Vision Rehabilitation Professionals Research Articles

Smartphones-Based Assistive Technology: Accessibility Features and Apps for People with Visual Impairment, and its Usage, Challenges, and Usability Testing.

Smartphones are less likely to be considered as assistive technology for visual impairment among a large majority of health care providers, excluding vision rehabilitation professionals, and the general public who are not familiar with accessible features and apps. The present review aims to highlight accessible features and apps along with usages, including educational, and access to smartphones as assistive technology for visual impairment and blindness. It also includes advantages and challenges faced by users, and usability testing by app developers. There have been significant recent developments in mobile technology that incorporate computer technology relating to electronic information, communication, and touch-screen accessibility. Such advances in technology are transforming the use of smartphones from a traditional visual interface to a truly visual free interaction using alternative body senses, such as haptic, gesture, and so on. There are many built-in accessible features and third-party accessible applications that enable people with visual impairment to perform daily activities, independent functioning, movement, social inclusion and participation, education, etc. They are universally designed, so they are unlikely to induce social stigma or negative reactions from peers or public. Healthcare practitioners, not limiting to eye care, and caregivers, family members, teachers, or special educators should be informed about the potential uses and benefits of smartphones for visually impaired in developing nations. Evidence shows that most of the users train by themselves. Enhancing the awareness along with training for teachers and caregivers would be helpful to improve access and skills among users with visual disabilities. Developers are continuously producing more innovative applications for visual impairment, which indicates the need for having a training guideline on the use of smartphones.

Bolder print does not increase reading speed in people with central vision loss

Patients with central vision loss are often advised by low vision rehabilitation professionals to read bolder print to ameliorate their reading difficulties. Is boldface print really effective in improving reading performance for people with central vision loss? In this study, we evaluated how reading speed depends on the stroke-width of text in people with central vision loss. Ten participants with long-standing central vision loss read aloud single, short sentences presented on a computer monitor, one word at a time, using rapid serial visual presentation (RSVP). Reading speed was calculated based on the RSVP word exposure duration that yielded 80% of words read correctly. Text was rendered in Courier and at six boldness levels, defined as the width of the letter-strokes normalized to that of the standard Courier font: 0.27, 0.72, 1, 1.48, 1.89 and 3.04× the standard. Reading speed was measured for two print sizes — 0.8× and 1.4× the critical print size (the smallest print size that can be read at the maximum reading speed). For all participants and both print sizes, reading speeds were essentially the same for text with stroke-width boldness ranging from 0.72 to 1.89× the standard, and were significantly lower for the thinnest and the boldest print. Most importantly, reading speed was not higher for bolder print than for the standard one. Despite the clinical wisdom that patients with central vision loss might benefit from bolder print, print with stroke-widths larger than the standard does not significantly improve reading speed for participants with central vision loss.

Drug-Induced Deficits in Color Perception: Implications for Vision Rehabilitation Professionals

