Steps to Success
by Stephanie K. De Long

At last month's Academy of Optometry meeting in San Diego, a number of courses addressed low vision and offered paths to participation in the category. One class in particular offered several strategies for success that bear repeating.

Taught by Rebecca L. Kammer, OD, and Lou Lipschultz, OD, "Roadmap for Incorporating Low Vision into Your Primary Care Practice" discussed both the low vision exam and dispensing devices.

Here are a few of the key points presented in their course.

1. CASE HISTORY

The first step is to take a case history. According to Kammer, there are seven critical subjects that need to be covered before the process begins there:

• Near vision needs and abilities
• Distance needs and abilities
• Activities or daily living issues
• Social history
• Illumination and glare needs
• Mobility
• Job-related needs

2. GOAL SETTING

Both doctors agree that the initial exam should begin with a discussion of goals. What does the patient most want to accomplish? According to a survey of 600 patient records, Lipschultz reports the goals most frequently mentioned by patients are, in order of importance to them:

• Being able to read
• Continuing to drive
• Managing personal finances
• Seeing the TV and/or faces
• Doing work or crafts
• Reading medicine bottle labels

Kammer adds that the next, and equally important, step is to help low vision patients prioritize their goals.

"Don't try to meet all their goals in one meeting," she explains. "And be specific. If they say reading is important, ask what kind of reading. Is it newspapers, magazines, books, or just labels? Are their reading needs spotty or intense?"

3. PRESENTING DEVICES

Working with devices is also an important part of that visit. In terms of sequence, both say the first step is to identify goals, and the second is to identify the level of magnification required to read.

While Kammer begins with hand-held magnifiers, Lipschultz starts with a CCTV. "I use it to assess how much magnification is needed," he explains. "It's a point of reference. And it lowers the patient's anxiety."

4. DEMONSTRATION INVENTORY

While devices are clearly an important part of the process, if you're new to low vision, it's difficult to know what to carry. To begin building a demonstration inventory, Lipschultz suggests starting out with no less than one and preferably two of each of the following.

• Magnifier trials: 3, 5, 7, and 10X. Cost: $250
• Telescopic trials: 3 and 7x binocular. Cost: $800
• Filters: Brown, yellow, and orange. Cost: $100
• Daily living aids: Check guides, writing guides, and talking watch. Minimum cost: $200
• CCTV: A color tabletop design. Cost: $1,500

The minimum investment, if you buy just one of each, is approximately $2,850.

Both agree that, even if you're just starting out, you should try to purchase at least two of each device so that if one is on loan, you don't have a void in your demonstration inventory.

5. PRACTICE POINTERS

Both speakers offered a number of practice-building tips. Among them are the following.

• Don't be afraid to mark up devices; it's a business and you need to make a profit
• Make sure you block out enough time for visits from your low vision patients
• Use forms and keep them in patients' files, including a record of what devices you have tried, their powers, and how well the patient did with them
• Put your return and reimbursement policies in writing, and make sure you specify both time limits (i.e., 100 percent refund only if returned within 30 days); and quality requirements (no scratches, damage, etc.)

And, most important, market your practice!

[device usage]

As part of a survey of 600 patients in his Chicago practice, Lou Lipschultz, OD, tracked which devices were most frequently purchased. Here's the percent of patients who use each of the most popular devices sold in his practice.

• 70%: Hand magnifiers
• 40%: High-add readers
• 30%: Stand magnifiers
• 30%: Distance telescopes
• 30%: CCTVs
• 10%: Reading telescope