Launch HN: Quadrant Eye (YC W21) – Tackling online eye exams and at-home eyecare

1) I don't believe I've stated that dilated eye exams should never be done. One of the biggest reasons remote eyecare is relatively far behind compared to other specialties (remote dermatology, for example) is the need to visualize the retina up to the ora, where a lot of pathology (e.g. retinal holes) can hide. Currently, the only ways to visualize the retina this comprehensively are a) scleral depressed dilated eye exams and b) use of wide retinal imaging (e.g. Optos.) Theoretically, "a" can be done in the home via an "on-call" ophthalmologist or optometrist and "b" can be done via an eye van (ZSFG actually has this option,) but neither of these can scale very well. So we're working on a scalable solution that will enable the collection of data on par with what can be gathered via a traditional dilated eye exam.

2) My 2 cents re: cost-saving and efficient glaucoma screening methods is that we need portable IOP measurement devices. Since we're currently limited by existing technology, my vote is for a using tonopen (portable, affordable, accurate) over non-contact tonometry (nonportable, expensive, not accurate) when it comes to rapid remote screening.

I won't argue that the current test isn't crude. We're rolling out increasingly sophisticated versions with each update, but I agree that in its current state our exam has a ton of room for improvement.

I do have to mention that the 1) vision check (e.g. do you see 20/20 with you current/expired prescription) and 2) the eye health tests are two different portions of our exam and serve two different purposes.

These latter set of "low-tech" maneuvers (double vision, amsler grid, red desaturation) are very high-level screening mechanisms for more serious underlying issues and do not have much to do with the numbers on a person's prescription. To be more specific, the overlapping circles are meant to assess if someone is having double vision, which in a worst case scenario could be a symptom of acute cranial nerve palsy.

1) Currently a lot of other services ask people to take "x" number of footsteps away from the screen to approximate "y" feet from the monitor. Using this context, I'd argue that the variation in arm length isn't as dramatic as variation in foot size. Ultimately though, when we're using near vision as a proxy for distance vision, the natural variation in arm length isn't crucial. But! Once we roll out our distance vision check, we won't be relying on arm length.

2) Will leave this to Kristine.

3) Interesting. Hadn't thought about this one. My guess is no because the most important ratio is optotype size:testing distance. (Optotype = the numbers/letters on the screen that a patient is reading)

4) It's possible and we'll need to pressure test this against gold standard in-person maneuvers.

5) Same as #4. Also this is a particularly interesting point because a similar problem exists in person. As an extreme example, I've had patients come in who've memorized the letters in the 20/20 line because they were very motivated by one thing or another (e.g getting their driver's licenses renewed.)

6) Is this the "which is better, 1-or-2" question? All I'll say is that there are a number of interesting ways we could try to simulate these.

Hope this answers some of the q's! Thank you for all the thought that went into them.

I think WP is a great company. I also agree that their vision check UX leaves a lot to be desired -- I ran through it myself a few times, and each time it caused intense frustration. There's something about needing to manipulate laptop and phone and having 14-20 ft of space that is just... impossible lol.

Anyway, our service is similar to WP's app in that we check vision for the purpose of determining if a prescription renewal is appropriate. But that's pretty much it. For us, this is only the tip of the iceberg. Fun times ahead!

Not sure how you'll get back to me, it never asked for an email or anything.

The no-script might be at fault though. You might consider not using any CDN for scripts, only host locally.

I did not try again because I don't have a prescription (I submitted an image saying "no prescription"), and I realized it can't do anything for me (I just wanted a checkup basically - just tell me how I did on the various sized letter thing).