Along with the aging of the population, various comorbidities may arise, such as arthritis, hypertension, and erectile dysfunction (Glynn, Monane, Gurwitz, Choodnovskiy, & Avorn, 1999; Ramage-Morin, 2009). These medical conditions are treated and controlled with various types of medications. In fact, nearly 83% of older adults in Canada take prescription medications by age 65 years. Several of these medications can induce subtle side effects, including decreased visual perception. For instance, previous research indicated that side effects of commonly prescribed type-5 inhibitors (such as Viagra) may include declines in color perception (Azzouni & Abu Samra, 2011; Santaella & Fraunfelder, 2007). Many health care professionals, including vision rehabilitation therapists (VRTs), should be aware of the possibility of drug-induced deficits in color perception when working with older adults. The main purpose of this report is, therefore, to identify the commonly prescribed medications for age-related conditions that disturb color vision, and highlight the colors that are most frequently affected by these medications. This report aims to provide professionals who work with older adults with guidelines on how to identify individuals at risk for acquired color deficits and how to consider these insufficiencies during various rehabilitative interventions. A scoping review of the literature was conducted to identify the most commonly prescribed medications for age-related conditions like arthritis that can potentially alter color perception. An advanced search in the following databases was conducted: PubMed, EBSCO, and Google Scholar. The main Medical Subject Heading (MeSH) terms that were used in combination in searching for peer-reviewed articles included: acquired color deficits, drug-induced color deficits, side effects, medications, color vision, drug toxicity, hydroxychloroquine, type-5 inhibitor, plaquenil, ocular adverse effects, and retinal toxicity. Key words found in relevant articles were added to the search terms. In addition, Boolean terms such as and and or were used to refine the quest for relevant articles. MEDICATIONS AFFECTING COLOR VISION Color perception is made possible by three cone cell types embedded in the retina that are preferentially sensitive to different wavelengths of light. The S-cones are sensitive to short wavelengths (420 nanometers [nm]; also known as blue-cone). A deficit or absence in S-cones results in tritanopia, causing a blue-yellow color deficit or blindness. Similarly, the M-cones are sensitive to medium wavelengths (535 nm; also known as green-cone) and the L-cones to long wavelengths (565 nm; also known as redcone). The absence of M- or L-cones results in deuteranopia or protanopia, respectively. A deficit in any cone type results in a decreased ability to detect color hues. Given that the eye is a high-metabolism organ that contains many blood vessels, it is susceptible to the effects of systemic medications (Santaella & Fraunfelder, 2007). It was long thought that congenital color deficits were more common than acquired ones. In fact, approximately 8% of males and 0.5% of females are diagnosed with a congenital color deficit (Simunovic, 2010). However, some researchers argue that acquired color deficits are more prevalent than previously thought; a study conducted in North America revealed that the prevalence rate is 20.8% for older adults between ages 58 and 102 years (M = 75.2) (Simunovic, 2016). The effects of acquired color deficits can vary widely. For instance, some may develop problems in the red-green color axis (deuteranopia/protanopia), and others in the yellowblue axis (tritanopia). Nevertheless, the most common type of acquired color deficit is in the blue-yellow axis. An Iranian study revealed that 66.1% of acquired color deficits result in tritanopia (Jafarzadehpur et al., 2014). There are several causes for declines in color perception, but the most common ones are natural decline with age or as a result of medication intake (Delpero, O'Neill, Casson, & Hovis, 2005). …

Empowering Individuals with Aphasia and Visual Impairments through Effective Communication

Advances in medicine have enabled an aging population to survive neurological events such as strokes more frequently. Consequences of a stroke can be widespread and severe, and it is currently the leading cause of long-term disability in Canada (Public Health Agency of Canada [PHAC], 2011). The PHAC report indicated that in 2009 approximately 315,000 Canadians were living with the consequences of strokes (PHAC, 2011). Consequences of strokes may include hemiplegia, reduced cognition and emotional control, difficulty with language (aphasia), and visual impairment, to list a few of the impairments and disabilities that may occur (Warren, 2008). To address the needs of individuals with language impairments resulting from strokes, there is a need for low vision rehabilitation professionals (optometrists, ophthalmologists, low vision therapists, high technology assessors, orientation and mobility instructors, rehabilitation counsellors, independent living skills teachers, and occupational and physical therapists) to become familiar with the impact of neurological events on an individual's ability to communicate. An individual who has survived a stroke may be left with multiple impairments including those that affect vision and communication. Visual impairment is a possible result, and it may present as a defect of visual fields, impaired eye movements, and problems with perception or cortical blindness (Hillis, 2007; Jones & Shinton, 2006; Rowe et al., 2009). Up to a quarter of stroke survivors may have vision loss, according to the National Stroke Association (2012). It is not unusual to encounter patients who had a neurological event with multiple impairments (including vision loss) when assessing and implementing a low vision rehabilitation plan. This report describes some communication strategies that may be utilized to create a successful low vision rehabilitation assessment and plan for a patient with a coexisting visual impairment and aphasia following a stroke. WHAT IS APHASIA? Following a neurological event, some individuals experience aphasia, which is an acquired condition following damage to the speech and language areas in the brain and which affects a person's ability to communicate (Hillis, 2007). It is a problem with language, not intelligence (National Aphasia Association, 2015). The areas of the brain that are responsible for language are found on the left side (Damasio, 1992; Hillis, 2007). Individuals with aphasia may have difficulties speaking, understanding what others are saying, and problems with reading and writing. Due to the complex nature of communication, there are several different classifications of aphasia that are widely disputed (Ardila, 2010; Marshall, 2010). The broad and more classic classification used by the National Aphasia Association (2015), the Heart and Stroke Foundation (2013), the American Heart Association (2015), and the National Institute on Deafness and Other Communication Disorders (NIDCD, 2010) when discussing aphasia with the lay community includes three types: expressive aphasia, receptive aphasia, and global aphasia. Expressive aphasia Individuals with expressive aphasia are typically able to understand what is being communicated to them, but have difficulty or are unable to respond either verbally or in writing. This is also known as Broca's aphasia (attributed to the person who discovered the condition and the area of the brain that is thought to be affected) or nonfluent aphasia (as individuals with this type of aphasia exhibit great effort when attempting to speak). Any phrases that the individual uses are generally understood by their unaffected conversational partner, but speaking is very difficult, laborious, and slow. Individuals with expressive aphasia typically choose the correct nouns, but small words are often improperly used (Damasio, 1992; Hillis, 2007). There is a reduction in the length of the sentences expressed (Hillis, 2007). …

