Optometric Management Tip # 105   -   Wednesday, January 21, 2004
Want to build your practice? Do you do Low Vision?

As described in Tip #100, lack of patient volume is one of the biggest problems optometrists face today. Adding a specialty to an existing practice is a good way to increase patient volume, because some percentage of the patients you already see will be candidates for the additional work. In a way, you refer the patient to yourself, and the appointment schedule gets fuller. Any optometric specialty will work, but low vision (LV) is a natural because there is growing demand for the service and surprisingly few practitioners offer it.

Getting Started

After I got involved in low vision practice, I found it was nothing like I remembered it from optometry school. It was much easier. Most of the aids were simple, such as stand and hand-held magnifiers of various powers, many with halogen illumination. An assortment of high-plus, prismatic reading glasses is a must. These devices solved 80% of my low vision patients' needs, and launched my LV practice. I added some electronic/video magnification systems and some more complex devices, such as microscopes and telescopes. I place all my low vision aids in a Craftsman rolling tool chest I bought at Sears Hardware. The drawers are perfect for storage and I placed a 21 inch TV set on the top for testing video systems. The cart is easily rolled into any of my exam rooms.

A low vision specialty is really not that expensive to start, but rather it's an investment that pays back many times over.

Low Vision Practice Management

In addition to my own supply of patients, I found low vision was a specialty that could easily attract referrals. I visited the local office of my state vocational rehabilitation department to introduce myself, and let them know that I'd welcome their referrals. I also informed local ophthalmologists and retinal specialists that I specialized in LV, and that I'd appreciate their reciprocal referrals. I had a good relationship with these doctors, since I was already referring patients to them, and low vision was something they didn't provide.

LV is actually very easy for anyone who is skilled in refraction, but it does require empathy, patience and plenty of time to interact with the patient. I spend a good deal of time simply talking to patients about what they hope to do with their vision, and helping them adjust to their relatively new disability. Much of my low vision work is really counseling, and explaining the nature of the vision loss. My usual mode of practice is fairly fast-paced, and I delegate many clinical tasks, but my style of low vision care is slower-paced and more direct. I find this to be a welcome change of pace. I schedule one hour of my time for a low vision exam, which is in addition to a full pre-test work-up performed by my technician. Additional time is scheduled for follow-up exams, dispensing and training sessions.

Providing large blocks of doctor time, LV diagnostic aids, and specialized clinical equipment is expensive, and it justifies high professional fees. I know there is a segment of patients who may not want, or be able to pay for this care, but there is a large group who will. We assist people who can't afford low vision care by referring them to state agencies which can help. While health insurance or Medicare may cover the eye health portion of a low vision exam, and even some low vision rehabilitation, I recognize that much of LV care is refractive in nature, and most health insurance is not intended to cover that. A large portion of my low vision fees are billed as private pay and due at the time of service, and I like it that way. Our professional practices are no different than any business, if a service is to be provided, it must be profitable. But the best reward in low vision practice is the good feeling I get from helping someone who had no where else to turn.

We all see patients who have best visual acuity of 20/40 or worse, and we've all heard of doctors who tell these patients nothing more can be done. Since that is not an acceptable option, we only have two choices: refer the patient to a colleague, or provide low vision care yourself.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management