Patients Missing Out On Low Vision Services

Megan Brooks

November 27, 2014

Many baby boomers who could benefit from low vision therapy aren't getting it for a variety reasons, including a lack of a standard definition of low vision and lack of referral to low vision specialists, a new survey shows.

"Despite the clear advantages, there remains a discrepancy between the number of patients who would benefit from low vision services and utilization of these services," report investigators from the New England College of Optometry, Boston, Massachusetts.

"While there have been studies geared towards patient barriers (economic status, physical distance from an office, etc), there wasn't really any research focusing on what we as optometrists could do to improve the efficacy of referrals to low vision specialists," Anne Bertolet, who worked on the survey, told Medscape Medical News.

The investigators surveyed 19 primary care optometrists who were members of the Massachusetts Society of Optometrists and eight low vision specialists at optometry schools across the country. They asked about low vision definitions, available resources, and referral practices.

Bertolet reported the survey results at the American Academy of Optometry 2014 Annual Meeting in Denver.

Fourteen of the 19 primary care optometrists said they refer patients to low vision specialists. But a major finding, Bertolet said, was the discrepancy between how low vision specialists and primary care optometrists define low vision.

"The majority of low vision optometrists use a functional definition of low vision: any visual impairment that can hinder quality of life or daily functioning," she explained. "On the other hand, primary care optometrists were a lot more varied in their definition, with less than half choosing a functional definition and the rest opting for various best-corrected visual acuity-based definitions."

With differing opinions, there are likely some patients who could benefit from low vision services, but are missing out because of low referral rates, Bertolet said.

Not Getting Needed Help

Currently, there is no single definition of low vision. "Our research suggests that developing a standardized definition of low vision would be advantageous to help standardize the referral and treatment processes," Bertolet said.

Many insurance companies use a numerical definition based on best-corrected visual acuity to determine which patients are eligible to receive low vision care. Medicare, for example, defines low vision as a visual acuity of worse than 20/60 while wearing best correction.

Bertolet and colleagues favor defining low vision as any visual impairment that impedes functionality. "Numerical definitions do not take into account a patient's quality of life, and may make it difficult for some patients to afford the care that could improve their livelihood," Bertolet said.

"Anytime you aren't functioning at the level that you want and vision is limiting you, that's an impairment, which is really dramatically different" than a numerical definition, Richard Jamara, OD, FAAO, low vision optometrist and professor at the New England College of Optometry, told Medscape Medical News.

The survey also found that 37% of primary care optometrists were unaware that some insurance plans cover low vision exams and devices, and 88% of low vision specialists said their new patients are unaware of available resources.

"While the majority of primary care optometrists stated they are providing resources (pamphlets, magnifiers, CCTVs, etc) or educating patients about low vision services and treatment options, most low vision specialists report patients are not aware of the resources available to them at the time of their first visit," Bertolet said.

"This suggests that there is ineffective communication from primary care doctors to patients in regards to low vision care. Clear communication is especially important in low vision referrals because patients are more likely to follow through if they understand the potential benefits of low vision services," she explained.

Dr Jamara said the survey is "interesting because it looks at the doctor's perspective, and the doctor's thinking is really what is going to be the driver."

Accessibility is also an issue. According to the American Optometric Association, there are currently about 36,000 doctors of optometry practicing in the United States, yet only about 1000 low vision specialists.

"The numbers don't work," Dr Jamara said. "We need the 35,000 other optometrists to address low vision, what we call 'entry level' vision, and that would be anybody with impairment up to before blindness. The people who are profoundly impaired would then go to the specialist. This survey shows that we have a lot of work to do toward that goal in the primary care optometrist arena," Dr Jamara said.

This study had no commercial funding and the authors have disclosed no relevant financial relationships.

American Academy of Optometry 2014 Annual Meeting. Poster F-094. Presented November 14, 2014.

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