Patient getting an eye exam
using 20/20NOW’s system.
NEW YORK—Three years ago, as ocular telehealth began to attract widespread attention throughout the eyecare industry, the focus was largely on “store and forward” technology, which involves collecting clinical information and sending it electronically to another site for evaluation, and the then new technology of visual acuity testing via computer or smartphone.

However, a New York-based software developer, 20/20NOW, conceived of a different approach. Their idea was to have a skilled technician perform a comprehensive eye exam on a patient in a fully equipped eyecare practice or retail location, and then forward the results to a licensed eye doctor located off-site. After reviewing the patient history, objective and subjective refraction testing data, plus additional eye health data and images, the doctor could write a prescription for eyeglasses or contact lenses, and recommend treatment, if necessary. The process was designed to increase access to comprehensive exams, provide a standard of care equivalent to in-person exams and lower costs for providers and patients.

20/20NOW’s telehealth model has since proven to be both clinically effective and commercially viable. The company reports that its system has been used to perform 40,000 comprehensive eye exams have been performed over the past three-and-a-half years by a growing roster of retail customers, and more than 2.5 million eye exams have been performed since 2013 using its proprietary software. The company is licensed to operate in 15 states, and another 29 states are open to its telehealth model, which it continues to refine and expand.

Chuck Scott.
“When we first started out, it was a refraction software company being interfaced with digital hardware and reselling that software to various optometrists and opticians,” said Chuck Scott, 20/20NOW’s CEO. “Then that software was interfaced with digital equipment from a couple of OEMs. That was basically to provide eyecare professionals the ability to refract patients objectively and issue an Rx at the end of the refraction for that eyewear.”

Scott, who joined the company in 2015, drew on his experience with telehealth in the field of radiology to formulate 20/20NOW’s telehealth strategy for eyecare. “I quickly realized we needed to do more than provide subjective refraction for these patients. We needed to have an ocular health or ocular screening portion of the exam built into the subjective refraction. So we sat down with our eyecare professionals and looked at the standard of care as published by a variety of different entities including the AOA (American Optometric Association) and AAO (American Academy of Optometry) and created our own matrix. We looked at what we could do through technology, and with having somebody in-person as having somebody remote. When all was said and done, we created a protocol with technology that met all the guidelines, except for dilation, which some states allow by a non-professional and some don’t.”

Greg Lechner.
Greg Lechner, a veteran optical industry executive who serves as 20/20NOW’s director of marketing and communications, emphasized what he said is the uniqueness of 20/20NOW’s patented approach to ocular telehealth. “Our solution is first and foremost designed to bring patients and consumers to the doctor’s office and complete the sale of eyewear when they’re there,” he explained. “Other solutions are designed to do everything else, and to pull away the services from the eyecare provider. We feel that our service is different in that respect. We believe we’re the only telehealth provider providing a true eye exam. While others claim that they do comprehensive exams, when you look at their exam protocol, it doesn’t measure up to what we doing. The standard of care is dramatically different.”

Lechner noted that 20/20NOW’s exam utilizes wavefront technology and proprietary algorithms to quickly refine prescriptions and make them extremely accurate. This results in shorter exam times in addition to optimizing patients’ visual acuity and comfort, which ultimately reduces remake percentages significantly lower than industry averages, he said.

20/20NOW has integrated multi-functional, wide-field retinal cameras into its exams. The retinal images captured by the cameras are integrated with FDA-approved artificial intelligence that immediately enhance the images to identify lesions in the retina that are typically undetectable to the human eye. The newly implemented technology, which 20/20NOW calls Eyelogic, assists doctors in diagnosing critical eye diseases such as diabetic retinopathy in early stages, a critical step toward preventing blindness and lowering health care costs.

Retinal image enhanced with
20/20NOW’s AI technology.
Additionally, 20/20NOW’s EHR provides doctors with the patient’s current and historical exam data/images, allowing doctors to compare current images to past images to more easily identify changes in the patient’s eye health, Lechner said.

The company also uses advanced, multi-functional diagnostic equipment with a smaller footprint that allows for expanded and more convenient access to comprehensive eye exams. This is in line with the company’s goal of increasing access to and utilization of comprehensive eye exams in areas and populations that are not well served.

As ocular telehealth gains ground, several competitors have entered the market, including Florida-based retail chain Stanton Optical and DigitalOptometrics, a New York-based startup. In June, 2018, 20/20NOW filed a patent infringement suit against DigitalOptometrics, which has its own patented version of a remote, comprehensive eye exam. The lawsuit, the latest to emerge from the rapidly expanding and highly competitive ocular telehealth category, has yet to be resolved.

20/20NOW is currently exploring ways to broaden its customer base. “Our initial focus was on chains,” said Lechner. “The primary need for our service is with stores without a doctor. Now we’re expanding our marketing reach out toward independent ECPs, both ODs and MDs.”

To connect with more practitioners, 20/20NOW has stepped up its participation at professional conferences. It has also recruited a prominent optometrist, Bryan Rogoff, OD, MBA, CPHM of EyeExec Consulting, to consult on clinical processes and compliance.

GVS Mobile Van, equipped by 20/20NOW.
“20/20NOW has become the leading ocular telehealth company because their strategy to increase exam access, lower costs and improve outcomes for patients, especially in demographics where optometrists are not present. Their exam process meets, and in some cases exceeds, the standard of care required by state boards minimum standard examination,” Dr. Rogoff told VM.

On a local level, 20/20NOW recently formed a partnership with General Vision Services (GVS), a leading New York-based vision benefits provider, to create the first mobile eyecare center featuring ocular telehealth. The center will provide on-site eyecare and eyewear services at GVS client locations. Members of GVS clients will be able to take care of all their optical needs while at work.

“After reviewing the available telehealth options GVS selected 20/20NOW because of their standard of care and experience within the ocular telehealth space,” said Maureen Flaherty, vice president of network operations for GVS. “This new digital healthcare technology will enable us to provide our members with convenient access to eyecare services while at the same time lowering costs. Oftentimes members don't receive regular eye exams because they have to take time off work to see the doctor. With ocular telehealth, members are now able to receive comprehensive eyecare in a very convenient and cost-efficient manner.”

As 20/20NOW CEO Chuck Scott commented, “This is another example how telehealth can improve access to state-of-the-art equipment and digital comprehensive eye exams.”