Eye Exams Using Telehealth

Paul Graves, State Representative from Washington contacted the FTC https://www.ftc.gov to get their thoughts on the impact that the proposed State Bill 5411H.B, 1473 (The Bill) would have on Washington State consumers and the market in general.

Specifically, the State Bill would add a new chapter on eye care that would make it unlawful for anyone, including both ophthalmologists and optometrists to write a prescription for eyeglasses or contact lenses if the patients does not receive an in-person comprehensive eye exam.

The Bill specifically excludes comprehensive eye exam evaluations done by ophthalmologists or optometrists based solely on the use of remote technology. Summing up, the Bill would prevent ophthalmologists and optometrists from writing prescriptions for corrective lenses based on data from technology obtained from an eye exam done remotely by the practitioner.

In response to Washington State’s invitation on the proposed bill, FTC’s Office of Policy Planning and the Bureaus of Economics and Competition, submitted their comments to the Washington State Legislature concerning the proposed legislation that would restrict the use of telehealth eye care.

From the FTC’s view, the Bill mandates that a comprehensive examination must be done in-person before prescribing corrective lenses, but does not take into account the patient’s visual health status, examination history, or other circumstances.

This requirement could override the judgement of a vision care provider who otherwise would have concluded that the standard of care could be met with more limited services, either in-person, or if allowed by telehealth.

The FTC is very interested in the competitive impact of the proposed bill. The staff feels that telehealth can potentially increase the supply of accessible practitioners and would increase price and non-price competition, reduce transportation expenditures, and improve access to quality eye  care.

The FTC staff reports that many healthcare professionals support the use of telehealth to address challenges to healthcare access that is arising from a growing aging population, healthcare workforce shortages, geographic, and other maldistributions of providers that can lead to shortages in urban as well as rural areas.

The FTC staff also thinks that the Bill would not only limit competition, access, and choice in vision care, but would potentially increase costs in two ways by requiring that all prescriptions for corrective lenses be determined in-person and by requiring that all prescriptions for corrective lenses be based on a comprehensive eye exam.

The American Academy of Ophthalmology acknowledges that online vision tests may be appropriate for young adults seeking a prescription for corrective eyeglasses only if they do not have eye conditions or have risk factors for ocular disease.

Telehealth evaluation for online vision tests taken at home could also be especially helpful to disabled individuals who have difficulty making a trip to obtain in-person care. The VA successfully uses telehealth to screen for serious ocular diseases and then prescribes eyeglasses using auto-refraction equipment. The VA has concluded that tele-ophthalmology has the potential to improve operational efficiency, reduce costs, and significantly improve access to care.

The FTC feels that an alternative to rigid restrictions is to allow qualified licensees to determine whether to use telehealth when it is sought by a patient. The “Guideline on the Appropriate Use of Telemedicine” produced by the Medical Quality Assurance Commission of the State of Washington, states that under the Guideline, “The practitioner may provide any treatment deemed appropriate for the patient and is responsible for knowing the limitations of the care provided no matter how the care is delivered.”

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