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Survey: Referral rate for low vision services low among glaucoma specialists
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There is a need for more clearly defined low vision services referral guidelines, according to researchers in the Journal of Glaucoma.
Glaucoma specialists were more likely to be high referrers to low vision services if they reported following the American Academy of Ophthalmology’s (AAO’s) Preferred Practice Pattern (PPP) recommendations for low vision, were happy with their current low vision services referrals and had several patients previously enrolled in low vision services, according to a survey distributed to American Glaucoma Society (AGS) members.
The survey was completed by 207 of 1,029 eligible AGS members.
The majority (98%) of ophthalmologist-respondents identified themselves as full-time fellowship-trained glaucoma specialists. Most respondents (73%) were seeing more than 50 glaucoma patients each week.
Most respondents were close in proximity to low vision services: 32% had a low vision clinic in their office or building, and 52% were within 10 miles of a low vision clinic.
About one-fifth, or 22%, of respondents were referring more than five patients each month to low vision services. At least 93% of all respondents had one or more patients who had attended a low vision clinic, and 68% reported communicating with providers at low vision centers.
Although 88% of respondents were actively referring at least one patient per month, only 22% were following the AAO’s PPP, according to researchers.
High referrers, who referred more than five patients monthly to low vision services, tended to be in academic practice and reported more than 10 patients per month who had already seen a low vision provider, researchers found.
High referrers reported having higher volumes of patients previously seen in a low vision clinic, following the PPP and greater satisfaction in their current low vision services referral practices than low referrers.
Those who reported following the PPP and who reported satisfaction with their low vision referral patterns were 2.8 and 2.6 times more likely to be high referrers than low referrers, researchers wrote.
The researchers found no association between reported patient volume and referral to low vision services.
While handouts and pamphlets can provide information to patients, it is not known what type of information is most important to increase low vision services utilization, they said.
Ophthalmologists who have the most experience with patients enrolled in low vision services and who familiarize themselves with practice patterns on low vision will be more likely to refer their glaucoma patients, researchers concluded.
The researchers recommend the AAO consider increasing education to ophthalmologists on the recognition and management options for glaucoma patients with low vision needs to improve referral rates.
Researchers also suggest improving the guidelines where the recommendations are vague, particularly for visual field loss, they said. – by Abigail Sutton
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Blair Lonsberry, OD, FAAO
Patients with low vision have more difficulty with daily living activities, greater chance of injury and more depression.
Despite the large number of patients who could benefit from low vision services (LVS), few get this specialized care.
The reasons for not accessing low vision care are complex, including not understanding what low vision is, what services are available, miscommunication between patients and eye care providers, lack of referral, inconvenient location, limited mobility, fear of judgment by society, education level and cost. The most common reasons for potential underutilization are related to lack of referral or miscommunication between patients and providers on the benefits of LVS.
The authors determined that high referrers of glaucoma patients for LVS were more likely to have the highest number of patients previously enrolled in LVS, follow the preferred practice guideline recommendations for low vision and report being happy with their current low vision referral practices.
This study reminds us of the importance of ensuring that our glaucoma patient’s daily living challenges are being addressed in between the scheduled IOP checks.
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