Morvari Ahi, OD
August 3, 2016
Low vision is increasingly common in our aging population. Develop a system to serve low-vision needs, and build your practice around it.
IDENTIFY NEEDS AND GOALS. Discuss the patient’s visual history and create a goal list where the patient explains what they most need help with in their daily activities.
ENCOURAGE & EDUCATE. Be empathetic, and be prepared to either personally offer them low vision aids and/or connect them to local agencies that will make life with low vision easier.
PROVIDE FULL-SERVICE CARE. Work closely with your patient’s family and local rehabilitation resources in providing the best care for your patients.
Low vision caused by eye conditions, like macular degeneration, diabetic retinopathy and glaucoma, is on the rise. With modern medicine, Americans are living longer and healthier lives. That’s a good thing, but that longevity comes with an increased risk of sight-threatening conditions. According to the National Federation of the Blind, over the next 30 years, the number of blind or visually impaired Americans will double.
Most of my low vision patients have eye diseases that have damaged their central or side vision. As a new office, we are currently growing our low vision practice. I reserve one afternoon a week to see low vision patients. If the afternoon is not fully booked, I use the time for marketing and networking with local businesses, such as home-care assistance programs and ophthalmology practices, that may have low vision patients in need of my help.
Low vision is not the main source of income in my office. Optometrists should be aware that while they will make a profit serving low vision patients, they should not expect a large ROI immediately. It’s more about expanding the services you offer patients, and thereby growing your patient base and building your practice. Initially, low vision may make up 10-15 percent of your gross revenue. As your practice grows, this percentage can substantially increase in the future. My strategy for building my low vision practice right now is increasing patient flow.
Most Important Tool: Thorough Interview With Patient
An OD’s most important low vision tool is a strong initial interview with patients. It includes a lengthy discussion of the patient’s visual history and the creation of a goal list of items the patient most needs help with in their daily lives. This may include watching TV, cooking dinner or writing checks. Every activity must be addressed separately because many optical aids will only address one concern or need. This initial meeting also includes patient education on what to realistically expect in visual improvement with the low vision aids, and the potential worsening of their condition.
Many low vision patients will require more than one optical aid, depending on their goal list. I educate my patients that each aid has a specific use. I also require that each patient plan for a training session with myself and/or my staff to make sure they are comfortable using the aid. We never simply give a patient their new aid and have them go home without providing training. We make sure they are comfortable turning on the aid, changing the batteries and using all of the functions. Often, patients request that a family member or caregiver be present for this training session, which we highly encourage.
Find Right Instrumentation & Supplies
I researched several options, and ended up choosing Bernell and Eschenbach as my main sources for equipment and optical aids for my patients.
Eschenbach has been an amazing resource for me as I started my low vision practice. First of all, their reps provide personalized training for ODs and their staff. Also, as an Eschenbach customer, you are provided free access to online webinars and education. The Eschenbach web site has detailed explanations of ocular conditions and how they impact the patient’s vision. Eschenbach offers several packages for low vision aids that can be customized based on your practice and your budget. The company also has been helpful in providing me as a referral for my local area. Several of my patients initially visited the Eschenbach web site inquiring about a local doctor. Eschenbach keeps a list of all of their current customers, and connected these patients to my practice.
Low Vision Resources: Educate Yourself & Your Patients
Information Web Sites
American Foundation for the Blind
International Society for Low Vision Research and Rehabilitation
The Low Vision Handbook for Eyecare Professionals by Barbara Brown
Coping with Vision Loss by Bill Chapman
Billing & Coding References
Educate & Encourage
Explaining to a patient that they may never regain their full visual ability is one of the most difficult discussions an optometrist has to prepare for. It is important to first listen to the patient’s frustrations. An optometrist should never take the patient’s anger or frustration personally. It is important to provide encouragement to the patient that there still may be hope with low vision aids.
According to the American Association for Research in Vision and Ophthalmology, Americans across racial and ethnic groups describe losing eyesight as potentially having the greatest impact on their day-to-day life — more so than other conditions, including loss of memory, hearing and speech. Blindness is often associated with anxiety and depression.
It is important that we remain empathetic toward what our patients are facing and be prepared to either personally offer them low vision aids and/or connect them to local agencies that will make this transition in their life easier.
