Focus On Low Vision
The growing role of technicians
By Erinn Morgan

Many low vision professionals report they are seeing more patients than ever--a trend that will continue as the baby boom moves into older age. "Low vision is probably half of my practice, and I see it increasing," confirms Phillip L. Cook, OD, with Specialty Vision Center in Tulsa, Ok. "Macular degeneration is the culprit. Thirty percent of the population over age 70 has this problem now, and look at the baby boomers coming into that age bracket. It is an epidemic."

	Certified ophthalmic assistant Adela Castano and Brian Knieriem, OD, of the Scott and White Eye Institute Center for Sight Enhancement Vision Rehabilitation in Temple, Texas

As low vision rehabilitation services expand, ECPs are relying more and more on their technicians to handle the labor-intensive fitting, dispensing, and training associated with low vision devices. In some clinics, the technician may also handle ordering and inventory management of devices including, in some cases, the selection of brands.

Technicians can also help increase profitability in a low vision practice. When they handle the admission procedures, pre-testing, device education, paperwork, and follow-up, it frees the doctor to see more patients and, thus, generate more income.

Most eyecare professionals in the low vision field agree that the importance of the technician will only increase in the future. "Technicians will play a greater role in low vision care, just like physicians' assistants have increased roles in other medical areas," says Susan Gormezano, OD, with Low Vision Associates in Bingham Farms, Mich., and chair of the low vision rehabilitation section of the American Optometric Association (AOA). Her practice is 90 percent low vision.

WHAT MAKES A TECHNICIAN?

A technician can be trained by the practitioner in the facets of low vision care or receive formal training in the field. The AOA has a para-optometric certification program and the Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) offers courses in assisting vision rehabilitation.

While low vision doctors find their technicians to be invaluable, they point out that prescribing lenses and other absorptive filters are solely the doctor's responsibility. "If it's a normal device, then our technicians know how to dispense it," says Cook. "If the patient requires a more technical aide, like a biopic telescope, I do that demonstration."

In general, however, technicians handle the education of the patient in the use of low vision devices prescribed by the doctor. "I'll write down a rehab plan, and our certified ophthalmic assistants will take them to the low vision room and demonstrate the devices," explains Brian Knieriem, OD, of the Scott and White Eye Institute Center for Sight Enhancement Vision Rehabilitation in Temple, Texas.

In addition to assisting patients and the doctor, Knieriem says, "I have my technicians generating income apart from me. We charge for her time, as well for describing everything to the patient. She can be doing that while I am seeing another patient. This is important to make a profit."

The job of the technician typically begins when the patient arrives at the low vision practice. "We employ a clinical technician who is JCAHPO-certified in low vision assisting," says Mark Wilkinson, OD, of the University of Iowa Carver College of Medicine Department of Ophthalmology and Visual Sciences in Iowa City, Iowa.

"Her role starts with the intake assessment. During the intake, she helps to establish the goals of the clinical low vision evaluation," Wilkinson says. "Once the comprehensive low vision evaluation is completed, she will work with the patient to educate them about the device(s) they will be using. This process usually takes between 30 and 60 minutes. As a follow-up, she calls patients 10 days later to see how they are doing with the devices and to see if there are any additional questions or concerns."

Many technicians are also responsible for ordering devices and, of course, paperwork--an increasingly important task, thanks to HIPAA. "They handle the ordering and reordering," says Cook. "They come to me for authorization if it is a more expensive or unusual item."

Looking ahead, there is no question that as the patient base for low vision increases, the role of the technician will become even more important.