bridging the gap: improving the efficacy of referrals from ...€¦ · standard procedure for low...

A. Bertolet, J. Adelsberger E. Humphreys, I. Kreydin, H. Woodward, J. Zebrowski

New England College of Optometry, Boston, MA

Bridging the Gap: Improving the Efficacy of Referrals from Primary Care Optometrists to Low Vision

Specialists

Introduction

Methods

Results and Findings Solutions

References

Acknowledgements

47%

10%

16%

16%

11%

Primary Care Responses: What is your

Definition of Low Vision?

Any visual impairment that limits a

patient's normal visual function

BCVA 20/40

BCVA 20/60

BCVA 20/100

BCVA 20/20087%

0% 13%

0%

0%

Low Vision Specialist Responses: What is your

Definition of Low Vision?

Any visual impairment that limits a

patient's normal visual function

BCVA 20/40

BCVA 20/60

BCVA 20/100

BCVA 20/200

63%

37%

Primary Care Optometrists: Are you Aware

that some Insurances Cover Low Vision Exams

and Devices?

Yes No

12%

88%

Low Vision Specialists: Are Patients Aware of

Resources Available to them upon their First

Visit?

Yes No

14

7

10

6

5

3

1

Primary Care Optometrists: What Resources

do you Provide Low Vision Patients?

53%

26%

16%

5%

Primary Care Optometrists: What is the

Standard Procedure for Low Vision Patients?

Referral to Low Vision Specialist

Provide Care Yourself

Low Vision Specialist on Staff

Nothing

1. Marinoff R. Referral patterns in low vision: a survey of mid-south

tri-state eye care providers. J of Behavioral Optometry. 2012; 23(1):

1-15.

2. Matti A, et al. Access to low vision rehabilitation services: barriers

and enablers. Clinical and Experimental Optometry. 2011 Mar; 9(2):

181-186.

3. Wittich W, Canuto A, Overbury O. Overcoming barriers to low-

vision rehabilitation services: improving the continuum of care. Can

J Opthalmol. 2013 May; 48(6): 463-467.

4. Enhanced Vision’s Introduces “Transformer USB” – An Intuitive

Magnifying Solution with Laptop USB Connectivity. Enhanced Vision

News. 2010 Nov. Web. Accessed April 7, 2014.

<http://www.enhancedvision.com/enhanced-vision-news-

media/enhanced-vision-news/enhanced-visions-introduces-

transformer-usb-an-intuitive-magnifying-solution-with-laptop-usb-

connectivity.html>

5. How Can The Lighthouse Low Vision Clinic Help You? Lighthouse

Louisiana. Web. Accessed October 31, 2014.

<https://lighthouselouisiana.org/low-vision-clinic/how-can-lvc-help-

you>

We would like to thank Dr. Richard Jamara for his

assistance in contacting low vision specialists, and Mr.

Michael Charron, Associate Executive Director of Member

Services of the Massachusetts Society of Optometrists for

his assistance in contacting primary care optometrists.

Thank you to NECO and the AAO for providing the

opportunity to present this work.

Based on this research, we propose three solutions for

the consideration of optometrists.

• Normalize a definition of low vision as any visual

impairment that impedes functionality.

Discrepancies in the definition of low vision can lead to

patients not being referred despite the fact that they

can benefit from low vision therapy.

• Provide resources for primary care optometrists

regarding insurance coverage for low vision

appointments and devices. These could be in the

form of a fact sheet, informational email from MSO or

other optometric organization, or Continuing Education

course.

• Provide advice for increasing the efficacy of

referrals to a low vision specialist. This may include

calling on behalf of the patient to book the appointment,

providing more information about the potential

advantages of low vision therapy, and providing

information regarding insurance benefits so that

patients know if their visits will be covered.

• Two IRB approved surveys were created to compare

the opinions and practices of primary care optometrists

and low vision specialists:

• Primary Care Optometrists at the Massachusetts

Society of Optometry (MSO).

• Low vision specialists at optometry schools across

the country.

• Questions within the surveys inquired about low vision

definitions and available resources, as well as referral

and intake processes.

For the survey sent to members of MSO, 21 responses were recorded. Of these, two responses

were discarded as the respondents did not identify their primary work as primary care optometry.

Additionally, 8 responses were recorded from the 22 low vision specialists from optometry schools

in the US.

OUR PURPOSE is to provide

potential solutions to help primary care

optometrists refer low vision patients

more effectively in order to make an

efficient and timely transition from

primary care optometry to low vision

specialty care.

Figure 1: Magnifying solution with laptop connectivity

via USB port 4

One in four Americans over the age of forty

experiences some level of vision impairment

(AOA).1

The services provided by low specialists can

significantly improve their patients’ quality of life by

improving emotional well-being and independence in

day to day life.2

• Management can include prescribing and training

patients to use low vision optical devices (telescopes,

video-magnification devices, or stand magnifiers) to

maximize remaining vision, as well as referring to

occupational therapists.1,3

Despite the clear advantages, there remains a

discrepancy between the number of patients who

would benefit from low vision services and utilization

of these services.2

• Optometrists play an important role in connecting low

vision patients with low vision specialists.

• Specific issues cited previously focus on potential low

referral rates by optometrists to low vision specialists

and poor patient education of services available to

them.

• Previous research focuses primarily on patient barriers

to accessing low vision services: driving distances,

depression, willingness, etc.

47% of the Primary Care Responders chose “any

visual impairment that limits a patient’s normal

visual function.” The rest of the responses vary

between 20/40 through 20/200

87% of the Low Vision Specialists considered

“any visual impairment that limits a patient’s

normal visual function” as being low vision.

Low vision is considered a numerical cut off in the minds of a many of the primary care

optometrists whereas most low vision specialists consider it to be based on the patient’s daily

function – with differing opinions, all patients are not provided the same options

37% of primary care optometrists are unaware that

some insurances cover low vision exams and

devices.

•Primary care optometrists may not have

adequate knowledge about insurance coverage

needed to effectively counsel patients.

53% of primary care optometrists state that their

standard of care is to refer patients to a low vision

specialist while 26% say they will provide care

themselves.

• This decreases referral rates from primary care

optometrists, so some patients may not be

effectively treated

14 out of 19 primary care optometrists referred to

a low vision specialist, while 10 also provided optical

devices or information about optical devices.

• Only 3 primary care optometrists cited that

they provide insurance information to patients

88% of Low vision specialists claim their patients

are unaware of resources available to them when

they present for consultation

There is a disconnect between the patients’ understanding and the resources that the primary

care optometrists believe that they are offering.