When to consider referring for low-vision rehabilitation

“I’m having trouble reading.”  

For any optometrist, this is a common concern to hear from patients. Often, this leads to a straight-forward treatment: new glasses, contact lenses or maybe a referral for cataract surgery. But what happens when you have tried those options and the concern persists? When do you consider referring to a low-vision rehabilitation optometrist?  

Does your patient need to be referred? 

The need for rehabilitation is dependent on the patient’s visual goals. With their current best corrected vision, can they read? Prepare food? Recognize faces? Drive? Whether the patient needs to be referred to help them meet their goals also depends on your own comfort level and your office. Do you have enough exam time? Do you have appropriate tests available, such as continuous text acuity cards? Do you have a range of devices available to evaluate? If the answer is no, then it may be time to make a referral. 

Who to refer to? 

Beyond word of mouth, there are several resources where you can find a low-vision rehabilitation optometrist. The AOA’s member directory lists members who provide vision rehabilitation. Some state associations also have vision rehabilitation committees with a list of providers. If you live near an optometry school, they are likely to have a low-vision rehabilitation clinic. If your patient is a veteran, they may qualify for low-vision services through the Veteran’s Administration.     

What does the low-vision rehabilitation optometrist need from the referring optometrist? 

A copy of your most recent comprehensive visual exam, including diagnosis and visual acuity, is helpful to include with a referral, but check with their office to find out what is needed. Inform your patient regarding what to expect at the low-vision appointment. Many patients arrive for low-vision rehabilitation evaluations thinking they will get a pair of glasses that will bring their vision back. This wrong expectation sets the patient up for disappointment and reduces their willingness to use any prescribed devices. It can be helpful to explain to the patient that the low-vision evaluation and devices are to enhance the vision they currently have, rather than return what has been lost.  

Encourage the patient to come to their appointment with vision-related goals. If there is a specific task they would like to perform (e.g., read music, perform a craft), have them bring a sample to the evaluation. Consider holding off on finalizing a new spectacle prescription prior to the referral, but have the patient wear their best correction to the exam, whether glasses or contact lenses. In some cases, a new higher add power or lens design may be prescribed. If you have an optical, the patient should be able to return with their new prescription. 

What to expect after the initial evaluation 

Your patient will continue to see you after they have been referred for low-vision rehabilitation. While some patients may require multiple low-vision sessions, success for a low-vision rehabilitation provider is often when a patient no longer needs them. That means they still need their primary eye doctor to monitor and treat the cause of their vision loss, along with any comorbid conditions, such as dry eye. You should receive a report or copy of exam notes back from the low-vision provider that includes recommendations and a care plan. 

Other considerations 

A common question asked by our primary eye care colleagues is: what does the patient’s visual acuity (VA) need to be to refer? While a best-corrected VA of worse than 20/40 provides a guideline, focusing solely on VA can overlook the patient’s needs. The best time to refer a patient is as soon as they start having vision-related functional issues that cannot be addressed in your office. Even at near-normal VA, scotomas and contrast sensitivity impairment can create challenges for your patients. On the other hand, a lack of functional vision (i.e., hand motion or worse) also may limit optical device options for your patient. While low-vision optometrists can still often review resources and sight substitution options, it may be more helpful to refer these patients to blind rehabilitation services in your area.  

Early referral is key 

A sentiment that many patients express following a low-vision rehabilitation evaluation is: why didn’t I know about you sooner? Co-managing with a low-vision rehabilitation optometrist is one way OD-to-OD referrals can improve outcomes for your patients. Early referral is key for your patient to maintain their quality of life. 

Written by David Simpson, O.D., and Sherry Day, O.D., members of the AOA’s Vision Rehabilitation Committee. 

_{Disclaimer: The information contained in this article represents the opinion of the author and not the AOA. These are not clinical practice guidelines, nor has the evidence been peer-reviewed. There are additional aspects to this topic that may not be presented, or considered, based on the specifics of the case.}