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Clinical Services
- Evaluation of low vision.
- Evaluation and prescription of optical and non-optical low vision devices.
- Training in the use of low vision devices.
- Information and referral services.
- Patient support group.
- Legal blindness determination.
- Determination of driving suitability.
- Evaluation of electronic and computer low vision devices
- Closed-circuit television and computer training.
Referrals and Referral Criteria
- Referrals may come from the following:
- Outside optometrists.
- Outside ophthalmologists.
- Outside physicians.
- Outside agencies, e.g., Department of Rehabilitation, HMO’s, schools.
- Family or friends.
- Internal optometrists.
- Internal ophthalmologists.
Exam Procedures for Low Vision Patients
- Appointments are 9:00 A.M., 10:30 A.M. and 2:00 P.M.
- May require two visits to complete the evaluation.
- Low vision evaluation includes:
- Intake questions (case history) with doctor, students, and rehabilitation personnel present.
- Measurement of distance acuity with current spectacles.
- Retinoscopy and trial frame subjective refraction with best corrected visual acuity measurements.
- Near visual acuity using text or word reading charts.
- Predict equivalent viewing distance required to attain goal print size.
- Measure contrast sensitivity.
- Visual fields.
- Binocular vision testing as needed.
- Color vision testing as needed.
- Evaluation of patient’s ability to use low vision devices.
- Evaluation of electronic magnifying devices.
- Evaluation of non-optical low vision devices.
- Counseling with our rehabilitation specialist.
- Evaluation of electronic and computer aids as needed.
- Anterior and posterior segment evaluation, as needed.
- Prescribing, dispensing, or recommendations for low vision devices.
- Report to the source of the referral.
Low Vision Devices
- Evaluation of patient’s ability to use low vision devices:
- Patients are instructed on the use of each type of low vision device.
- Trials are conducted with hand-held and stand magnifiers.
- High-add spectacles, single vision or bifocal are evaluated.
- Electronic magnifying and computer systems are evaluated.
- Telescopes for distance tasks, including bioptic telescopes, are considered.
- Rehabilitation specialists demonstrate non-optical low vision devices.
- Ordering and Dispensing:
- Once approved, devices are ordered if not currently in stock.
- If the Department of Rehabilitation is providing coverage for the devices, prior authorization must be obtained before any devices may be dispensed.
- Dispensing visits are scheduled at 10:30, 11:00, 11:30, 2:30, 3:00 and 3:30 P.M. Patients are trained on the use of the device, how to replace batteries, and how to replace light bulbs.
- Batteries are included with those devices requiring them.
Guidelines for Billing
- Billing the Department of Rehabilitation for Low Vision Services:
- Include the proper code from the International Classification of Disease, ninth revision, Clinical Modification (ICD-9-CM).
- Department of Rehabilitation prior authorization must be obtained for all devices prior to dispensing.
- Codes for low vision devices include:
- V2600 for hand-held and other non-spectacle mounted devices (including tints and stand magnifiers).
- V2610 for single lens spectacle mounted low vision aids (including high add spectacles, prism half- or full-eyes, microscopics, Optivisors and spectacle mounted loupes).
- V2615 for telescopic and other compound lens systems, such as distance vision telescopes, near vision telescopes, and compound microscopic lens systems (including hand-held or spectacle mounted distance or near telescopes).
- The report should include an opinion as to the cause of the low vision, best corrected distance and near acuities, acuities with low vision aids (when appropriate), a description of the aid dispensed or recommended (include the manufacturer’s name of the device, the catalog code number, and the wholesale and retail costs).
- Medi-Care and HMO’s do not reimburse for devices.
- All records must include reports in order for the records to be considered complete.
Patient Reports
- All patients have a report generated.
- Reports are sent to the source of the referral.
- If there is no referral source the original of the report is kept in the file.
- Reports contain the following information:
- Brief ocular and medical history.
- The patient’s chief reason for seeking low vision care.
- Measurement of the refractive error with best corrected acuity.
- Measurements of near acuity.
- Contrast sensitivity, visual field, and if applicable, color vision results.
- Anterior and posterior segment findings (when applicable).
- Recommendations concerning driving.
- Legal blindness determination.
- Recommendations for optical and non-optical devices.
Educational Objectives
- Prerequisites for Low Vision Clinic – the student must be able to:
- Pass Optometry 251 – Low Vision.
- Perform a low vision case history.
- Perform a trial frame refraction.
- Perform a trial lens refraction over patient’s correction.
- Perform retinoscopy with trial lenses.
- Perform radical retinoscopy.
- Measure low vision distance acuities.
- Measure low vision reading acuities.
- Determine magnification needs for distance and near.
- Assess a patient’s ability to use distance and near devices.
- Select and prescribe distance and near low vision devices.
- Assess illumination needs.
- Understand the uses of non-magnifying optical devices such as prisms and reversed telescopes.
- Train patients in the use of low vision aids.
- Verify optical properties of low vision aids.
- Assess patient performance with video magnifiers and train patients in their use.
- Communicate, both verbally and through written reports, with other health care and rehabilitation professionals.
- Present patient chart review and case during seminars.
- Faculty Responsibilities:
- Clinical Faculty are the providers in low vision. Students are secondary providers (observing).
- Provide training in low vision techniques through demonstration, seminars, and critique of student performance.
- Over time, allow students to assume a greater role in patient care and prescribing of aids.
- Review examination records and letters.
- Oversee computer data entry for accuracy and completeness.
Forms
- Exam
- Medicare consent to pay non-covered services
- Billing
- Checklist
- Chronological record
- Order
- Consent for exchange of information
- Legal blindness