[HN Gopher] Launch HN: Quadrant Eye (YC W21) - Tackling online e...
___________________________________________________________________
Launch HN: Quadrant Eye (YC W21) - Tackling online eye exams and
at-home eyecare
Hey HN -- This is Quinn and Kristine of Quadrant Eye
(https://www.quadranteye.com). We're a cataract surgeon and
software engineer duo who are spearheading the at-home eyecare
revolution. Our goal is to provide comprehensive eyecare to people
at home, and as a first step, we're tackling online glasses/contact
lens prescriptions renewals. I (Quinn) started the company after I
took care of a grandfather who tragically went blind during the
Covid lockdown. This could have been prevented if he had had access
to reliable at-home eyecare. During my training, I had seen
countless similar scenarios play out around the country, but to
have it happen in my own clinic was the last straw. Eyecare is a
weird and tricky space. On the one hand, there are legitimate
reasons why eye doctors and their patients are tied to a physical
office, and they mostly center on bulky hardware limitations (e.g.
the slit lamp biomicroscope.) On the other hand, there are actually
few legitimate reasons healthy people without eye disease need to
be making routine in-office visits. In fact, the American
Association of Ophthalmology (AAO) recommends that folks with
healthy eyes, good vision, and no risk factors for eye disease get
a comprehensive exam just once in their 20s and twice in their 30s.
With this context, it's absolutely wild that while millions of
people are overexposed to eyecare via unnecessary pupillary
dilations and air puff tests (which by the way are wildly
inaccurate,) millions more can't access even basic eyecare
services, including refractions (aka the measurement of one's eye
prescription.) After all, 24% of U.S. counties have no optometrists
or ophthalmologists! Online eye exams are a first step toward
addressing this pervasive access and resource allocation problem.
We're building our own version (feel free to play around with the
prototype but please _access via deskop /laptop only_:
https://app.quadranteye.com/va/creditcard) which is an asynchronous
exam that assesses your vision and eye health; the exam results,
along with a glasses/contact lens prescription uploaded by the
patient, always get reviewed by an offsite MD/OD. Our online exam
is live and we've been renewing prescriptions for a few weeks now!
Unfortunately, online eye exams are limited in their scope and
utility -- for one, they are unable to measure essential eye vitals
such as pupillary response and eye pressure. These exams also
happen to be extremely controversial, especially since they disrupt
the traditional "go into the eye doctor's office, renew your
prescription, buy your glasses/contacts from your eye doctor"
model. For evidence that the $18B domestic optical industry stirs
up strong emotions, check out this previous HN thread:
https://news.ycombinator.com/item?id=21653437 (and dang tells us
there have been many others!) We believe online eye exams are a
good catalyst for change, but they are definitely just a stepping
stone. We've got our eyes on a much bigger vision -- true at-home
eyecare, including the ability to measure eye vitals -- and we're
excited to have everyone follow along! Thanks for reading and see
you in the comments below. :) Cheers, Quinn and Kristine P.S.
We're in the middle of a redesign and would love your feedback on
how to improve the flow + ux! P.P.S. We can't talk much about the
details right now, but if you want to be notified when we roll out
the beta version of our comprehensive exam (which includes
hardware,) please fill out this survey:
https://qhqh.typeform.com/to/whuiAFHo
Author : Killakwinn
Score : 79 points
Date : 2021-06-07 15:30 UTC (7 hours ago)
| yatacct1 wrote:
| Looks promising. Like the site design; Will try this today.
| Killakwinn wrote:
| Amazing -- thanks so much :D
| trashface wrote:
| I'm a former programmer, now in mid forties, and recently
| diagnosed with low-tension glaucoma, so I appreciate the value in
| your service. I have no family history so I wonder if my long
| years of staring at screens had something to do with it, though I
| realize the causes are complex and not well understood.
|
| In my case it was caught reasonably early but I feel it could
| have been caught earlier. Its a bit surprising to me since I did
| have regular dilated eye exams. If screen time is indeed
| implicated, I do wonder if there is an epidemic of eye/optic
| nerve damage brewing, especially since those who don't wear
| corrective lenses probably aren't getting regular exams and may
| not realize they have risk factors or even damage.
|
| Perhaps its not the screens themselves, but what's on them. The
| stress of social media causing everyone's IOP to randomly
| skyrocket.
|
| I'm still coming to grips with my diagnosis and its
| repercussions. Not the least of which is the cost of the drops I
| need to take now for the rest of my life. $110 for a three month
| supply, and I also have to agree to not make a claim on my
| insurance to reimburse me, so its all out of pocket. Its pretty
| shady, but they are what my ophthalmologist wants me to use, and
| I don't want to mess around with blindness.
