“Low Vision in practice is a lot different than what you probably learned in school,” advises Dr. Henry Greene. “In school we learned it’s not Low Vision, it’s Slow Vision,” he jokes, but he’s dedicated his career in optometry to practicing this specialty and teaching others to rethink what their preconceptions about how a low vision practice is run in the real world. In his experience, Low Vision is easy to do, it’s a great way to separate yourself from other providers, and it’s a rewarding way to build life long relationships with patients and feel a sense of purpose in your career.
Dr. Henry Greene graduated optometry school in 1974 from the Pennsylvania College of Optometry. After graduation he moved back to his home state of New York but was having a hard time standing out and attracting patients in a saturated optometric landscape. Adopting a specialty focus on Low Vision was the niche that really separated him and launched his successful practice and career. His passion for this profession led him to found Ocutech, an optometric low vision device company that creates leading edge telescopic and digital vision enhancement technology.
How to Get Started with a Low Vision Specialty
In school, instructors are tasked with teaching all of the possible work up and treatment options in a short amount of clinic time. Just like your routine primary care exams probably look a lot different in real life practice than they did when you were a third year student in optometry school, in real life you will take a more straightforward goal specific approach to Low Vision exams. Dr. Greene simplifies the exam by explaining you have only 3 possible goals to target: improve distance, midrange, or near activities. Most doctors will use the same handful of devices for all of their patients so once you know your tools, you can quickly implement them for the right patient needs.
“You can’t learn low vision from a text book,” Dr. Greene advises. The first step to setting up a practice should be to find someone to mentor you. Watch how they perform their exams, how they schedule their patients, and how they manage their patients’ expectations and outcomes. There are also several conferences held each year that are great learning events. He recommends attending the Envision Conference at UAB in March and at Western University in October.
Another great resource for getting started are low vision device companies. Dr. Greene shares that there’s an enormous demand for more Low Vision specialists. At Ocutech they field calls all of the time from patients searching desperately for a Low Vision provider in their area. If you know you want to practice Low Vision but aren’t sure where to set up your practice, you can even call Ocutech to get an idea of the locations around the country that are most in need!
Performing the Exam
The exam should start with taking a careful patient history and asking patients about their specific desires or goals. When you perform a Low Vision exam, you already know the patient’s medical diagnosis, so this exam focuses on solving patient goals. Are they wanting to address distance (driving, TV watching), midrange (computer), or near (playing cards, reading)?
Dr. Greene explains there are only 3 ways we can improve distance vision for our patients.
- Refraction: It is RARE that a better refraction will make a difference for a Low Vision patient – they wouldn’t be in your chair if this is the case.
- Move closer. If your patient can’t see at 10 feet, then have them move closer to 5 feet – that’s 2 x magnification for free. Sometimes it’s as simple as educating a patient where they should sit in relation to their television screen. But sometimes you can’t move close enough to see something, and that’s when we reach for option 3.
- Bioptic Telescope Devices. This is the specialty of his company, Ocutech. In future we’ll likely see digital options as well.
- Stronger Reading add. If you have prescribed an add higher than +2.50 for a patient, you’ve already done a Low Vision prescription!
- Hand held or stand magnifiers. These are typically good up to 4 x magnification.
- Digital Magnifiers. These include CCTV technology and electronic digital magnifiers that have zoom functions. Our phones and tablets are often great low vision devices as well since they can zoom in and adjust contrast and font size to aid in reading.
Dr. Greene is passionate about why Low Vision exams shouldn’t solely focus on near vision enhancement and ignore distance vision in patients with more severe vision loss. Distance vision is a social sense – we use it to make eye contact and read body language. Loss of distance vision impacts quality of life in ways above and beyond the loss of near range vision. With near vision loss, there are so many readily available assistive technologies. Audio books, large print books, and eReaders or tablets are all readily accessible. But if you want to see your granddaughter from across the room, there’s no resource to help you. Studies show that distance loss can lead to depression, and is correlated with cognitive decline. Losing distance vision causes people to feel isolated and they restrict their social activities and stop engaging with world around them. That’s why providing Low Vision services is so important and valuable as an optometrist.
Getting the Word Out
A successful Low Vision practice needs patients, and one of the best places to start is reaching out to your local retinal specialists. All ophthalmology programs are required to have education about the importance of Low Vision referrals. When patients first get their diagnosis, however, they often go through grief and denial stages – patients are looking for a cure, not a device. Even though they aren’t ready to pursue Low Vision at these initial treatment stages in many cases, these patients still need to be made aware of the options when they are ready to accept their visual state. Dr. Greene strongly believes that all patients with vision loss need two eye doctors: they need their medical eye doctor who is going to treat their disease, and their vision eye doctor who is going to improve their visual function.
When you reach out to your retina ophthalmologists, ask who they refer their low vision patients to? If you hear “umm…” then they probably aren’t referring to anyone. Ask for their referrals and provide them with pamphlets and information that can be easily distributed to patients in their office.
Another great way to grow your business is through local media. If you get a feature story in your local newspaper or your local TV news, your phone will ring off the hook with new appointments. Reach out to local vision loss support groups, nursing homes, or assisted living facilities to see if you can provide educational events. Social media is also very important. There are support groups for patients with visual impairment on Facebook and other online forums, and they are looking for your help and expertise.
Want to learn more? Dr. Greene and Dr. Janet Sunness, retinal specialist, are hosting a webinar on Monday, March 4th where they’ll be talking about the latest medical and genetic treatments for vision disorders and the latest technological advancements to assist in visual impairment. They will also be taking live questions from patients that are living with vision loss!
Thank you to Ocutech for supporting the production of this podcast.
Join us for a webinar on the latest advancements in low vision!
- Date: March 4, 2019, at 12:30 EST
- Registration Link: https://meeting.zoho.