Veterans Affairs Low-vision Intervention Trial II: One-year Follow-up

Abstract

This Program Memorandum (PM) alerts the physician and provider community that Medicare beneficiaries who are blind or visually impaired are eligible for physician-prescribed rehabilitation services from approved health care professionals on the same basis as beneficiaries with other medical conditions that result in reduced physical functioning. We are issuing this PM in response to the language in the committee report accompanying the FY 2002 Labor/Health and Human Services/Education appropriations bill. It states: "Medicare beneficiaries who are blind or visually impaired are eligible for physician-prescribed rehabilitation services from approved health care professionals on the same basis as beneficiaries with other medical conditions that result in reduced physical functioning. The Committee urges CMS to direct its carriers to inform physicians and other providers about the availability of medically necessary rehabilitation services for these beneficiaries." The attached article is for publication in your next regularly scheduled bulletin. For your information, the applicable manual sections pertaining to rehabilitation services are as follows:

Trend, Pattern and Presentation of Visual Impairment and Blindness among Students of Schools for the Blind in South-East Nigeria

“…Similar to studies reported within and outside Nigeria, majority (85.9%) of the students were blind and only 14.1% had visual impairment [6,8,10,15,17,20,25].…”

“…This study surveyed 92 students from 3 schools for the blind in South-Eastern Nigeria made up of 52(57%) males and 40 (43%) females. The higher number of males in schools for the blind was also reported in similar studies in Nigeria and some other African countries [12,25,26]. This might not necessarily mean a higher incidence of visual loss in males, as male to female visual impairment prevalence ratio of 1:1.5-2.2 indicate more likelihood of females having visual impairment than males in all regions of the world [27].…”

“…None of the students similar to other studies in Nigeria [5,25] had normal/ mild visual impairment in contrast to some studies in developed countries [6,9]. The social stigma associated with visual loss in this part of the world unlike some other countries where normal sighted children go to schools for the blind probably so they can benefit from the free eye care, education, accommodation, and feeding may account for this disparity in findings [25].…”

Economic Evaluation of Low-Vision Rehabilitation for Veterans With Macular Diseases in the US Department of Veterans Affairs

“…The design of the LOVIT II study has been described elsewhere. 8,9 Briefly, 323 patients eligible for VA health care services with a primary eye diagnosis (better-seeing eye) of macular disease and a best-corrected distance visual acuity of 0.40 to 1.00 logMAR (6/15-6/60 or 20/50-20/200 Snellen), using the Early Treatment of Diabetic Retinopathy Chart were randomized to receive LV rehabilitation or basic LV services at 9 VA facilities. All participants received an optometric LV examination, and they were eligible to receive the same LV devices without charge.…”

“…To our knowledge, LOVIT II was the first multicenter RCT comparing LV rehabilitation with basic LV services for patients with macular diseases and near normal or moderate levels of visual impairment. 8,9 In this study, we examined the costs and consequences of LV rehabilitation or basic LV services.…”