Article Submission Guidelines for Practice Management, EHR, Glaucoma, and Managed Care

Management Tip of the Week > A New Look at Low Vision Care

Exclusive Date: November 27, 2013

A New Look at Low Vision Care


 Sponsor: AIR OPTIX® AQUA Multifocal Contact Lenses

Every optometrist in practice today already has two important factors to add a profitable, private pay service.  The service is low vision.  Before you stop reading and decide you don't want to provide that specialty, realize that there have been some big advancements in that field and it can be easy and profitable.  Easy and profitable may be two adjectives you would not typically think of with low vision, but you could simplify the process and provide help to many people who do not need or want advanced level care.

The big picture
The two important factors you already have are:

  • Patients who need the service.  We all see patients every week who do not have vision that is correctable to 20/40 or better for one reason or another.  This group is getting larger as our population ages due to the baby boom and people living longer.  If you don't provide basic low vision care and if you just tell these people nothing can be done, the patients are missing out and so are you.
  • You have the knowledge and skill needed.  Your basic training and experience in vision correction and optics is all you need to prescribe magnifiers and electronic devices and to give the guidance and counseling for most low vision patients.  More training and experience is helpful, but you could jump in right now and be very successful.

The one important ingredient you may not have is a supply of low vision aids and devices to use in testing, but that is very easy to acquire and does not have to be very expensive.

Advancements
There have been many advancements in technology over the past five years that have been a big boost to people with low vision.  Unfortunately, the people who have low vision are often not very knowledgeable about computers and electronics.  They need some basic advice and guidance.

Here are a few technology trends that are a big help in low vision. 

  • Computer tablets, iPads and e-readers.  Large print is a huge advantage for low vision patients who want to read.  It is often easier than using a magnifier on small print.  We used to scramble around looking for printed sources of popular books or magazines, which were mostly not available.  Today, everything is available on computer tablets and the size of the print and photos are easily changed.  The small screen of an iPad can be a challenge for some, although its ease of use often overcomes that.  Many people will use a computer with a 26 inch monitor instead.  Plenty of real estate on that screen and they are quite inexpensive.
  • Video cameras.  Electronic magnification has provided many advantages over optical devices for many years, but cameras today are extremely small, inexpensive and produce amazing clarity.  Many innovative designs are available from low vision suppliers.
  • Lighting.  Lighting is extremely important for low vision patients.  Except for a few eye conditions, most people need a lot more of light.  LED lamps are being incorporated into stand magnifiers to provide clean white light where it is needed.  LED bulbs in desk lamps help around the house.

Different levels of care
Think about low vision and reinvent how you would provide the service.  At the most basic level, you could train an optometric technician to work with your low vision patients.  The doctor could do a basic examination first, determine the best corrected acuity and be sure that refractive needs are met.  The doctor could make some recommendations about low vision aids and consumer products to try for each patient.  Patients with more advanced vision problems should be referred to a low vision specialist, but many people have fairly good vision and the simple things work best.  The technician would help the patient to try various devices and make notes in the record.

At a higher level of care, the optometrist could schedule special low vision appointments, about an hour in length.  He or she would work with the patient and a caregiver in order to prescribe the best aids and to provide counseling.

You can sell the optical products and low vision camera devices and make some profit, or you can just provide the patient with a list of online resources where they can buy the products directly.  Be aware that some low vision items end up being returned, so you can decide if you want to be involved in that or not.  You definitely need to be compensated for your professional time and expertise.  Some aspects of a low vision exam can be billed to medical insurance, but there is nothing wrong with making other aspects of the work a private pay service.  Always follow the contracts you have in place with insurance plans and check with their support team to be sure of coverage.

Diagnostic aids
Check with low vision suppliers for all kinds of resources and tools and make an investment to have the items on hand when your next patient with reduced vision is in your exam chair.  I keep a large collection of items in a Sears tool chest; the type with drawers on large wheels.  We simply roll that cart into an exam room and we are ready to go.  Consider these items for your low vision cart:
  • Large print near point card.
  • A Feinbloom distance chart to be used at 10 feet.
  • A strong desk lamp.
  • A collection of high plus/prism half eye readers.
  • An assortment of hand-held, stand and pocket magnifiers of various powers; with and without illumination.
  • One or two video camera devices for magnification.  Some can be plugged into an existing TV or computer monitor.
  • An iPad or e-reader.
  • Access to a computer by the patient

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


Management Tip of the Week > A New Look at Low Vision Care