When do you say when to low vision services?
Arguably, there are many excuses for not providing low vision services. For starters, there is the issue of outcomes. Unlike performing a refraction or contact lens fit, the goal of low vision is rarely 20/20, binocularity and normal peripheral vision.
Then there is the matter of chair time. Low vision work-ups are often time consuming and the subsequent training sessions repetitive. Simply put, there is no easy way to expedite low vision.
And if this is not enough, consider patient satisfaction. True, most visually impaired individuals appreciate our efforts. But are they really enthralled with the outcome? Many are elderly individuals who find it difficult to accept their loss and are resistant to change.
Finally, there is the matter of financial compensation. Most health insurers do not understand the intricacies of providing low vision care. Therefore, reimbursement is often absent or woefully deficient.
Regardless of these excuses, perhaps the greatest hurdle to providing low vision services is simple apprehension. Considering the many reasons for visual impairment and the variety of treatment options, it is understandable why the primary care optometrist finds low vision so daunting.
Should you commit to full scope low vision or offer a limited menu of services? If the latter, do you provide low vision services for a few select conditions? For certain levels of visual impairment? Only when the condition is stable? In other words, just when should you say when?
Clearly, there is no easy answer. Unfortunately, while clinicians grapple with this dilemma it is the visually impaired who suffer. No one can deny that the visually impaired population is growing. The improved survival rate of premature infants, the aging of the baby boomer sector and an increased life expectancy facilitate this trend. Fortunately, the low vision practitioner has more treatment options than ever before.
In addition to traditional optical devices, there has been a tremendous proliferation of "high technology" devices. Computer software programs, closed-circuit televisions and infrared-driven variable focus video cameras are just a few examples. Combining these devices with orientation and mobility instruction further increases the visually impaired patient's likelihood of success.
So, given these options, can one justify not providing low vision services? In the final analysis you cannot. Every clinician must assist the visually impaired in some capacity. With respect to actual services provided, draw the line wherever you please. Offer just a little, or offer a lot.
And if your patient requires a more specialized approach? Refer. Utilize resources in your own backyard, be it a low vision clinic, agency or private practice. Above all, do not deny your patients access to these services. The last thing they need is another impairment!