AAO to Eye MDs: Let's Do More for the Visually Impaired
The SmartSight initiative will detail levels of practice involvement.
BY JERRY HELZNER, SENIOR EDITOR

With age-related vision loss already reaching what retina specialists call "epidemic proportions" -- and with baby boomers about to enter their senior years -- the American Academy of Ophthalmology (AAO) will soon call upon all ophthalmologists to get involved in low-vision rehabilitation at some level.

The Academy's SmartSight initiative, scheduled to be launched early this year, is the result of more than a year of effort by a national task force made up of approximately 30 ophthalmologists. SmartSight will detail four levels of practice involvement, ranging from handing out low-vision literature that provides tips for daily living and referral information to patients and their loved ones, to offering comprehensive low-vision rehabilitation services within the practice.

Patients Have Been Neglected

"We're now dealing with the changing demographics of vision loss," says Rebecca K. Morgan, M.D., a low-vision rehab specialist at the Dean A. McGee Eye Institute, and clinical professor of ophthalmology at the University of Oklahoma College of Medicine, both in Oklahoma City.

"For most of the 20th century, visual rehabilitative efforts were directed toward veterans, employable-age adults and children who were blind or legally blind. Now we see more and more seniors suffering permanent, age-related vision loss from AMD, glaucoma and diabetic retinopathy, and most of them are slipping through the cracks. Ophthalmologists haven't done much for them in the past. They're usually sent out the door and given a yearly examination."

Dr. Morgan recognizes that most ophthalmologists haven't done much for low-vision patients within their practices because vision rehab is time-consuming and doesn't fit into the typical practice environment.

"The initial objective of SmartSight is to make ophthalmologists more aware of vision rehab," says Dr. Morgan. "At the most basic level of participation, doctors can provide patients with literature and referral information supplied by the AAO so that they can get their patients started on the path to getting the help they need."

As part of this effort, SmartSight will set up a national "800" phone number that patients and families can call to get information on low-vision resources in their local area.

Who Should Receive this Information?

The SmartSight Task Force recommends providing information to these patients: anyone with a symptomatic field loss or scotomata, reduced contrast sensitivity, or irreversible best-corrected central acuity to a level worse than 20/40. The 20/40 metric has been chosen because that's when compromise of newsprint reading begins, when lighting becomes critical, and when glare may begin to interfere with function.

Going to the Next Level

Ophthalmologists who want to do more than hand out information can participate at SmartSight Level 2, which the Academy anticipates will ultimately become a routine part of all comprehensive ophthalmology practices.

At Level 2, ophthalmology practices will be asked to add these "4 Rs" of rehabilitation:

Record acuity. Determine precise acuities for all patients, including those with levels as low as 20/1000. This can be accomplished easily with the use of appropriate, inexpensive charts.

Refract accurately. Perform manifest refractions with loose lenses and trial frames. Phoropter or trial frame retinoscopy yields accurate results, but phoropter manifest reactions and pinholing are inadequate for patients with central scotomas.

Recommend simple reading aids. Recommend or prescribe bifocal or single vision adds up to +5D, clip-on adds up to +4D or prism half-eye readers up to +6D. These aids can serve a large number of visually impaired patients who can no longer discern standard-sized print.

Report to the primary care physician. The implications of the patient's compromised visual status must be communicated to the primary care physician, as there is a resultant risk of depression, falls, medicine mix-ups and Charles Bonnet Syndrome.

The SmartSight initiative will also detail vision rehab service Levels 3 and 4 for doctors interested in providing more extensive help within the practice.

Another goal of SmartSight is to make low-vision education a distinct component of every ophthalmology residency program in the country.

"Ophthalmologists need to be proactive in helping their low-vision visually impaired patients," says Dr. Morgan. "It's the duty of every ophthalmologist to do this. It should be an automatic reaction because every patient with vision loss could find themselves in trouble, and they shouldn't have to wait until they experience extreme vision loss before they get help."