A Patient's Perspective
By Lynne W. Kinnan, MA

By the time I'd struggled through childhood and college, I had seen five eye doctors. They all told me the same thing—nothing could be done to help me see more of the world.

Then, as a young adult listening to the radio, I heard about something called a low vision specialist. Going to this appointment changed my life. It was like a new world had opened up to me. And, for the first time, something could be done to improve my quality of life.

After consulting with a retina specialist, I was diagnosed with cone dysfunction (Vitro Tapeto Retinal Dystrophy). It has been described to me as a tiny hole in my retina, which affects my central vision.

Through the years, I have visited a total of 11 eye doctors. Based on these experiences, I've written a two-part series on suggestions for what you, as an eyecare professional, can do to create a positive office visit experience for low vision patients. Every step in the visit should be designed to make this the one place where, whenever possible, a visually impaired person can feel successful.

BEFORE THE APPOINTMENT

Written materials: If mailing materials to new patients prior to their first appointment, be sure the materials are in large-print and easy- to-read formats.

Insurance: It is expected that, as a medical professional, you will be paid. But understand that the more insurance options you provide for your patients financially, the more options they have for a positive change in their lives.

Public transportation: If possible, it is better to be in a location that is accessible to public transportation. This way, if patients are not able to drive, they can easily arrive to your office and feel independent.

Building address: Make sure the address on the building is in large, easy-to-read numbers that contrast with the color of the building.

Building access: Have an entrance and office that are well marked, free from stairs if possible, and have handrails where needed.

If there are stairs, make sure they are easy to distinguish. Remember that your patients already have visual impairments. Since their eyes will probably be dilated during the exam, their ability to manipulate their
environment will be even further reduced.

Lighting: Provide good lighting in the waiting area for completing forms or reading.

Reading material: Provide large print materials such as the Readers Digest. It is better to have magazines or publications with short articles so that there is time to finish reading them while in the office.

Office forms: Have any form, whether mailed or presented upon arrival for the appointment, in large print. And, if reproduced, make sure the copy is clean and crisp.

DURING THE EXAM

Introduction: Be aware that the patient may not be able to see your face clearly from a distance. Make a point of standing or being physically close enough to the patient so that he/she can see you. This is important for both the doctor and the staff.

Building a relationship: Let the patient develop a relationship with one person, at least at first, and feel more comfortable. If at all possible, for at least the first couple of visits, conduct the entire appointment yourself instead of having staff assist with checking eyesight. Once a patient has been in a few times and feels more comfortable, then the staff can start the exam.

Reading the chart: Understand that not being able to read an eye chart is embarrassing and creates an internal feeling of failure.

Starting with big letters: Help the patient to feel some success. For example, most regular eye doctors
start with the small letters on the eye chart. If you are aware that the patient is nearsighted, start with the big letters instead.

Using technical terms: For many patients, this may be the first time they are dealing with terms describing conditions and even phrases such as "visually impaired" and "low vision specialist." These are scary terms for
people to comprehend. Be aware of how they are used—and, more important, how they are received.

Asking questions: Contrary to popular belief, there actually is such a thing as a dumb question. I can't even begin to tell you how many times I have been asked if I have trouble seeing at night or seeing color. How would I know? What do I have to compare it to? Think to yourself before you ask a question: Does this patient have a point of reference that would enable her to answer the question I'm going to ask?

Answering questions: Even though it takes a lot of time, it is critical that patients' questions are answered. This is a life-altering situation and your patients need to make informed decisions.