South Carolina residents must continue to obtain in-person eye exams for new glasses or contact lens prescriptions after the state Supreme Court upheld a ban on online vision testing.
In a unanimous decision issued Wednesday, the court ruled that the state’s 2016 law blocking remote vision tests does not violate the South Carolina Constitution. The ruling ends a nearly decade-long legal challenge brought by Visibly, a Chicago-based telehealth company formerly known as Opternative.
Visibly’s service allowed patients aged 18 to 55, with existing prescriptions, to take an automated vision test using a smartphone or computer. A licensed optometrist or ophthalmologist in the user’s state would then review the test and issue a prescription.
The U.S. Food and Drug Administration (FDA) cleared the technology, which is allowed in 35 states. But in 2016, South Carolina passed a law that effectively banned its use unless followed by an in-person exam. The legislation was supported by the South Carolina Optometric Physicians Association.
Gov. Nikki Haley vetoed the bill, but the General Assembly overrode her decision in May 2016.
Visibly sued later that year, arguing the law was unconstitutional. The courts disagreed. In a July 2024 decision, now Court of Appeals Judge Kristi Curtis wrote the law was intended to protect patients from inadequate care.
Visibly’s attorneys argued the law favored optometrists’ business interests by requiring in-office visits, which can include opportunities to sell glasses and contacts.
“If you’re not coming in, they’re losing that opportunity to make a sales pitch,” attorney Joshua Windham told the South Carolina Daily Gazette.
Kevin Campbell, chair of the state optometrists association, supported the ruling. “We know an in-person exam is the safest and most comprehensive form of care,” he said.
The court cited expert testimony from an optometrist and a neuro-ophthalmologist, who said annual in-office exams help detect vision and systemic health conditions, including glaucoma, cataracts, and diabetes-related issues.
However, some in the medical community disagreed. Dr. Kurt Heitman, a Greenville-based ophthalmologist, noted that not all eye professionals opposed the online tests.
“Young, healthy patients with glasses don’t need to come into the office every year,” Heitman said. “If the technology is accurate, it’s actually beneficial because it’s less expensive and increases access to care.”
Visibly also claimed the law was discriminatory because other medical professionals in South Carolina can prescribe treatments like eye drops through telehealth. State law limits telemedicine only for opioids, medication abortion, glasses, and contact lenses.
“Glasses are not like opioids and abortion,” Windham told the Gazette.
Writing for the court, Justice John Few drew a contrast between remote services that include live video evaluations and automated online eye tests. He wrote that the latter lacks a direct visual examination by a medical professional.
Windham criticized the ruling, calling it “an abdication of the court’s duty.” He argued the law targeted Visibly to protect traditional optometry business models.
Still, the justices acknowledged the evolving role of technology in health care.
“In light of the speed in which artificial intelligence and other technology continues to develop, we are confident the General Assembly will continue to monitor the policy rationale behind the Eye Care Consumer Protection Law,” Few wrote.