A.O.A. Low Vision Rehabilitation Section Student Awareness Program

1. A.O.A. Low Vision Rehabilitation SectionStudent Awareness Program JERRY DAVIDOFF O.D., F.A.A.O, LVRS COUNCIL VICE-CHAIR

2. WHAT WE ARE GOING TO DO • Discuss why YOU should provide low vision rehabilitation services • Review training options in low vision rehabilitation • Discuss benefits of membership in the AOA LVRS as well as your State Association’s (province’s) Low Vision Rehabilitation Committee • Discuss benefits of referral for low vision rehabilitation care

3. RECOGNIZE THE NEED • There are lots of visually impaired people who need services • Estimates range from 4 to 14 million in the USA • Expected to increase as baby boomers age • Every 7 minutes someone in America becomes blind or visually impaired • The need for quality LV care is growing and being filled by less qualified individuals • Closed head injury cases are adding to the LV need

4. RECOGNIZE THE NEED • Other disciplines are getting involved • National focus on low vision rehabilitation • AOA Healthy Eyes Healthy People initiative • NEI Low Vision Education Program • NIH Healthy People 2010 • AOA LVRS needs your help… • ~35,000 ODs/1,000 members AOA LVRS

5. Why should you “do low vision?” • Optometrists do it best!! “Optometrists are uniquely qualified to manage visually impaired patients in that they can assess ocular status, evaluate visual functioning, prescribe low vision devices, and provide therapeutic intervention or coordinate other forms of care to improve the functioning of the patient’s impaired visual system.”

6. AOA LVR STATEMENT The American Optometric Association supports the interdisciplinary approach to rehabilitation of patients with low vision (legally blind and/or visually impaired). As part of the vision rehabilitation network, the optometrist plays an integral role through diagnosis and management of the individuals that are visually impaired and prescription of optical and non-optical devices to provide this population with optimal use of remaining vision. Optometrists who provide comprehensive low vision care establish clinical treatment plans including, but not limited to, prescription, training, education and interdisciplinary consultation.

7. Eye care specialist Low vision specialist Teacher of students with visual impairments Low vision educator Orientation & mobility specialist Rehabilitation teacher Vocational rehabilitation counselor Occupational therapist Physical therapist Technology consultant Social worker Gerontologist INTERDISCIPLINARY TEAM

8. WHAT IS OPTOMETRY/ LV • OPTOMETRY IS THE PRIMARY EYE CARE PROVIDER • PRIMARY CARE IS DOING IT ALL AND REFERRING WHAT SOMEONE ELSE HAS UNIQUE KNOWLEDGE OF • PEDIATRICS, VISION THERAPY, CONTACT LENSES, PATHOLOGY, GERIATRICS ARE ALL ENCOMPASSED IN DIFFERENT ASPECTS OF LOW VISION.

9. “Yeah, but I want to do…” • Geriatrics! Many of the conditions which cause visual impairment are more common in the aging population: AMD, cataracts, glaucoma, diabetic retinopathy • Contact lenses! Aperture control contact lenses, bitoric RGPs, contact lenses for nystagmus, high refrac.errors, K-Cone CL telescopes

10. “Yeah, but I want to do…” • Disease!! • Aniridia • Chorioderemia • Best disease • Diabetic retinopathy • Glaucoma • Macular degeneration • Blepharospasm

11. “Yeah, but I want to do…” • Kids!! • Visually impaired infants through school aged kids • You will be a member of the child’s educational team • You will be able to positively affect the child’s educational experience • You can draw on many VT concepts in working with this population

12. “Well, I’ve heard low vision is too…” • Hard to do—Bull! Low vision rehabilitation IS optometry. Refraction is the basis for all prescribing Knowledge of optics is essential, but can be learned (and better be before boards) Prescribing requires knowledge of the ocular disease process, visual functioning, and patient characteristics and psychology

13. “Well, I’ve heard low vision is too…” • Time consuming • Good care requires an average of 1 hour of the doctor’s time, on the initial visit • Testing and working with devices can be delegated to knowledgeable staff • Fees for services should reflect time spent with the patient

14. “Well, I’ve heard low vision is too…” • Expensive to set up • If you have a lane of equipment, you have most everything you will need for evaluation • You will need to invest in a stock of devices, including some electronic items and some specialized testing equipment • It takes no more room than a standard examination lane in a primary care practice • Creativity and flexibility are the most important resources

15. “Well, I’ve heard low vision is too…” • Depressing • Almost all of your patients are afraid and in crisis and you are uniquely able to help them!!! This is an area of practice that can be extremely rewarding!! Think of seeing faces for the first time with a telescope and the smile it brings.

16. Charles Bonnet Syndrome • If you save a patient from “hallucination Dx” you have helped them • First described in 1769 • Vivid and complex hallucinations • Recognized as unreal • In persons with bilateral vision loss • Images include dwarf people, animals, plants, etc. • May have no personal meaning • Will be formed images- not vague • Recognized as unreal and are not disturbing

17. The practical considerations… • This area of interest makes you more marketable to potential employees/associates • You can offer a unique service to the practice • In doing so, you will establish a new patient base

18. The practical considerations… • These patients are needy • They can take up more of your time • They may not be happy with what you tell them • They may not be happy with the treatment options Refer out your low vision patients if you can’t handle the downside!!! Compassion is necessary.

19. WHY I DO LOW VISION • I make a living doing it. • I love the impact I have on the patients lives. • I provide a service that is unique and needed. • I love it, along with my primary care practice.

20. Getting involved with your Profession • Join the AOA and the AOA Low Vision Rehabilitation Section • Join your State Association’s Low Vision Committee. • If they don’t have one – form one • Join other organizations dealing with visual impairment and eye disease. Represent optometry to others in healthcare

21. Benefits of Membership • Bi-monthly informative newsletter • Quality continuing education • Representation to advocacy groups and third party programs, i.e. Medicare, VSP, etc. • Professionally produced patient education materials to enhance your practice. • The Low Vision Rehabilitation Section Manual, containing practice management and other useful information

22. Benefits of Membership • Membership Directory. • The latest in product information on low vision systems from optical companies. • Coupons for savings on low vision industry goods and services. • Regional opportunities to network with other LVRS members and optometry students. • Membership certificate suitable for framing.

23. Summary • “If you have never felt a lump in your throat or a tear in your eye, you have not truly experienced practicing low vision rehabilitation” – RT Williams, OD • You will enhance your value to your patients, your colleagues and the medical community if you practice LVR • You will build your practice faster with LVR

24. Happiness • Is seeing a smile on the face of a LV patient attaining a goal • Is hearing that a patient can regain employment after a successful rehabilitation program is carried out • Catching an AMD just as it goes exudative before much damage can be done • Watching EAGLES 38, Rams 3

25. Our thanks to Optelec and Shop Low Vision.com for their Generous Support! My thanks to Dr. Boland and the UMSL for inviting me.