Telemedicine and Opticianry

There has been a shortage of “Quality Opticians” in Florida for quite some time now, most likely everywhere else as well, and for those of us in the actual field, it has been a financial windfall.  This shortage has made Licensed Opticians a much more valuable commodity than before, which can be reflected in the starting hourly pay, as compared to a decade ago, which has increased substantially in many parts of Florida. I have been in this industry for over 30 years, I remember the starting pay being $10-13/ hour, and now in 2023 that has shifted to more than double that amount. Most Florida Licensed Opticians are being offered anywhere between $23 to $32/hour, plus a signing bonus with little or no experience.

An Optical, not owned by an Optometrist or Ophthalmologist, is required to have a qualified Florida Licensed Optician to be on the premise at all times to order, verify, dispense and directly supervise unlicensed staff who can and will do the same for safety and well being of the patients who come in with a verified prescription. Licensed Opticians were and are still considered Essential Employees to dispense Eyewear and Contact Lenses during the COVID Pandemic and otherwise.

Let’s just say for example You are a -8.00 Myope and your newly adopted dog “ate/destroyed” your only pair of glasses, your Contact Lens Prescription is expired, you work an hour away from home, and have to drive, how essential is your vision now?  How essential is your local Optical now?  How essential is that a Licensed Optician necessary to produce, verify, and dispense that pair of glasses you need to work, earn money, and provide for your family?

According to Chapter 484.002(3) of Florida Statues (Dispensing of Optical Devices and Hearing Aides) “Opticianry” means the preparation and dispensing of lenses, spectacles, eyeglasses, contact lenses, and other optical devices to the intended user or agent thereof, upon the written prescription of a licensed allopathic or osteopathic physician or optometrist who is duly licensed to practice or upon presentation of a duplicate prescription. The selection of frame designs, the actual sales transaction, and the transfer of physical possession of lenses, spectacles, eyeglasses, contact lenses, and other optical devices subsequent to the performance of all services of the optician shall not be considered the practice of opticianry; however, such physical possession shall not be transferred until the optician has completed the fitting of the optical device upon the customer. (Summary of subsection 3)

This does not mean the Licensed Optician cannot have other associates/coworkers who are not Licensed Opticians perform the same duties, work can be delegated to others under “Direct Supervision.”  Chapter 484.002(5) defines this as “supervision where the licensee remains on the premises while all work is being done and gives final approval to any work performed by an employee.” (Summary of subsection 5)

Since the recent COVID-19 Pandemic, there has been a need created within the medical community to provide medical care by doctors, while at the same time, reducing the amount of “physical contact/interaction” with anyone who could be considered “COVID Positive” or as a “asymptomatic carrier of a COVID Variant” that could further spread the infection to the medical community.  This precaution introduced the increased use of Telemedicine to help diagnose, treat, and provide overall healthcare to everyone with little or no physical interaction.

Telemedicine is defined by the American Medical Association (AMA) as the exchange of medical information from one site to another through electronic communication. Others have described it as using telecommunications technologies to support the delivery of all kinds of medical, diagnostic, and treatment-related services, usually by doctors. The Centers for Medicare and Medicaid Services (CMS) has defined it as the use of electronic information and telecommunications technologies to extend care when you and the patient aren’t in the same place at the same time.  Telemedicine is nothing new and revolutionary. Probably one of the earliest and most famous uses of hospital-based telemedicine was in the late 1950s and early 1960s when a closed-circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital for psychiatric consultations.  Investment in telehealth from a state and system level began in the early 1990s and rapidly expanded during this decade due to the aforementioned “COVID Pandemic.”

As many of us in the Optical community have experienced, finding an available Florida Licensed Optometrist has become just as difficult as finding a Florida Licensed Optician.  This led to the creation of Teleoptometry.  Teleoptometry is currently defined as the practice of providing ocular health and vision care services to patients via telecommunications technology by providing a series of pre-screening tests, the patient then proceeds to the exam lane for remote subjective refraction. An ophthalmic technician (certified or not) will appear onscreen via high-definition videoconferencing (using Zoom, Skype or another platform) and perform the refraction in real-time providing the office with a valid prescription signed by an optometrist or ophthalmologist at another location that does not even need to be in Florida, much less the United States.

As of July 1, 2019, Florida passed Telehealth, Chapter 2019-137, Laws of Florida, which establishes standards of practice for telehealth services, including patient evaluations, record-keeping, and controlled substances prescribing. The law also authorizes out-of-state healthcare practitioners to perform telehealth services for patients in Florida upon meeting certain eligibility requirements and registering with the Department of Health.

This was a major accomplishment for locations looking to have an Optometrist on site to provide exams and increase sales for their dispensary, which is considered the real “profit center” of the optical with the higher margins between profit and loss (P&L).  Many companies started capitalizing using this method, many Florida Licensed Opticians were left feeling very “uncomfortable” working in these environments.  Over the recent years, I have had many Opticians calling me about the legality of this kind of business and more so about the “morality” of having patients not “physically interact” with an actual Licensed Optometrist, as well as the many “flawed” prescription remakes associated with the work they had to process.

