In episode 8 of “Can I Ask You One Question?”, Dr. Mike Rothschild of Leadership OD shares his experiences and offers some great insight into the topic of telemedicine.

Below are the key points from the interview. Scroll down to see the entire interview.

Mike starts the interview by making sure everyone is “speaking the same language” when it comes to telemedicine.

He does this by defining asynchronous versus synchronous care:

Asynchronous care involves using an online tool to get healthcare information or advice without ever talking with anyone.

A lot people think of telemedicine as online apps where you log onto an app and take an eye test and get an eyeglass prescription without ever talking to anybody.

“We’re all opposed to that. None of us think that’s good for our patients or our profession.”

Synchronous care involves a connection – you can see and talk with someone in real time.

“That’s the way you want to connect with a patient and give them care.”

A year before COVID, Mike started a practice with the main premise being to deliver eye care remotely.

His practice provides a comprehensive eye exam with a remote provider.

Like any other practice, they have autorefractors, retinal cameras and all sorts of instruments and testing being done. The difference is the doctor(s) remote in and control the instruments remotely while talking to the patient.

They remotely do the history, listen to complaints and make recommendations through the Internet.

The computer monitor sits where the doctor would be sitting, and the patient and doctor are face to face.

He also offers what he calls VAHO – virtual at-home optometry visit

The patient logs in at home through a device like Zoom or, and you’re connecting with the patient and doing certain eye tests, follow-up visits, contact lens progress exams and even triaging emergencies.

This is often used in combination with in-office visits.

We can acknowledge it’s not the same thing as seeing a patient in person, but more ODs are becoming increasingly open to a hybrid model of care.

This provides more opportunities to enhance the care provided to patients.

There are applications in areas where accessibility to eyecare is limited, even in big cities with access problems due to limited transportation.

As for trends, society is becoming less and less patient about waiting for care and wanting care when it’s convenient for them.

Mike’s Rule #1:

“Our job is to make sure we have enough clinical information to make a good clinical decision based on the patient’s individual needs.”

If we can’t get enough information from these instruments to satisfy Rule #1, we need to insist on another way, which may require bringing the patient into the office.

Watch the interview below.


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