The Low Vision Doctor's
The history, physical examination, functional assessments of vision, and evaluation of low vision aids come together with the patientís goals and diagnoses to allow for the development of a rehabilitation plan. It becomes the initial blueprint for low vision rehabilitation and should consider each of the following areas:
General Eyewear: Should the patientís general eyewear be changed? What types of prescription eyewear are advised? What type of material and lens style? Are filters, antireflection coatings, ultraviolet coatings advised? When should it be worn? Are there eye safety issues?
Light and Glare Control: Is a sunglass required? What color? Is supplemental task lighting required? Has a hat or visor been advised? Should the work, home or office lighting be modified?
Optical Aids for Use at Near and Intermediate: Are magnifiers or dedicated microscopic reading eyewear required for reading or other close or intermediate tasks?
Optical Aids for Use at Distance: Is a bioptic system, hand held telescope or head worn binocular aid required?
CCTV Video Magnification Systems: Does CCTV technology aid the patient? Which systems are recommended? Where will the system be used and for what purposes? What features are required? Which type of contrast is best for the patient? How large a monitor is required? Is color required? Are there physical limitations that may require further training?
Visual Field Rehabilitation: Are visual field awareness prisms or reverse telescopes indicated? Is scanning therapy being prescribed? Are adaptive strategies being prescribed?
Computer Vision Considerations: Is a computer required for vocational or occupational needs? What size monitor? Is screen enlargement software advised? Is screen reader required? Is dedicated computer eyewear or bioptics required? Are technical computer adaptations required that may indicate the need to refer the patient to a technology specialist?
Electronic Reader Machines: Is a dedicated electronic reading system indicated? Can software and/or scanner be added to the patientís existing computer?
Patient and Family Education / Counseling: Have the patient and family been counseled on the condition, visual effects, the rehabilitation process, and safety issues? What literature or videotapes, are being provided? Has the patient been directed to specific web sites or to the practice web site for additional information? The low vision practice web site allows the doctor to provide updated information on the latest products, online manuals for products they may be using and can direct them to websites specific for their condition.
Medical Surgical Issues: Are other medication treatments indicated? Is referral indicated to other specialists? Have orders or prescriptions been written?
Binocular Vision and Eye Motility Issues: Is prism, occlusion or orthoptic therapy required in office or at home?
Low Vision Training: Is home and/or in office training for eccentric fixation or scanning being prescribed?
Rehabilitation Teacher: Is a referral indicated for training in independent living aids or Braille? Is in home independent living training required? Does the patient require home modifications?
Occupational Therapy: Is an occupational therapy consultation advised for activities of daily living? Is scanning therapy or home modification advised? Have orders been signed for OT?
Motility and Orientation Training: Is orientation and mobility training indicated or has the patient already been trained? Is a guide dog a consideration?
Driving Issues: May the patient continue to drive? What warnings were given? Is referral for a driverís rehabilitation evaluation advised? Are we requesting a Bureau of Motor Vehicle behind-the-wheel driving evaluation? Is the patient a candidate for bioptic or hemianoptic driving rehabilitation?
Vocational Counseling: Is referral to a vocational rehabilitation counselor advised? Is the patient referred for disability certification?
School VI Teacher / Special Education: What recommendations are to be made to teachers, the visual impairment teacher or the special education department? Is there a preferred seating position? Is special classroom adaptation required? What devices such as CCTVs are being requested for the school to provide? What treatments should be added to the patientís educational plan?
Psychological, Psychiatric or Neuropsychological: Is a referral for general psychological or psychiatric consultation advised? Has the patient refused referral? In the brain injury patient, is a neuro-psychological consultation indicated?
Support Groups / Patient Information: Has the patient been referred to a support group or to a patient ambassador program? What patient information, forms, brochures and videotapes have been dispensed?
Reports: Who should receive reports (referring professional, eye care providers, physicians, therapists, teachers, family, patient, vocational rehabilitation counselors, teachers and case managers)?
Third Party and Funding Issues: What steps do we need to perform to aid the patient in finding funding or in providing information to their insurance company, reports, cost statements, and/or statements of medical necessity?
Follow-up Care: When should the patient return for progress evaluations? Is a full re-examination date advised? Has the patient been released back to his primary care provider?