Low vision affects quality of life for 240,000 Australians and has a ripple effect, impacting the lives of those people’s families, friends and carers. Offering a comprehensive low vision service is one way to reduce the burden on all of these people while also differentiating your optometry practice.
Low vision – described as a visual acuity of worse than 6/12 in the better eye1 – impacts an estimated 240,000 people in Australia.1 The majority of people impacted are older with the primary causes of irreversible vision loss being age-related macular degeneration, diabetic eye disease and glaucoma.
Low vision interferes with a person’s ability to carry out their day-to-day activities and is unable to be adequately corrected using medical therapies or standard vision-correcting devices. It is treated by maximising a person’s eyesight beyond what glasses, contact lenses or surgery can achieve.1
There is an enormous range of aids, equipment and assistive technologies available – from specific lighting through to high definition magnifiers and text to speech devices – and optometrists are well positioned to advise patients on the most appropriate choices.
Low vision services are a great way to differentiate your practice and can also provide staff with new opportunities for professional development and satisfaction
Options for Service
Some practices choose to develop referral pathways and relationships with low vision service providers such as Vision Australia or Guide Dogs. Macular Disease Foundation Australia guides people to these service providers and has a low vision clinic in its Sydney office. Additionally, Quantum RLV and Humanware provide low vision services.
Optometrists can also acquire the skills to take a proactive role in low vision management. This can involve providing assessments and directly selling low vision aids or facilitating in-store demonstrations through low vision consultants in return for a commission.
Julie Heraghty, CEO of Macular Disease Foundation Australia, said to proactively offer low vision services, optometrists needed to acquire expertise in low vision assessment and advice and be committed to this area of work.
She said providing the most appropriate aids and technology to a person with low vision can be life changing. “Low vision interventions can provide the opportunity to increase reading, participate in paid work and/or volunteering, social interaction, hobbies and sport and engage in everyday activities such as housework, cooking and gardening. These interventions provide a greater sense of self-worth, reduce anxiety and depression, and enable people to function independently while reducing the need for in-home or residential care.”
Ms. Heraghty said across Australia there was a need for more low vision assessment services, particularly in remote and regional areas of Australia. “Optometrists, with their prominent shop fronts, are ideally placed to fill the gap”.
Low Take Up
According to Jason Abrahams, Managing Director or Humanware, less than 5 per cent of practices stock low vision aids and technologies and offer patients advice.
“Optometrists often care for the sight of their patients from childhood or early adulthood through to old age, yet when the patient’s vision deteriorates significantly, many of them feel unable to offer appropriate support so they refer on. In fact advising patients on low vision aids and technologies is straight forward and there is no reason why you should lose your relationship with a patient just because glasses or contact lenses will no longer suffice.”
Although many eye care professionals perceive the area of low vision services to be complex and out of their level of expertise, Mr. Abrahams said there is now plenty of support available. “Low vision is taught to orthoptics students at the University of Technology Sydney and to fifth year students at the University of New South Wales School of Vision Sciences, for instance. That means we have a lot of newer eye care professionals coming out with knowledge of low vision aids and technologies available who are often quite interested in offering the service themselves rather than always referring on to other low vision organisations. Of course these students are usually more confident and comfortable with technology which makes them perfectly placed to understand digital aids and educate their patients.”
From the patient’s perspective it makes sense to consult their optometrist about low vision aids and technologies, particularly because the optometrist has a detailed and in-depth understanding of their eyes and eyesight. The optometrist is best placed to steer them in the direction of the most appropriate type of vision aid.
Education Available
Although many eye care professionals perceive the area of low vision services to be complex and out of their level of expertise, Mr. Abrahams said there is now plenty of support available. “Low vision is taught to orthoptics students at the University of Technology Sydney and to fifth year students at the University of New South Wales School of Vision Sciences, for instance. That means we have a lot of newer eye care professionals coming out with knowledge of low vision aids and technologies available who are often quite interested in offering the service themselves rather than referring on to low vision organisations. Of course these students are usually the ones with the greatest grasp of technology which makes them perfectly placed to understand digital aids and educate their patients.”
