Why an online eye test can't replace your eye doctor

For many people, the notion of being able to get an eyeglass prescription and buy glasses without a trip to the eye doctor sounds appealing. But is this really a good idea?

Here's what you need to know about online eye "exams" and vision tests before thinking about saying goodbye to your eye doctor.

Online eye tests

First of all, it's important to understand that an online eye test — even if it's called an "online eye exam" — does not evaluate the health of your eyes.

Usually, an online eye test (more accurately, an "online vision test") only measures your visual acuity and estimates your refractive error. In some cases, other vision tests, such as contrast sensitivity and color blindness, are included.

But these measurements tell you little or nothing about the health of your eyes and whether you have conditions such as cataracts, glaucoma or macular degeneration.

Even if you choose to try an online vision test, be aware that you should still have routine eye exams as frequently as your eye doctor recommends. A comprehensive eye exam is the only way to insure your eyes are healthy and free from sight-threatening conditions.

Online eye tests, however, do have value.

For example, some online vision tests can enable you to quickly renew your expired eyeglass prescription so you can replace your glasses. This can be very useful if you break or lose your eyewear when vacationing away from home or you cannot schedule an appointment with your eye doctor for some other reason.

Also, in some cases, an online vision test can help you monitor your eyesight and refractive error between routine eye exams. But be aware that though the results of some online eye tests have been validated with limited studies, this is still relatively new technology with often unproven accuracy.

More research is needed to guarantee that the accuracy of an eyeglass or contact lens prescription generated by an online vision test is comparable to a prescription determined in person by your eye doctor.

Visibly 'online eye exam' recalled by FDA

One "online eye exam" company is Visibly, which was established in 2012 as Opternative. Visibly has been at the center of the controversy about online vision tests.

The U.S. Food and Drug Administration (FDA) recalled Visibly's online vision test in early August 2019. The FDA's Class 2 Device Recall says the Visibly online vision test was recalled because the Chicago-area company had not received FDA authorization to market the product.

The American Optometric Association (AOA) had been complaining to the FDA about the Visibly test since 2016. The AOA maintained that the Visibly test "potentially posed serious health risks to the public and did not comply with federal law."

Former AOA President Christopher J. Quinn, OD, said on the AOA website: "In our initial complaint to the FDA we called upon the agency not to permit the continued marketing of this online vision test until the agency fully reviewed the safety and efficacy issues raised by the device... This FDA recall is a clear response to AOA's call to action to protect patients."

[Update: We visited Visibly’s website in August 2020 and found that the company is encouraging eye doctors to register their practice with Visibly to obtain “free access to its anywhere, anytime virtual vision test technology” during the COVID-19 pandemic.

The company also has this statement posted on its homepage:

“Visibly Digital Acuity Product is manufactured and distributed by Visibly, Inc. and operates under the Enforcement Policy for Remote Ophthalmic Assessment and Monitoring Devices during the Coronavirus Disease (COVID-19) Public Health Emergency issued by the FDA in April 2020. This product has not been approved by the FDA.”]

Risks of online eye exams

It's worth repeating: If you choose to replace a comprehensive eye exam by your eye doctor with a self-administered online eye "exam," it's important to know that there are a number of risks you are taking on.

First and foremost, there is no trained eye care professional present to carefully examine the health of your eyes.

As previously mentioned, online eye exams cannot determine if you have cataracts, glaucoma, diabetic eye disease and other eye or general health problems that your eye doctor can detect during a comprehensive eye exam.

Early detection of these problems can improve treatment outcomes, potentially preventing vision loss and even legal blindness.

Even if your eyes are perfectly healthy, there is a greater risk of getting an incorrect prescription for eyeglasses or contact lenses with self-administered online vision tests.

Even if the results of your online "exam" are reviewed by an eye care provider before your eyewear order is filled, there is no eye care professional present when you are actually taking the vision test to ensure the testing is performed properly.

If you don't take the online vision tests correctly, it's possible you won't be seeing as clearly as you should for driving, or you may experience problems such as headaches and eyestrain with your new glasses or contacts.

Online eye exam cost: Not necessarily a money-saver

You might think an online eye test or some other way to have your vision tested will save you time and money compared with the cost of a comprehensive eye exam performed by an optometrist or ophthalmologist.

But remember — you are only receiving a small part of the services provided by your eye doctor during a complete exam.

Also, the cost of online vision tests typically are not covered by health insurance or vision insurance.

Therefore, if you have a vision benefits plan, your co-pay cost for a comprehensive eye exam might be less than the cost of an online eye test.

If you are employed, be sure to ask your employer what type of coverage you have for eye care. Many people are unaware that they have vision benefits and fail to use them.

Understand the services provided

When using an online eye test, online eye exam, or other types of mobile eye care services, the key is to understand what the service does and does not provide.

Keep in mind that testing your vision, estimating your refractive error and obtaining a prescription for eyeglasses and/or contact lenses does not guarantee your eyes are healthy.

It is essential for you to have a live, face-to-face comprehensive eye exam with your eye doctor on a routine basis to safeguard the health of your eyes and enjoy a lifetime of good vision.

Page published on Wednesday, February 27, 2019