Eyeglasses are an essential service for eligible veterans, as vision impairment can lead to mental health concerns, falls and need for social care. VA Prosthetic and Sensory Aids Services is committed to providing all eligible veterans with eyeglasses and, in 2023, provided nearly two million pairs of eyeglasses to veterans.

Eye care is one of the top three busiest VHA services, and eyeglasses represent between 10-20% of VA prosthetic purchases. High demand can lead to waiting for eyeglasses and a negative experience for veterans.

A team of prosthetic staff from Veterans Integrated Services Networks (VISN) 23 and VISN 22 recognized that manual eyeglass ordering was time-consuming.

Those two VISNs serve veterans in Arizona, New Mexico, California, Iowa, Minnesota, Nebraska, North Dakota, South Dakota and portions of Illinois, Kansas, Missouri, Wisconsin and Wyoming.

One order could be 40 steps long and take hours to complete. With a vision to improve the experiences of an estimated 1.3 million veterans ordering 1.6 million pairs of eyeglasses, the team created 4-Sight. This software tool uses automation to improve the speed and efficiency of eyeglass delivery to veterans.

Framing the future of eyeglasses for veterans

The journey to 4-Sight started in 2015 when Tim Strebel and colleagues at VA Long Beach Healthcare System developed a way to automate oxygen delivery to veterans' homes. After the practice was designated a Diffusion of Excellence 2017 VHA Shark Tank Competition winner, the successful automation process gained the attention of the VISN 23 prosthetic program.

VA employees Brian Kaiser and Spencer Mion were on a mission to improve the eyeglass ordering process. Together, the team developed 4-Sight, an adaptation of the automated oxygen delivery software tool reconfigured to reduce or eliminate processing time for eyeglass orders.

4-Sight also increases the likelihood that veterans will receive the correct eyeglasses by ensuring vendors receive accurate patient prescription information.

In 2018, with support from VISN 23 staff, Kaiser piloted 4-Sight at Sioux Falls VA, reducing the number of steps in the process from 40 to six. After this impressive achievement, the team was able to expand the practice across VISN 23 and VISN 22 that same year.

Spectacular results

By the end of 2018, 4-Sight saved 3,605 hours of processing time for 112,3477 orders of eyeglasses. The team entered 4-Sight in Diffusion's 2018 VHA Shark Tank Competition and the practice was selected as a winner to replicate at Lexington VA and Great Lakes VA. By the end of 2019, 4-Sight had reduced veteran wait times for eyeglasses by over 53%.

"We were able to essentially work more efficiently and provide better services to our veterans," said Mion, noting how the improved process allows more attention for other orders, such as wheelchairs and prosthetic limbs. By improving efficiency and reliability, the practice supports VA's journey to a High Reliability Organization.

In collaboration with Diffusion, the 4-Sight team has implemented its innovation in 82 sites across 13 VISNs, processing over 4,000,000 eyeglasses orders and saving over 55,000 hours of processing time, getting eyeglasses to veterans faster.

"The goal would be to have it at every medical center in the country," shared Kaiser. The team is on its way to achieving this vision and sustaining the practice with plans to create a web-based application with enhanced reporting features.

To learn more about 4-Sight, explore their page on Diffusion Marketplace. If you are a veteran looking to learn more about VA eye care services, contact your VA primary care provider. Want to learn more about innovation at VA? Visit our website, scan Diffusion Marketplace, subscribe to our weekly newsletter, and explore VA Pathfinder to learn more about our opportunities.

Innovation Heroes is a recurring series from the VA Innovation Ecosystem focusing on VA employees who are driving innovation forward and improving the lives of veterans and fellow VA employees.