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Is it a good idea to get your eyes examined over the internet?
You're watching your favorite TV show when you notice your vision seems a little off. You reach for your laptop, and an hour later, you've had your eyes examined and ordered glasses...more - photo by Jennifer Graham
If a clerk at the Department of Motor Vehicles is the only person who has checked your vision since grade school, youre likely due for an eye exam with a health-care professional.

And with the advent of telemedicine, it's never been easier, if you're between the ages of 18 and 50. Just log on to your computer, enter some personal information, take a vision test online and get a prescription for eyeglasses or even contacts.

But is an online eye exam safe for you and your family?

A group of optometrists and ophthalmologists in Connecticut say no, and they've convinced the state Legislature to consider a bill that would put restrictions on online eye care. The purpose, according to the bill's authors, is to "protect consumers from dubious technology that can compromise well-accepted standards of care and place a patient's health at risk."

If the bill passes, Connecticut would join South Carolina and Virginia in imposing restrictions on what's known as ocular telemedicine.

But companies that offer online eye exams which include 1-800 Contacts, based in Draper, Utah, and the Chicago-based Opternative (available in 39 states, including Utah) say they're providing quality service at a low cost. "Stay home. Eat some ice cream. Get a vision exam," 1 800 Contacts invites consumers.

The ice cream is not included, but an online exam for both glasses and contacts costs $60, or $40 for glasses alone, on Opternative. Meanwhile, in-office exams can anywhere from $50 to more than $200, the Connecticut Post reported.

The skeptics

The American Optometric Association recommends that school-age children and adults up to age 60 have eye exams every two years. After 60, the association recommends an annual checkup.

The group also warns consumers of the risks of buying glasses online, citing the results of a study it co-sponsored that found nearly 48 percent of 154 pairs of glasses obtained online had the wrong prescription or safety issues related to impact.

Online retailers that offer eye exams create a prescription by having the person stand away from the computer and respond to questions about what they see on the computer screen, sometimes holding a hand over one eye, similar to how eyes are checked in a doctor's office.

More difficult to do remotely is measuring the distance between your pupils. The pupillary distance, or "PD," determines where the center of the lens is placed when the glasses are made.

"Measuring your PD is akin to cutting your own hair," the Optometric Association's website says, noting that some online retailers ask that customers obtain their PDs from a previous optometrist.

But even before the advent of online eye exams, eye specialists have been reluctant to release PDs. They're required by law to give you a copy of your contact lens or eyeglass prescription, according to the Federal Trade Commission, but sometimes those providers give prescriptions without the PD. The specifics of what they have to reveal is different in each state, as is how long the prescription is valid (it's two years in Utah, and the pupillary distance does not have to be on the prescription.)

In an article in The Boston Globe Magazine, writer Chris Morris argued that all optometrists should give out the PD at no charge with no questions asked. She said she has friends who want to order glasses online but don't want to face the awkwardness of asking their eye doctors for the information, and she wrote that an optician seeing her daughter once told her, "Don't you dare order her glasses online."

Morris eventually ordered a pair of glasses online by following the instructions given to her by the online retailer Warby Parker, which had her upload a picture of herself with a credit card under her nose so they could determine her PD. (Some other retailers let you measure yourself with a ruler.)

"For the record, I saw no better or worse with my discount glasses than with those purchased through my optometrist. But I felt like a million bucks and had several hundred more in my wallet," Morris wrote.

Of course, you can avoid all this extra work by going to an eye doctor for your exam and purchasing eyeglasses or contacts through the doctor's office. There, you'll also have the health of your eyes assessed, which becomes even more important as we age and is why online prescriptions aren't always available for people 50 and older.

A report issued last fall by the National Academies of Science, Engineering and Medicine said that nearly two-thirds of adults over the age of 40 experience some sort of eye problem, including vision impairment, myopia, macular degeneration or cataracts.

Almost everyone middle-aged or older has presbyopia, a condition that makes it difficult to focus on objects that are close.

And presbyopia's opposite, myopia (or near-sightedness) has increased significantly in recent decades, almost doubling among adults 25 or older.

Also, an office exam could catch glaucoma, cataracts, diabetes or even melanoma that a remote examiner might miss.

And eye specialists say that in certain cases, getting online exams could actually be dangerous if the prescription and measurements are wrong. In Connecticut, state Rep. Kevin Ryan, who has a doctor of optometry degree, told Susan Haigh of the Associated Press that ill-fitting contacts can damage the eye.

But for younger people who have no eye health issues, and who have seen eye specialists before, an online exam is an option. You'll need about 30 minutes, a computer and a smartphone, as well as a credit card to pay for the service.

How it works

In Prevention magazine last year, writer Amber Brenza recounted her own experience using Opternative, then seeing a local optometrist so she could compare the results.

The online exam, which took 25 minutes, was faster, but it was 24 hours before Brenza got the results, and they didn't take insurance. In person, she got her prescription immediately.

And the online exam was different in what she was asked to do. "... Instead of being shown the same letters and numbers over and over again, a series of shapes and lines appear on screen, and you have to determine their clarity or blurriness," Brenza wrote.

"The program also provides written and spoken instructions (often repeated several times, which got a little annoying, to be honest), like to stand up, sit down, move away from or closer to the computer, and so on."

But the prescriptions turned out to be identical, causing Brenza to conclude that, for people who qualify for online exams, a combination of care might be the best idea.

"Go for the online exam if you qualify and are pressed for time but know that it doesn't replace a sit-down with your own optometrist for a more detailed examination of your eye health," Brenza wrote.

Likewise, Morris, the travel editor for The Boston Globe who wrote about her online purchase, said she recently visited an optometrist for her annual exam.

"I worked up the courage to ask him what he thought of online retailers, and his answer secured me as a patient for life," Morris wrote.

"In a somewhat hushed tone, he admitted he uses them himself. 'For that money, you cant go wrong.' Then he gave me my PD, no credit card needed."
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