Provide Full-Service Care
An office specializing in low vision should prescribe more than just optical devices. Our office works to provide “full-service” care to our patients, and works closely with the patient’s family and local rehabilitation resources in providing the best care for our patients. For example, some patients may require additional training with their aids at home, orientation and mobility training, or even counseling to help cope with the emotional aspects of losing their vision.
Many of my patients are fortunate enough to have close friends and family nearby. These individuals are often the ones to check on the patient throughout the week. If a patient’s low vision aid is not working one day, or if the patient forgets how one of the functions work, it is helpful when a family member is able to drop by and assist a patient immediately.
Prescribe Help for Everyday Tasks
Most of our low vision patients have basic eyewear prescribed from their previous optometrist and/or ophthalmologist. After confirming this prescription, I offer them various low vision aids such as hand magnifiers, stand magnifiers, loupes or telescopes.
Eschenbach has a manufacturer’s suggested retail price for their products, but this is not a requirement. Some insurance plans may contribute to the low vision exam, but not the actual aids. Becoming familiar with how to bill for low vision exams is beneficial for every practitioner interested in providing these services. Also, be vigilant that most patients will require multiple aids, and these aids can run as much as $4,000 each.
Prepare Staff to Serve Low Vision Patients
If any of your staff members are interested in low vision, I would take advantage of that by having them take a larger role in this area of your practice. Low vision assistants can help coordinate referrals from ophthalmologists, schedule appointments for patients with other potential agencies, such as orientation and mobility specialists, and help with patient training. Hands-on training has worked the best for me. Instead of providing your staff with a book about low vision, let them practice using the aids, or have them teach another staff member how to use them.
Staff members can also assist a new low vision office with marketing and networking by dropping off brochures/business cards to local agencies and specialists that may have patients in need of low vision. While you are in the office seeing patients, your staff can be a strong resource for growing your practice.
Improve Your Own Knowledge & Credentials
A low vision residency is not required to provide low vision services to your patients. I knew that I was interested in low vision before starting optometry school. It was beneficial for me to have that knowledge and interest during interviews as I met with different schools. Some optometry schools have a stronger emphasis in a certain field: ocular disease, contact lenses, pediatrics, low vision, etc. I was fortunate enough to start clinical observations at the Perkins School for the Blind in Watertown, Mass., before my first day of optometry school at NECO.
In optometry school, I also took advantage of extra clinical courses, research and volunteer opportunities involving low vision. Once I graduated, I found numerous resources where I could receive additional low vision training and keep up-to-date with new technology and resources for my patients. In California, our local optometry group, the California Optometric Association, has a sub-group, the Low Vision Rehabilitation Section, that provides education throughout the year.
Review State Driving Requirements for Minimum Vision
I would encourage every optometrist to look closely at their state regulations for driving and low vision. In addition, review the Vision Examination Report that patients might bring to your office after failing their vision test at the DMV. Over half of the states in the U.S. have peripheral field requirements. Bioptic telescopes are allowed in over 25 states.
I would recommend checking your state’s official DMV web site for the most up-to-date information, but this web site has a compilation of all the states’ driving-related regulations.
Licenses have various restrictions that can be included: corrective lenses, no night driving, etc. Patients often will ask you for solutions to aid them in driving comfortably. Many of my patients complain about glare and night driving. There are various solutions, including anti-reflective coatings and lens filters, that may help.
Finally, it is important that eyecare professionals are comfortable having a discussion with a patient and/or their family about limiting their driving. Understandably, many patients fear losing the ability to drive because it is a loss of independence. We must be sensitive to this and address their concerns fully.
Build Relationships with Other Doctors
As a member of the local chapter of the California Optometric Association, I am fortunate to network with local ODs who may have patients in need of low vision services. For ophthalmology referrals, I researched all of the local ophthalmologists in my area and sent them a short e-mail with a short biography about myself, my practice and the low vision services we offer. Some of them have been kind enough to let me drop off brochures, which they can provide to their patients. Many glaucoma and retinal specialists will be excited to work with you and offer low vision services to their patients.
Many of the patients who are referred to me have long-standing eye diseases, and are often at advanced stages. It is crucial to have constant communication with their ophthalmologists, and to provide them with reports of the care you are providing the patient. In return, the ophthalmologist can provide you with information about the patient’s eye health that can help you provide the patient the best low vision care.