How to Coexist With Industry Disruptors

The COVID-19 pandemic accelerated change in all markets, from health care to business sectors. Even from my (MK) perspective as a 2020 graduate, the past 2 years have seen immense change from industry disruptors. In general, we as a people have shifted more towards remote work and an even greater reliance on technology.

One definition of an industry disruptor is a company or innovation that changes the way business is done in an existing market or the way services are provided to consumers, thereby “disrupting” the status quo.¹ Disruptors can sometimes create an entirely new competitive business market in the process. One example is the emergence of rideshare apps, such as Uber and Lyft, several years ago, which shook up the entire taxi industry and changed how people get around. There has also been a shift to integrate new technology to make remote work possible and of comparable quality to its in-person equivalent. It’s no surprise that we are seeing changes in the way we use technology in the optometric profession to diagnose and treat eye conditions.

In this article we share some ideas to help you keep up with the times and get the most out of your career.

DISRUPTORS IN EYE CARE

Patients and doctors are seeking out more innovative ways for eye care to be delivered. The introduction of market disruptors to our field, such as remote eye examinations, online refractions, and remote review care, has not only changed patients’ expectations of their typical visit to their optometrist, but has also changed the mindset of the provider regarding their methods of delivering eye care. This shift to offering more remote technological services is already under way. As an optometrist, how will these changes affect the way you practice and run your business?

Remote Examination and Online Refraction

Remote eye examination, also referred to as teleoptometry, may have once been thought of as a temporary service, but it looks as though it’s here to stay. This is because some patients and providers have accepted the idea that a doctor doesn’t have to physically be present in the examination room to perform routine comprehensive care. Hence, the emergence of numerous telehealth companies and in-office technologies that provide various aspects of remote care.

Remote examinations can be characterized into two categories: 1) live remote examinations, where a provider tunes in from a remote location to diagnose and recommend treatments to a patient in real time, and 2) remote review examinations, in which data are collected by a technician and sent to the doctor to review and respond to the patient within a reasonable time frame (eg, 24-72 hours) via secure email or patient portal.

Optometric telehealth companies such as 2020 EyeCareLive and Digital Optometrics have developed software that allows patients to be examined remotely by their eye doctor using automated, computer-controlled equipment. Meanwhile, other companies have developed new tech-driven devices, such as the Chronos (Topcon) for subjective refractions and the VisuALL virtual reality visual field perimeter (Olleyes), offering doctors the flexibility to take the remote review method. It is often best practice for the remote review method to be used with routine patients who have already established a doctor-patient relationship in a live setting, whether in person or via live remote examination.

Many providers are already keenly aware of online prescription renewals. Often referred to as “eye tests” or “vision tests” by online companies, these prescription renewal practices offer a subjective at-home vision screening conducted through the patient’s smart phone application or computer. MDs and DOs are often the ones authorizing these prescriptions, as their single medical license allows them to practice across multiple states (an OD’s license is valid only in the state in which it is issued).² Once the patient receives their prescription, they can order new eyeglasses or contact lenses, completely bypassing the need for an annual examination by their optometrist.

LOBBYING GROUPS RESPOND

As if huge disruptors aren’t creating enough of a challenge, some groups are using these market disruptions to push their own agendas. For example, the National Association of Optometrists and Opticians (NAOO) is a lobbying group with members consisting of large retailers. This group represents the interest of opticians, often at the expense of the interests of optometrists. In its letter to the California Board of Optometry during the height of the pandemic in mid-2020, the NAOO stated that, “there is little if any evidence that patients can’t understand the need for a comprehensive eye examination or recognize that as a separate issue from how they benefit from improved visual acuity by using corrective eyewear.”³

This statement is problematic because it is written in a letter that aims to basically remove limits and checks for teleoptometry, implying that an online refraction is a sufficient substitute for an annual examination, and that it’s the patient’s responsibility to know when they need to see an optometrist, despite all the eye conditions that present with minimal or no symptoms. This narrative unfortunately contradicts ways that optometrists can innovatively use teleoptometry to provide comprehensive eye care and pushes the idea that remote examinations should be used to pump out refractions quicker in lieu of annual comprehensive eye care, benefitting the interest of these larger retail groups.

BE IN YOUR PATIENTS’ CORNER

To combat the efforts of the NAOO and advocate for our patients, we must educate them on the differences between the different types of remote examinations and explain how we triage what signs, symptoms, and existing diagnoses must be addressed in a traditional live setting. The obvious questions here are: “How can I get this information to my patients?” and, “How can I keep patients coming to see me when they are tempted to switch over to companies that offer online refractions and services?”

