Few Doctor's Offices Provide Accommodations for Patients With Significant Vision Impairment

By Linda Carroll

December 06, 2021

NEW YORK (Reuters Health) - Just 10% of doctor's offices in the U.S. provide two basic accommodations - describing the clinic space and offering materials in large font - for patients with severe visual limitations, a new study suggests.

Survey responses from more than 450 randomly selected physicians across seven specialties revealed that 60% provided neither of the two accommodations. Moreover, ophthalmologists didn't fare much better, with just 24% providing both accommodations, researchers report in JAMA Ophthalmology.

"Three-fifths of physicians - even ophthalmologists - do not usually or always provide even the most basic accommodations to their patients who are blind or have significant vision impairments," said lead author Dr. Lisa Iezzoni of Harvard Medical School and the Health Policy Research Center-Mongan Institute at Massachusetts General Hospital, in Boston.

"Many people have vision problems later in life, in addition to those people with significant vision impairment or blindness," Dr. Iezzoni told Reuters Health by email. "Providing large font on printed documents and describing the office should be simple, low-cost things that would increase the comfort for growing numbers of people as our population ages."

What might spur physicians to make these kinds of accommodations?

"The large font should be helpful to lots of patients beyond those with significant vision impairments - so the main thing is for physicians to simply think about it and make it part of their office routines," Dr. Iezzoni said. "To get them to describe their office settings to their patients will also take thinking about it and doing what is best for their patients - a professional ethical imperative."

To learn how many physicians were making accommodations for visually impaired patients, Dr. Iezzoni and her colleagues searched for and identified all board-certified physicians practicing in the U.S. in seven specialties: family medicine, general internal medicine, rheumatology, neurology, ophthalmology, orthopedic surgery and obstetrics-gynecology.

Then, after excluding trainees, hospitalists and several other subgroups, the researchers further winnowed their list to 1,400 by selecting a random sample within subspecialties: 350 physicians each in family practice and general medicine and 140 physicians each in the five other specialties. Surveys were sent out to all 1,400, of whom 714 responded.

The researchers eliminated another 252 because these physicians either had no patients with significant vision limitations or there were missing survey data.

Of the 462 respondents included in the analysis, only 9.1% provided both accommodations, while 60.2% provided neither. When the researchers broke out ophthalmologists from the group, they found that 62.8% of non-ophthalmologists provided neither accommodation, but the same was true of 29.3% of ophthalmologists. And just 24.0% of ophthalmologists provided both accommodations.

"It is alarming to learn that less than one-tenth of U.S. physicians caring for patients with significant vision limitations provide these two basic accommodations," said Leannza Tang, an optometrist at the New York Eye and Ear Infirmary of Mount Sinai.

"As an eye care provider myself, it is even more concerning that only 24% of ophthalmologists surveyed provided both accommodations," Tang told Reuters Health by email. "This study supports the need for further education and training to eye care professionals in disability rights and other considerations when caring for patients with significant vision limitations."

"With electronic health records being more commonly used in healthcare settings, it is usually feasible to print out patient education materials or instructions in larger font when needed," Tang said. "Implementing these low-to-no-cost patient accommodations will hopefully lead physicians to consider further accommodations for patients with decreased vision so that they feel more at ease when receiving healthcare."

SOURCE: https://bit.ly/3xS7pa7 and https://bit.ly/3Ef6fIa JAMA Ophthalmology, online December 2, 2021.