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Most of the eye care providers I know do not provide low vision care. I think it's an excellent specialty that an optometrist could easily add to his or her primary care practice, but even if that does not interest you, make sure your office is equipped to treat patients who do not have corrected visual acuity in the normal range. You may not call them low vision patients; to you they may be AMD patients or diabetic retinopathy patients, but the result is the same. We all have plenty of patients whose best corrected visual acuity in the better seeing eye is 20/40 or worse. These patients deserve the best eye care possible and a few inexpensive items will help you provide that.
A (non) low vision checklist
Here are a few items I highly recommend for all practices that will help you provide better care for patients with visual disabilities. Check to see if you have them and consider how you handle each need.
- A Feinbloom acuity chart with easel. This is a spiral bound cardboard flip chart available from many low vision suppliers. I got a tripod artist's easel and installed a hook at the top to hang the chart on. I can move the chart into any exam room and it is easy to store. I'm lost if I can't record an accurate visual acuity and we all have many patients who can't see the big E on the standard Snellen chart. Yes, you can have them get up and walk toward the chart but that is not nearly as accurate and you certainly can't refract that way. The Feinbloom chart is set up at ten feet from the patient with no mirrors, which allows the patient to relate better and perform better. The largest character on this set of charts is 20/700, but when placed at ten feet, you would record 10/700. That is equivalent to 20/1400 and I hardly ever see a low vision patient who can't see this chart! With eccentric viewing, these patients are very pleased that they found an eye doctor that has a chart they can work with! They become motivated to try.
- A good near point card. I use a card that has the largest letter at 20/800 reduced Snellen or 72 points and it goes down to 20/20. On the other side are two paragraphs of text, one at 20/40 and the other about 20/80. It is easier to read letters with space around them compared to actual words in a sentence, and I like to test with both.
- Illuminated stand magnifiers. The new LED light technology has made these devices much better. There are no bulbs to burn out, batteries last an incredibly long time and they produce and even bright white light. You could have a couple of basic powers on hand, like 3X and 5X.
- Pocket magnifiers. Large stand magnifiers are not useful in the supermarket, so have a couple of good magnifiers that fold into their own case. A larger 3X and a smaller 6X are good. These items are not expensive but with your recommendation and guidance, a magnifier can have a huge impact.
- Assorted prism half eyes. Wearing a high plus reading Rx works great in eyeglasses because the patients hands are free to write, turn pages or handle an object. But since the working distance must be quite close, there is often a convergence problem, unless the patient is monocular. Premade half eyes with +4, +6, +8 and higher are available with the right amount of base in prism to achieve convergence at the proper focal distance without eyestrain. Of course, these aids are only useful for patients with little or no astigmatism and anisometropia, but they are an affordable aid that helps many.
- Resources. Be ready to refer your patients to online suppliers of products for the visually impaired, desk lamps, video magnification devices and other items.
Counseling a low vision patient can be just as important as prescribing a device. Here are few common bits of advice:
- Get a good desk lamp with a moveable head. Turn on more room lights (older folks often conserve on electricity). Most low vision patients need more light. If you're working with one of the rare conditions that does not need more light, you'll know it.
- How to hold materials closer to read with high power adds or reading glasses.
- Use a felt tip pen instead of a ballpoint.
- Watch more television because it's easier than reading for news and entertainment.
- Watching TV will not hurt your eyes.
- Sit close to the television; move the furniture to accommodate this.
- Get a larger TV; 42 inches or more.
- Order low vision checks from the bank.
Referrals to another optometrist
Finally, don't make the mistake of telling your low vision patients that nothing can be done and don't stop with the basic care I've outlined above. Get to know an optometric low vision specialist in your area and make a professional referral when indicated.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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