notall ocular telemedicine options are created equal—some will be moreappropriate than others, depending on the population's particularneeds. (Image: Shutterstock)

The COVID-19 pandemic has fundamentally changed how patientsaccess care through their insurance benefits, particularly at-riskpopulations like seniors and those with underlying healthconditions. Many of these members are unable to receive eye examsand other essential in-office eye care services, as socialdistancing has become the "new normal."

Fortunately, telemedicine technology has been rapidly advancingto deliver eye exams and other critical care at home – and itspopularity is unlikely to wane in the wake of thepandemic.

Related: 4 tips for employers as telehealth usegrows

However, many members may not understand that their visionbenefits can afford them ocular telemedicine options, with someforegoing critical eye care altogether. To add, not all oculartelemedicine options are created equal—some will be moreappropriate than others, depending on the population's particularneeds.

Benefit brokers and managers must truly understand theopportunities and limitations of ocular telemedicine to be able toeducate members on the true value of their vision benefits in thechallenging environment presented by the pandemic, especially withopen enrollment season right around the corner.

Telemedicine use is growing and likely here to stay

Originally, telemedicine was used to provide consultations athome that would typically require frequent or regularly recurringin-office patient visits, such as therapy. However, in recentyears, national, state and private health policies have beenexpanding the approval and reimbursement of remote technologiesthat would traditionally require in-person provider office visits.In fact, 223 state telemedicine bills were introduced in 2019,particularly in states with significant rural areas and underservedresidents.

The COVID-19 pandemic has sped this process up, and telemedicineapprovals have grown exponentially in just a few months in a widerange of services, including eye care, as patients have been waryof in-person care that requires human contact. In response toCOVID-19, the Center for Medicare and Medicaid Services broadenedaccess to Medicare to allow a wider range of services to becovered—and this expansion may last long after the pandemic.

Ocular telemedicine is a partner, not a replacement

The potential for ocular telemedicine is great—it serves toimprove access, lower costs, ensure quality care for patients andprovide greater efficiency for patients, care providers andinsurers alike. However, current technology has not yet been ableto match the imaging capabilities of in-office exams. Therefore,ocular telemedicine, in its current stage of development, cannotentirely replace the value of in-office visits with eye careprofessionals. Rather, its best used to enhance in-office visits bysupporting ongoing care and strengthening the relationship betweeneye care professionals and their patients.

For instance, in the case of a patient with a degenerativevision condition, such as age-related macular degeneration,patients can monitor their eye health at home and regularly shareimages of their eyes with their eye care professional to determinewhen emergency care is required, so that patients only need toschedule in-office visits when absolutely necessary.

Ocular telemedicine limitations and considerations

Even though telemedicine is rapidly expanding, oculartelemedicine still has many state-by-state limitations on the typeof eye care that can be reimbursed by insurers. Further, providersand insurers are still grappling with concerns about privacy,security and validity of the technologies, imaging quality and evenlegal licensure requirements across state medical boards.

In response, insurers' approaches to ocular telemedicinereimbursement are continually evolving as members' needs andopportunities for better technology arise.

A few core principles for a reimbursable ocular telemedicinevisit at this moment in time include:

• The technology must authenticate the location and identity ofthe requesting patient.
• The technology must disclose and validate the identity andappropriate training of the professional rendering care.
• The professional providing care must be appropriately licensedand the telemedicine services must be approved by both thejurisdiction extending the professional license and thejurisdiction in which the patient is resident.
• The telemedicine service organization and professional musthave policies and procedures assessing patient satisfaction,safety, privacy and security of the medical record consistent withfederal and state regulations.

Eye Exams can serve as a window to health

Despite strict requirements for ocular telemedicinereimbursement in some areas, it is still possible to receive an eyeexam via digital technologies. Particularly for seniors or thosewith underlying health conditions, telemedicine eye exams arewidely available and can provide a wealth of information intooverall health.

For instance, in the case of a senior experiencing eye pain ordischarge, emergency eye exams can be provided in residence viatechnology-enabled, real-time video and audio communication.

Because people with vision problems are more likely than thosewith good vision to have diabetes, poor hearing, heart problems,high blood pressure, strokes, as well as an increased risk forfalls, injury and depression, the concern is that delaying care mayexacerbate existing conditions and lead to overall deterioration ofhealth. Rather than delay care because of barriers stemming fromthe pandemic, an eye exam can also be one of the easiest and mostcost-effective way to evaluate eye health, identify vision problemsand detect close to 30 chronic health conditions.

Although telemedicine has made impressive progress in the pastfew years and months, it still has a long way to go. Until thattime, it is best used in cases of emergencies or as a supplement toin-person care. Brokers and benefit managers can serve as helpfulconnectors between eye care professionals and members on the valueof vision benefits for understanding when and how to use oculartelemedicine.

Dr. Mark Ruchman is the chief medicalofficer at Versant Health, a managed vision care company focusedon creating an integrated and seamless experience for health plans,members and eye care professionals across the total eye healthvalue chain.

Read more: 

• Why more employees are embracingtelemedicine
• 6 tips for changing the telemedicineconversation
• Feds look to telehealth to rein in Covid-19coronavirus