New Research: Patients not Referred for Low Vision Services in a Timely and Efficient Manner

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Last month, at the 2014 American Academy of Optometry Annual Meeting, a group of student researchers from the New England College of Optometry presented survey data that identified (a) patient barriers to low vision services and (b) the actions optometrists can take to improve the efficiency of referrals to low vision specialists.

Their research revealed a discrepancy between what primary care optometrists and low vision specialists define as low vision (i.e., a functional versus numerical definition); in addition, this discrepancy creates a situation in which many patients who could benefit from low vision services are not being referred. The research group concluded that "developing a standardized definition [of low vision] would be advantageous to help normalize the referral and treatment processes."

About the Research

This important low vision research, entitled Bridging the Gap: Improving the Efficacy of Referrals from Primary Care Optometrists to Low Vision Specialists, was conducted by Anne Bertolet, Emily Humphreys, Hannah Woodward, Jessica Zebrowski, Inna Kreydin, and Jenna Adelsberger, from the class of 2017 at the New England College of Optometry (NECO).

From NECO Students Share Research at Academy 2014, via NECO News:

Their research focused on identifying patient barriers (economic status, physical distance from an office, lack of information) to low vision treatment and what optometrists can do to improve the efficacy of referrals to low vision specialists.

Anne Bertolet explains, "One of the major points our results suggest is that there is a discrepancy between what primary care optometrists and low vision specialists define as low vision. The majority of low vision optometrists use a functional definition of low vision: any visual impairment that can hinder quality of life or daily functioning."

"Interestingly, we found that primary care optometrists were a lot more varied in their definition, with less than half choosing a functional definition and the rest opting for various best-corrected visual acuity-based definitions."

"This suggests that there are some patients who could benefit from low vision services, but are not getting referred and that developing a standardized definition would be advantageous to help normalize the referral and treatment processes."

About Low Vision

If your eye doctor tells you that your vision cannot be fully corrected with ordinary prescription lenses, medical treatment, or surgery, and you still have some usable vision, you have what is called low vision. Having low vision is not the same as being blind.

Having low vision means that even with regular glasses, contact lenses, medicine, or surgery, you might find it challenging, or even difficult, to perform everyday tasks, such as reading, preparing meals, shopping, signing your name, watching television, playing card and board games, and threading a needle.

You can learn more amount low vision, including the differences between low vision and legal blindness, at Low Vision and Legal Blindness Terms and Descriptions.

What Help Is Available?

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Doctors who are low vision specialists can provide you with a low vision exam as a first step in determining how you can best use your remaining vision.

Often, a low vision specialist can give you recommendations about optical and non-optical devices and vision rehabilitation services that can help you to maximize your remaining vision and learn new ways of doing everyday tasks.

Some examples of helpful devices that a low vision specialist can discuss with you include:

  • illuminated stand magnifiers or electronic aids for reading
  • strong glasses or small telescopes for seeing the computer screen, reading sheet music, or sewing
  • telescopic glasses for seeing television, faces, signs, or other items at a distance
  • glare shields for reducing glare and enhancing contrast
  • adaptive daily living equipment to make everyday tasks easier, such as clocks with larger numbers, writing guides, or black and white cutting boards to provide better contrast with food items.

In addition, low vision services can include any or all of the following:

More about the Research

Excerpted from Patients Missing Out on Low Vision Services, via Medscape (registration required):

Many baby boomers who could benefit from low vision therapy aren't getting it for a variety reasons, including a lack of a standard definition of low vision and lack of referral to low vision specialists, a new survey shows.

"Despite the clear advantages, there remains a discrepancy between the number of patients who would benefit from low vision services and utilization of these services," report investigators from the New England College of Optometry, Boston, Massachusetts.

"While there have been studies geared towards patient barriers (economic status, physical distance from an office, etc), there wasn't really any research focusing on what we as optometrists could do to improve the efficacy of referrals to low vision specialists," Anne Bertolet, who worked on the survey, told Medscape Medical News.

The investigators surveyed 19 primary care optometrists who were members of the Massachusetts Society of Optometrists and eight low vision specialists at optometry schools across the country. They asked about low vision definitions, available resources, and referral practices.

Fourteen of the 19 primary care optometrists said they refer patients to low vision specialists. But a major finding, Bertolet said, was the discrepancy between how low vision specialists and primary care optometrists define low vision.

"The majority of low vision optometrists use a functional definition of low vision: any visual impairment that can hinder quality of life or daily functioning," she explained. "On the other hand, primary care optometrists were a lot more varied in their definition, with less than half choosing a functional definition and the rest opting for various best-corrected visual acuity-based definitions."

Bertolet and colleagues favor defining low vision as any visual impairment that impedes functionality. "Numerical definitions do not take into account a patient's quality of life, and may make it difficult for some patients to afford the care that could improve their livelihood," Bertolet said.

"While the majority of primary care optometrists stated they are providing resources (pamphlets, magnifiers, CCTVs, etc) or educating patients about low vision services and treatment options, most low vision specialists report patients are not aware of the resources available to them at the time of their first visit," Bertolet said.

"This suggests that there is ineffective communication from primary care doctors to patients in regards to low vision care. Clear communication is especially important in low vision referrals because patients are more likely to follow through if they understand the potential benefits of low vision services," she explained.

The AFB Low Vision Pilot Project

The American Foundation for the Blind (AFB) recently launched the Low Vision Pilot Project on VisionAware, which expanded the listing of low vision service providers to include independent service providers. Previously, the Directory listed only nonprofit low vision service providers.

If you are a low vision service provider and would like to be included in the Directory, you can sign up online. To learn if you are eligible for inclusion in the AFB Directory of Services, see the eligibility requirements. To learn about low vision services that are available to you in your area, use VisionAware's Directory of Services to find help.

And kudos to NECO students Anne Bertolet, Emily Humphreys, Hannah Woodward, Jessica Zebrowski, Inna Kreydin, and Jenna Adelsberger for this important work. We appreciate your insight and efforts!


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