Doctors encourage patients to become more active with regard to their health care. They know that engaged patients are more likely to have better treatment outcomes. The Internet, smart phones, and apps now provide patients with unprecedented access to health care tools, including home eye tests and other do-it-yourself diagnostic exams. This technology may help patients feel more confident about seeking early treatment, but ophthalmologists and optometrists know that home eye tests and apps can provide misleading results. The key message for patients is that an online eye examination is not a substitute for seeing a doctor who can detect much more than poor vision. Eye doctors frequently catch other illnesses, and detect chronic conditions such as diabetes and high blood pressure.
Early detection and treatment reduce the risk of vision loss, but many Americans do not receive proper eye care. The reasons for avoiding the ophthalmologist (or optometrist) examination vary, according to a 2011 survey by the CDC, with nearly 35% of participants saying that they did not think they needed an eye exam and almost 40% citing cost or lack of insurance as a reason for not seeking professional eye care. These home eye tests and apps may help these individuals identify vision problems and encourage them to make an appointment when necessary. Essilor, a French company that produces ophthalmic lenses and other ophthalmic optical equipment, offers a variety of home eye tests. The simple tests help patients learn if they have myopia, hyperopia, presbyopia, or astigmatism. Essilor even put the Ishihara test online to help patients diagnose daltonism via their computer or smartphone screen. Google offers visual acuity tests based on the Snellen chart, Amsler grid tests, and AMD test for macular degeneration, as well as a glaucoma survey.
One of the more significant problems with these home tests and apps is that they are not necessarily standardized and environmental factors can influence results. For example, poor lighting can affect how the Ishihara test looks on a screen. Glaucoma surveys are just that—surveys—and are not appropriate substitutes for intraocular pressure testing. The astigmatism test is very subjective, in that many people learn to “ignore” astigmatic areas in their fields of vision, so asking patients to stare at a pinwheel and identify areas of light print is vastly less precise than keratometry, corneal topography, retinoscopy, and auto-refraction. While subjective tests, such as the clock dial and cross cylinder, are standard tools for the optometrist, treatment should always rely on objective approaches with regard to diagnostic testing.
As an eye care specialist, do you find that your practice is enhanced or inhibited by these new technologies? Are you gaining new patients who took an online test and appropriately followed up with you as a practitioner?
- Eye test. Google play website. August 21, 2014. https://play.google.com/store/apps/details?id=com.b2creativedesigns.eyetest&hl=en.
- Reasons for not seeking eye care among adults aged ≥40 years with moderate-to-severe visual impairment—21 states, 2006–2009. Centers for Disease Control and Prevention website. May 20, 2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a3.htm.
- Test your eyes. Essilor website. http://www.essilor.com/en/eyehealth/lensesforyourvision/ testyoureyes/Pages/home.aspx.