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November 21, 2018
by Brian T. Horowitz, PC Magazine
Companies such as Opternative and Warby Parker offer online eye exams to save you a trip to the optical store. But questions remain about whether an online approach to eye care is really good for consumers.
You can buy so much online these days, including big-ticket items like cars and computers. You can even get help with real estate to find your next home. But would you go online to take an eye test to buy your next pair of glasses? Companies such as Opternative and Warby Parker offer online eye exams to help you get a prescription for glasses. And Zenni Optical lets you get fitted for glasses online through an application called “Zenni Frame Fit.” These companies are becoming more and more prevalent, with Hexa Research projecting the US online eyewear market growing to $505.4 million by 2025 from $338 million in 2017.
But when you get fitted for glasses online, does that mean you don’t need an eye doctor or optical store anymore? Not quite. Experts still recommend that you keep your electronic medical record up to date by visiting an eye doctor for a health checkup to screen for conditions such as glaucoma, a disease that causes damage to optic nerve in the eyes and may cause vision loss. Still, even with this recommendation, online eyewear makers are offering an innovative new eye care experience that some may prefer over a brick-and-mortar sales experience.
Eyeglass retailer Warby Parker offers an eye test service called “Prescription Check.” How it works is you take the test and then an eye doctor checks it over. But only certain people are eligible to get an eyeglass prescription this way.
“We have very strict eligibility criteria and a number of questions where, if we don’t feel very confident that this is a good service for you, we’ll refer you to go see an eye doctor in person,” says Dave Gilboa, co-founder and co-CEO of Warby Parker. “And we do that all the time with people that try to use the service.”
Gilboa admitted that online eye tests may not be for everyone but noted they have their merits. “We do think that if you don’t have a particularly complicated prescription, if you don’t have a family history of glaucoma, if you don’t have any complications that would require you to go get a comprehensive eye health exam in person, then we do find that a lot of the population really can benefit from a service like this.”
Warby Parker already has 75 retail eyeglass stores in the United States, with eye doctors working in those locations. However, because some patients live in remote areas without a store nearby, Warby Parker looked for a way for patients to take an eye test remotely and then have an eye doctor check it over. The company calls Prescription Check a “telehealth service.” Many employers are now offering remote health care as part of their insurance coverage. An eye doctor reviews the results of the eye exam to make sure a patient is seeing properly; the doctor then updates the glasses prescription accordingly. An eyeglass prescription costs $40 in Prescription Check. To use Prescription Check, you click “How to get a prescription” under “Education” on the bottom of Warby Parker website’s homepage.
Warby Parker wanted to replicate the experience of an eye test in the home. To do this, an object of a known size appears on a screen, and customers look through lenses to report what they can see and what they can’t. Gilboa said the key to making a remote eye test work is to measure the precise distant of a patient from a screen and mark down the resolution of that screen. The test displays the objects on the screen, and customers input answers on their phones. An eye doctor then review the results remotely.
To use Warby Parker’s Prescription Check app, you must live in one of 25 states and be between ages 18 and 50 with a single-vision prescription. You also must answer questions about past diagnoses, family history, and current symptoms. And considering the personal nature of this data, it’s probably a good idea to do this kind of test from a secure device, one that’s covered by both malware protection and a virtual private network (VPN) connection.
Warby Parker also offers a tool called “Find Your Fit,” which uses the TrueDepth camera of the Apple iPhone X$999.00 at Verizon Wireless to help people get fitted for glasses. The Warby Parker iPhone app shines a matrix of light on a person’s face, and that results in a 3D mesh. The app can measure facial data points and pick the best 11-13 frames from Warby Parker’s online selection based on that information. It uses the phone’s infrared camera to take 30,000 points on a user’s face.
“We think there’s a huge opportunity to use technology to help narrow the selection and indicate which of our frames are going to look good or fit certain face shapes and face types,” Gilboa said. Find Your Fit is not an augmented reality (AR) app, however. Virtual try-ons with AR fail to deliver precise measurements of a user’s face, Gilboa noted.