Book Review: Making Life More Livable: Simple Adaptations for Living at Home after Vision Loss

Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, Third Edition, Maureen A. Duffy. New York: AFB Press, 2016,234 pp. Paperback, $39.95; e-book (ePUB or Kindle), $27.95; online, $23.95. Making Life More Livable: Simple Adaptations for Living at Home After Vision Loss, Third Edition, by Maureen A. Duffy, is an exceptional revision of the previous edition. It includes information that has been updated to address the changing trends in adapting to vision loss, as well as expanded information regarding a variety of vision rehabilitation services that can be offered to individuals with visual impairments. The foundational information and techniques for adapting the home and everyday activities remains the same as described in earlier editions; however, the new edition introduces information about advancing technologies (smartphones, tablets, and electronic independent living devices), provides new and updated resources, and includes full-color photographs and illustrations of described adaptations. In addition, the Preventing Falls in Your Home section in Chapter 4 and the Notes section at the end of the book are welcome additions. A PERFECT RESOURCE FOR INDIVIDUALS AND FAMILY MEMBERS The book is a perfect resource for individuals who are experiencing vision loss and the loved ones who support them. The book presents a comprehensive list of simple adaptations, information, and resources for living safely and functioning efficiently in every room of the home; it also provides practical tips on ways to modify everyday tasks in an affordable manner. The book provides immediate assistance to individuals who are visually impaired and their loved ones by providing information on how to tackle the everyday challenges that are experienced with vision loss. It also introduces and describes the network of vision rehabilitation services and professionals who are available to offer more specialized training. In addition, the large-print book is easy to read, with balanced spacing, color, and contrast among text; bulleted lists; and colored illustrations and text boxes. It is written in a straightforward tone in layman's language, which is appropriate for readers who are new to vision loss. Although much of the information represented in the book can be accessed on vision loss-related websites (such as VisionAware.org) and from professional vision rehabilitation textbooks written by seasoned educators and practitioners, which validates the authenticity of the book's content, the option to have this information compiled in a comprehensive resource is invaluable, since it allows for easier access to the information. Subsequently, the book can also serve as a resource for new and existing vision rehabilitation professionals as a complement to the professional texts that are used in training programs for vision rehabilitation. In fact, any person who is connected to an individual who has vision loss should buy and read this book. CLEAR, CONCISE, AND WELL ORGANIZED The information in the book is well organized and presented in a clear and concise manner. It informs readers that it is possible to live independently with vision loss and provides general principles on how to make the home environment more comfortable and functional. It offers tips, solutions, and adaptations on how to modify every area of the home room by room to achieve safety and independence, while also promoting safe movement and addressing additional health complications that often occur simultaneously with vision loss. The information provided is extremely coherent and consistent--each chapter is organized in a like manner, which allows for more fluid reading. The book opens with an overview of the impact of vision loss in adulthood. It provides current statistics on vision loss among the various adult age groups (that is, those aged 18 years and older), and describes normal changes in vision and the major eye disorders that affect adults and older adults. …