Turning back to the purpose of this article, and how this affects Opticianry.  It is all about the wording of our Laws and Rules here in Florida.  As you read earlier in this article, definitions of what a Florida Licensed Optician’s purpose is defined as lack a some minor verbiage that is now about to be exploited.  Let us break down the wording and see where our profession is being “exploited” to the point where a “Big Box Store” can avoid employing Florida Licensed Opticians for each location during all hours of operation.

Chapter 484.002(5) defines this as “supervision where the licensee remains on the premises while all work is being done and gives final approval to any work performed by an employee.” (Summary of subsection 5)

I need to play “Devil’s Advocate” here and point out that nowhere in Chapter 484 or in 64b12 does it ever mention that a Florida Licensed Optician needs to “Physically” be on the premise, it is easily “assumed,” but we all can recall that old saying about if you “assume something you only make an, “ well you get it.

There is nothing there that specifically indicates that “Supervision” means physically being there.  A Florida Licensed Optician can be considered “Supervising” unlicensed staff through videoconferencing using such platforms like Zoom, Skype or any other platform that allows them to view what the staff is doing in “Real Time” as well as verify a prescription, fitting heights through all the modern Digital Lensometers that can transmit the information to Licensed Optician’s computer 10, 15, 100 miles away.

With new digital equipment being used to attain the pupillary distance measurements and the fitting heights for their customers, the need to have highly paid Florida Licensed Opticians on the payroll may no longer be a necessity or a requirement.  A big company, with many locations, can simply employ a single Florida Licensed Optician for every three or four locations, slashing their payroll expenditures and increasing their profit margins for every location greatly.  I am not bringing this to light to scare you all with a “the sky is falling, the sky is falling” scenario.

This is happening right Now!

! I have received many calls from many Florida Licensed Opticians who trust my understanding of the Florida Laws and Rules to consult them on whether or not to accept an offer that they have been approached with. They have been offered generous hourly wages and to be additionally compensated extremely well to “Supervise” other locations for the fitting, as well as the dispensing of each set of prescription eyewear and contact lens orders to their customers at locations that are anywhere from 50 to more than 100 miles away from where they are currently working or residing.  They are worried because their Licenses will be hanging on those walls and they fear legal repercussions that can end their career as a Florida Licensed Optician as well as possibly cripple them financially with the legal costs of penalties they will accrue in an investigation by the Florida Board of Opticianry.

This can be prevented by the Florida Board of Opticianry, with a declaration that clears up the definition of “Direct Supervision” by inserting the simple word “Physical” to clear up the necessity of having an Optician be present upon inspection and verification. The purpose of a Florida Licensed Optician is stated at the beginning of Chapter 484’s first two declarations in subsections 1 and 2.

Chapter 484.001 (1)   The Legislature finds that the practice of Opticianry by unskilled and incompetent practitioners presents a danger to public health and safety. The Legislature finds further that it is difficult for the public to make an informed choice about Opticians and that the consequences of a wrong choice could seriously endanger their health and safety. The only way to protect the public from the incompetent practice of Opticianry is through the establishment of minimum qualifications for entry into the profession and through swift and effective discipline for those practitioners who violate the law.

Chapter 484.001 (2) The sole purpose of enacting this part is for the protection of public health, safety, and welfare.

It all sounds pretty plain and simple but let us really look at this as another attempt for “Big Box” stores to eliminate Opticianry across the board for money instead of quality.  This will start off here in Florida, then spread across the country as an easy way to cut their payroll costs and increase profitability, particularly using states that have reciprocity with others. They can also just encourage current Licensed Opticians to get additional Opticianry Licenses in multiple States which could make our profession a “work from home” position.

I cannot, honestly, predict that the quality of prescription eyewear will suffer, nevertheless, it is highly likely that such a future will be inevitable unless something is done to prevent this.  As Opticians we will absolutely fail the public’s health, safety, and welfare for the sake of a loophole that will only profit those major retail opticals that are looking for a way to cut costs and increase their bottom lines.

You may not be a Florida Licensed Optician, and this whole article may seem frivolous to you, however, keep in mind that this appears to be where Opticianry is going, Licensed or not.

Sources:

https://floridasoptometry.gov/licensing/out-of-state-telehealth-provider-registration/
https://www.reviewofoptometry.com/article/telemedicine-what-weve-learned-and-whats-to-come
https://www.aoa.org/AOA/Documents/Advocacy/position%20statements/AOA_Policy_Telehealth.pdf
https://floridasoptometry.gov/licensing/out-of-state-telehealth-provider-registration/
http://laws.flrules.org/2019/137
https://flboardofmedicine.gov/latest-news/telehealth/#:~:text=Florida%20passed%20Telehealth%2C%20Chapter%202019,keeping%2C%20and%20controlled%20substances%20prescribing.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9805855/
https://www.reviewob.com/wp-content/uploads/dlm_uploads/2020/05/Telemedicine-Special-Report.pdf