Low vision telerehabilitation aided veterans’ access to care during pandemic
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At-home telerehabilitation during the COVID-19 pandemic increased access to optometry services for veterans with low vision ocular pathology, according to a study.
Cancellation of in-person, low vision services at the Veterans Affairs Western New York Healthcare System in Buffalo, New York (Buffalo VA) and all low vision telehealth services at community-based outpatient centers (CBOCs) and rural VAs prompted “a new challenge to ‘think outside the box’ and ‘work outside comfort zones’ ... to modify low vision ocular rehabilitation clinical video telehealth (CVT) services and switch all low vision services (in-person and original telehealth services),” Carolyn Ihrig, OD, FAAO, a low-vision rehabilitation optometrist at Buffalo VA, wrote in Telemedicine Journal and e-Health.
“With the concern of potential decline of functional ability over time, the goal was to minimize delay in beginning low vision ocular rehabilitation services when diagnosed,” Ihrig said.
Ihrig followed 82 patients from the Buffalo VA and CBOC rehabilitation clinics, including 26 patients who had in-person appointments canceled at the beginning of the pandemic and 56 who were referred to these clinics after 4 months. The delay in beginning low vision rehabilitation was determined by comparing the date of the original canceled in-person service with the date of patients’ completed home ocular rehabilitation telehealth appointment or rescheduled in-person appointment.
Of patients with canceled in-person appointments, those who scheduled the new home low vision ocular rehabilitation telehealth evaluation (58%) were delayed on average 25 days. In contrast, those who waited until in-person clinics were open (27%) were delayed 153 days, those who waited until rural VAs and CBOCs were open (11%) were delayed 138 days, and those who waited until the original home ocular rehabilitation telehealth with therapist assistance was open (4%) were delayed 98 days.
“Expanding home low vision telerehabilitation services during the COVID-19 pandemic noted an overall increase in veterans who were able to access low vision optometry services utilizing CVT in their home when in-person services were canceled,” Ihrig wrote.
Of 56 newly referred patients, 91% scheduled home low vision ocular telerehabilitation evaluations without delay, 5% waited until in-person clinics were open, and 4% waited until rural VAs and CBOCs were open.
“As technology advances, future cost-saving technology can be utilized for consultations with a low vision optometrist and therapist,” Ihrig concluded. “Ultimately, a modern interdependent low vision telerehabilitation service system providing simpler, faster and cheaper services for veterans who are partially sighted or legally blind could be implemented.”
Perspective
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This study is specific to veterans with low vision. While telehealth cannot replace in-person services like trial frame refraction or assistive device evaluations, the author does well to underline the opportunity for telehealth to deliver the extensive counseling and coordination of care needed during low vision exams.
Optometrists in both private practice and institutional settings can make use of telehealth services for this informative, verbal component of low vision care. Remote appointments can be utilized for patient health concerns, but also a pre- or post-exam consultation ancillary to comprehensive exams.
Counseling in low vision involves topics such as: changes to near working distance, occlusion for binocular rivalry, use of low vision aids, introduction to accessibility settings on smart devices or computers, contrast enhancement, glare control, and so much more. This can be an overwhelming amount of information for patients to digest while performing a comprehensive eye exam, and many patients do not have time for such extended appointments.
An additional advantage of telehealth services is the assessment of a patient’s home environment, giving context to a patient’s specific visual goals and functional complaints. This study would be improved by including data from multiple clinics and diverse modes of practice, as the trends shown here may not be reflected in other populations or different regions.
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