Book Review: “The Low Visibility of Low Vision: Increasing Awareness through Public Health Education

Low Visibility of Low Vision: Increasing Awareness through Public Health Education, by Rosemary Janiszewski, Shelly L. Heath-Watson, Adrienne Y. Semidey, Arlen M. Rosenthal, and Quynh Do, published in the 2006 Special Supplement of the Journal of Visual Impairment & Blindness, Volume 100, pp. 849-861. As the director of the Professional Preparation Program in Vision Rehabilitation Therapy at Salus University and a practicing certified vision rehabilitation therapist, I am responsible for educating and training students, colleagues, consumers, families, and the community about the critical role vision rehabilitation therapists retain throughout the entire vision rehabilitation process. Consequently, I consider advocacy to be an integral component of my professional ethics and practice. Over time, however, my advocacy pursuits have led me to conclude that the vision rehabilitation therapy profession, and other vision rehabilitation professions (low vision therapy and orientation and mobility), are not well known to many of the eye care professionals, consumers, and communities we have been trained to consult and serve. Thus, the continuum of care provided to those individuals with visual impairments (that is, blindness or low vision) falls short. It has been reported that the prevalence of visual impairment is expected to increase as the population lives longer (World Health Organization, n.d.); however, despite valuable global actions to prevent visual impairment, such as the Vision 2020 initiative launched by the World Health Organization and the International Agency on Preventing Blindness, there remains a need for vision rehabilitation intervention when sight-saving measures do not prevail. It is at this juncture in the continuum of care in which individuals experiencing vision loss should be referred to vision rehabilitation therapists and other vision rehabilitation professionals for treatment and training to restore independence and safety. In my role as an educator and advocate for vision rehabilitation therapy, I search for literature and research materials that support the theory, practice, and relevancy of vision rehabilitation service delivery. In that search, I discovered a JVIB article entitled, Low Visibility of Low Vision: Increasing Awareness through Public Health Education, and I was immediately intrigued by the article's emphasis on the need for a health education program to increase awareness of low vision, a that would correspond to professional practice in vision rehabilitation therapy. The article discussed in detail the components of an effective public health education to increase the awareness of low vision by: identifying the intended audience and formulating an appropriate communication strategy to disseminate the message, pre-testing the communication strategy with the intended audience (that is, use of focus groups); implementing the strategy by collaborating with visual impairment organizations and creating educational materials, exhibits, and programs that further convey the message; and, finally, assessing and evaluating the effectiveness of the communication strategy and identifying refinements where needed. This article spoke directly to one of the major challenges facing the profession of vision rehabilitation therapy today: lack of professional identity and awareness of vision rehabilitation therapy among eye care professionals, people with vision loss, and other members of the rehabilitation team. In April 2014, Salus University and Vision-Serve Alliance convened the Vision Rehabilitation Therapy, Strategic Planning, and Advisory Symposium to address these challenges. Participants included representatives from professional preparation programs, state vocational rehabilitation agencies, the Academy for Certification of Vision Rehabilitation and Education Professionals, consumer groups, and the Veterans Administration. …