For those well out of university, companies like Humanware and Quantum RVL offer demonstrations and education to ECPs in practice or will work directly with patients.
“All optometrists are trained to recognise and measure low vision conditions. However where they often struggle is in keeping up with the rapidly growing range of vision aid options,” said Mr. Connell. “We offer in-servicing for staff regarding the latest developments in low vision rehabilitation options, including lighting, optical devices, hand-held and desktop electronic devices as well as reading machines. Our low vision consultants also offer an in practice education/awareness service for patients.”
“The exciting new OrCam MyEye is a good example of a product that just a few years ago would have sounded like science fiction. As a product that attaches to a spectacle frame, all optometry practices should be aware of the benefits it can offer their clients. To do this they need to establish relationships with technology providers to ensure their knowledge and advice is current.”
Financially Viable
Mr. Abrahams said low vision is a viable service to provide for optometrists.
“Medicare rebates are available for low vision consultations and if you are a reseller for companies like Humanware you get the opportunity to earn margins on low vision devices in the range of 25 – 45 per cent. HumanWare also offers a referral program – however I believe it is more preferable for all if the optometrist was able support their local community by offering the expertise on low vision from the practice.”
Recent changes to the National Disability Insurance Scheme (NDIS) for people who develop low vision before the age of 65 and to the Commonwealth Home Care Support Programme for those over 65 make it more important than ever for optometrists to be aware of the low vision equipment and funding options available – even if they simply want to refer patients on to low vision service providers such as Vision Australia, RSB or Guide Dogs.
“Patients are now given a budget and then they are often instructed to shop around,” said Mr. Abrahams. “Unfortunately they usually don’t know where to start. So if you, as an optometrist, can talk to them about the current and often simple to use low vision solutions available to suit their vision needs, or at least refer them on to the most appropriate provider, you will be offering a great service.”
Ms. Heraghty cautioned that the system is complex and inequitable. “People who acquire a disability such as low vision at the age of 65 years or older are required to obtain their support through the aged care system. People who acquire a disability after the age of 65 years are excluded from the (NDIS.
“They are required to access supports and services through the Aged Care system, which is neither funded nor designed to provide the supports that people with disability require.
“In addition, many younger people with vision less than legal blindness are excluded from the NDIS, yet have significant impairment to their functional vision and could also benefit from additional services and supports relating to their low vision,” said Ms. Heraghty. Macular Disease Foundation Australia is proactively lobbying government to achieve equitable access to appropriate low vision aids and technologies for Australians of all ages who have a vision disability.
Differentiating Your Practice
Low vision services are a great way to differentiate your practice and can also provide staff with new opportunities for professional development and satisfaction.
“When planning your future business, it’s important to be open to considering new area beyond the traditional offerings of frames and lenses,” said Mr. Abrahams. “If you are considering offering low vision services, first consider the staff you have on board – you’ll often find you already have an optometrist or optical dispenser who is interested in offering the service. You may also have a practice manager who will see the opportunity to advise and guide patients following the initial consultation. Alternatively, if you’re taking on a recent graduate, this may be a great way to engage them and give them a sense of ownership within the practice.”
Mr. Connell said developing a close supplier relationship and dedicating an area to low vision is important. “Practices that sell vision aids typically have a small counter display of hand-held options, information on larger options, and a relationship with a supplier to fulfil more extensive demonstrations and home trials.”
As well as providing education, low vision equipment distributors offer practices and optometrists loan equipment to trial at home or in practice. “Quantum RLV offers data sheets and information for patients, their families and carers and can provide an information session about changes in funding opportunities for Low vision appliances under the National Disability Insurance Scheme and Aged care funding,” said Mr. Connell.
