Comanagement Q&A

The Lowdown on Low Vision

Edited by Paul C. Ajamian, O.D.

Submit a question to Dr. Ajamian



Question: When should I consider sending a patient to a low vision specialist?

Answer: Most optometrists are capable of tackling the visual goals of patients with mild to moderate visual impairment (i.e., BCVA in the better eye between 20/40 and 20/100). But when visual acuity is 20/100 or greater, you might not have the equipment necessary to satisfy the visual goals of the patient. In such a case, you can refer the patient to a low vision specialist or clinic, says Ned S. Witkin, O.D., director of the Vision Rehabilitation Service and assistant professor of ophthalmology at Emory University School of Medicine in Atlanta.



Question: What is the role for the referring optometrist who sends a patient to a low vision specialist?

Answer: You'll continue to be the patient's primary eye doctor, Dr. Witkin says. When a patient gets referred to his clinic, he does a low vision evaluation of the individual and usually prescribes a device. On the second visit, he trains the patient on how to use the device, and then sends the individual back to his or her O.D. to continue care.

"We also send the referring O.D. a letter to explain what we did and to familiarize the doctor with the particular device that we prescribed so he or she can answer almost any question if the patient has a problem," Dr. Witkin says. If the primary eye doctor is stumped by the patient's problem, the doctor can call and troubleshoot it with the low vision specialist.

Dr. Witkin adds that if the patient's functional vision worsens, the referring optometrist can send the patient back to the low vision clinic. Pathology such as choroidal neovascular membrane may cause a loss of visual acuity. In that case, the referring O.D. would send the patient to the appropriate specialist-a retinal specialist.



Question: What are the most typical problems that patients have with their low vision aids, and how can I, as the referring O.D., solve these problems?

Answer: Often the problems are simple, such as replacing a burned-out bulb on a video magnifier. The doctor just needs to figure out the problem from the patient's description. Other problems patients typically have with their low vision aids are:
  • Adjusting to reading distances. People usually hold reading material at 14-16 inches, "but with a pair of low vision glasses, they're holding things at 3-4 inches from their nose," Dr. Witkin explains. Even after training, some people forget and revert to the customary reading distance. You can simply remind them to hold it closer.
  • Misuse of distance aids. Again, even though the low vision specialist shows the patient how to use such a device, the patient may forget. This is understandable, Dr. Witkin says, since a patient may confuse the use of a bioptic with a bifocal. Instead of tilting the head up to use a bifocal, the patient must tilt his or her head down to use the telescope of a bioptic. Sometimes, though, the optics aren't aligned properly. The referring O.D. or an optician can change that as easily as making a spectacle adjustment.
  • Learning to adjust telescopes. Patients adjust handheld monocular or binocular distance telescopes by a knob, just as they would a pair of binoculars. "Some patients need additional coaching to be able to recognize how to do that," Dr. Witkin says. "Sometimes that can be done over the phone, and sometimes the patient may have to come into the O.D.'s office."

top

Have a question for Comanagement Q&A? 

Have a question for Comanagement Q&A? E-mail it to reviewofoptometry@jobson.com , fax it to (610) 492-1049 or send it to:

CMQA, Review of Optometry
11 Campus Blvd., Suite 100
Newtown Square, PA 19073

top
© Review of Optometry OnLine
November 15, 2000

Return to November Highlights
| | | | | |