Don't want to name the firm because it is a startup, the location only opened recently, and there could be teething pains. It was also unusual in that I had just had an exam by an ophthalmologist, tracking some retinal issues, and didn't want or need any parts of the second exam except the refraction, to determine the eyeglass prescription.
The first part of the exam involved tonometry (puff of air to measure eye pressure), taking a fundus image, and operating a slit-lamp camera. The technician operated the machines, pushed a button, and computer voice would say "fundus image received," "slit-lamp image received," etc. The point being that the technician was actually doing any examining, just capturing images for a doctor to examine.
The "refraction" didn't go too well. It involved a phoropter--the machine that clicks in lens combinations--and a computer monitor on the wall to display Snellen letters. They were designed to be operated remotely. The first problem was that the remote technician (not sure of her credential, not a doctor) couldn't connect to the phoropter. The next was that she could operate the phoropter but not control the Snellen chart screen, which just continued to display a giant letter C. Those were resolved. The next problem was that I need a prism correction to get my two eyes to coordinate and fuse properly, so she could tune in one eye, but when she asked me to read with both eyes open, I couldn't. She said "Hmmm... I've never had to use prism on this instrument before, I'm not quite sure how to do it," and after a lot of clicking and trying she figured out how.
A significant point here is that possibly there's more than one brand or kind of remote photopter, and maybe these technicians are expected to know a bunch and don't always know everything. I can't imagine that an optometrist personally using a phoropter wouldn't know all the adjustments.
No real problems so far, but much waste of time.
Finally, a remote doctor--optometrist, I think--came on the screen to review the exam and "finalize" the prescription. When she brought up the fundus photo, it was a total blur. She said "you know, just looking at this, I can't even tell if it's the right eye or the left." At this point, my bad... I should have said "well, should they be re-taken?" And I should have also asked "Are the slit-lamp images usable?" But I just wanted to get out of there, so I said, truthfully, "I don't really need that, I had an ophthalmologist examine me two days ago and he took a 220° fundus photo."
Here's my big point. The refraction seems like a legitimate candidate for telemedicine. The optometrist (or technician) isn't viewing or examining anything. They are just operator a phoropter and a Snellen chart and asking questions, "which is better, #1 or #2" and "what's the lowest line you're able to read?" You don't need any real "telepresence" to do that.
On the other hand, my experience suggests that perhaps a non-medical person, or at least someone not well-trained and experienced, may not know how to get usable results from tonometers and fundus cameras and slit lamps.
The experience isn't over, because I haven't received the glasses yet. Another theory is that their "3D scan" of your head enables the glasses to be made so they will fit you without adjustments. We'll see if that's true, and we'll also see if the prescription looks bang-on when I put the glasses on.
The first part of the exam involved tonometry (puff of air to measure eye pressure), taking a fundus image, and operating a slit-lamp camera. The technician operated the machines, pushed a button, and computer voice would say "fundus image received," "slit-lamp image received," etc. The point being that the technician was actually doing any examining, just capturing images for a doctor to examine.
The "refraction" didn't go too well. It involved a phoropter--the machine that clicks in lens combinations--and a computer monitor on the wall to display Snellen letters. They were designed to be operated remotely. The first problem was that the remote technician (not sure of her credential, not a doctor) couldn't connect to the phoropter. The next was that she could operate the phoropter but not control the Snellen chart screen, which just continued to display a giant letter C. Those were resolved. The next problem was that I need a prism correction to get my two eyes to coordinate and fuse properly, so she could tune in one eye, but when she asked me to read with both eyes open, I couldn't. She said "Hmmm... I've never had to use prism on this instrument before, I'm not quite sure how to do it," and after a lot of clicking and trying she figured out how.
A significant point here is that possibly there's more than one brand or kind of remote photopter, and maybe these technicians are expected to know a bunch and don't always know everything. I can't imagine that an optometrist personally using a phoropter wouldn't know all the adjustments.
No real problems so far, but much waste of time.
Finally, a remote doctor--optometrist, I think--came on the screen to review the exam and "finalize" the prescription. When she brought up the fundus photo, it was a total blur. She said "you know, just looking at this, I can't even tell if it's the right eye or the left." At this point, my bad... I should have said "well, should they be re-taken?" And I should have also asked "Are the slit-lamp images usable?" But I just wanted to get out of there, so I said, truthfully, "I don't really need that, I had an ophthalmologist examine me two days ago and he took a 220° fundus photo."
Here's my big point. The refraction seems like a legitimate candidate for telemedicine. The optometrist (or technician) isn't viewing or examining anything. They are just operator a phoropter and a Snellen chart and asking questions, "which is better, #1 or #2" and "what's the lowest line you're able to read?" You don't need any real "telepresence" to do that.
On the other hand, my experience suggests that perhaps a non-medical person, or at least someone not well-trained and experienced, may not know how to get usable results from tonometers and fundus cameras and slit lamps.
The experience isn't over, because I haven't received the glasses yet. Another theory is that their "3D scan" of your head enables the glasses to be made so they will fit you without adjustments. We'll see if that's true, and we'll also see if the prescription looks bang-on when I put the glasses on.
Statistics: Posted by nisiprius — Mon Dec 23, 2024 9:32 am