Preferred Retinal Loci Relationship to Macular Scotomas: A10-Year Comparison

Age-related maculopathy is the leading cause of vision loss among adults in developed countries, and its prevalence is expected to double over the next decade (Congdon et al., 2004; Friedman et al., 2004). The two forms of age-related maculopathy--exudative and nonexudative--are capable of affecting the macula, with potential symptoms including decreased contrast sensitivity, decreased visual acuity, abnormal adaptation to the dark, and central or pericentral scotomas (Jager, Mieler, & Miller, 2008). When a central scotoma impairs the ability of the fovea to distinguish detail, one or more preferred retinal loci (PRL) (Schuchard & Raasch, 1992; von Noorden & Mackensen, 1962; White & Bedell, 1990), also known as pseudo-foveas (Guez, Le Gargasson, Rigaudiere, & O'Regan, 1993), naturally develop at eccentric retinal locations and become the new points of fixation. The location of the PRL varies from person to person, as does the ability to maintain steady fixation with the PRL and to use it for reading and activities of daily living (Dalgleish & Naylor, 1963; Fletcher, Schuchard, & Watson, 1999; Timberlake et al., 1986; Whittaker, Budd, & Cummings, 1988). Fletcher and Schuchard (1997) reported the results of a study examining patterns of PRL ability and location relative to macular scotomas. They mapped dense scotomas and determined the location of the PRL in 1,339 eyes in 825 persons with a scanning laser ophthalmoscope during a standard low vision rehabilitation evaluation. Fletcher and Schuchard created a scoring system to measure the pursuit ability, fixation stability, and saccadic ability of the PRL. They determined the characteristics of dense scotomas within 2.5 degrees of the PRL or fovea. Of the 1,339 eyes, 84% (1,130) demonstrated an established PRL, ranging in size from 1.0 degrees to 9.0 degrees in diameter, and 82.5% had a central dense scotoma. The PRL had no dense scotomas on any border in 14.8% of the eyes. It had one, two, or three borders with a dense scotoma in 39.7%, 19.0%, and 9.0% of the eyes, respectively. Ring scotomas, bordering the PRL on four borders, were present in 17.4% of the eyes. Of the eyes with one scotomatous border, most had a field defect located either superior (39.0%) or to the right (33.7%). It was less common for the eyes to have field defects to the left or inferior, with 19.9% and 7.5% of the eyes, respectively. This report presents a 10-year comparison of these previous findings. It examines whether the PRL characteristics of persons with low vision remained steady over the ensuing decade. Changes in PRL and visual field characteristics among persons with low vision over time could have implications for the approaches of low vision rehabilitation professionals to training in eccentric viewing and other rehabilitation techniques. METHODS The study used 271 persons who were referred to the Frank Stein and Paul S. May Center for Low Vision Rehabilitation at California Pacific Medical Center (CPMC) in San Francisco between 2005 and 2007. All consecutive patients with low vision were included in the study, regardless of age, gender, race, and other demographic variables. Participants were excluded only if they lacked the cognitive or physical ability to complete a macular perimetry examination, as determined by the clinical impression of the ophthalmologist. Approval from the institutional review board was obtained from CPMC for the retrospective analyses of charts. As part of the standard low vision rehabilitation evaluation, an ophthalmologist measured visual acuity with the Early Treatment of Diabetic Retinopathy System chart (Ferris, Kassoff, Bresnick, & Bailey, 1982). The characteristics of the scotoma and PRL were measured with a Scanning Laser Ophthalmoscope (SLO; SLO-101, Rodenstock, Dusseldorf, Germany). The SLO was outfitted with a smart microperimetry (MacKeben & Gofen, 2007) program with a gaze-contingent display that automatically monitors eye movements, blinks, and other factors. …

Dual Sensory Impairment in an Aging Population

Dual Sensory Impairment in an Aging Population

Content validity of a home-based person-environment interaction assessment tool for visually impaired adults

Home-based assessments require in-depth analyses of daily living difficulties. No assessment tool that has been validated with visually impaired adult subjects has allowed such analysis. This research adapted a home-based person-environment interaction assessment tool designed for persons who are visually impaired. The Model of Competence, an explanatory model of the person-environment relationship, served as the conceptual framework. A qualitative study was conducted with professionals, visually impaired persons, and informal caregivers. Focus groups and semistructured individual interviews were used for data collection. The content and form had to be modified to adapt the assessment tool for use with visually impaired adults. This qualitative study documents the content validity of the Home Assessment of Person-Environment Interaction-Visual Version. The assessment tool will provide vision rehabilitation professionals better screens and explanations of handicap-created situations faced by visually impaired persons at home. By using a structured analysis based on a person-environment theoretical model, this new assessment tool fills a scientific and clinical gap, optimizes the evaluation process, and documents the intervention plan by providing an understanding of the home context.

