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    Challenges facing vision rehabilitation services


    In the United States, ophthalmologists and optometrists provide components of vision rehabilitation in private practices, academic departments, and independent rehabilitation agencies. The situation in Canada is similar, with optometrists and ophthalmologists in private practices and academic departments providing components of vision rehabilitation that complement services offered by the CNIB.

    Optometrists and ophthalmologists in both countries tend to provide visual function evaluation, assessment for optical devices, and rehabilitation planning by assessing visual function, doing refractions, assessing for specific devices, and planning rehabilitation. The U.S. State agencies and CNIB in Canada tend to provide training services or client support services.

    Barriers to service

    Unfortunately, in both countries, not all individuals who require and can benefit from devices have access to them.

    “Although some Canadian provinces offer some device coverage, there is no universal access,” Dr. Jackson said. “In the United States, some states provide some devices, but for many patients with vision loss, purchasing devices is another element of health-care-related financial hardship.”

    Other barriers to services for this patient population are transportation to services and referrals. Dr. Jackson cited the American Academy of Ophthalmology SmartSight initiative, spearheaded by Lylas Mogk, MD, which was an effort to address these barriers.

    “Level 1 of the SmartSight model of incorporating vision rehabilitation into the continuum of ocular care is encouraging every ophthalmologist to advise patients with acuity less than 20/40, scotoma, visual field loss or contrast sensitivity loss, that vision rehabilitation options exist,” Dr. Jackson said.

    “The goal,” she said, “is to have evidence-based services that offer accessible vision rehabilitation as part of the continuum of ocular care.

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