DRY EYE DISEASE (DED) remains one of the most common conditions seen in practice, affecting ~16 million Americans (Stapleton, 2017). Many patients delay seeking care, with up to one-third of patients experiencing symptoms for 5 years before seeing an eyecare provider (ECP), 20% waiting longer than a year, and 60% delaying care for at least 4 months (Wozniak, 2025). Most patients try to self-treat until symptoms become too disruptive.

Teleoptometry is already valuable in diabetic retinopathy screening, glaucoma monitoring, and low vision rehabilitation (Massie, 2022). A recent example is a direct-to-consumer telehealth platform built specifically for dry eye (Rain Eyecare LLC, 2026). Patients complete an online symptom questionnaire, a licensed provider reviews the case, and treatment—usually cyclosporine 0.05% ophthalmic emulsion paired with preservative-free artificial tears—is shipped directly to their home using a subscription-based model.

The Evidence Actually Supports It

Telehealth services have been provided since 1999, with their use increasing significantly between 2015 and 2021 (Massie, 2022). Having a reliable symptom questionnaire is essential for remote assessments. The Ocular Surface Disease Index (OSDI) is one of the most validated patient questionnaires in all of ocular surface disease (Wolffsohn, 2024). The OSDI is sensitive and consistent, and it performs well in both full and abbreviated formats (Wolffsohn, 2025), which makes it a tool for telehealth-based follow-up care. Electronic versions of the OSDI and similar tools are easy for patients to complete at home, which is ideal for monitoring responses to treatment (Amparo, 2018).

The real sweet spot for using virtual visits: following patients who already have a diagnosis. Teleoptometry makes sense for a patient who has undergone a clinical exam to track clinical signs, treatment compliance, medication tolerance, and symptom patterns.

But There Are Real Concerns

Symptom history and some external signs can be picked up using an image on a screen. But conditions that mimic dry eye—infection, uveitis, corneal pathology—need an in-person exam to rule them out.

A complete dry eye workup involves equipment that doesn’t work through a camera: slit lamp exam, meibomian gland expression and grading, tear breakup time, fluorescein staining, osmolarity and Schirmer tests. Telehealth platforms, especially asynchronous ones, risk poor image quality, which could impact a provider’s ability to assess accurately.

The Tear Film & Ocular Surface Society Dry Eye Workshop III framework recommends a stepwise approach based on subtype and severity (Jones, 2025). A diagnosis of DED is based not only on symptoms but also on at least 1 sign of loss of homeostasis—distinctions that are challenging to make without proper diagnostic equipment.

The Practical Reality

The ideal situation, particularly for DED, is somewhere in the middle. Teleoptometry works well for patients who are already diagnosed. It’s beneficial for managing refills, improving access to care, and monitoring symptoms and compliance between visits. However, it’s not a replacement for a comprehensive dry eye exam.

A hybrid model is the most effective approach: starting with a telehealth visit to review symptoms and history, followed by an initial in-person exam, then remote follow-up for treatment monitoring. An ECP’s job isn’t to resist this technology, it’s to guide how it’s used and ensure it supports, rather than replaces, the ability to provide quality care.

References

1. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017 Jul;15(3):334-365. doi: 10.1016/j.jtos.2017.05.003

2. Wozniak P. Dry eye symptoms, severity, treatment and unmet needs: an analysis of the United States of America and a multinational snapshot [NESTS study]. Poster presented at: 43rd Congress of the European Society of Cataract and Refractive Surgeons (ESCRS); September 15, 2025; Copenhagen, Denmark. Poster No. ESCRS25-PP-3336.

3. Massie J, Block SS, Morjaria P. The role of optometry in the delivery of eye care via telehealth: a systematic literature review. Telemed J E Health. 2022;28(12):1753-1763. doi: 10.1089/tmj.2021.0537

4. Rain Eyecare LLC. The first dedicated dry eye telehealth brand has arrived: Rain Eyecare Launches FeelRain.com. PR Newswire. Published May 19, 2026. Accessed August 10, 2026. https://www.prnewswire.com/news-releases/the-first-dedicated-dry-eye-telehealth-brand-has-arrived-rain-eyecare-launches-feelraincom-302776034.html

5. Wolffsohn JS, Travé-Huarte S, Craig JP, Muntz A, Stapleton FJ. Appropriateness of questionnaires for the diagnosis and monitoring treatment of dry eye disease. J Clin Med. 2024 May 27;13(11):3146. doi: 10.3390/jcm13113146

6. Wolffsohn JS, Benítez-Del-Castillo JM, Loya-Garcia D; TFOS collaborator group. TFOS DEWS III: Diagnostic Methodology. Am J Ophthalmol. 2025 Nov;279:387-450. doi: 10.1016/j.ajo.2025.05.033

7. Amparo F, Dana R. Web-based longitudinal remote assessment of dry eye symptoms. Ocul Surf. 2018 Apr;16(2):249-253. doi: 10.1016/j.jtos.2018.01.002

8. Jones L, Craig JP, Markoulli M, et al; TFOS Collaborator Group. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025 Nov;279:289-386. doi: 10.1016/j.ajo.2025.05.039