In our eight-doctor ophthalmology center, low vision services have been provided to visually impaired patients (V.I.P.s) in Southern Colorado for more than eight years. How low vision is handled differs from practice to practice, but I'd like to share a bit about our model, and why it works for us.

The practice went through an initial period of trying to coordinate all the requirements to allow us to bill Medicare for the services to our senior patients--who are, of course, also the vast majority of low vision patients.

THE DOCTOR'S ROLE

As part of creating a model, we've developed a way of handling the device segment of our business that works for us. In the new model, the doctor doesn't spend extra time offering practical daily living skills information to our impaired patients.

Instead, at that juncture in the appointment process, the main role of the ophthalmologist, optometrist, or retinal specialist is to take a few extra moments to explain that there are aids, devices, and alternative techniques that can keep impaired individuals independent. And then they make the referral to my department.

Our low vision services department is actually one person--me--who, among other things, specializes in evaluating, testing with various magnifiers and other aids, instructing in their use, dispensing, providing some adjustment counseling, and offering information regarding alternative means of accomplishing daily tasks, hobbies, etc. My office also produces a quarterly newsletter which has proven to be a well-received contact between the doctor's office and the patients.

Our services are unusual in that I am visually impaired myself. I have been legally blind for many years due to Stargardt's disease. It has been encouraging for both the patients and their family members to watch me function, using visual aids as I work.

If you're looking for staff, I suggest you don't overlook a visually impaired person. The empathy is obviously beneficial, but, of course, not every practice would be able to locate such an individual who would meet the practice's specific requirements.

So, what should you look for? I suggest considering an ophthalmic technician, optician, rehabilitation counselor, occupational therapist, or even nurse. All those degrees are of value, but you may find that a staff person who is given specific training and who has a rapport with patients can provide this essential service to those who have been told by their doctor that there is nothing more that medicine or science can do at this time.

There is so much available in the form of aids and equipment, as well as rehabilitation training and support, that is important to the adjustment of people with vision loss. However, all this is of no value to the visually impaired unless someone makes them aware of their options.

My specific training has been from workshops, seminars, conferences, manuals and books, and on-the-job in terms of both my condition and actual experience. I was certainly not a senior when I developed the juvenile form of macular degeneration and began dealing with the practical issues of living with visual impairment; but, I was almost a senior when I joined the ophthalmology clinic more than eight years ago.

In my particular case, I felt that to forego two or more years of formal training was the right choice. However, for several years now, I have taught a five-week course to student ophthalmic technicians in a local community college program. Recognizing the value of such programs, I do acknowledge that providers of low vision services are best positioned to serve all their patients' needs if they hold a degree or a certification in the profession.

IN-OFFICE SERVICES

There's also no question that the emphasis should be on providing services to the maximum number of patients who need assistance, and that can be best offered within the context of the eyecare professional's practice. Not every office, clinic, or practice, needs its own low vision services. The larger communities that draw patients from surrounding rural areas will, however, benefit from providing this service within one of its local practices.

As for how it can benefit the practice, providing low vision services can be rewarding and economically sound. It can also be good public relations for the practice as a whole, as well as a great service to the community.

The low vision staff should become familiar with all current product and offer patients the best variety their circumstances allow. Your low vision services will grow or change as you determine what is best for your practice and patients.

If providing a packet of resource information and a referral to the closest low vision or rehabilitation agency or clinic is the most practical service for your practice, that is still far more information than many of the vision impaired have received. Even if you don't provide the services yourself, but simply refer, it is a helpful means of providing direction regarding the practical issues of vision loss.

Additionally, it promotes good rapport with the patients and increases their inclination to maintain regular eye exams. If you add low vision services to your practice, however, it will benefit everyone--your patients, your community, your practice, and you.

If you'd like to contact the author, she can be reached by e-mail at sondrawilliams@earthlink.net.