A recent study finds that while most glaucoma specialists make low vision service (LVS) referrals based on appropriate criteria, only a small percentage of glaucoma patients seek LVS because communication with practitioners remains a critical roadblock to referral.1
American Glaucoma Society members surveyed about their LVS referrals reported that patient difficulty performing activities related to vision (78%) and degree of visual field loss (63%) are their top criteria when making a low vision referral. Other relevant factors include level of visual acuity loss (24%), loss of contrast sensitivity (4%) and the perception that patients would follow through with a referral (2%).1
But roughly one third of patients don’t get considered for LVS. Top barriers include patient failure to report difficulty with activities related to vision (34%), the doctor’s judgment that there’s insufficient time to counsel patients and discuss options during clinical visits (32%), and the perception that patients would not be able to afford LVS (31%).1
However, it’s not the eye care provider’s job to financially advise patients and judge what they can and cannot afford, suggests Richard Shuldiner, OD, of Low Vision Optometry of Southern California. Regardless of expense, it is only fair to present patients with all of their options and let them decide which is best, he says.
Of survey respondents, 23% said referral practices were restricted because they did not have enough experience with LVS or understand the criteria for referral, 20% reported their perception that patients would not follow through with a referral and 16% responded that local LVS were not very effective or would not benefit their patients.1
Dr. Shuldiner says that financial concern may also affect low referral rates. When a glaucoma specialist receives a referral, rather than refer that patient to LVS, the specialist sends them back to the referring doctor to ensure a continued stream of patients. He notes that if those who do refer receive complaints from patients about paying high expenses and not having perfect vision, they’re less likely to keep referring due to patient dissatisfaction.
To start the conversation about low vision between providers and patients, the study concludes that standard questions inquiring about difficulties related to vision should be included in the patient interview to ensure patient needs are being met and raise awareness of future signs and symptoms of vision loss.1
Due to the minimal education and exposure to low vision that ophthalmologists receive during training, the authors suggest a more proactive approach, as “efforts to increase education on low vision and rehabilitation services early in training may lead to greater comfort and consequently higher referral to LVS.”1
|1. Kaleem MA, West SK, Im L, et al. Referral to low vision services for glaucoma patients: referral criteria and barriers. J Glaucoma. 2018;27(7):653-5.|