According to a report published by the National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division, vision care availability in the U.S. varies significantly depending on location. Each of the 50 states regulates vision care, determining which provider categories — traditionally ophthalmologists and optometrists — are allowed to give preventive and follow-up eye care. Telemedicine has the potential of meeting the vision care needs of patients, so long as the states allow it.

Opternative, an online vision care company, provides prescriptions for contact lenses or glasses based on an online vision test. The company disclaimer states it does not give full eye exams but does offer vision tests sufficient for corrective eyewear prescriptions. Opternative’s associated ophthalmologists and optometrists evaluate the patient’s visual acuity, diagnose the refractive error, and issue prescriptions where clinically appropriate. Patients do not need a webcam but must have use of a smartphone, a laptop, or desktop computer; a broadband Internet connection; and 10 feet of walking space. Patients seeking prescriptions for contact lenses and those who need more than a “mild prescription” must also provide a previous prescription to give the medical professionals a better understanding of the patient’s vision history. Patients can take the prescription to any eyewear provider or select among Opternative partner companies.

Opternative vision test availability depends on the state of residence. The company website lists 32 states in which the test is available. According to the company, it is continuing to seek doctors within the remaining states that do not restrict its ophthalmologists from practicing in the state. A South Carolina court recently rejected a lawsuit brought by Opternative that challenged the state’s Eye Care Consumer Protection Law that prohibits online vision testing based on refractive error only or by a kiosk. The suit claimed the law is protectionist and unconstitutional. The court dismissed the suit with a statement that the plaintiff had no standing, which is defined as “a personal stake in the subject matter of a lawsuit.” Such lawsuits and claims regarding vision and other telemedicine care will likely face similar challenges in other states as telemedicine continues to find new applications.