FOCUS ON LOW VISION

Don’t Give Up On Low Vision

Why low vision can be a rewarding (yes, even profitable) service

no one can argue that prevention of vision loss and increasing visual function are essential services that are well provided for by eye doctors, both optometrists and ophthalmologists.

To maintain quality of care, providers are offered thousands of course hours on therapeutics, eye diseases and disorders, ocular allergies and inflammations, ocular neurology, ocular surgery, and methods of vision correction and improvement.

We do a great job of prevention and improvement. BUT, once you lose vision, you are in trouble.

In fact, there is no question that low vision care is the most neglected service in the optical profession. Few are providing care, referring, or even discussing the possibility of care to the visually impaired.

Every day I hear: “The doctor said nothing more can be done.” And, because eye doctors are not interested in low vision, there is little CE on low vision.

Richard Shuldiner, O.D., fits the late actress Jane Russell with a 1.7x telescope with reading cap

ELIMINATING MYTHS

I believe that low vision care is the least-provided service in eyecare because of the following myths.

• Low vision is difficult.

• Low vision takes too much time.

• Low vision patients are never happy.

• There’s no money in low vision.

Now is the time to debunk these issues. In 1996, after 20 years of providing agency-based, non-profit, traditional low vision care, I introduced a model for low vision care in private practice, The Richard Shuldiner, O.D./William Feinbloom, O.D., Philosophy & Methods For Providing Low Vision Care.

Working in private practice, I was not providing low vision care until a macular degeneration patient requested help in recovering her driver’s license. After providing bioptic telescopic glasses and successfully having her recover her license, I saw an unmet need: Prescription low vision glasses.

The model addresses and eliminates the myths, and includes a 12-step evaluation that is easy and takes just one hour. A five-minute telephone conversation, which occurs prior to setting an appointment, handles all the issues that might have arisen during the visit, while eliminating and managing the patient’s expectations before their arrival. As a result, patients leave better and happier than they walked in.

The model is based on my belief that prescription low vision glasses are what patients want. They will accept traditional devices, but I’ve observed a preference for prescription glasses. When patients see better and perform tasks better, they are willing to pay for the product and service. Patients pay out-of-pocket to hear better; they will pay out-of-pocket to see better, too. You just have to show them.

Low vision doctors need to prescribe for the patient’s vision condition, not their wallet. If the patient says they can’t afford it, then the doctor can suggest less expensive alternatives.

CO-MANAGING PATIENTS

The eyecare professions have a history of co-managing patients. The same can occur in low vision. With the co-management program developed by The International Academy of Low Vision Specialists (IALVS), all providers can share in the care and reimbursement of the visually impaired patient.

A former real estate broker in Los Angeles purchased a truck, filled it with over-the-counter low vision product, and makes “house calls.” Is that how we want low vision care to be delivered?

Regaining Independence

Patient Wayne Fielder’s ophthalmologist told him his vision did not meet requirements of the California DMV, so he lost his license, his independence, and his sense of worth. He found my phone number in an advertisement, and here’s what happened:

At the M.D.’s office, his acuity was 20/200 because the Snellen chart was being used. Since he could not see 20/100, his visual acuity was listed as 20/200. However, his acuity was 20/160 on the Feinbloom chart, and because California DMV requires one eye to be better than 20/200, he in fact does meet their vision requirements. I filled out the forms, fit him with bioptic telescopes, and he regained his license after a road test. “Thrilled” doesn’t come close to the emotions he expressed in the message he left on my answering machine.

Patient Wayne Fielder in bioptic telescopes that allow him to drive again

There is no certifying agency for low vision doctors, but if you want to refer, look for a member of the IALVS, a Low Vision Diplomate of the AAO, or a member of the Low Vision Section of the AOA or Academy of Optometry. A co-management relationship gives new hope to your low vision patients.

— Richard Shuldiner, O.D.

Richard Shuldiner, O.D., is an AAO low vision diplomate, founder of IALVS, and director of Low Vision Optometry of Southern California.