| Killakwinn wrote:
| Hi. Thank you for sharing your story. Vision is such a critical
| part of our daily lives, so receiving a diagnosis like this can
| be very painful.
|
| Unfortunately, the only way to slow down the damage related to
| glaucoma is to lower eye pressure (IOP.) This is accomplished
| via medications, lasers, and surgery. Typically we start with
| the least invasive option, which is medications (aka eyedrops.)
| It sounds like you are receiving the standard of care, which is
| a good thing.
|
| Re: cost of care, I think we can all agree that things need to
| change.
| LorenPechtel wrote:
| Not wanting you to make an insurance claim sounds very shady
| indeed. As in being ripped off.
| flanbiscuit wrote:
| What were your symptoms? or was this only noticed during an
| exam and you had not realized anything was going before the
| exam?
|
| > and I also have to agree to not make a claim on my insurance
| to reimburse me, so its all out of pocket. Its pretty shady,
| but they are what my ophthalmologist wants me to use, and I
| don't want to mess around with blindness.
|
| I'm not too familiar with the all the inner workings of
| insurances but curious why you had to do this?
| trashface wrote:
| I did have some eye discomfort, dryness, etc. I chalked this
| up to allergies. I wasn't immediately diagnosed, but she said
| it was suspect. About a year later the visual field test
| showed that it had worsened, so the diagnosis became
| official.
|
| As far as the drops go, its a a brand-name drug. My doc
| suggested that there was a generic option available but it
| was also clear that it wasn't her preference. The signup
| process was online and as part of it I had click through on
| an agreement that said I wouldn't try to claim it on my
| insurance. I don't know what happens if you violate that.
| Maybe they refuse to give you refills. There were other
| suspicious aspects and dark patterns in the UI of the signup
| process; it smelled like a moneymaking scheme.
| conqrr wrote:
| I was diagnosed with glaucoma at the age of 17 by a doctor. It
| was hard for me to comprehend that I'd have to take drops for
| the rest of my life. I do have pretty bad myopia and
| astigmatism. This was in the middle east. On doing a recheck
| back in India, I had a very comprehensive testing with multiple
| doctors checking for glaucoma and retinal damage and was told
| that while I'm a suspect, there's no reason for me to take
| drops. My IOP was calculated taking into account the diameter
| of the pupil (I think) and Goldman test which wasn't done
| previously. The doctors proceeded to explain that in the west,
| doctors are more likely to prescribe treatment for glaucoma
| because of all things around insurance etc. At minimum, I
| recommend getting a second opinion, if possible from a country
| that's not riddled with such insurance schemes.
| Killakwinn wrote:
| There are several difficulties when it comes to managing
| glaucoma: 1) There are different types of glaucoma that have
| different diagnostic criteria 2) Different people have
| different risk factors for glaucoma development, disease
| progression, and treatment response. What works for one
| person may be completely ineffective for another 3) Our
| glaucoma data (for diagnosis, progression, treatment) is
| largely based on a cohort of data gathered from Caucasian
| patients; researchers and clinician are generating
| population-specific (Blacks, Asians, etc,) data, but there's
| definitely still a long way to go 4) There is some
| subjectivity that goes into diagnosing/treating/monitoring
| glaucoma, which is why one doctor may decide to start you on
| drops while another may choose to observe without
| intervention -- in cases that are not clear cut, either
| approach may be correct
| trashface wrote:
| Thanks for your story. I hear what you are saying and I do
| plan to get a second opinion. Apparently here in the US there
| are some people who have had their glaucoma un-diagnosed.
|
| But I have some confidence that its real. First, my doc
| wasn't eager to do it, she just suspected it at first, and we
| did some tests and waited for a while. But later, a followup
| visual field test did show some actual loss in one of my
| eyes, but not something I noticed.
|
| The whole business with the drops is annoying, but its not
| unexpected. Still, that would be a business model worth
| disrupting.
| hsiaosquad54 wrote:
| Awesome! Excited to see the progress!
| Killakwinn wrote:
| Appreciate the support :)
| bobawu wrote:
| Congrats on the launch! So what technology or design are you
| using that allows you to have the same kind of accuracy as an in
| person office visit?
| codegeek wrote:
| "unnecessary pupillary dilations and air puff tests (which by the
| way are wildly inaccurate,) "
|
| How true is this ? I am not refuting this as I have no
| credentials in this space but as someone who is very near
| sighted, I depend on these exams to make me feel safe and I do
| them once every year as the doctors have suggested over the
| years. It is scary to know that they are wildly inaccurate.
