Randy Jose, O.D. answers questions recently submitted to Eyecare Business.

GETTING STARTED

Q. What resources can I use to get more LV patients into my practice?

-Optometrist, Skokie, Ill.

A. The best first step is to visit with local retinal specialists. Most low vision patients we see will have maculopathy of some sort and will have been referred from primary care M.D.s and O.D.s to the retinal specialist. In this meeting you can discuss what low vision services are, how they can complement the retinal treatment programs, and offer to set up a referral system that will bring a minimum of work to the specialist's office.

Once you have his or her interest, bring in lunch for the staff and spend 30 minutes with them describing the type of patients that will most benefit from low vision services.

Most staff and practitioners assume a patient should not be referred until the acuity has dropped to 20/200. Instead, advocate for the 20/40 referrals or suggest this criterion: If the patient is still complaining about the lenses at the third visit, then refer to low vision. This will usually get the early-onset patients and allow you the greatest opportunity to help.

IMPROVEMENTS IN HEAD SETS

Q. I recently saw some new video headsets for low vision patients. The physical appearance seems much improved from the discontinued LVES. What about fitting?

-Optometrist, St. Paul, Minn.

A. There are many new improvements in video display systems. They are getting easier to wear and easier to fit.

The latter is an important ergonomic factor because if the doctor cannot put it on the patient easily and get an immediate response, it is likely to sit on the shelf.

Fewer bells and whistles makes the device easier for the patient to afford or at least to "mentally buy into." Also, letting the patient return for two or three visits builds up their confidence so that they will use the system and see its benefit. It then becomes an investment instead of an expense.

LOW-LEVEL PROBLEMS WITH GLARE

Q. I see a lot of patients now who are just reaching the low vision category (e.g., 20/60) and need glare control. In some cases, traditional low vision or medical filters seem too harsh. Do you have any suggestions?

-Optician, Baton Rouge, La.

A. There is a growing need for research and clinical studies on glare control as part of the low vision prescription. As we begin to serve individuals earlier in the disease process, glare becomes more important. With 20/40 acuity or better, photophobia and contrast are not usually the significant problems.

If we put a gray lens on, it acts like a neutral density filter and simply makes it darker. Thus the person is more comfortable, but cannot see as well.

Likewise, filtering is not of significant concern when the patient still has good acuity and contrast. I have had modest success with sideshields and antireflection coatings to bring comfortable vision to patients with early onset macular degeneration. It might be worth a try. EB