I’m in a dark room, 12 paces away from my laptop, holding my phone and trying really hard not to squint at a screen I can barely see.
“Which shape is different,” my phone asks as I look at what I’m pretty sure–OK, kinda sure—are assorted shapes on the screen of my laptop, which is on a desk across the room. Shape number four. Maybe. My phone records the answer. Two shapes appear on my laptop.
“Which of these shapes has the sharpest lines?” Uh, the right one…?
I’m taking Opternative, an online eye test, at work. It’s easy. All you need is an Internet connection, a smartphone, a computer, and 25 minutes. The exam is free; $40 for eyeglasses or contacts, or 60 bucks for both, and you don’t even have to go to an eye doctor.
I am really bad about going to the eye doctor. And I’ve always been lackadaisical (at best) about taking care of my eyes. My vision started going fuzzy when I was in sixth grade. When I couldn’t see the blackboard, I simply walked to up to it. When I couldn’t tell if someone was smiling or waving, I’d pretend I didn’t see them. When I played soccer… well, just put me on defense, coach. Less pressure to accurately locate the ball than most positions.
A year later, I finally gave in. I chose the slimmest, most nondescript pair of what I now know were rose gold wire frames (I was so ahead of my time). I took them off the moment I was “done seeing” for the day, and everything would go fuzzy again. I loathed my eyeglasses. When my parents told me they’d give me contact lenses as a middle school graduation gift, my excitement knew no bounds. And rightly so: they made life generally more pleasant, and the whole touching-your-eye thing never phased me.
Not that I was any better about caring for my eyes. In college, I often fell asleep while wearing them, which is a big problem if you’ve been drinking. Dehydration makes them stick to your eyes, and you risk scratching your cornea removing them. When I’d invariably lose them, I’d borrow my roommate’s. So what if her eyes were worse than mine? I’d just bear the searing headaches. I regularly got eye infections while living in the Caribbean, and now, as in right now, I am once again out of contacts, my eyeglasses are broken (and the prescription too weak) and so…
I’ve basically been blind.
The problem, of course, is time. I don’t have time to find a doctor, book an appointment, deal with insurance. And I know that’s a first-world problem (or rather, an excuse). Almost everyone faces the same time crunch. But admit it—going to the eye doctor is a pain in the ass, and I invariably put it off until I’ve mooched a pair of contacts from everyone I know.
Opternative wants to change all of that.
Give Me Convenience, Or Give Me Blindness
I am hardly alone in wanting convenience. Co-founder Aaron Dallek says 19,000 people have signed up for Operative since it launched in July. Now, Operative doesn’t test eye health—only a doctor can do that—but it can offer me a prescription. Which is all I really need right now, because damn it, I just want some new glasses and contacts and to go on my way. If I can do that without leaving the house or office, even better.
“This is not an eye health exam,” says Dr. Bruce Goldstick, medical director for Opternative and a practicing ophthalmologist for more than three decades. “We actually screen with questions before the test and exclude patients if they don’t meet the criteria.” If someone doesn’t meet the criteria–they see floaters, for example, or experience eye pain—and may have a medical problem, Opternative prompts them to try and find an eye doctor.
Dallek says the test was based on real-world exams of more than 1,500 patients using the conventional refraction eye test and other methods. The idea of an online test first came to Operative co-founder and opthamologist Dr. Steven Lee six years ago when a patient asked why eye tests weren’t done online. He stewed on that for awhile, then decided to pursue the idea when he and Dallek teamed up three years later.
So why not use a webcam to peer into people’s peepers?
“That is one of the first questions everyone asks us,” Dallek says. “We decided we wanted to build the exam only using the technology that patients have on their desks or in their pockets. We didn’t use a camera in part because there are a lot of variations in the different cameras being used today.”
There’s also the fact that a webcam can be inaccurate, as there are differences in quality, lighting, and so forth. That said, future iterations of Opternative may use a smartphones camera, but only so a doctor might have a look at them. The camera would not be used to determine a prescription.
Am I Doing This Right?
Opternative is crazy easy. Sign on, sign in, and take the test. Opternative will text a link to your phone, and then it will become your coach. You’ll cover one eye, then the other, while you change distances from your computer screen. You’ll be asked things like “which of these lines is sharper, the right one or left one?” and “which of these four shapes is different?” Your phone screen will have the answer options, and you’ll tap what you think is correct. This goes on for about 20 to 25 minutes, just you, in a dark room by yourself, walking away from and up to your computer, tapping answers into your phone.
When you’re done, a doctor reviews the results, looks for any red flags, and sends you a prescription. You don’t get a signed copy with all the doctor’s info—which you need to get a pair of glasses or a supply of contacts—until you’ve paid up, though.
As easy as it is, I can’t help but wonder if I’m doing it right. I mean, I was fairly sure I counted off the right number as I walked away from my laptop. I’m almost certainly correct that I was covering the correct eye at the correct time (the app’s constant positive reinforcement of “Good job” and “You’re doing great!” helps). But still. It’s more than a bit weird giving yourself an eye exam at work. I’m used to the “lean-back” experience of going to the doctor (on those rare occasions when I actually go to a doctor). Am I really qualified to give myself an eye test?
Yes, Goldstick assures me, referring me to a clinical study the company conducted that claims its patient-administered, computer-based test is as accurate as one given by a healthcare professional. And in the last seven weeks it’s seen a 99.4 percent satisfaction rate with the prescriptions it offers—if you’re not happy with your prescription, Opternative will give you your money back.
I still don’t know if I entirely trust myself, but I really want to—as does the Internet at large. A 2013 Pew study found that 35 percent of Americans try to medically diagnose themselves online. There’s a telemedicine market developing beyond using the Internet as a paranoid diagnostic tool, though: There exist many Internet-only therapy networks, like TalkSpace and Breakthrough, and there are increasing video chat-based doctor appointment services, including HealthTap.
Most of the argument against telemedicine comes down to the thing that makes Opternative so attractive: prescriptions. A recent study found that tele-doctors were over-prescribing certain kinds of antibiotics compared to doctors who saw patients in real life, and there are concerns about how telemedicine will impact the doctor-patient relationship. While people are more apt to reveal personal problems online, there’s some resistance from doctors who feel it’s “depersonalizing.” To be fair, it is, but is it any less so than a visit to the doctor’s office?
About that Prescription…
As far as Opternative goes, the American Opthamologists Association is interested, yet skeptical. “Doctors of optometry are are the forefront of the development and use of new technologies to expand patient access, deliver the highest quality care, and improve health outcomes. At the same time, we’re concerned about abuses of technology’s promise and false claims that can leave patients misled, misinformed, or confused,” the association said in a statement.
While Opternative goes to great lengths to insist it offers a vision test, not an eye exam, the association worries patients might not know the difference and suffer for it. “Patients should never be put at risk because they believe an eye examination has been performed when it has not,” it says.
Still, there are many arguments in favor of Opternative, and telemedicine in general: People who live far away from healthcare facilities or don’t have adequate insurance; people who must refill a prescription and pretend their lives are so busy they couldn’t possibly make an appointment, people with an aversion to doctors.
I’ve received my prescription from Opternative, and apparently my eyes have gotten worse. Big surprise there. With luck, when the contacts I just ordered arrive, my vision will be crystal clear and pin-sharp. But who knows? I’m not a professional or anything.