Put yourself in the mindset of an average patient with no existing ocular diagnoses who is unaware of the importance of annual comprehensive care and is looking to simply renew a prescription for glasses or contact lenses. What would sway you to choose an online service instead of making an appointment with your optometrist? Price can certainly play a role, but the real answer here is convenience. For example, would you pay a few more dollars for an item on Amazon for the convenience of knowing it’s “on the way” with only a click of a button, instead of taking time out of your day to go to the store? Working people value time, and the less time a task requires, the better.

In the age of online shopping, we cannot ignore the fact that, as service providers, we must compete with the convenience patients enjoy when they can do something online and on their own time. So, how do we respond?

FIGHT BACK

The average consumer spends roughly 3 hours per day on their phone, a 31% increase from last year.⁴

Meet Them Where They Are: Online

One option is to use social media. Optometrists can have a strong online presence on platforms such as Instagram, YouTube, Facebook, and TikTok, which we can use to increase patient education by posting interesting eye care facts, including signs and symptoms that warrant urgent eye care. We can emphasize the importance of annual comprehensive checks to assess the importance of ocular and visual health. We can also use social media and our practice websites to ease the appointment-making process and provide a “message answering system” for patient inquiries.

Create Your Own Version of Remote Eye Care

Another way to increase convenience for patients and to keep up amid market disruptions is to implement your own version of remote eye care, whether you use the software programs mentioned above or communication tools (email, video chat, etc) you may already have at your disposal. Take the “if you can’t beat them, join them” approach, but do it in a way that ensures your patients are being well cared for and that they have a way to be urgently triaged in an in-person setting if needed.

You may be thinking that your patients are so used to seeing you in person that they’ll never switch to remote eye care, but you never know until you try—or at least ask. In January, we took 2 months off to travel to different cities in Mexico, Costa Rica, and Peru. Prior to this trip, we were both working a traditional, in-person, 5-days-a-week patient care schedule.

I (JB) implemented a remote review examination model for my practice, in which an optometry student gathers all the necessary components of the comprehensive examination for routine, established adult patients. Patients are notified online at the time of booking their appointment about this new type of hybrid examination, which combines in-office testing with remote review by the doctor. In-office testing and procedures commonly include but are not limited to taking a patient history, assessing visual acuity, eye movement testing, lensometry, ultrawide-field retinal imaging, widefield OCT scan of the optic nerve and macula, autorefraction, autokeratometry, subjective refraction, tonometry, and an HD-quality video of the slit-lamp examination. I then review these data and contact the patient with copies of their finalized prescriptions, assessment, and treatment plan.

Email has proven to be the preferred method of communication for nearly all of my patients, but other forms, such as video chat, can also be good options. Patients are always able to have an open line of communication, something that is often desired but tends to be missing with many health care providers. This is one reason why patient satisfaction has been high, as reflected in their online reviews. Standard of care is always maintained, if not exceeded. Using an extensive array of equipment, any conditions that do not present with any obvious symptoms can be identified and swiftly referred.

I (MK) took a different approach to the remote review model and was able to increase patient convenience while still affording my desired travel lifestyle. I adopted a schedule where I work for 3 months and am off for 3 months by alternating schedules with another doctor who does the same. During the 3 months of work I put in 12-hour days 6 days a week of patient care to maintain a comparable salary, as does my colleague during their own 3-month shift. This rotating schedule improves patient convenience by increasing doctor availability. With our 12-hour workdays, patients can schedule same-day appointments as late as 9:00 PM, 6 days a week.

While on this 3-month rotation, I’ve had many patients tell me how much they appreciate the after-work hours after their busy day is done, while their children are home being watched, or without having to use a personal day. Appointments are easily booked online, and patients are always provided with their doctor’s email address for any questions that arise after their appointment. Patients are never left feeling abandoned and are usually scheduled for follow-ups and annual visits during their prospective doctor’s scheduled shift, but they always have the option to be seen in person by another doctor if an emergency arises.

A third option is to use the live remote model, in which patients are seen in real time at the clinic by a technician using a computer-operated phoropter and slit lamp while the doctor is remote.

We have found that both in-person and remote appointments can get the job done, and more importantly, that patients are accepting of these methods and still receive quality comprehensive care.

SHAPE YOUR FUTURE

Although the term “disruptor” may be loaded with negative connotations, we can still have positive takeaways from understanding their effect on our field. Such disruptions are already here, but we have the power to use them to our advantage. With innovations in remote care technology, patients and doctors can decide how they would like to approach eye care. These emerging methods, when used appropriately, should be viewed as an expansion, rather than a disruption, of the eye care we provide.