As eyecare professionals look for new growth opportunities, many are viewing low vision in a new light. "Low vision adds another dimension to your practice because it combines optics and functioning, and it is more dynamic than many other areas," explains Paul Freeman, O.D., a veteran low vision specialist from Pittsburgh.

Given the growing interest in this category, we asked Freeman and 10 other optometrists and opticians who've already taken the plunge to talk about steps you, too, can take to get started-and then build business-in low vision. Here are some of their recommendations.

	Photo courtesy of Enhanced Vision Systems

The Mindset

Though education and training are imperative, our experts say that the real first step is to develop-and make sure you are comfortable with-the attitude and the patience required to succeed in low vision.

The psyhological factor. Several practitioners stress the importance of understanding the psychological impact vision loss has on patients. Of all disabling conditions, the only one feared more than blindness is mental illness.

English optician Richard Dormser says, "Low vision patients need to go through stages of adjustment. And the problem with education for treating low vision patients is that the psychological aspect is rarely addressed. A doctor I studied under here says that anyone interested in low vision should begin by studying pscychology. If they're not interested in that, then low vision is not for them."

The value of motivation. Thomas L. Porter, O.D., from St. Louis' stresses the importance of understanding the role of motivation in determining how successful a patient will be. And understanding the multiple factors that come into play with these patients is critical as well. As he told EB, "Very important factors that must be considered are the patient's level of motivation, cognitive skills, and additional physical problems. As challenging as the training aspect can be, training is the ingredient that often converts simple optical success in the exam room into functional success in the real world for our low vision patients."

Commitment to training. As Porter says, training is key. "There are a lot of reasons that historically a large number of low vision devices have ended up on the closet shelf within six months of dispensing," concurs consultant William H. Croft, Jr. "Perhaps the patient wasn't properly motivated, the patient's condition worsened, or the device didn't meet the patient's expectations. Regardless, the one common denominator in an unsuccessful outcome is the lack of rehabilitation training following dispensing. If you are not willing to invest the time and staff time in training, then low vision is not for you."

Lifestyle dispensing. In terms of devices, you need to be comfortable recommending multiple solutions for the multiple tasks patients wish to accomplish. Alex Yoho of Hawkins Optical, a wholesale lab in Topeka, Kan., says this aspect of low vision is well suited to opticianry. "It's still filling prescriptions," explains Yoho. "The doctor may prescribe a magnifier for reading. If the optician discusses other tasks the patients wants to accomplish-and recommends the appropriate powered product-then it becomes lifestyle dispensing, but with low vision aids instead of eyeglasses."

Starting Out

Once you've decided that you and your practice are able to make the commitment to low vision, how do you get started? Education is, of course, the key, and our experts suggest several resources for taking a first step.

Continuing education. Courses at trade shows and annual meetings include: Vision Expo East, West, and Eyequest (800-811-7151); the American Optometric Assn.(314-991-4100); and American Academy of Optometry (301-984-1441).

Reading. Several practitioners suggest starting by perusing books on the subject. Among the titles they recommend are: "The Art and Practice of Low Vision," Paul B. Freeman, O.D. and Randall T. Jose, O.D. (Butterworth, 1991, 1997); and two by Joseph Maino, O.D., Dominick Maino, O.D., and David Davidson, O.D.-"Computer Applications in Optometry" (Butterworth, 1989) and "Clinical Geriatric Eyecare," also by Maino, (Butterworth, 1995).

Suppliers. Talk to low vision suppliers and organizations. For example, a number of programs are conducted by the Lighthouse International (212-821-9460), and, Eschenbach Optik sponsors an ongoing series of training programs (877-422-7300).

Building Business

What do veteran low vision specialists recommend in terms of building a business you've begun? They suggest both resources you can tap as well as resources you can become.

Be a clearinghouse. For opticians, suggests Yoho, "you may be more help as an information clearinghouse than anything else. Keep your eyes on what's happening in LV circles. There are often low vision support groups." 

Waiting room literature. Large print Reader's Digest issues in the waiting room will tell patients you provide low vision services, suggests Anthony Chin, a volunteer at Jules Stein Eye Institute who is working to get a reimbursement bill passed in California.

A logical step. Optician Joe Bianchi of Bianchi's Hemet Optical in Hemet, Calif., says that low vision can be something you grow into gradually. In his case, he simply followed the needs of the aging population in his market. "I started out dealing with people who had cataracts and glaucoma," says Bianchi, "and it's just grown from there."

Mike Myers of Myers Opticians in Las Vegas took a similar path. "Ten years ago, we saw one patient a month with macular degeneration," he recalls. "Now, it's every day."

Speaking out. Croft suggests getting the word out by visiting nursing homes, speaking before senior groups, including large-print signage near the entry to the office, and perhaps offering to write a low vision newspaper column.

Getting Referrals

Patient and practitioner referrals. "The best referral sources are when low vision patients speak to other patients about your care," says Paul Freeman. "And also to get referrals from retina and cataract doctors." His wife, Kathy Fraser Freeman, O.D., adds that pediatric ophthalmologists are also a good referral source.

Staff interaction. Randy Jose, O.D., from Houston, suggests not only contacting retina specialists, but "once you have his or her interest, bring in lunch for the staff and spend 30 minutes with them describing the type of 
patients that will most benefit from low vision services."

Local societies. Kansas City optometrist Joe Maino suggests getting information, resources, and referral sources from local optometric societies, as well as the AOA's Low Vision Section.

Schools and agencies. Porter adds that state agencies for rehabilitation for the blind and special schools for the visually impaired are excellent sources.

Occupational therapists. For opticians, Yoho stresses the value of getting to know occupational therapists and mobility specialists. "They work with patients, but teaching them how to use products can be ignored. That's where the optician can come in."

The bottom line, says Bruce Linder of Linder Opticians in Bel Air, Md., is that low vision is all about learning and continuing to educate yourself about this field's ongoing advancement. "You have to read constantly, talk to your associations, labs, and manufacturers, and go to the better trade shows. If people will study, explore, investigate, and do the work to understand the technological differences between products," concludes Linder, "then low vision does, indeed, represent a great opportunity." EB