By PATRICK DUNDAS
Photographs by IRIS JOHNSON

The low vision industry in the U.S. is in the midst of an evolutionary change that is gaining the attention of healthcare providers and the healthcare delivery system challenged to address it. The next 25 years will see an unprecedented increase in the 65-year-old and over population, and with it a growing need and thriving market for low vision products and services. Eyecare practitioners who are alert to these changes will be able to take advantage of the opportunities ahead in the changing world of low vision care for senior citizens.

The median age of the U.S. population is the highest in our history with the senior segment on the verge of exploding. The Census Bureau projects a doubling of the senior population from today’s 35 million to 70 million by 2030 and the National Eye Institute (NEI), a branch of the National Institutes of Health (NIH), projects a corresponding increase in the incidence of vision impairment.

Prevent Blindness America’s 2007 Economic Impact of Visual Problems reports the annual cost of adult vision problems in the U.S. comes to approximately $51.4 billion. Nearly $11 billion is non-medical nursing home care. To attack this rising cost and help the visually impaired achieve independent living skills, the Center for Medicare & Medicaid Services (CMS) has moved to authorize Occupational Therapist performed low vision rehabilitation under the order of a physician or optometrist (CMS Program Memorandum AB-02-078, May 29, 2002).

Although optometrists are in a remarkably good position to perform low vision exams, provide low vision aids and refer patients for occupational therapy, few do. They, and the ophthalmologists who would refer these patients, are largely unaware of the new Medicare ruling and how to implement it. Surprisingly few optometrists service low vision patients at all.

IT’S TIME TO LOOK AT LOW VISION
Strategic thinking suggests that optometrists take a serious look at the low vision market being fed by the demographic shift toward senior citizens. The NEI, which tracks vision threatening retinal disease, estimates there are nine million Americans with age-related macular degeneration (AMD), glaucoma and diabetic retinopathy in the over 40 segment of the U.S. population. This number will grow to over 13 million by 2020 and can go even higher with an estimated 7.3 million additional people at high risk for vision loss from AMD. This represents a remarkable practice building opportunity that when properly positioned and managed, can be a profitable and a highly satisfying component of the practice.

ADDING LOW VISION TO THE PRACTICE
Adding a low vision specialty is a great way to expand the practice. Serving seniors who know about or suffer from vision threatening disease, is a remarkably positive community service. When effectively communicated, it will drive referrals from ophthalmologists, retina specialists, general practitioners, vocational rehabilitation departments and senior citizen centers. And, it will attract thankful family members as new patients when they are made aware of the hereditary nature of retinal disease.

What about professional fees? Working with partially sighted seniors takes extra patience, extra time and extra visits. It requires not only clinical evaluation and examination, but also counseling on how to cope with irreversible vision loss, explanation of the vision loss, helping with the selection and use of low vision magnifying devices, and preparing the patient for rehabilitation visits. All of this justifies high professional fees that are billed as private pay… a nice break from the routine of low paying managed-vision-care plans. Adding a low vision specialty to the practice may even make room for the dumping of an economically weak vision plan. The good news is the low vision specialty can and should be profitable with revenue generated from professional fees and from the sale of low vision spectacle lenses and magnifying devices.

LOW VISION AIDS

The growing pool of partially sighted seniors has not gone unnoticed by medical device companies. New imaging and optics technology developed for consumer electronics markets is being applied to low vision magnification devices and adaptive products. New and improved closed circuit televisions (CCTVs), feature-rich video magnifiers, computer compatible devices, portable digital viewing screens, head-worn LCD screens for multiple viewing distances, specially designed commercial magnification systems that help patients return to the workplace, and a wide array of more conventional hand-held, stand, and illuminated magnifiers, telescopic lenses and prescription eyewear (prism spectacles, high-add bifocals, etc.). Problems with glare and contrast sensitivity loss is common with low vision patients. Once again, there is a solution available with the prescribing of filtering lenses and/or electronic low vision aids with contrast enhancement features. These products have life changing results for the visually impaired and are a boon to the ECPs who prescribe them.

Prescribing the right combination of low vision aids requires the matching of devices to what patients want to do with their remaining vision, i.e. what activities are most important in their daily lives. Counseling patients in advance on the benefits of a distance viewing device (telescope), near reading magnifiers and perhaps portable illuminated magnifiers for viewing in dimly lit conditions, will help them understand the need and positive results that will come from a multiple item purchase and will show them how their goals will be met. Too often, patients are “sold” magnifiers or telescopic lenses without determining the patient’s goals or providing adequate training on how to use the devices. Patients pay dearly for magnifiers that end up in the drawer never to be used again. On the other hand, when properly selected and prescribed with appropriate training, multiple devices are a blessing for the visually impaired. For the practice, it’s possible to get started with a basic selection of handheld and stand magnifiers, some trial prismatic and high-add spectacles, and one or two of the most popular electronic and digital devices. Beyond a working device inventory, all that might be needed is a low vision distance acuity test chart, large print near point chart and reading speed test card. Testing the patients reading speed is an excellent way to measure progress on follow- up visits. low vision aid company representatives are highly specialized and can be great resources during start-up and with special-needs patients. Some companies provide low vision education courses and practice development workshops.


Pictured, above l to r: spectacle magnifier (noves Eyewear: #1682-4); video magnifier (Color Pocket Viewer); binocular telescope designed for watching TV and viewing distant objects (MaxTV: #1624-1); illuminated stand magnifier (Scribolux: 1565-1); illuminated stand magnifier for viewing text (Makrolux: #1436-1); illuminated stand magnifier; wraparound absorptive glasses with orange-tinted filters that reduce glare and enhance contrast. Yellow, amber and gray also available. (SolarShields: #D267A). All products courtesy of Eschenbach Optic of America. An array of low vision products