Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice

Abstract

Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened (n = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient’s overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.

Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology

“…There are limited comparative data available as the few reports on LVR utilization were outside the US health system, relied on patient self-report, or used different visual acuity referral criteria. In these reports, utilization of LVR service ranged between 49% and 97% …”

“…In these reports, utilization of LVR service ranged between 49% and 97%. 7,17,18,20 Across medical specialties, CDSSs have been shown to be effective at improving health care delivery processes and outcomes. [21][22][23][24] Endocrinology, primary care, radiology, and other specialties have initiated CDSS and associated quality improvement efforts, but to date, despite preliminary interest, 25 there are no published works that we know of in ophthalmology examining the use of CDSSs.…”

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

“…Existing studies mainly examined either the perspective of patients or healthcare professionals [ 22 – 24 , 26 – 31 ]. However, Khimani, Redmon [ 32 ] and Sarika, Venugopal [ 33 ] recently showed that investigating both point of views can be beneficial as it generates a broad perspective, which contributes to a better understanding about factors influencing the referral pathways to LVS. Furthermore, earlier studies were mainly conducted in countries with no systematic national provision or financial coverage of LVS and/or with a low income, such as the United States [ 25 , 28 , 32 ], Australia [ 30 , 31 ], Canada [ 23 ], India [ 29 , 33 ], Colombia [ 34 ] and Ghana [ 35 ].…”

“…However, Khimani, Redmon [ 32 ] and Sarika, Venugopal [ 33 ] recently showed that investigating both point of views can be beneficial as it generates a broad perspective, which contributes to a better understanding about factors influencing the referral pathways to LVS. Furthermore, earlier studies were mainly conducted in countries with no systematic national provision or financial coverage of LVS and/or with a low income, such as the United States [ 25 , 28 , 32 ], Australia [ 30 , 31 ], Canada [ 23 ], India [ 29 , 33 ], Colombia [ 34 ] and Ghana [ 35 ]. As a consequence, insights to referral barriers and facilitators are particularly lacking from high-income countries in general with different types of healthcare and coverage systems.…”

Telerehabilitation Training to Facilitate Improved Reading Ability with New Magnification Devices for Low Vision

“…Significant increases in reading speed also occurred after additional vision rehabilitation in the LOVIT II trial, which did not change in the group without additional therapy 7 . This trial provided vision rehabilitation services in-office, but there are several barriers that can limit low vision patients' ability to attend in-office training sessions as part of clinical practice, such as lack of transportation and poor physical health 8–11 …”