Access Low Vision in Pennsylvania

I am so proud of what we at the POA have achieved this year. The POA has provided leadership development for over 40 members and established a new Diversity, Equity and Inclusion (DEI) Committee. Additionally, we have developed a new POPAC Proactive Optometry Initiative. After advocacy efforts this year, we've seen the successful passage of the Early Eye Drop legislation. We have even supported Salus University’s Ophthalmic Lasers Procedures for Anterior Segment certification course. You can register here. 

In addition to our established initiatives with the Pennsylvania Diabetic Eye Health Alliance (PDEHA)  and Children’s Vision Care Alliance (CVCA), the POA has now formed a Low Vision Awareness Committee. The overall purpose of the Low Vision Awareness Committee is to promote Low Vision awareness to Optometrists, Ophthalmologists, other health care providers, and the general public.

We are reminding our members that the standard of care for a patient with low vision is to refer to one of the many Optometrists in Pennsylvania who provide Low Vision rehabilitation.

So, what constitutes a referral for Low Vision services? No longer is the trigger for a referral to Low Vision a certain visual acuity, visual field or diagnosis. The standard of care now is to refer any patient who is struggling with at least one activity of daily living due to their vision loss. Examples could be: difficulty reading mail or pill bottles; trouble keeping up in school (at any age); concerns about driving; difficulty performing work-related tasks; difficulty traveling through unfamiliar environments; trouble reading books, magazines, or computers; inability to see favorites hobbies or past-times; difficulty seeing to provide self-care such as shaving; or difficulty seeing to perform housekeeping such as cooking and laundry. 

If you have provided the best optical correction, but your patient is still struggling, please refer to a Low Vision Optometrist. They can tackle the problem, not only by traditional glasses or contact lenses, but also by use of lighting, contrast, prisms, modified working distances, eccentric fixation, various forms of optical and electronic magnification, training with these devices and techniques, and referrals as needed to other supportive professionals. The earlier the Low Vision Optometrist can become involved, the more successful your patients are likely to be.

Of course, at no time should Low Vision care replace proper medical or surgical intervention. But do remember, Low Vision is an essential treatment modality to those with visual impairments. Also, please do not prejudge a patient’s ability to adapt to Low Vision care or pay for the services. Low Vision consultations are generally covered under a patient’s medical insurance. If not, other funding sources are available such as the Pennsylvania Bureau of Blindness and Visual Services. Get to know your local Low Vision Optometrists. They can guide you. Consider the Low Vision Optometrist a part of your team. They do the rehabilitation and you continue to be the patient’s primary eye care Optometrist.

If you are a POA member who provides Low Vision Rehabilitation, please make sure your AOA profile indicates you have a special emphasis in Low Vision Rehabilitation. Also, join the AOA Vision Rehabilitation Advocacy Network by signing up on the AOA website under practice > specialties > Vision Rehabilitation. By identifying yourself as a Low Vision Provider with your professional association, your colleagues and the general public will be able to find you on the AOA and POA “doctor finder” under Low Vision Emphasis. If you are not a Low Vision provider, search on the AOA or POA websites for a Low Vision Optometrist in your area.

I want to thank the POA for all its support. I ask members to stay involved, join PDEHA, join CVCA, and join or refer to POA Low Vision Optometrists. Become a keyperson. Join the Proactive Optometry Initiative. We all know that Optometry is the premier eye care profession in Pennsylvania. Let’s keep it that way. Great things are being planned for 2023, and I look forward to continued success for Optometry in Pennsylvania. 

Tracy Carpenter Sepich, O.D., M.S.

Doctor of Optometry

Masters of Science in Low Vision Rehabilitation

Accommodating patients with a hearing disability

What your obligations are and are not

Sooner or later, a practice will face a communication challenge when a patient with a hearing impairment schedules an appointment. The protocol on how to deal with this type of disability in an examination has led to some confusion in the past.

First and foremost, an optometric office, regardless of the title ‘private practice,’ is a public accommodation. As a public accommodation, steps to ensure the practice and services are accessible to individuals with disabilities should be taken. Individuals with disabilities, as defined by the September 2008 amended Americans with Disabilities Act (ADA), are those with a physical or mental impairment that substantially limits one of more major life activities of such individual; a record of such an impairment; or being regarded as having such impairment.

Patients with a hearing impairment may request a sign language interpreter, but an optometrist is not required to hire one unless both parties have agreed on it. Other means of communication are an option, like having a family member of the patient or a certified employee interpret, writing a conversation with the patient on a note pad, or using various tools like a computer or phone to communicate. Auxiliary aids or services should be agreed upon prior to the scheduled appointment.

An optometrist is permitted to deny the use of an interpreter if there is proof that the cost or service of the interpreter would be an undue burden. An undue burden is a significant difficulty or expense for the practice. Factors in deciding the inclusion of an interpreter are: cost against financial status of the practice, the need for enhanced communication and the availability of the service desired. If an interpreter is needed, the optometric office is responsible for covering the cost. The patient holds no obligation to incur the fee. Passing this cost along to the patient would be a violation of the ADA, as would refusing to see the patient based on the needs of their disability or referring the person to another physician solely because the patient wants an interpreter.

The person with disability is entitled to only reasonable accommodation and cannot demand an interpreter if other alternative services are available. If no satisfactory services can be found, the practitioner is required to provide an interpreter. The downside to this justification is that ‘satisfactory’ differs for each person, but this means an interpreter is not always necessary. If a reasonable alternative is found, and would otherwise be acceptable, the patient cannot refuse the accommodation.

If hiring an interpreter, the best way to find one would be through a licensed audiologist. Using one of these professionals can ensure premium service and occasionally a discount.

Under the ADA, an optometrist is responsible to accommodate every disabled patient wanting to use the practice’s services, but are not obligated to accommodate with only an interpreter. Exploring all options is beneficial to the practice and the patient, who may assume the only option is an interpreter. Discussing all available auxiliary aids and services with patients helps to reduce financial cost in the long run. A person may not be denied an appointment or referred away from the practice based on their disability or desire to have accommodations made.