The South Carolina Supreme Court affirmed a circuit court decision upholding the state's Eye Care Consumer Protection Law in a ruling that deals a significant blow to telehealth companies offering automated eye examinations. The court's decision in *Opternative, Inc. v. South Carolina Board of Medical Examiners* maintains restrictions on prescribing eyewear based solely on automated testing equipment.
The case centers on sections 40-24-10 and 40-24-20 of the South Carolina Code, known collectively as the Eye Care Consumer Protection Law. The statute prohibits eye doctors from prescribing "spectacles" or "contact lenses" based solely on information generated by automated equipment designed to measure refractive error. Specifically, the law states that "a prescription for spectacles or contact lenses may not be based solely on the refractive eye error of the human eye or be generated by a kiosk."
The legislation defines a "kiosk" broadly as "automated equipment or an automated application, which is designed to be used on a phone, computer, or Internet-based device that can be used in person or remotely to provide refractive data or information." This definition effectively encompasses the technology developed by companies like Opternative that allow patients to conduct eye examinations using smartphones or computers.
Opternative, Inc., a telehealth company that developed automated software allowing individuals to use computers or smartphones to determine their eyeglass prescriptions, challenged the law as a violation of equal protection and due process rights under article I, section 3 of the South Carolina Constitution. The company argued that the restrictions unfairly targeted their innovative technology and prevented consumers from accessing convenient and cost-effective eye care services.
The legal challenge was supported by the Institute for Justice, a libertarian public interest law firm known for challenging occupational licensing restrictions. Joshua A. Windham and Robert J. McNamara from the Institute for Justice, along with Miles Edward Coleman from Nelson Mullins Riley & Scarborough, represented Opternative in the case.
Defending the law were the South Carolina Board of Medical Examiners and the South Carolina Department of Labor, Licensing and Regulation, represented by Eugene Hamilton Matthews from Richardson Plowden & Robinson. The South Carolina Optometric Physicians Association intervened as a respondent, represented by Kirby Darr Shealy III from Adams and Reese LLP.
The case originated in Richland County, where Circuit Court Judge Kristi F. Curtis initially ruled in favor of the state defendants. Opternative appealed directly to the South Carolina Supreme Court, which heard oral arguments on June 3, 2025, before issuing its decision on Jan. 21, 2026.
Justice Few authored the court's opinion, which affirmed the circuit court's ruling without providing detailed reasoning in the excerpt available. The court's decision supports the state's argument that the Eye Care Consumer Protection Law serves legitimate regulatory purposes in protecting consumer safety and ensuring proper medical oversight of vision care.
The ruling reflects broader tensions between traditional healthcare delivery models and emerging telehealth technologies. Supporters of automated eye examination technology argue that such services increase access to eye care, particularly in underserved areas, while reducing costs for consumers. They contend that automated refractive testing can be as accurate as traditional methods for routine vision correction needs.
Conversely, traditional eye care professionals and regulatory bodies maintain that comprehensive eye examinations require direct physician involvement to detect serious eye conditions that automated equipment might miss. They argue that regulations like South Carolina's Eye Care Consumer Protection Law protect consumers from potentially inadequate care that could delay diagnosis of serious eye diseases.
The decision has implications beyond South Carolina's borders, as similar debates over telehealth regulation and automated medical testing play out in legislatures and courts across the country. Several states have enacted or considered similar restrictions on automated eye examinations, while telehealth companies continue to challenge such laws as protectionist measures that stifle innovation.
For Opternative and similar companies, the ruling represents a significant setback in their efforts to expand automated eye care services. The company's business model relies on providing convenient, app-based vision testing that allows users to obtain eyeglass prescriptions without visiting a traditional eye care provider.
The South Carolina decision may influence similar cases in other jurisdictions and could affect how courts balance consumer protection concerns against arguments for technological innovation and market competition in healthcare services. The ruling demonstrates that state supreme courts are willing to uphold traditional regulatory frameworks even when faced with constitutional challenges from technology companies seeking to disrupt established healthcare delivery models.
Looking ahead, Opternative and other telehealth companies may need to adapt their business models to comply with state regulations or pursue legislative rather than judicial avenues for changing restrictive laws. The decision underscores the ongoing legal and regulatory challenges facing companies that seek to introduce automated alternatives to traditional medical services.