Low Vision Clinic Guidelines

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