If you’ve been following, you read the Dugout Dirt column of two months ago, regarding Rhode Island’s fight to reasonably regulate tele-optometry’s inroads into that state. For best results, read the article first: http://fluorescene.odcommunity.com/what-telemedicine-baseball. Here is a follow-up, in the form of a response from Mr. Mike Stenhouse, Director of the Rhode Island Center for Freedom and Prosperity. (Mr. Stenhouse, a former major league baseball player, has argued against the regulation of tele-optometry in the state of Rhode Island.)

“Dr. Potter, very much appreciate your anecdotes and professional note. Unfortunately, my memory of games long ago is not as good as yours. I had a good laugh.

Regarding the issue you raise, let me first say that I share your concerns. However, we do not believe that stifling government regulation is the answer. I’m sure you understand, regardless of the good intentions, that, to many, such an approach immediately appears protectionist in nature. In far too many emerging technologies and industries, similar concerns (some valid, some contrived) have been used as excuses to impose protectionist policies against competition. This kind of cronyism is harming economic growth and consumer freedom.

The alternative, as with most all regulatory issues, is free-market competition. As I suggested to a local optometrist last year, land-based eye care professionals almost always have first-contact with the patient. There is no reason you cannot create your own educational pieces to leave with them, to engage in the online business yourselves, or to form your own private association of accredited ocular telemedicine providers and use that to your competitive advantage via a dedicated marketing campaign.

As non-medical professionals, we have no basis to make any judgment about the medical safety or effectiveness of any procedure. But we strongly believe, that unless there is some absolutely proven circumstance where certain practices must never be allowed to occur, that the free-market must work such issues out on its own. There are risks in every consumer decision, whether ladders, autos, or a pair of scissors.

Short of a ban or oppressive mandate, labeling or other informational warnings/messaging, may be a compromise solution. But ultimately, we strongly believe that consumers should have the right to make their own informed choices.

I see that a House and Senate bill has been submitted again this year. We will likely provide written testimony to the committee.

Best wishes to you and it would be great to chat further over a bucket of balls…out on the field, though, not in a cage! LOL



Mike Stenhouse, CEO”

My response

Dear Mike,

I am not sure of that one, referring to the bucket of balls on the open field. I can still cut a fastball into the fat part of a lefty’s bat, and the open field accentuates how hard the ball is hit.

On the tele-optometry issue, I’d like to make a few more points. I agree that it is difficult to argue against free-market forces. I admired my Wharton classmates at Penn, and I hold their beliefs in the economic system that we have evolved here in the United States. But, healthcare issues merit separate consideration, and here is why:

For your “ladders, autos, or a pair of scissors,” I have an example in mind. If Home Depot sold a series of defective ladders, my neighbors and I would know it, because we guys are pretty good at judging ladders, i.e., you fall off or you don’t. If the store failed its duty, market forces would certainly take over, and sales would plummet. 

Healthcare results are much more nebulous, as well-being is a long-term status and not an event. The subtleties of a proper eye exam go far beyond the layman’s skill set. You could generalize this to any area of medicine, but for us, hardly a day goes by where we don’t pick up the nuances of early glaucoma, cataract, and macular degeneration. The “fall” from this ladder is a much more vague and drawn-out process.  You can’t rely on market forces to mitigate the million optic nerve fibers that might be lost in early glaucoma.

Your point about educating patients is a good one, and most of us do so with great enthusiasm. The problem is that human nature builds a long lag time before our consultations sink in. It often takes years of relationship-building to attain the desired result.

Let me go back to one more point. Healthcare professions are already regulated to near-death. Our exams are specified by law in NJ and other states. Our procedures and prescriptions have strict scrutiny. We report data to the government to a degree that the layperson cannot begin to understand. With telemedicine, we have an opportunity to appropriately regulate the procedure and actually afford the level of protection that is indicated.

In closing, let me say that I admire the advocacy that you and your center pursue. I am hoping that the compromises that you propose can be elaborated, with best results for public health and safety.

Best regards,


William B. Potter, OD