Online Glasses and Contacts

Some might say that I am old fashioned or that I have a vested interest in the status quo (which I do to some extent), but I feel I should express my opinion regarding online websites that essentially work around in-person examinations. These websites are becoming more and more common in my experience. They essentially sell contacts or eyeglasses without the need for a recent prescription from an eye care provider, usually taking advantage of a webcam or phone camera. I have to say that I understand this is the wave of the future, and I think that using websites or smartphone apps as part of eyecare is inevitable. I think that it is inevitable but also very positive. Proper use of online services currently consists of utilizing online services as an adjunct to proper in-person care. Creative uses of online technology could include better triage than pure phone triage, i.e. it could be easier to determine whether an issue that a patient is having is serious or not with a video conference compared to an audio-only phone call. There are surely many other creative uses as well. However, at this time, there is no technology that can substitute for a proper in-person evaluation and replicate what a slit lamp examination can do. Indeed, even if I am physically with someone in person who is having an eye issue, I can’t be confident in my recommendation unless I have the proper examination equipment. Maybe someday technology will exist that can do what the slit lamp can do, but it definitely doesn’t now. So why is it a big deal to have a proper exam if all you want are new glasses or contacts? Unfortunately, the reality of medicine (not just eye care) is that most diagnoses can be prevented from becoming big problems if they are detected early enough. Once someone starts to notice they are having issues, some of the damage may be permanent. Take glaucoma as an example. Glaucoma is relatively asymptomatic until the more advanced stages of the disease. If early signs are detected during an examination in someone who wants glasses or contacts because they attend an in-person exam, damage from glaucoma can prevented. However, once the damage is done, it is not reversible by any method we currently know. This is not the only reason that online services are insufficient on their own, but it is a big one. That is why I encourage most everyone to have annual eye exams (as well as annual medical examinations) so that problems can be identified earlier and treated earlier. That sort of examination and preventive medicine is currently only possible in person, and, as far as eye care is concerned at least, I don’t see online services catching up any time soon.