U.S. Optometrists' Reported Practices and Perceived Barriers for Low Vision Care for Mild Visual Loss

Abstract

Identification of modifiable barriers to low vision rehabilitation (LVR) can inform efforts to improve practice management of patients with low vision (LV), through, for example, targeted educational programs for optometrists who do not practice LVR. PURPOSE: Mild vision loss (20/25 to 20/70) is increasing in prevalence among the aging population, yet it is unclear whether near-reading complaints (the highest presenting chief complaint) are being addressed. Studies of LVR provision by U.S. optometrists are currently lacking. This study elucidated self-reported optometric practice patterns for patients with mild vision loss. METHODS: Anonymous surveys were completed by 229 actively practicing optometrists across the United States. The survey inquired about the frequency of providing LVR for mild vision loss patients and the top barriers that prevent them from offering LVR management (including optical aids or referral). RESULTS: Compared with those moderately actively practicing LVR, twice as many (2.08Â) practitioners who do not practice any LVR reported that they never prescribe near-reading add power of 4 D or greater for mild vision loss (P < .001). Among those who do not practice LVR, 39 and 11% indicated that they never prescribe any LVR management strategies for patients with visual acuity of 20/25 to 20/40 and 20/50 to 20/70, respectively. The two most commonly reported barriers to LVR indicated by about half of respondents were "cost of the LV exam and/ or devices" and that "patients are not interested or would not go to an LV exam." Nearly a third of providers reported that "it is not feasible to stock magnifiers in office." CONCLUSIONS: A sizable group of non-LVR providers in the United States may not be addressing the near-vision needs of patients with mild vision loss. Several of the reported top barriers are potentially modifiable through the development of targeted educational programs for providers.

Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework

“…Lack of equipment was also a common theme in low vision where a lack of low vision devices such as hand and stand magnifiers, telescopes and high-tech magnifying aids were barriers. 31,38,42,44,54 summarised that '. .…”

“…38,42,44 Patient factors. Disinterest or lack of motivation 33,46,49,54,55 and lack of affordability 30,33,54 were common patient barriers to optometrists delivering eye care. Patient factors were an issue for glaucoma, 30,32,35,47 with studies listing a diverse range of patients issues such as patients failing to attend follow-up appointments, 30,47 poor affordability 30 and patient objections to certain tests such as pachymetry.…”

“…Optometrists' beliefs around patients, expected outcomes, litigation and perceived difficulties were reported as a barrier to delivering eye care. 18,25,31,32,[34][35][36]38,40,42,43,47,50,51,[54][55][56] Eye care areas where optometrists' beliefs were an issue were low vision, 38,42,54,56 AMD 34,40,50,55 and glaucoma. 32,35,47 For low vision, optometrists' beliefs about the benefit of low vision care 42,54,56 and of patients' acceptance of care were issues.…”

“…18,25,31,32,[34][35][36]38,40,42,43,47,50,51,[54][55][56] Eye care areas where optometrists' beliefs were an issue were low vision, 38,42,54,56 AMD 34,40,50,55 and glaucoma. 32,35,47 For low vision, optometrists' beliefs about the benefit of low vision care 42,54,56 and of patients' acceptance of care were issues. 38,56 For AMD, optometrists' beliefs about patients was a barrier to delivering nutritional recommendations, with one optometrist commenting, 'I think telling people, eat more fruit and vegetables, low GI food and some nuts, it just sounds like every bit of dietary advice, and it doesn't sound special, and they've got a special eye threatening disease, and that just sounds so generic, like how can that possibly work.…”

Personalized Telerehabilitation for a Head-mounted Low Vision Aid: A Randomized Feasibility Study

“… 12 The reasons for nonuse had been identified as multifactorial, involving the device, the user, the environment, and the intervention. The costs associated with the device as well as the low vision examination and low motivation of the patient to undergo a low vision examination 13 were identified as important barriers. 11 …”