AOA, Congress urge VA to uphold promise of one standard of care for veterans

Rural veterans deserve a standard level of care commensurate to peers living within range of Department of Veterans Affairs (VA) facilities, which is why a new VA eye and vision screening pilot program misses the mark entirely.

Although AOA commends the VA's ongoing efforts to expand veterans' access to eye and vision health care, an experimental screening initiative now in operation at the Atlanta VA Medical Center subverts the VA's guarantee of "one standard of care" by sidestepping the high-quality care afforded by in-person, comprehensive dilated eye examinations.

This experimental program, coined Technology-based Eye Care Services (TECS), identifies rural veterans residing outside the footprint of full-service VA facilities to receive vision and eye disease screenings as part of their local primary care visit. These services are performed by an ophthalmic technician, include an unproven hybrid of eye disease screenings, and may result in the creation of an eyeglass prescription based solely on auto-refractor readings.

Working alongside and in conjunction with the Georgia Optometric Association (GOA) and the Armed Forces Optometric Society (AFOS), AOA communicated concerns to the VA that veterans being offered these TECS screenings may receive substandard diagnoses and care, and may mistakenly assume that they have received a comprehensive eye examination. Furthermore, AOA voiced concerns that this pilot program could delay timely diagnosis and care afforded by a comprehensive eye examination at a frequency advocated by AOA and the American Academy of Ophthalmology.

More specifically, AOA voiced concerns that providing eyeglass prescriptions to veterans based solely on auto-refractor readings is leading to substandard refractive diagnosis and vision correction treatment. This type of substandard care is expressly prohibited in Georgia and nearly a dozen other states; although, these laws do not apply to the VA system. AOA raised concerns that the eye disease screening portion of TECS, which is in the initial phases of study by the National Eye Institute (NEI) for its effectiveness, will catch some eye diseases, but also will miss a wide range of eye health issues common among veterans.

While limited in its current reach, the TECS program is dangerous and poses a barrier for doctors of optometry, both within and outside of the VA, to deliver quality care," says Andrea P. Thau, O.D., AOA president. "The AOA, the Georgia Optometric Association and the Armed Forces Optometric Society, as the advocates for our profession and, more importantly, our patients, are taking a stand on behalf of all patients, including those who have served our great nation by fighting for our country. We will speak out against inappropriate uses of telehealth technologies and inferior care to ensure that this program cannot grow or potentially influence policymakers and others outside of the VA."

Congressmen agree with AOA's concerns

It's a message that resonated with members of Georgia's U.S. Congressional Delegation, who took up a bipartisan letter and signed on their support—a show of force against such a potentially harmful program.

In addition to reiterating AOA's initial concerns to VA Secretary McDonald, the eight Congressmen made clear their belief that "while such screenings can be beneficial as an adjunct to regular comprehensive eye examinations, these limited screenings are no substitute for the one standard of care the VA has always offered eligible vets, and that is a comprehensive, dilated eye examination."

"We are concerned that the TECS program is offering, in our opinion, a reduced level of care for some veterans, which does not conform with existing VA policy," the lawmakers concluded in the letter. They also asked the VA to answer specific questions, including why the VA was moving forward with the experimental program when the NEI has yet to conclude its study comparing the effectiveness of the TECS protocol with a face-to-face comprehensive, dilated eye examination.

The letter—sent to the VA Sept. 27—was signed by Reps. Barry Loudermilk (GA-11), Sanford Bishop, Jr. (GA-2), Lynn Westmoreland (GA-3), John Lewis (GA-5), Rob Woodall (GA-7), Jody Hice (GA-10), Austin Scott (GA-8) and Earl "Buddy" Carter (GA-1).

"We truly appreciate the VA's continual efforts to expand access of care to veterans, which means that most veterans in Georgia and across the country now have ready access to either VA eye doctors or contracted eye doctors through previously existing contracting efforts, and now through the VA Choice program," the Congressmen's letter states. "With doctors ready and able, we question why TECS screenings are being deployed in Georgia and tested on our veterans."

Although this letter doesn't halt the pilot program, it marks an important step to ensuring this does not become the norm system-wide.

"As soon as we learned about the TECS program, the Georgia Optometric Association took swift action, working with AOA to quickly educate representatives about the substandard care the program delivers to our veterans," says Ben Casella, O.D., GOA president. "This is a crucial first step, and we must continue to work together to fight for the whole profession and the eye and vision health of all of our patients."

Advocating for veterans' eye care

Eye care clinics staffed by VA doctors of optometry—and residents—are among the busiest primary care settings in the veterans' health care system. In 2014, more than 1.2 million veterans received comprehensive eye examinations and other essential care through VA doctors of optometry.

AOA has long supported measures that expand veterans' access to timely, quality eye and vision care services offered by in-person, comprehensive eye examinations, including legislation in this current Congressional session.

Passage of the bipartisan "Veterans Access, Choice and Accountability Act of 2014" (Choice Act) created the Veterans Choice Program, a way for eligible veterans to access care via non-VA providers should the veteran face an extended wait time or geographical hindrances. But an AOA-backed provision, H.R. 2496, effectively made it easier for veterans to qualify for this care. Through the Choice Act, non-VA doctors of optometry can provide care to America's veterans when needed.

Read how AOA members serve America's service members—at home and abroad—including via the Veterans Choice Program, in the November/December 2015 edition of AOA Focus.