| 542458 wrote:
| I strongly object to these statements.
|
| Dialation may not be necessary every single time for a healthy
| adult, but it's good to do occasionally as there are serious
| diseases that can only realistically be checked by getting a
| good look at the back of the eye.
|
| Puff test can be vision-saving. It takes almost no effort, and
| is an excellent screen for glaucoma. Catching glaucoma early is
| essential to saving your vision.
| Killakwinn wrote:
| Good question. These statement applies to patients who have
| _no_ to _very minor_ eye issues, meaning healthy people under
| age 40 who have refractive errors of ~1D (ideally less,) who
| have never been diagnosed with eye disease, who have no family
| history of eye disease, and who have good vision (that they are
| happy with.) It sounds like you probably have a refractive
| error of >6D, in which case yearly dilated exams are good
| practice.
|
| Re: inaccuracies, what I am referring to is the air puff test.
| The air puff test is a very crude measurement of eye pressure
| (aka intraocular pressure, or IOP.) The gold standard is
| Goldman Applanation, which involves putting yellow fluorescein
| drops in your eye and then using the applanation tip and a blue
| light to assess IOP.
|
| More on Goldman Applanation here:
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206330/
|
| Hope this helps!
| entee wrote:
| Just got a postcard from my optometrist the other day saying it's
| time for my annual prescription check. My eyes are no different,
| but my glasses are scratched, so I need to spend an hour or two
| to get this fixed instead of just reordering glasses online.
| Can't wait to use a service like this instead, much faster and
| easier, good luck!!
| KingMachiavelli wrote:
| In the US at least, you can order glasses online as long as you
| _know_ the prescription. It 's contacts that require a 'valid'
| prescription which only lasts a year and they will only let you
| buy a 'years' worth of contacts at a time.
| Killakwinn wrote:
| The rules around this vary state by state. In states like CA,
| it's unfortunately illegal to sell glasses/contacts to
| someone with an expired prescription.
|
| More info on buying glasses/contacts:
| https://www.consumer.ftc.gov/articles/buying-prescription-
| gl...
| karaterobot wrote:
| I'm in WA, and I have to upload a photo of my prescription to
| buy glasses from a popular online eyeglass vendor whose name
| rhymes with Warby Parker. My impression is that it's a state-
| by-state thing. In my opinion it's pretty silly require this
| for eyeglasses (contacts are a different matter).
| Killakwinn wrote:
| I think that there are many scenarios in which there
| shouldn't be a 1 year expiration date for glasses or
| contacts. For example, if someone has a very
| straightforward glasses/contact lens prescription (<2D, no
| astigmatism) that has not changed in years and if that
| person has also never had an abnormal eye exam, then there
| is an argument to be made about having a more open-ended
| expiration date.
| jackson1442 wrote:
| Same here in TX. Got a nice bold expiration date on my
| prescription too, but can't remember if it's one year after
| I uploaded the picture or one year after the scrip was
| issued.
| 542458 wrote:
| There are two parts to this. One, yeah the optometrist wants
| your money, sure. You probably don't need your script checked
| annually unless you're old or there's something serious already
| known to be wrong with your eyes.
|
| But... Not perceiving a change in your vision doesn't mean your
| eyes are healthy - there are all sorts of diseases that a
| decent optometrist is screening for during an eye exam. Most
| notably glaucoma, which is irreversible and often presents no
| symptoms. This is what a lot of "check your vision at home"
| things miss - they can hand you an eyeglass prescription (so
| long as your vision isn't too far outside the norm) but they
| almost never screen for disease, and catching those diseases
| early can be the difference between seeing and legally blind.
| Killakwinn wrote:
| Hi! This is the perfect use case and one that we keep hearing
| over and over again from friends/ family/ colleagues/
| acquaintances. Really looking forward to helping you out! :)
| bruceb wrote:
| I think its cool to have more options. But what is the difference
| between this and the ones that are free online at the moment?
| 100kristine wrote:
| Great question!
|
| All existing online eye exams focus on prescription renewals
| and omit the eye health checks that you would get in an in-
| person visit. (An optometrist can catch all sorts of issues -
| eye tumors, early signs of glaucoma etc.) We're working to
| build a better and safer way to access the full spectrum of eye
| care online, going beyond just prescription renewals.
|
| The current exam has some eye health maneuvers that flag
| unusual symptoms and intake answers that should be investigated
| more closely. This is just the start though - much more in the
| works!
| ingend88 wrote:
| Would $30 be covered by the insurance as well ?