Guest Editor's Page

It ain't what we don't know that gets us into trouble. It's what we know for sure that ain't so. --Mark Twain The year 2008 represents a new world for visual impairment in the United States and Canada. The demographics of vision loss have changed radically in the last several decades. Today, the greatest number of people with visual impairments are not children or young adults; rather they are seniors with age-related macular degeneration (AMD), who outnumber younger visually impaired adults and children by wide margins. According to the National Eye Institute, people 80 years of age and older currently make up 8 percent of the population, but account for 69 percent of those with visual impairment and blindness, largely from AMD. Indeed, macular degeneration is the cause of the majority of all visual impairment and blindness in Americans. This matters because much of what we know for sure about visual impairment and vision rehabilitation just ain't with macular degeneration. Why? Two key reasons. DIFFERENT LIFE EXPERIENCE Seniors are a population distinct from all others, including younger and middle-aged adults. Just as children have their own medical specialty--pediatrics--so seniors have theirs--geriatrics. Just as kids are not little adults, seniors are not wrinkled adults. They are unique physiologically, medically, and psychosocially. They require different rehabilitation strategies and approaches, different visual and functional devices, and different teaching approaches and methods for effective rehabilitation. Age-related physiological changes in hearing, balance, agility, recovery time, learning patterns and memory make part of the difference. Seniors often rely on their vision to compensate for these other age-related losses, so that when vision is lost too, they are particularly vulnerable to age-specific functional declines and dangerous falls. This situation does not preclude them from being successful in vision rehabilitation, but it does mean that rehabilitation professionals must understand how to address these conditions and assume the responsibility for doing so, or else partner closely with other health care professionals who can address them. When working with seniors, successful vision rehabilitation professionals may need to modulate the pitch and pacing of their voices, adapt their teaching practices to maximize learning, and take the physiological differences of seniors into account. Clients with low vision may need support canes, rather than long canes, to maintain safe balance when walking. They may need contrasting shower bars, contrasting color mats, and adaptive lighting in order to remain safe in the bathroom. With seniors, these considerations are not side issues but are an integral part of vision rehabilitation practice. Seniors also present with a range of medical conditions that shape vision rehabilitation practice, possibly including a history of minor strokes, diabetes, early-onset Parkinson's, arthritis, hypertension, heart disease, osteoporosis, chronic joint or back problems, reduced range of motion, under- or overdosing on medications, and clinical depression as a result of vision loss. Vision rehabilitation professionals must recognize the symptoms of these conditions, understand their interplay with vision loss in compromising function, and address them as an intrinsic part of vision rehabilitation. Seniors are also at a different life stage, with different skills and resources from younger and middle-aged adults, often with other profound losses in their lives--the loss of a spouses, siblings, jobs, or even homes as they move to retirement or assisted living facilities distant from their familiar neighborhoods. Successful vision rehabilitation requires understanding and incorporating these physical, psychological, and cultural differences that sculpt seniors' experiences of vision loss and influence their approach to rehabilitation. …

Strategy for developing an evidence-based transdisciplinary vision rehabilitation team approach to treating vision impairment

Background Many individuals with vision impairment experience significant loss of the ability to perform daily living activities, which often results in a further decline and loss of quality of life. Appropriate rehabilitation of the population with vision impairment has the potential to both improve individual abilities for health and personal management as well as maximize utilization of available health care resources. Methods The case for an evidence-based model for the vision rehabilitation health care team as a medical rehabilitation program is presented. The recommended strategy has 3 main components: development of a consensus team clinical practice guideline leading to a future evidence-based team guideline for vision rehabilitation; evaluation and measurement of the knowledge, attitudes, and practices of the involved vision rehabilitation professionals before and after implementation of the new paradigm; and measurement of outcomes that estimate the effects of the proposed paradigm on patient care by measuring both the improvement in visual ability of the patient and the economic impact of the model on optometric practice. Conclusions Development of a state-of-the-art evidence-based transdisciplinary team model guideline will facilitate improvement in the quality of life of individuals with diseases that result in chronic vision impairment.

