Can Your Smartphone Replace your Eye Doctor?

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For most of the history of mankind, we have built specialized machines to do work: plows to attach to oxen, hoes to till the field, screwdrivers to turn screws, eye examination appartuses (I have no idea what they are actually called) for optometrists to, well, examine our eyes.

Over time, as these machines have become more sophisticated, we have found that they could work better if some of the manual tasks were performed by computer. Thus, telescopes gained computerized controls, cars gained computerized cruise control, eye exam machines (really, no idea) gained digital images and measurement.

At the same time, we have begun walking around with pretty powerful mini-computers in our pocket - our smartphones. As the computers on machines became more powerful - and, in many cases, more expensive - than the base machine itself, it became almost inevitable that smartphones with tools attached could replace some specialized machines with computers attached.

Entire professional-quality commercials have been shot using iPhones and some add-on lenses. Heart sensors are being added. Square and others offer credit card readers. The business of manufacturing many devices has moved from specialty equipment manufacturer to specialty smartphone add-on manufacturer.

Next in the target of change: eye exams.

Smart Vision Labs, a New York-based startup, has combined an add-on iPhone lens with software to do an entire optometry exam. The device - which is larger than the iPhone itself, but smaller than a professional camera lens - measures the retina and all parts of the eye, uses software to pull it together, and then is able to give a precise vision correction recommendation.

Will this replace the optometrist? If so, how; if not, then who? Assuming they succeed (big assumption):

First of all, specialized equipment costs will go up. Yes, your ophthalmologist will now need to pay more for his/her special eye exam machine. Whereas these manufacturers used to sell higher-end devices to ophthalmologists and middle- to lower-end to optometrists, much of their lower and middle market will dry up if devices like these succeed. Why pay a premium to manufacturers for some lenses and a specialized computer when you already have an even more powerful computer and software? With the move upmarket, manufacturers will have no choice but to have higher margins on a smaller market. The same effect happens when drugs come off patent: the generic costs much less than the protected name-brand used to, but the name-brand price goes up.

Second, some optometrists will see their businesses threatened. With consumers, insurers, employers and governments all looking to cut health care costs, automation of the eye exam process is like automation in every industry - replacement of highly-trained workers with a few machine operators. A properly automated eye exam, for the majority of use cases, can be done by a trained technician or nurse; no optometrist required.

Third, because of the above 2 factors, ophthalmologist services will cost more but be used less often, while eye exams will cost less and be used more frequently.

Finally, the founders' dream of "bringing eye exams to the third world" may have some success, but primarily due to traveling doctors. People who cannot afford the $5 equivalent for an annual eye exam with the local optometrist equivalent most definitely do not have a $200 smartphone, let alone $650 iPhone. But "Medicins Sans Frontieres" and similar organization very well may.