| Killakwinn wrote:
| Good question. Right now everything is out of pocket. The ideal
| scenario is for this service to be covered by employers as well
| as payers; don't worry, we'll make this happen in the future!
| ottermax8 wrote:
| congrats on the launch Kristine and Quinn!
| Killakwinn wrote:
| Thank you so much -- love the enthusiasm from this community :)
| shkkmo wrote:
| I haven't had an eye exam on over a decade (since my mid 20s). I
| use my old prescription and order cheap glasses online. The
| extreme savings and arguably higher utility of this approach had
| always given me the strong impression that the eyecare industry
| is fundementally broken and full of rent seeking.
| Killakwinn wrote:
| There really is a lot that we can do to improve how people get
| eyecare and eyewear. I did want to point out that there's an
| entire other side of the eyecare industry -- eye health -- that
| gets overshadowed by the eyewear/optical aspect of eyecare.
| Obviously all sides of the eyecare industry need fixing, but I
| do I think part of the puzzle is bringing the eye health
| portion more front and center. (But ultimately there's no
| argument that things are broken.)
| shkkmo wrote:
| This is true amd something that I had not strongly
| considered. While my prescription still seems fine, it us
| probably worth scheduling an exam to check my eye health now
| that I am in my 30s.
| Killakwinn wrote:
| I support this! :D
| somberi wrote:
| Quinn and Kristine : Congrats on what seems to be an useful
| service. All the best.
|
| Sent you an email on a visual nit (from nandyal)
| Killakwinn wrote:
| Yes, we got the email -- thank you for the input!
| KingMachiavelli wrote:
| I love this. At least in the US, ophthalmology & dentistry seem
| ripe for disruption/improvement as they have some really strange
| rules yet 90% of people's interactions with them are very
| routine.
| Killakwinn wrote:
| Completely agree, and I would attribute some of this to
| excellent marketing. Lately I've been thinking about how so
| much of our behavior and societal/cultural norms (e.g. bacon
| and eggs are breakfast food! drink milk to prevent your bones
| from crumbling into a million pieces!) all come down to
| brilliant longform marketing efforts.
| hhw3h wrote:
| Is your service available at this time? The website suggests that
| it is, but based on your post here it sounds like you are pre-
| beta?
|
| Congrats on the launch, I can see the value in this.
| Killakwinn wrote:
| Yes, we are in fact live and have been renewing prescriptions!
| The beta signup link is for our _full_ software + hardware
| exam, which is currently still in the works.
| shkkmo wrote:
| The eye exam layout on mobile Firefox is broken, stuff is being
| pushed off the left side of the screen but you don't allow
| scrolling to bring it into view. It still doesn't work properly
| if I switch to desktop mode.
| 100kristine wrote:
| That's our bad! The exam is only built for desktop - we don't
| allow mobile in the usual flow because the vision charts need
| to be displayed at a certain height (*will add to our post).
|
| I can't seem to replicate the issues you're having on
| firefox/desktop, it displays normally for me. If you shoot me a
| screenshot at kristine@quadranteye.com, happy to take a look.
| shkkmo wrote:
| I sent a screenshot to your support chat widget when it
| happened.
| Killakwinn wrote:
| Sorry about this, we're looking into it. It's optimized for
| desktop/laptop viewing, so it's strange that you're having
| desktop issues.
| jb1991 wrote:
| Interesting, I went through it, but then it got to this slide:
|
| > look at the image of the circle at the top of the page.
|
| And there is no circle whatsoever on that page, so I didn't know
| if it was a typo, a browser problem... or my eyes went blind!
| 100kristine wrote:
| Hmm, we have actually never gotten that! Can dig into it.
|
| What browser/device are you on? We don't support mobile (added
| this to post!) because the vision charts need to be displayed
| at a certain size. There's usually a warning that pops up for
| mobile, but it's earlier in the flow than what we posted to
| HKN.
| BrianB wrote:
| Would you work with endmyopia.org to progressively reduce
| prescription strength?
| Killakwinn wrote:
| I am not familiar with this organization and will look into it.
| Thanks for bringing them to my attn!
|
| Re: working with orgs, we're interested in partnering with
| those committed to advancing quality eyecare for all population
| segments. We're currently working with nonprofits like
| LightHouse for the Blind to bring eyecare to those with low
| vision. I've personally referred many patients to LightHouse
| and think that they provide a valuable resource to an otherwise
| overlooked portion of eye patient population!
|
| One last point here. Re: slowing down myopia progression, I
| personally think atropine is the most promising intervention!
___________________________________________________________________
(page generated 2021-06-07 23:00 UTC)