Issue: July 1997
July 01, 1997
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Striving to meet the low vision demand

Issue: July 1997
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Primary Care Optometry News: Given the changing demographics and a maturing U.S. population, will low vision become a larger part of the eye care practice in the future?

Eleanor E. Faye, MD: mugshot It should already be a big part of it. The statistics about the aging population are already impressive, but the future shows an increase in this group and in age-related conditions. I feel that when the baby boomers begin having age-related eye diseases, they're going to be adamant about getting better care; they'll demand it. So, both optometry and ophthalmology are challenged, and they should be challenged right now because it's an underserved population.

The baby boomers are already suffering. I'm getting a wave of them in my practice now, and they're infuriated by having anything happen to their vision. It's interesting to see their attitudes, and if low vision hasn't been stamped out by the time they age even further, they're going to be very demanding, which is good.

PCON: As a low vision specialist, where do you recommend the primary eye care practitioner draw the line in terms of which patients they can treat and which low vision devices they should have in their practices?

Dr. Faye: If you commit yourself to doing low vision, then you really have to do it if you want to offer a service. However, I do think a primary eye care practitioner should be aware of resources such as low vision clinics, agencies or practitioners who do low vision so they are equipped to refer.

For example, I see nothing wrong with giving an add of 3 D, maybe even 4 D, 5 D or 6 D, for a person who has no other problems and has a clear-cut visual objective. But if it's more complex, the primary care practitioner might not meet the needs of these people. Although the practitioner may have some knowledge and interest, they should be able to refer.

If you're willing to commit to doing low vision, you'll learn it. The analogy of contact lenses is good because if practitioners are going to do contact lens work, they have a fitting set and they learn it. It's the same with low vision. You must also recognize your limitations, for example, deciding that you can handle a moderate low vision patient who just needs optical devices.

I don't see any reason why a practitioner couldn't have a minimal set of magnifying devices covering a certain preset number of diopters. You might say as a practitioner that you won't give anything more than 20 D, then just have a set that fills your expertise.

PCON: What low vision devices or systems are you currently working with that are new and innovative?

Dr. Faye: I'm working with the Inwave prism lenses. I'm very interested in these, and I've had some very good results so far with their Channel prism lens.

I'm also interested in some of the newer generation virtual image machines. Some of the new computers have a lot of promise, and I think the sophisticated computers and scanning devices — multi-use computers with zoom text —are going to be the answer, because there's no limit to what you can do with them.

This represents a tremendous change in low vision. We can do a lot with simple magnifiers, but that's not the answer anymore, because a person who's going to get a job in today's competitive world will have to go the way of computers and sophisticated technology. They can use magnifiers for fillers and temporary things, but basically the work is going to be done through computers.

These devices are also getting cheaper. It's interesting that when closed-circuit televisions first came out 25 years ago, they were about $2,000, and everyone thought that was a shocking amount to pay. Well, they're still about $2,000, which means they've gone down in price because everything else has gone up. I also think the baby boomers who be come visually impaired will be designing their own software programs for these computers.

PCON: So the demand for low vision care and technology will only increase?

Dr. Faye: Yes, and my major concern is that the professions really aren't treating low vision, even after all this time. There's a group of really dedicated optometrists and ophthalmologists who are doing low vision, but it's a very small group and it hasn't grown enough. I don't know why.

I think that low vision is perceived as not being a money-maker, involving too much work, or too much variation. There's no pattern to low vision — every person is different, and you have to be ingenious. It seems that the cookie-cutter type of doctors just don't want to do it for any of these reasons.

Also, rehab is very low on the priority list in terms of what people think of as being glitzy. Rehab is basic to all medicine, but ophthalmology and optometry have neglected it. The concept of rehab has never caught on in either profession.

On a national scale, the government is not interested in this either. We can never engage Medicare; it's always been a battle. I think it's also a matter of in come, because if your overhead is high and you spend 2 or 3 hours doing low vision, it's basically pro bono work. I'm willing to do it because I have a thriving practice that pays for the other parts of it. I also do it for good will and the satisfaction of doing it.

So, in a practical sense, the reimbursement is the problem. Insurance does not want to pay for something that's basically rehab, and that's a flaw in American thinking. I'm a little cynical about it, but I continue plugging away because I believe in it and it isn't fair to these patients to desert them.

It's also an appreciation of our patients. If you give these patients just a little help, it can turn their lives around, and who can resist that? It's one of the greatest things you can do if you're providing patient care.

Low vision should be included in every residency program and in every curriculum to create the demand, and to create a demand in the public as well. I'm hoping the baby boomers will be our salvation and create the demand we need.

For Your Information:

  • Dr. Faye is ophthalmological advisor to the Lighthouse National Programs. A widely recognized leader in low vision, Dr. Faye received the first annual Pisart Vision Award in 1981 from the New York Association for the Blind, as well as the American Foundation for the Blind's Migel Award Medal. She is the author of Clinical Low Vision (Boston, Little, Brown Co., 1984) and has collaborated on several film and videotape productions about low vision. A founder and instructor with the Lighthouse Low Vision Continuing Education program, Dr. Faye is an attending ophthalmic surgeon with Manhatten Eye, Ear & Throat Hospital. She may be contacted at The Lighthouse Inc., 111 East 59th Street, New York, NY 10022; (212) 821-9200; fax: (212) 821-9713. Dr. Faye as no direct financial interest in any of the products mentioned in this article, nor is she a paid consultant for any company mentioned.