For decades, it’s been called slow vision. Many eyecare professionals refer patients who are diagnosed with common forms of low vision out of their office from the get-go, others comanage, and some keep patients in their optometric practice until the condition advances.
Here, EB talks to 2 experts—1 optometrist and 1 specialty lab owner—who believe more folks in optical should provide at least some low vision services: Laura Miller, OD, with 2 Northwest Hills Eye Care locations in Austin, Texas, and #EBGameChanger Charlie Saccarelli, ABOM, president of Chadwick Optical Inc., an independent wholesale specialty lab headquartered in Schwenksville, Pennsylvania.
There are lots of ways to enter the low vision field, whether it’s full-time or as an added service to patients in an existing practice. “You can really start out slow if you’re in a more traditional practice,” says Dr. Miller. “You can do a lot with a trial frame, some high-powered readers, and then just keep adding as you grow.”
Focus on Function
One of the problems, adds Saccarelli, is that “many practitioners miss the mark for patients by focusing on a diagnosis, not the resulting impairment, and then helping with the functional effects of that diagnosis. The question we should be asking is, ‘How can we supplement those functions?’”
That often involves devices. “That’s very basic, and there are only a few principles from an optometric perspective,” explains Saccarelli, who lectures on low vision at several schools of optometry. “Make it bigger. Make it brighter. Use another sense. Use some kind of technology. In other words, a lot of it is asking people to do things differently.”
Dr. Miller agrees. “I always make it clear that I’m not going to bring back any vision that your ophthalmologist wasn’t able to. I explain that it’s fraction vs function. I’m going to try to help you function better with different glasses or devices. You may have to do things in a different way, but we want to help you remain independent.
“Keeping someone independent is truly making a difference,” adds Dr. Miller. “Whether it’s keeping them employed, in their homes, [or] as independent and as happy as they can be, that for me is the biggest reward.”
Time and Money
Like everything, there are both positives and negatives.
One plus for practices? Cash. Maybe not a cash cow, but a cash calf, perhaps. Name it what you will: The fact is that when it comes to some office time and nearly all devices, patients are paying out of pocket. That can make the device business a profitable one for your practice.
On the other hand, low vision is still called slow vision because it’s time-consuming. “We do spend more time with these patients,” admits Dr. Miller.
All in the Family
“That being said,” adds Dr. Miller, “I always tell students that low vision is the one specialty that really helps grow your business beyond just that one area. If you’ve helped grandma, every other family member wants to come to you, too. Plus, they’ve seen how compassionate we are.”
Looking at it from another perspective, Saccarelli adds, “If you consider yourself a family practice, then you should include at least basic low vision services.” It is something that is likely to touch every family at some time or other, so be there to help however you can and refer to another ECP when necessary.
Both Saccarelli and Dr. Miller agree on the importance of doing what you can, focusing on function in the earlier stages of low vision before passing the patient to the next level of care as their condition advances, while perhaps continuing to address some of the functional aspects of that treatment. All are important roles you, as an ECP, can play in the life of a low vision patient.