Milton Hom, O.D., F.A.A.O.: I attended a major allergy conference (AAAAI Annual Meeting) in which remote allergy practices were discussed: Allergy labs have been setting up technicians to perform skin prick testing in medical offices without allergists. The technician does the test and sends the results to a central lab. The lab and appropriate associates establish an immunotherapy program, and the patient gives him/herself shots at home. The local practicing allergist is totally bypassed, and the lab bills the patient’s insurance for all services.

Ben Gaddie, O.D., F.A.A.O.: This is a growing trend in healthcare, and I think we are going to see more of this almost itinerant practice model of remote testing and evaluation. Don’t be surprised to see more of it in eye care. Just look to the looming kiosk legislation in Utah to know where the next phase of the war will be waged. Some of the tenets to the Affordable Care Act will stimulate the need for more delivery models, such as the allergy story you mention.

M.H.: As you mentioned Ben, I think we are already seeing elements of this in eye care (online glasses, wrong prescriptions, incorrect PDs, induced prism, poor fitting frames, etc.).

I also voiced a concern about safety issues at the conference. When immunotherapy is delivered, patients are observed in an allergist’s practice for 30 minutes after the shot is administered due to the risk of anaphylactic shock. However, there have been very little reports of complications with home treatment because the amount of allergen delivered is very small.

So, the main drawback is efficacy. Some allergists say small amounts yield higher safety but don’t really give very good outcomes. People are on allergy shots for years. It’s unfortunate if you have a huge time investment with little to show for it. I would be pretty upset.

B.G.: The question is not if, but when, regarding remote eyecare delivery. Where will the clinical optometrist fit in with this arrangement? I think the earlier we accept that the concept is going to happen, the easier it will be to begin building the infrastructure for O.D.s to play a central role in its evolution. Though I’m not particularly happy about it, I prefer to explore the opportunities rather than stick my head in the sand.

M.H.: Ben, I like your proactive philosophy. The first thought that comes to mind is the need to apply what we have learned about contact lens sales. We have shifted our emphasis to professional services, rather than material costs. A second thought is specialty expertise. We have seen the evolution of the contact lens practitioner to experts with specialty lenses. Perhaps the solution is to become experts in underutilized areas, such as binocular vision or occupational vision, as well. OM