As it stands, low vision is a specialty subset of eye care. At a primary eye care office, a patient with advanced low vision from diseases such as AMD or glaucoma may not be able have their needs met, and so they’re referred to specialists who have the equipment and training to manage their cases. Optometric researchers in the United States are now saying that may not be enough—and asking why primary care optometrists aren’t embracing more low vision patients.

Low vision specialty practices provide low vision patients the most valuable care available, but researchers note that cases of mild vision loss (those with best-corrected visual acuities of 20/25 to 20/70) are becoming more prevalent, particularly with an aging population. Naturally, these cases could overwhelm the low vision specialists and flow over into primary care practices.

The researchers analyzed results from an anonymous survey completed by 229 actively practicing optometrists. They found that, from a patient prospective, access to a low vision specialist is limited. Some regions have “virtually no low vision rehabilitation services, but even with access to services, there is limited uptake,” the research explains. “In general, fewer than 20% of patients with vision impairment access low vision rehabilitation services.”

From a physician perspective, the most commonly reported barriers to embracing mild low vision treatment was the cost of the low vision exam to the patient and access to proper equipment. The survey shows 55% of optometrists polled believe that “patients are not interested or would not go to a low vision exam.” Others—29%—believe that storing necessary equipment such as magnifiers in their offices is not feasible. Another 17% said they were uncertain of the benefit that low vision services could provide to mild vision loss patients. Other common responses included “lack of proficiency with high adds” (13%) and “lack of time” (13%).

According to the survey, 19.3% of optometrists who were not low vision specialists engage in low vision rehabilitation, but did not complete any residency program. Another 11.8% completed an optometric residency and are engaged in low vision rehabilitation. A quarter of respondents completed an optometric residency but do not provide low vision rehabilitation care in their practice. But most (43%) neither completed any residency program nor provide low vision rehabilitation care.

With the prevalence of mild vision loss growing, the researchers suggest launching additional studies to understand what interventions patients with mild vision loss will respond to and which are most effective.

Malkin A, Ross N, Chan T, et al. US optometrists’ reported practices and perceived barriers for low vision care for mild visual loss. Optom Vis Sci. 2020;97:45-51.