This article is an excerpt from the Changes & Challenges report.
Teleoptometry is redefining how optometrists practice, creating new career pathways and extending access to care. Alex D. Louw, chief operating officer of DigitalOptometrics, describes it as a “force multiplier,” enabling optometrists to connect with patients nationwide, around the clock. “We’re expanding access to care,” Louw says. “The old notion of one doctor in a practice seeing only people who walk through their door is not sufficient to meet the needs of communities.”
The teleoptometry model leverages remote technicians and advanced technology to deliver efficient comprehensive patient care. In the DigitalOptometrics model, local technicians run the tests in the office and then remote technicians perform a preliminary subjective refraction. Doctors join synchronously to review results with the patient and complete their exam, with the local technician on hand if a test needs to be repeated or the doctor wants a particular view. The optometrist can remotely control the phoropter to refine the initial subjective refraction and issue a final prescription. “Doctors can see patients all day long without being tied to one physical location,” Louw explains, emphasizing the model’s flexibility.
Mike Rothschild, OD, piloted a teleoptometry-only practice with 2020NOW in rural Georgia just before the start of the COVID-19 pandemic. He notes how the pandemic boosted acceptance of remote care. “Pre-pandemic, teleoptometry was controversial,” Dr. Rothschild says. “But during the pandemic, acceptance rates went up, and there’s now a higher level of comfort with it.” The remote practice he started shifted back to a more traditional model in 2021. Even so, he says that the interest in telemedicine, which surged during the pandemic, is likely to continue a gradual and steady climb.
WORKFORCE IMPACT
While there are logistical and economic issues, teleoptometry is on track to change the way some patients access care and some doctors provide it. “There are job openings for approximately 6,000 optometrists today in the U.S.,” says Louw, “and it’s estimated to increase to 8,000 by 2030. Filling these positions conventionally seems challenging with about 1,700 graduates a year coming into the workforce.”
That’s where the concept of the “force multiplier” comes into play. Louw says that optometrists who work for DigitalOptometrics can select the hours that suit them. “We have full-time employed ODs for whom this is their primary work and hybrid, hourly ODs who supplement their in-office hours with a few days a week or certain hours of the day.” Doctors can also work with the company’s technology to care for just their own patients in their own practice for extra hours or while they’re away.
DigitalOptometrics encourages ODs who want to work remotely full time to carry at least five state licenses. That provides them with a deep enough pool of potential patients to keep them moving from one patient to the next smoothly.
For these doctors, it’s an efficient system. “The no-show rate in our industry is a horrible number,” he says. “There are practices that get to 50% no-shows, and it’s not uncommon for a location to run 30% to 35% no-shows.” With this model, it is unlikely that doctors need to wait long to see their next patient. When they complete their exam, they hand the patients back to the local technician. If the patients need to be seen in person, they can either be referred to the list of specialists and emergency providers that the contracting practice has preloaded into the system. Or if it’s not urgent and there’s a doctor in the location, the patient can come back in for another appointment. The doctor providing the remote care then turns back to their computer and selects the next patient in the queue.
DigitalOptometrics recently passed the benchmark of 2.5 million patient exams completed, since its launch in 2018. Louw expects that number to increase to 3.5 million in the course of 2025.
LICENSING LOGISTICS
Companies building the teleoptometry network have built an infrastructure to help doctors apply for and maintain multiple licensures. While there are optometrists who hold licenses in multiple states, most do not hold more than one or two current state licenses, says Dr. Rothschild. He highlights the potential of interstate compacts, such as the Interstate Medical Licensure Compact used in medicine, that could streamline the process. “Optometry hasn’t adopted interstate compacts yet, but it’s an interesting idea that could benefit military families and expand opportunities for remote care,” he says.
For optometrists willing to embrace teleoptometry, the model offers flexibility and career growth. “We’ve had doctors move their families to Spain or work remotely from a vacation spot, ” Louw shares. “With multiple state licenses, optometrists can serve patients nationwide, offering unparalleled freedom and job security.”
But that’s true only if the patients are there. Dr. Rothschild found when he was piloting his teleoptometry-only practice that in rural Georgia, the patient volume just wasn’t high enough to make remote care feasible for his one location. “For urban centers with high patient volume, remote care may be feasible,” he explains.
And it can help fill critical gaps, especially in under- served and rural areas or for practices where the owner has been unable to hire another OD. Offices can remain operational during a doctor’s absence, whether due to illness, parental leave or other reasons. “This model ensures patients always have access to care, even when a doctor can’t be physically present,” Louw says.
The American Optometric Association (AOA) approved a position statement on telemedicine in optometry in 2022. An updated policy is expected in the summer of 2025. The AOA says, “We are constantly evaluating new products entering the market, especially those seeking to use AI for patient care. AOA’s Quality Improvement and Data committee engages with new market entrants relying on AI, and we are currently evaluating and updating our Telemedicine in Optometry statement in response to our open comment period on the statement that closed in November 2024.”
AOA’s Teleoptometry Statement
The 2022 policy says: The AOA supports the appropriate use of telemedicine in optometry to access high-value, high-quality eye, health and vision care. Telemedicine in optometry can serve to expand patient access to care, improve coordination of care, and enhance communication among all health care practitioners involved in the care of a patient. The AOA supports coverage of and fair and equitable reimbursement for telemedicine in optometry. The AOA also affirms that efforts are needed to ensure health equity in telehealth. All individuals should have the opportunity to receive the standard of eye health and vision care regardless of location, socio-economic status, or any other Social Determinants of Health.
The report further details some of the criteria that would help define high quality in telemedicine in optometry, including training and protocols, the use of direct-to-patient technology and protecting the doctor/patient relationship. Read the AOA 2022 policy here.
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The Changes & Challenges report is supported by Alcon.
