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Original Investigation
April 2018

Rehabilitation Referral for Patients With Irreversible Vision Impairment Seen in a Public Safety-Net Eye Clinic

Author Affiliations
  • 1Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
  • 2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
  • 3Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham
JAMA Ophthalmol. 2018;136(4):400-408. doi:10.1001/jamaophthalmol.2018.0241
Key Points

Question  What proportion of adults with irreversible vision impairment are referred to low-vision rehabilitation services by ophthalmology residents and attending ophthalmologists working in a publicly funded eye clinic that primarily serves uninsured persons?

Findings  In this cross-sectional study of 143 patients with irreversible vision impairment in 1 or both eyes, referral for low-vision rehabilitation services was low for patients with irreversible bilateral (11%) and unilateral (2%) vision impairment, as noted in the electronic health record.

Meaning  Findings highlight the need for improved education of ophthalmologists and residents in ophthalmology about referral to rehabilitation services for patients with low vision.

Abstract

Importance  The prevalence of irreversible vision impairment in the United States is expected to increase by 2050. Vision rehabilitation is the primary treatment option. Clinical trials have established its efficacy in improving quality of life. Yet studies indicate that patients experience many barriers to accessing low-vision care.

Objectives  To examine the rate of referral for low-vision rehabilitation services by resident and attending ophthalmologists for adults with irreversible vision impairment and to assess the knowledge, attitudes, and beliefs of patients about vision rehabilitation.

Design, Setting, and Participants  Cross-sectional study with enrollment from June 20, 2016, to January 31, 2017, of 143 adults 18 years or older seen in a publicly funded, comprehensive eye clinic in Jefferson County, Alabama, and having 1 or both eyes with irreversible vision impairment (visual acuity was defined as 20/60 or worse) per the electronic health record.

Exposures  Demographic characteristics; patient questionnaire on knowledge, attitudes, and beliefs about vision rehabilitation; general cognitive status (Short Orientation-Memory-Concentration test); depressive symptoms (Patient Health Questionnaire-9); health literacy (Rapid Estimate of Adult Literacy in Medicine, Revised [REALM-R]); and self-reported difficulty in everyday activities.

Main Outcomes and Measures  Proportion of patients with irreversible vision impairment who were referred by ophthalmologists to low-vision rehabilitation services per the electronic health record.

Results  Of 143 patients enrolled with irreversible vision impairment in 1 or both eyes, the mean (SD) age was 55.4 (11.1) years and 68 (47.6%) were women. Most patients were African American (123 [86.0%]), uninsured (88 [61.5%]), and unemployed (92 [64.3%]); on average, they had normal cognitive status, minor depressive symptoms, and limited health literacy. As noted in the electronic health record, the rate of referral for low-vision rehabilitation services was 11.4% for patients with irreversible bilateral vision impairment (4 of 35 patients) and 1.9% for those with unilateral impairment (2 of 108). Most patients with bilateral (31 of 34 [91.2%]) and unilateral (90 of 97 [92.8%]) impairment indicated that they were bothered by their vision impairment, and most reported difficulty with reading (33 of 34 patients [97.1%] who were bilaterally impaired vs 85 of 104 [81.7%] who were unilaterally impaired).

Conclusions and Relevance  Results of this study suggest a need to better educate ophthalmologists and residents in ophthalmology about referrals to low-vision rehabilitation services for patients with irreversible vision impairment.

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