Models of low vision care: past, present and future

Abstract

Over the last 50 years, the concept of a low vision service has changed considerably. It has moved away from just the optometrist or optician dispensing magnifiers, to having a large team working across the health and social/ community care sectors, with voluntary organisations often playing an important role. This paper reviews how low vision rehabilitation services have evolved and what models of low vision care are currently available. It goes on to consider the effectiveness and accessibility of low vision care. Over the last 50 years, the focus of low vision care has moved from helping people with a visual impairment to read with magnifiers, to a holistic rehabilitation process involving a range of professionals.

Low-vision Service Provision by Optometrists

“…The range of LV devices that respondents had available in their practice can be seen in Table 2, along with the results of Lim et al 24 If the respondents did not manage many patients with minimal amount of visual disability and simple goals using high-powered additions and lighting (level D) or simple optical devices such as magnifiers and filter lenses (level E) in question C10 (shown in Fig. 25,26 The three most common reasons were the lack of LV devices (75.3%), the lack of LV equipment (70.7%), and the lack of experience (58.2%). 4A).…”

The Barrie Jones Lecture—Eye care for the neglected population: challenges and solutions

“…Major causes of low vision included retinal diseases (35.2%), amblyopia (25.7%), optic atrophy (14.3%), glaucoma (11.4%) and corneal diseases (8.6%). Low vision care, initially a hospital-based service, focused on dispensing optical and non-optical devices, eventually evolved into a multidisciplinary holistic rehabilitative approach 60 . However, these services are still inadequate in many areas 61 .…”

Will optometry respond to the growing challenge of providing evidence‐based low vision care?

“…In countries that do, there has been a move away from a solo optometrist to a holistic approach, wherein optometrists are part of a multidisciplinary team, such as the Kooyong Low Vision Model developed in Melbourne, Australia. Ryan describes various other existing multidisciplinary models, including hospital‐based services, in‐patient services (for example, the USA Veteran Affairs Services), government‐funded low vision care by community optometrists linking with other community professionals and voluntary organisations (for example, the Welsh model), self‐management education programs and a primary/secondary/tertiary tiered system (for example, the World Health Organization model) . Although each model has its advantages and disadvantages, it does not seem that any one model is entirely effective, given the number of people with low vision who would benefit but remain without low vision services in the countries where these models operate.…”

“…These matters and more are presented and discussed in the selected abstracts of Vision2014—The 11th International Conference on Low Vision. Leaders in low vision service delivery and research offer their perspectives on models of low vision care, as well as other topical issues and research in the field, such as the explosion in technological assistive devices, which Ryan notes will shape future models of care. Among others, topics include, ageing and low vision, driving with low vision, falls, dual sensory loss, neurological vision impairment, cerebral vision impairment, epidemiology, service delivery, standards for comprehensive vision rehabilitation, research in low vision, the role of occupational therapy, orientation and mobility, psychosocial aspects of low vision, paediatric low vision, employment, client outcomes, visual function, activities of daily living, reading, optical and electronic devices, quality of life, education for all, workforce and professional development, sport, environmental factors, advocacy, information access, medical and surgical management and bionic implants.…”

“…Ryan describes various other existing multidisciplinary models, including hospital-based services, in-patient services (for example, the USA Veteran Affairs Services), government-funded low vision care by community optometrists linking with other community professionals and voluntary organisations (for example, the Welsh model), self-management education programs and a primary/secondary/tertiary tiered system (for example, the World Health Organization model). 22 Although each model has its advantages and disadvantages, it does not seem that any one model is entirely effective, given the number of people with low vision who would benefit but remain without low vision services in the countries where these models operate. What is apparent is that best practice is to develop easily accessible, affordable multidisciplinary services, which should be designed and delivered as inter-agency partnerships and appropriately funded by government and the health insurance sector.…”