Low vision... in the news

BIOPTICS Update

Driving with bioptic telescopes can help keep some low vision patients mobile and independent. Introduction of high-tech product options over the past few years has increased interest in the category.

Bioptics are lens systems incorporating Galilean or Keplerian telescopes set in the upper portion of a carrier lens, typically in powers of 2.2X, 3.0X, or 4.0X.

The carrier lens consists of the patient's regular Rx, which is mounted in a frame. This allows the patient to look through the telescope to magnify distant objects, such as road signs, while switching to the carrier lens for overall viewing.

Recent Initiatives

There are several initiatives to develop more patient-friendly bioptics, including the possibility of implanting telescopes in the eye. One study being conducted at the Low Vision Rehabilitation Laboratory at The Schepens Eye Research Institute, an affiliate of Harvard Medical School in Boston, is the "in-the-lens telescope," which uses mirrors embedded in the carrier lens. In addition to being lighter-weight and less obviously a visual tool, the in-the-lens telescope would allow users to see both a magnified and unmagnified view at the same time.

An ongoing multi-year research project utilizing a multidisciplinary grant with principle investigator Eli Peli, MS, OD, of The Schepens Eye Research Institute and collaborator Dr. Kent Higgins, Lighthouse International's research investigator, is working to develop optical and electronic devices and test the efficacy of the devices.

Currently, most states allow those with low vision to substitute documentation from an eye doctor for the standard vision test for a driver's license, but visual acuity requirements without driving restrictions range from 20/30 to 20/70--with the average at 20/40. Some states accept a visual acuity of 20/100 with corrective lenses for a restricted driver's license.

It is essential to become familiar with all the driving regulations of your state, and to keep up-to-date, as regulations can change rapidly--often due to the increased success of lobbying efforts of organizations and agencies pushing for the continued mobility of the visually impaired.

The American Optometric Association, for example, recommends "individual evaluation of individuals wearing spectacle- mounted bioptic telescopes for driving."

With the passage of the Consolidated Appropriations Act of 2004 (the Omnibus Bill), a five-year demonstration project has been launched to provide national coverage for vision rehabilitation services as provided by orientation and mobility specialists, rehabilitation teachers, and low vision therapists.

The project will begin July 1 this year, and mandates that the Federal Centers for Medicare and Medicaid Services (CMS) develop policy recommendations allowing vision rehab professionals to provide services on-site at patients' homes and other out-of-office locations.

With a budget of up to $2 million dollars in the coming year, CMS will be able to implement national coverage of rehabilitation services and launch a study to examine issues surrounding coverage of vision rehab. Once the study is complete, the demonstration project will continue while seeking Congressional approval to adopt final language to establish services and service coverage on a permanent basis.

According to the National Vision Rehabilitation Cooperative--one of the organizations named as consultants for the study--passage of the Act offers "an outstanding opportunity to gain our full goal of permanent Medicare coverage for these services." Currently, vision rehabilitation services are partially covered by Medicare on a state-by-state basis.

The Medicare Vision Rehabilitation Services Act S.1967/H.R.2484 did not pass the 107th Congress last year. Reintroduced as S.1095/H.R.1902 in the 108th Congress, the Act seeks to standardize Medicare coverage nationwide and establish quality standards for specialized vision rehabilitation professionals.

While it has garnered Congressional support, endorsing organizations such as the American Academy of Ophthalmology, American Optometric Association, and National Vision Rehabilitation Cooperative are seeking additional support.

For more information updates, visit www.medicarenow.org.