Image courtesy of Opternative.
Opternative is a Chicago-based health care technology company. Founded in 2012, it has received $9 million in investment financing led by Trust Ventures and Pritzker Group Venture Capital. Opternative offers an online eye exam on a mobile phone tablet or laptop. You can use your mobile phone as a remote control to record what you see on the computer screen, or just use one device. The test checks for distance, color vision, and astigmatisms, which occur when a person’s lens inside the eye is curved and the cornea has an irregular shape. After you take the exam, an eye doctor will review the results and issue you a prescription. You’ll need to provide your previous prescription to the eye doctor as well so the physician can compare them. Dr. Steven Lee, co-founder and Chief Science Officer (CSO) at Opternative, noted that Opternative’s service is classified by the US Food and Drug Administration (FDA) as a Class 1 Medical Device, which means it has a low-to-moderate risk level for patients.
Opternative has designed its online eye test tool to be seamless between the e-commerce world and the online store. That means you can start your test online and finish it up in the store.
“What this does for the retail optical store is, it optimizes the whole flow for the patient,” Lee said. “Instead of patients going into the store, spending an hour and a half, for instance, now they’ve actually already completed some of the vision test [before arriving].” Patients can then concentrate on getting their eye health checked at an eye doctor, picking out frames and lenses in a store, or purchasing their frames online.
Lee boasted that more than 1 million people have used Opternative since 2015. Joe Doyle, Senior Vice President for Strategic Development at digital health agency Intouch Group, has taken the Opternative eye tests. He said that he had perfect vision until his 40s, but then became farsighted with early signs of presbyopia, a loss of the ability to focus up close as a person ages. Because Opternative requires test takers to measure their distance from the screen, Doyle had to record his shoe size.
“The website asked for my shoe size so that I could ‘accurately’ measure out my distance from the screen,” Doyle said. “It told me that I needed to take 11 steps because I wear a size 11½ shoe.”
For Doyle, the experience was similar to what he would experience in an optometrist’s office. He focused on the letter “E” and used his phone to select the direction of the test page. “But in the optometrist’s office, I would say [the letter] aloud,” Doyle said. “The letter ‘E’ is pointing left or up or down. As a busy person, I can just do it [online] from my office.”
Doyle considers himself an early adopter of health care technology and was happy with the Opternative user experience (UX). “The way that they used illustrative characters and that sort of thing, it was enjoyable,” Doyle said. “It wasn’t tech-heavy, and when you think about people who might have vision loss, you really want to make things as simple as possible.” Doyle said he takes his prescriptions from Opternative and buys his glasses online from Warby Parker, which mails customers glasses to try on before they buy.
Zenni Optical is an online eyeglass retailer that provides a tool called “Zenni Frame Fit.” The tool lets you upload a photo to see what you would look like in a pair of eyeglasses. Users must enter their pupillary distance (PD), which “measures the space between the pupils of your eyes” according to the Zenni Optical website. Zenni Optical provides a video here on how to measure your PD. “Frame Fit is our virtual try-on tool that allows anyone shopping at Zenni.com to see how a pair of frames will look on their own face,” said Bai Gan, Chief Product Officer at Zenni Optical. “Currently, users simply take a digital selfie, go to Zenni Frame Fit on our website, and click ‘Upload Your Photo.'”
Zenni Optical plans to add a full-motion 3D experience to Zenni Frame Fit to give users an even better idea of how their glasses will look. “What we are working on is not only showing the aesthetics of glasses, but we are also trying to use virtual technology to produce some of the measurements of the glasses for making prescriptions,” Gan said. “To make an accurate pair of glasses, the most important thing is pupil and distance.”
As for concerns of accuracy when you order a pair of glasses online versus in the store, Zenni Optical stands behind its product. “Zenni lenses are as accurate as any you would purchase from an eye doctor or another retailer,” Gan said. “Every order of eyeglasses goes through several stages of quality control. At each step of the manufacturing process, the Rx Lab and the Edging Lab run multiple quality checks, including scoping the prescriptions after surface generation and checking for defects after each of the coating and tinting steps.”
