What's in an eye exam?

What’s in an eye exam?

It seems that the current catch word in our society is “disruptor”. Amazon is disrupting many businesses. Malls sit empty as consumers sit at home ordering over the internet and having their products magically appear at their door in days or even hours.  You don’t need to go to your favorite restaurant because doordash, grubhub  or another company will deliver your food right to your door.

So, where does this leave medical care in general and in particular eye care? Can you truly have your eyes “examined” online? This question will surely arise as the term, “there is an app for that” enters our daily life. More and more patients will opt for some form of online service to save money and or time.  Seems reasonable doesn’t it?

I wonder how well the app will find the subtleties in a case history? Will the patient quietly whisper to the app…”This morning I tried to talk and the words wouldn’t come out..” Surely the app will pick up on the subtleties of dry eye, misalignment of the eyes, or the issues of eyes that do not converge.

Surely the app will notice a slightly bulging eye indicating a thyroid issue? And it won’t possibly miss a pupil abnormality indicating some form of nerve damage or stroke…will it?

I have always noted that patients do not magically appear for yearly exams like teeth cleaning. Usually there is some issue that brings them to the office.  Although every patient does not get the answer they are seeking, at least they are able to voice their concerns about flashes of light, floaters, or just a general uneasiness when reading or watching television. I personally evaluate patient’s binocular vision. This seems like an obvious part of an evaluation, but many patients comment that no one has ever done the testing even though the patient is sixty years old.

No, I’m afraid that online testing and even the new companies that have a technician test the refractive error of your eyes while some doctor sits thousands of miles away supervising are probably going to overlook the issue of skipping over words or retracing sentences while reading. I’m sorry to report that the questions patients invariably have concerning their day to day issues such as itchy eyes or redness will not be addressed by these new methods.

I only hope that the disruptors do not succeed to such an extent that there are fewer places for patients with real issues to turn. Offices that actually listen to the patient and offer recommendations on how to address issues which face us all at some time or another.