Patient, provider perception of low vision services may influence referral rates
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Nearly 75% of patients with visual acuity of 20/200 or worse were never referred for low vision services, an outcome possibly driven by perception of rehabilitative care, according to data published in Optometry and Vision Science.
“Low vision and blindness are considered one of the leading causes of disability for adults in the United States,” Katherine Dalzotto, MD, a resident physician in ophthalmology and visual sciences at the University of Wisconsin School of Medicine and Public Health, and colleagues wrote. “Cases are predicted to more than double by 2050, highlighting the critical need for low vision examinations and rehabilitation services.”
Dalzotto and colleagues conducted a retrospective, electronic medical record review of 2,014 patients with visual acuity of 20/70 or worse at the University of Wisconsin between 2014 and 2019, during which time a low vision clinic was established and significantly advertised to patients.
From 2014 to 2016 — before the establishment of the university’s low vision rehabilitation program — researchers reported that 91.7% of patients had visual acuity of 20/70 to 20/200 in their better-seeing eye at their first visit, but only 2.2% of patients were referred for low vision services. Moreover, just 12.5% of patients with visual acuity worse than 20/200 were referred during this time.
After the establishment of the low vision program, referral rates at the first visit improved from 2.2% to 8% in patients with visual acuity of 20/70 to 20/200 (OR = 3.88; P < .001) and from 12.5% to 31.9% in those with visual acuity worse than 20/200 (OR = 3.29; P = .002).
However, 89.8% of patients with visual acuity of 20/70 to 20/200, and 74.4% of patients with visual acuity worse than 20/200 were never referred for low vision services. Among those that were referred, 10.3% of patients declined services.
“Perception toward low vision rehabilitative services may have played a key role to referral outcomes, and providers play an important role in how this perception is driven,” Dalzotto and colleagues wrote. “Despite referral rates being low, establishing a low vision rehabilitation service did improve referral rates for all vision categories at our institute.”
They continued: “We hope to break down patients’ misconceptions of low vision services and deconstruct providers’ assumption that low vision services are a last-resort treatment for those with poor vision. Ultimately, we want to break societal stigmas and promote a positive perception of low vision services in the community to increase access and timely referrals.”
Perspective
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As optometrists, we are well aware of the various low vision aids available and the critical lifestyle benefits these aids can provide. Unfortunately, few patients are aware these options exist, and, as illustrated by this study, only a small number of health care providers do, also.
This study suggests that with the absence of a low vision clinic, frustratingly few patients will get referred to a low vision specialist, exacerbating the effects of the patients’ already debilitating condition on their remaining daily routine. Fortunately, we find that by establishing a low vision clinic and educating the affiliated providers (of all specialties) of its existence, the study found a statistically significant improvement in the rate of referrals to low vision specialists. As promising as these results are, the percentage of patients referred was still far from 100%. This suggests that continued community education, both in the public and within the various health care specialties, is needed. For practicing clinicians, these results should tell us that our work in patient advocacy and our need to continuously network with other providers is a daily goal.
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