Michigan Lawmakers Debate the Use of Telehealth for Eye Exams

The battle over using telehealth to conduct eye exams has surfaced in Michigan, where lawmakers are debating a bill that would allow virtual exams for prescribing contact lenses.

HB 4356, introduced in March by State Rep. Luke Meerman, has passed the House and is now before the Senate. As proposed, it would allow a healthcare provider to use a telemedicine platform to perform an eye exam, as long as the standard of care is the same as an in-person exam and the patient has had an in-person eye exam within the previous five years.

The bill resurrects a battle over ocular telehealth hat had been waged in several states prior to the coronavirus pandemic, but had been quiet as of lately. And this one is generating the same arguments for and against.

Proponents say the use of connected health platforms would improve access to care for residents who can’t easily get to an eye doctor’s office, while opponents say the online eye exam isn’t comprehensive or accurate enough to replace the in-person exam.

“Passing this law would allow ocular telemedicine in Michigan and ensure that Michiganders have the right to get prescriptions for contact lenses and glasses renewed online,” Americans for Vision Care Innovation, a national coalition of organizations supporting ocular telehealth, said in a March letter to Michigan lawmakers. “Taxpayers, who help to fund state employee health insurance systems, will save money too, and will experience long-term benefits by the example that ocular telemedicine sets for other state health care programs.”

“More than 40 million Americans wear contact lenses and millions more wear glasses,” the three-year-old group continued. “Michigan contact lens and glasses consumers deserve the right to lower costs, more convenience and easier access to vision care. Online prescription renewal tests have been offered for more than four years in this country. During this time, close to one million online prescription renewal tests have been performed using online platforms and at this time we are unaware of a single adverse event, medical malpractice claim or consumer initiated medical board complaint as a result of using these services.”

Roughly 30 states allow the use of telehealth for eye care, while several others have restricted or banned the technology altogether. In states like South Carolina and Indiana, online eye exam vendors have filed suit against the state over the restrictions and lost. On the other hand, the Federal Trade Commission has weighed in with support for telehealth services, saying state efforts to restrict the services are hindering access to care.

Supporters say the Michigan bill includes plenty of safeguards. It requires a prescription from an eye doctor before any telehealth services are used, and any eye exam that results in a change in prescription would lead to an in-person exam.

“It’s strictly for renewal of an existing prescription that still works for the contact wearer,” Greg George, the director of legislative affairs for the Mackinac Center for Public Policy, recently told the Capitol News Service. “We see it as a way to open up access to cheaper contact renewal services.”

Opponents say the online eye exam can’t catch serious eyes concerns that an in-person exam does.

“The telehealth eye exam is not an exam. It is a determination of the visual acuity over the person’s present contact lenses,” Roger Seeyle, an optometrist based in Owosso, told the news service. “Many things can be happening in the structure of the eye that don’t cause pain or blurred vision. Not getting comprehensive eye exams can have a devastating effect on eye health and can be life- threatening.”

Seeyle said the in-person exam is composed of two parts, one an examination of refractive status that determines the prescription and the second an actual examination of the eye for health concerns such as diabetes and ulcers. The online exam only covers part of the total exam, and misses issues that could lead to blindness or worse.

“What they do online is a very incomplete evaluation of one of those components,” he said. “There’s no evaluation of the sensory motor abilities of the eye or of any ocular health components of the eye.”