Should family and friends be involved in group-based rehabilitation programs for adults with low vision?

This qualitative study investigates the views of clients with low vision and vision rehabilitation professionals on the involvement of family and friends in group-based rehabilitation programs. Both groups outlined advantages and disadvantages to involving significant others, and it is essential that clients are given the choice. Future work is needed to examine the uptake, process and outcomes of rehabilitation programs in which clients are able to invite family and friends.

Use it or Lose it: The Medicare Low Vision Demonstration Project

The Low Vision Demonstration Project is now one year old. This project constitutes a unique and pivotal opportunity for vision rehabilitation professionals. If it succeeds, it will open up significant opportunities for funding and provision of services. But, if it fails, it could represent another nail in the coffin of specialized services. The question now is whether professionals in the field of visual impairment and blindness will step up to the plate to ensure that this project is successful. The achievements of the project have been encouraging so far, but there are a number of significant weaknesses, and there is still much to do. This column offers a progress report on the project and examines its serious implications. Although some reports have appeared in previous issues of the Journal of Visual Impairment & Blindness (JVIB) (see, for example, the Comment entitled Medicare Coverage for Orientation and Mobility Services, by Lorraine Lidoff, which appeared in October 2005; and the special report that appeared in the From the Field department of the August 2006 issue), let me first provide an overview of the project for anyone who is not familiar with it. SCOPE OF THE PROJECT Begun on April 1, 2006, the Low Vision Demonstration Project is a five-year project established to help deliver services in a new manner and evaluate the utilization of funding for vision rehabilitation services by a new set of providers who had not previously been covered by Medicare: certified low vision therapists, orientation and mobility (OM however, the demonstration project also covers vision rehabilitation training that may be provided in the eye care specialist's office or at a qualified agency. Because the project is funded by Medicare, service providers are obliged to follow its requirements, which may differ from customary procedures in vision rehabilitation. Specifically, all services must be preceded by a written plan of care, with specific goals and a statement of the location at which the services are to be provided, which must be approved by the supervisory physician and reviewed every 30 days. The service provider must detail the training provided and the progress made by the patient. Training is limited to nine hours total, to be provided within 90 consecutive days, and cannot be extended. Vision rehabilitation services are billed in 15-minute increments. For this demonstration project, six different sites in four states and two cities throughout the United States have been selected: Atlanta, Georgia; Kansas; New Hampshire; the five boroughs of New York, New York; North Carolina; and Washington State. The patient must reside in one of these six areas, and the supervising eye care specialist must have his or her practice in one of the six sites. The patient must have a corrected visual acuity in his or her best eye of 20/70 or worse, or have a documented central scotoma, a general constriction of the visual fields, or bilateral hemianopia. Qualifying patients must show a medical necessity for the services rendered, be capable of progress, and be able to derive a benefit. …

Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding

A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

Toward a Collaborative Working Relationship among Vision Rehabilitation and Allied Health Professionals

This article explores the issues of allied health professionals who provide vision rehabilitation services to individuals who are visually impaired. It also raises questions about whether allied health professionals have had the opportunity to acquire sufficient training to work with visually impaired people, identifies the challenges facing the vision rehabilitation field, and explores how allied health professionals and vision rehabilitation professionals can work together to mutually benefit consumers who are visually impaired.

A Key to Aging in Place

Vision impairment is often overlooked by gerontological health professionals or attributed to normal age-related vision changes. With 26% of persons over the age of 75 reporting a vision impairment, it is time for vision rehabilitation professionals to be recognized and included in the multi-disciplinary service team. As the older adult population increases in numbers and longevity increases, it is expected that serious vision loss will become more prevalent. Recognizing the indicators of normal and pathological vision changes and the appropriate individual and environmental intervention strategies available are presented. A functional vision screening questionnaire is offered. Recognition of the unique and complimentary roles of each particular rehabilitation discipline can lead to more effective collaboration.

Teaching Job Placement Techniques to Vision Rehabilitation Professionals: A Working Model

Teaching Job Placement Techniques to Vision Rehabilitation Professionals: A Working Model