focus on low vision

by William H. Croft, Jr.

Readers Ask About Devices

If the rise in recent questions are an indication, low vision has finally shed its "Rodney Dangerfield" image of no respect. Following is a sampling of those questions.

WHAT ABOUT REIMBURSEMENT?

Q I see many patients who, when prescribed simple devices, expect their insurance to pay for them and in the absence of reimbursement, reject them.

Is this common?

A Entitlement can be a very pervasive force. Doctors have all seen patients reject a device that will significantly improve their lifestyle not because they didn't have the funds, but because they expected it to be given to them.

Others have seen patients, who were children of the depression, defer help and continue to deny their own needs. Fortunately, baby boomers tend to have a totally different attitude and are more likely to invest in things that will improve their lives.

SHOULD I LOAN DEVICES?

Q Some patients expect to be able to borrow a device. Is offering loaners a good solution?"

A Some patients never try a device that is loaned to them because of a lack of commitment; plus we all know the perceived value, or lack thereof, of something that doesn't have a cost associated with it.

Loaning a device tends to result in the minimum result since practitioners are reluctant to loan expensive technology.

Also, the patient isn't prone to suddenly move up to something else if the first device "worked" for him—however marginal the results may have been. The patient who needed one thing typically gets another, and so on.

DEVICE NON-USE

Q I've been told that there are studies that show a large number of low vision devices don't get used by the patient after several months.

Is this poor product, a poor treatment plan, or just par for the course?

A 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.

Perhaps the patient wasn't properly motivated, the patient's condition worsened, or the device didn't meet expectations.

Regardless, the one common denominator in an unsuccessful out-come is the lack of rehabilitation training following dispensing.

Not-for-profit clinics have proven the best to date in executing the low vision rehabilitation model.

Unfortunately, patients often experience extremely long waiting times, sometimes months, for an appointment.

Today, there are also a number of for-profit initiatives that help provide these services.

Looking ahead, we will, in fact, see explosive growth in this arena as more businesses view low vision as a profitable category.

CHINESE MAGNIFIERS

Q More and more devices, especially magnifiers, available now were made in China. At the same time, devices that come through traditional [European import] channels are rapidly going up in price. As the U.S. dollar continues to weaken, the price difference between the two continues to grow.

Are the lower cost, so-called "value devices" from China a legitimate substitute?

A Like any product, some imports from any country are better than others from that same location. So, quality—or lack thereof—isn't automatically a given one way or another.

By in large, however, the quality of the optics is definitely superior in product imported from European manufacturers than from China. That's why so many of the devices from China are considered, and sometimes promoted as, "value devices."

That's only part of the answer, however. The more basic part of your question is a philosophical one. Do you believe the cheapest solution, regardless of product efficacy, is the best because a low vision patient doesn't have enough money? Or, do you believe in offering your patient with as much help as possible, which is provided by the higher priced devices with superior optics? That doesn't mean you don't offer other devices, if the one you consider best truly is beyond their monetary reach.

But don't forget that low vision cuts across all demographic lines, so to assume patients are indigent is simply wrong. This is one of the biggest problems with today's low vision care—that some professionals assume patients and their families are not willing to invest.

Fortunately, however, there are a growing number of vision care and rehabilitation experts who believe that you have an ethical and professional obligation to begin by demonstrating and offering a patient the best device to match his or her rehabilitation goals.

That is, after all, why they came to you—for your professional expertise. EB