Killakwinn

Is it biotech or is it techbio!!!!!

One could argue that a $79 annual exam is more affordable than paying $200 every month for an injection to manage endstage, out-of-control diabetic eye disease.

That being said, I think annual exams are unnecessary for certain population subsegments (e.g. young healthy folks under 40 years old, have good vision, have no personal or family history of eye disease, have no risk factors for developing eye disease ie poorly controlled diabetes;) for those people who NEED annual eye exams (e.g. those with mild nonproliferative diabetic eye disease,) these should be free. But for those without insurance, this is not the case.

Wow, thanks for the detailed note of support. I agree with all of the above.

Wow, this is super helpful in that it gives me extra context outside of what I'm used to. Also just good to know what else is out there :) Thank you so much!!!

Glad that my training and knowledge base is on point, hehe.

Thank you so much for the kind words. My biggest wish is for my team to use our combined skills and expertise to bring high-impact, scalable solutions to those who can't access an eye doctor (or don't want to go into the office.)

Ok, I’m happy to hear it. This reminds me that another important caveat re: eyecare is this — even within a country, there’s a lot of variation in how ophthalmologists treat the same condition (eg one doctor might choose to do tube surgery on a glaucoma patient, whereas another might choose to do a laser procedure for the same patient.)

I imagine that internationally the differences are even more dramatic! But this doesn’t mean that one country is more “correct” than the other; in fact, I’d hypothesize that for population specific disease variants, geography factors into the trajectory of one’s disease outcome. For example, ophthalmologists in Asia are likely much better at treating normal tension glaucoma (NTG,) which has a higher prevalence in Asian patients. So perhaps these patients tend to do better, but this is only a crude guess.

That is INCREDIBLE. When someone is paying for a full eye exam out of pocket in the US, it can cost anywhere from $69 to $150 USD.

I know right!!! Let’s just say “legit” and “contraband” glasses all come from the same handful of factories in Chinese cities such as Danyang and Shenzhen.

From a clinical standpoint, as long as a person has had the same prescription for years and is happy with their vision, things really ought to be that easy.

Yeah, in the absence of in-person supervision, there are a lot of safety measures that need to be implemented. For example, making sure that people are at the correct testing distance (via a number of potential feedback mechanisms that we're testing) and making sure that people can't zoom in on the optotypes to cheat.

The psychology of how people relate to their vision -- especially the independence that good vision affords -- is very complex and certainly something I wish that our training spent more time emphasizing. There are patients who come into clinic with relatively minor and non-vision threatening problems who are afraid of imminently going blind, and there are patients on the other end of the spectrum who are imminently going to go blind but are in denial about it (or are not terribly bothered by the possibility.) Handling these scenarios and all the gray spaces inbetween is one of the more challenging parts of delivering eyecare (and healthcare in general.)

Ultimately, we're aiming for clinical accuracy and scalability first, with an understanding that there are lots of underlying incentives and potential roadblocks that we will tackle head on when the time is right.

Hi!

I think WP is a great company. I also agree that their vision check UX leaves a lot to be desired -- I ran through it myself a few times, and each time it caused intense frustration. There's something about needing to manipulate laptop and phone and having 14-20 ft of space that is just... impossible lol.

Anyway, our service is similar to WP's app in that we check vision for the purpose of determining if a prescription renewal is appropriate. But that's pretty much it. For us, this is only the tip of the iceberg. Fun times ahead!

I hesitate to provide medical advice here. But if you are 30 and you have a glaucoma diagnosis, you should really be followed by a glaucoma specialist (vs a comprehensive ophthalmologist or an optometrist.)

Thanks! Kristine and I will do some tag-teaming on this.

1) Currently a lot of other services ask people to take "x" number of footsteps away from the screen to approximate "y" feet from the monitor. Using this context, I'd argue that the variation in arm length isn't as dramatic as variation in foot size. Ultimately though, when we're using near vision as a proxy for distance vision, the natural variation in arm length isn't crucial. But! Once we roll out our distance vision check, we won't be relying on arm length.

2) Will leave this to Kristine.

3) Interesting. Hadn't thought about this one. My guess is no because the most important ratio is optotype size:testing distance. (Optotype = the numbers/letters on the screen that a patient is reading)

4) It's possible and we'll need to pressure test this against gold standard in-person maneuvers.

5) Same as #4. Also this is a particularly interesting point because a similar problem exists in person. As an extreme example, I've had patients come in who've memorized the letters in the 20/20 line because they were very motivated by one thing or another (e.g getting their driver's licenses renewed.)

6) Is this the "which is better, 1-or-2" question? All I'll say is that there are a number of interesting ways we could try to simulate these.

Hope this answers some of the q's! Thank you for all the thought that went into them.

Did you do the exam on mobile or desktop? Also, what browser were you using?

We're looking into this circle bug -- very sorry about that!

I won't argue that the current test isn't crude. We're rolling out increasingly sophisticated versions with each update, but I agree that in its current state our exam has a ton of room for improvement.

I do have to mention that the 1) vision check (e.g. do you see 20/20 with you current/expired prescription) and 2) the eye health tests are two different portions of our exam and serve two different purposes.

These latter set of "low-tech" maneuvers (double vision, amsler grid, red desaturation) are very high-level screening mechanisms for more serious underlying issues and do not have much to do with the numbers on a person's prescription. To be more specific, the overlapping circles are meant to assess if someone is having double vision, which in a worst case scenario could be a symptom of acute cranial nerve palsy.

There are very few instances in which a patient with chronic glaucoma needs monthly IOP checks (vs someone who came into clinic with an acute event and goes on to need emergent surgery.) And in those cases where monthly IOP checks are needed, it is definitely not gold standard to use the air puff test.

I'd say that measuring IOP every 3-4 months is a typical regimen for a patient with more advanced glaucoma; these measurements should always be done via the same method (Goldman applanation) at the same time of day (due to AM to PM fluctuations in IOP) to be the most accurate.