Hospital rehab work can complement optometric private practice
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Most of the rehabilitation hospitals in the U.S. were built in the last 20 years.
There is tremendous need at these hospitals for vision therapy and neuro-optometric rehabilitation services, yet it’s a mode of practice that many optometrists aren’t even aware exists.
Over the years, I have transitioned to providing more and more hospital-based care and now divide my town time equally between private practice in the mornings and hospital-based work in the afternoons.
Hospital-based optometry is challenging. Sometimes the patients are belligerent or even under police guard – although it is far more commonplace that they are confused and overwhelmed. Some of the patients are very badly injured, with severe cognitive and communication impairments following a stroke, car accident or brain surgery.
But for all its challenges, rehab hospital work is incredibly rewarding. Medically complex, inpatient evaluations are well compensated by insurance. Doing this kind of work can establish you as an expert in the community, and it provides opportunities to build a strong rapport with physicians and other rehabilitation professionals.
Most importantly, we are literally saving lives. Improving patients’ visual function will almost certainly enhance all other areas of their recovery. Often, I can help the patient function better right away. If they are seeing double and I’m able to relieve those symptoms with prisms or binasal occlusion, for example, it enables the patients to make progress in their other therapies.
I spend about 30 minutes evaluating each new patient. I develop a treatment plan, provide any glasses, prisms or other lenses that are needed, and instruct the therapy staff on how to help the patient continue to progress.
Here are five tips for success in this type of work.
Begin with an in-service for the therapy staff. They will be your allies and extenders to help the patient recover. They need to understand what you do and why.
Allocate time to go over all the charts for the day when you arrive, so that you know the patient’s medical history and functional testing before you walk in the room.
Many of these patients will not be able to answer your questions reliably – if they can speak at all. If possible, do evaluations with a family member and the occupational therapist in the room.
Carry inexpensive spectacles (I always have plano glasses and +6 D to -6 D with me). You would be surprised how many people end up in the hospital without their customary glasses. Sometimes their cognitive problems improve when they merely put their glasses back on.
The plano glasses can be used for binasal occlusion or a blur patch. I have found that waiting for the hospitals to provide glasses is unreliable, so if I spend $50 to $75 per month on “giveaway” glasses, it is well worth it to see more rapid progress.
Be hopeful! Even with significantly debilitating injuries, patients can get better. I have seen patients with no pupil reflex or no light perception at all recover their vision.
I hope more optometrists will consider doing hospital rehabilitation work. It can complement or replace private practice or be a wonderful part-time option for someone who is semi-retired or wants more time with family.
For more information
Marsha Benshir, OD, FNORA, specializes in diagnosing and treating binocular vision disorders and visual problems related to congenital and acquired brain disorders, such as ADHD, traumatic brain injury and stroke. In addition to her private practice, the Center for Vision Development and Rehabilitation in New Market, Md., she is on staff at five rehabilitation hospitals in the Washington area, including MedStar National Rehabilitation Hospital.
Benshir will be teaching a course on building a hospital-based neuro-optometric practice at this year’s NORA virtual conference for experienced optometrists who want to transition to providing hospital-based care. For more information and to register, visit www.nora2021.com.
Disclaimer: The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of the Neuro-Optometric Rehabilitation Association unless otherwise noted. This blog is for informational purposes only and is not a substitute for the professional medical advice of a physician. NORA does not recommend or endorse any specific tests, physicians, products or procedures. For more on our website and online content, click here.
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