updated refraction that seems perfect one day, then once they fill the prescription a month later and their health has either improved or declines, the glasses (or contacts) no longer perform adequately.

Throughout the vision test, a voice reminds you over and over that, “There are no wrong answers” and encourages you to power through the test until the end. It did become somewhat annoying, especially to someone who understands that good refractions take a little time in order to increase accuracy. I did go through the test twice (the second time was just to get pictures), and, to be honest, without the sound on it was much better (not having to listen to an overly encouraging voice prompt ad infinitum).

Once the vision test is completed, you are prompted to upload your old prescription for glasses (and contacts, if desired) or, alternatively, there is an option for the Opternative team to contact your eye care provider to obtain that information. You are charged $40 for a glasses prescription and $60 for both glasses and contacts. Some may ask why you can’t just get a contact lens prescription for $40 and go without the glasses, but as an ophthalmologist myself, I always recommend that contact lens wearers always have a good backup pair of glasses in the event that they cannot wear their contacts (e.g. eye infections, allergies, etc.).

Concerns

Opternative’s website claims that “the digital prescription is delivered in 24 hours or less”, which was not the case with my experience. Granted, they did contact the office within 24 hours, but due to a medical record mix-up, I was contacted the day following my exam asking to confirm details of my previous exam, which I did, and I even provided a prior office’s information in case they continued to have difficulties. I didn’t hear back over the weekend and eventually I got a phone call again from the Opternative team and decided I would send in a record of my prescription, after which I received my new script within 24 hours. Had there not been difficulty from the beginning, I think they would have provided my digital prescription within their touted time-frame.

Unfortunately, part of the reason I think they would have hit their deadline of a sub-24 hour turn-around time is because I was sent a carbon copy of my previous prescription, but it did have an updated expiration date. At the end of the vision test, you are asked if you are satisfied with your current glasses/contacts. I replied that I was satisfied, which in turn (as I was advised by the Opternative team after questioning the results) prompted the ophthalmologist reviewing my results to write me the same prescription, although this conflicted with my results which were generally outlined after the computerized vision check (the computer told me I had low myopia in one eye and low myopia and astigmatism in the other eye – although this is not the case in my current prescription). It does bring into question the confidence Opternative has in the ability of their software to accurately measure one’s refractive error, although their website references one clinical study they have performed to validate the software’s accuracy. They did say that my results were within a quarter diopter of my old prescription, which is minimal, but if it was undercorrecting a myopic patient, they would likely need to use the guarantee offered on the website to “make it right”.

Finally, the major concern that I had even prior to using the software was how an online service could dispense a contact lens prescription and how they would make sure patients use them correctly. To my surprise, there was a complete lack of any guidance for contact lens use/hygiene. There is absolutely nothing on the website that provides any information (which should be a reminder to patients based on their past interactions with eye care professionals, rather than a new revelation) on how to properly use contacts. This, especially in light of the fact that there is no ophthalmic exam, could potentially be devastating to a patient that has dangerous habits when using contacts (e.g. sleeping in lenses, overwearing, not cleaning properly, etc.). After speaking with the founders of Opternative on a conference call, they did reassure me that this was something that they would be adding to their website, as they also felt that it was necessary to provide some anticipatory guidance to patients who use contact lenses.

Other notes

During my review, I was interested in what the larger organizations of optometrists and ophthalmologists who provide this service in their offices think about emerging technology that could provide in-home refractions and open a new avenue of competition. Interestingly, the two major groups seemed to have different opinions on this subject, with the American Optometric Association (AOA) overwhelmingly opposing the Opternative service, as they write that people using the service likely don’t realize that a vision test is not a substitute for an eye exam, and could lead to underdiagnosis of serious ocular conditions. The American Academy of Ophthalmology (AAO) did not have much to write about services such as this, but statements about emerging technologies that the AAO has made seem to be more open to evaluating the benefits of new methods of providing services that would enhance the lives of its users and/or reduce “health care visits and costs”.