Comprehensive eye and vision examinations are performed by eye physicians (either optometrist or ophthalmologists). Unfortunately, some patients are found to have a decrease in visual function such as reduced visual acuity, visual field deficits, contrast sensitivity loss or sensitivity to glare. These visual impairments are caused by several different ocular diseases and neurological disorders. Low vision is the term for vision impairment that is not correctable with conventional eyeglasses, contact lenses or either medical or surgical treatment. Individuals with a visual impairment, however, have the potential for improved quality of life independence through the process of vision rehabilitation.
Vision rehabilitation is part of the continuum of the eye and vision care that extends from the initial diagnosis of the impairment to treatment and rehabilitation. These services can be performed by a single vision rehabilitation physician or by a multidisciplinary team. It beings with an initial clinical evaluation of the patient’s visual functions by an eye physician. This is followed by:
- An assessment of what impact the impairment has on function (e.g., how well the patient can perform activities of daily living).
- development of a treatment plan for rehabilitative interventions. Some individuals might only need enhanced lighting when reading whereas others might require a range of interventions.
- Management of the impairment. Because low vision impacts several aspects of daily living, eye physicians may need to coordinate the rehabilitation care and services provided by different professionals including:
- Low vision specialists (Optometrists/ophthalmologists who specialize in low vision)
- Occupational therapists
- Certified low vision therapists
- Certified vision rehabilitation therapists
- Certified assistive technologists
- Certified orientation and mobility specialists
- Teachers of the visually impaired
- Collaborative clinical decision making with the patient as an active participant in the rehabilitative process.
- Ongoing re-evaluation of the patient’s vision impairment(s).
NOTE: Optometrists and ophthalmologists can provide a low vision evaluation and provide the order for Medicare-reimbursed occupational therapy. Among several items that must be included on the order is the level of visual impairment as a primary code and the disease which caused the impairment as a secondary code. It should be noted that rehabilitation services are covered by the Center for Medicare and Medicaid Services but devices are not.