With 25 million pairs of glasses sold to date, Zenni Optical has a database of preferences from customers from which to draw to gain insight into what to stock for the future. Zenni Optical uses a database from Oracle to store the data.
On Nov. 15, 2018, a company called EyeQue released “VisionCheck,” an automated at-home eye test. It has been named a CES 2019 Innovation Awards Honoree in the “Technology for a Better World” category. VisionCheck lets you check for refraction error in each eye. It consists of three precision optical lenses that connect to a smartphone and a Bluetooth-connected optical scope. The mobile app lets you measure digital PD. EyeQue says the refraction tool came from a patent out of the Massachusetts Institute of Technology (MIT) involving the Inverse Shack Hartmann optical method, which uses a photo sensor to measure refracted light and spot optical errors.
Experts have raised concerns about the validity of an eye test as a telemedicine option. However, right now, online eye test providers are focused on prescriptions only and don’t plan to eliminate eye doctors. “Our goal is certainly not to cut doctors out of the process,” Warby Parker’s Gilboa said. “In fact, we think doctors are more important than ever. But these tools, like telemedicine, can make things easier, cheaper, and more convenient for consumers as well as increase access to people that don’t have eye doctors readily available in person.”
Gilboa believes that eye tests can be separated from the need to get checked out by an eye doctor, without compromising their eye health. “It’s really just isolating the refraction portion that’s required to write a prescription for a new pair of glasses,” Gilboa said. “And we still encourage every one of our customers to regularly go in person to see their eye doctor for a comprehensive eye health exam. But we don’t think people need to do that every time they want to buy a new pair of glasses.”
Opternative’s Lee agrees on the need for in-person eye exams despite the availability of online eye tests. “We still recommend that patients still get a comprehensive eye exam every two years,” Lee said. “And this means that there’s always going to be a need for eye doctors and opticians.”
Some experts in the optometry industry have reservations about online eye tests as well as about purchasing glasses online. Samuel D. Pierce, OD, is President of the American Optometric Association (AOA) and an optometrist in private practice in Trussville, a suburb of Birmingham, Alabama. Pierce notes the health risks involved with buying glasses online regarding being able to verify the accuracy of a prescription. “Anything that’s offered by telemedicine, for it to be accepted and mainstreamed, it needs to be…evidence-based, and proven to meet current standards of care or even elevate standards of care,” Pierce said. “To my knowledge, there is no telemedicine service that does that, that beats the current standard of care—which is an in-person, direct evaluation eye exam by a doctor of optometry.”
Pierce went on to say that it’s difficult to verify that lenses bought online come from a certified lab or meet or exceed federal standards. “There’s not a certificate issued with a pair of glasses to verify that,” Pierce said. “I would say most brick-and-mortar companies do that simply just for liability issues. But when you order glasses online, you have no idea what the country of origin is or where they’re sourcing their products from, so it is a buyer-beware situation.”
If you do decide to take an online eye test, then make sure you get the prescription checked by an optometrist, and continue to see your eye doctor to check for eye conditions such as glaucoma. “Separating the eye health check from the vision test is certainly a concern I would have just from the perspective of the overall health and well-being of our patients,” said Dr. Chris Wroten, an optometrist at the Bond-Wroten Eye Clinic, in Louisiana. He recalled a recent case in which a 17-year-old patient came in with a brain tumor. It would not have been caught in an online eye test, he said.
Dr. David Turner, Head of Research and Development (R&D) for the Contact Lens Platform at Johnson & Johnson Vision, agreed on the need for eye doctors despite the availability of online tests. “Even with just an online exam to determine your refractive correction or your correction needs, you really need to go much beyond that and go see your professional,” Turner explained, “to make sure that they look at your eye in all the ways that a professional looks at your eye, which is well beyond just your refractive needs.”