Author: midwestlowvision

• I have accidentally become a neuro-optometrist.  Patients with TBI and other neurological deficits often have low vision…so I see them regularly.
• Beyond the usual functional vision goals due to decreased visual acuity, these patients need help with various vision and other related symptoms.
• TBI symptoms can include blurred vision, headaches, photophobia, reading difficulties, eyestrain, diplopia, eye movement disorders, visual field defects, color vision changes, impaired contrast sensitivity, perceptual difficulties, and vestibular dysfunctions such as visual motion sensitivity (VMS).

• My Top 5 TBI Treatments:
  • Filters, Light Control
  • Prism, for Alignment/Binocularity, as well as Sectoral, Yoked, and Base-In
  • Increased Plus Power for Near
  • Selective Occlusion
  • Vision and Occupational Therapy Referral

LEARN MORE about how Dr. Long helps these patients

We schedule low vision patients for 60 minutes at our main office and 75 minutes at satellite offices (I usually have no help from a low vision technician when I travel).  This seems to work MOST of the time.

Here is a time-related concept, “Eigenzeit,” and my experience applying it to low vision examinations.  The link will take you to this month’s edition of my low vision care newsletter.  Feel free to subscribe to our newsletter and/or browse through archived editions.  Thank you!

Who should you refer for advanced low vision care and is it your responsibility to do so?  Are you a “Five-Percenter?”  I promise to explain, but first consider, really consider, this common question I’ve been asked over the past 25 years:

“Why didn’t one of my other eye doctors

tell me about you (sooner)?”  – Patient

To be fair, maybe you didn’t realize that a referral for low vision care was appropriate, or maybe you didn’t know it was your responsibility.  Well today, I offer you some guidance on both counts.

Before I help explain “who” to refer for low vision care, I believe it’s important to know “why” it should be YOU referring YOUR patient.  And…I’ve actually just given you the answer.  She is YOUR patient and no one knows her better than you do!  She is relying on YOU to help her see what she wants, and needs to see, in order to function in this world.

“Secondary and Tertiary Care Ophthalmologists

are not Referrers.”  – Dr. Long

By definition, they are almost always being Referred To.  They provide a specialty service for YOUR patient.  While many of them recognize the need, and do refer regularly for low vision care, they are not gatekeepers.  I believe it is the primary eye care doctor’s responsibility to refer for low vision care.

Now, with the “why you?” question answered, on to Who to Refer for Advanced Low Vision Care:

Put quite simply, any individual with an unmet functional vision complaint.  Complaints are commonly related to reading, driving, working, watching television, doing handwork, using the computer, improving mobility, and enjoying various hobbies.  See if any of these examples of what to listen for sound familiar to you:

20/30 – 20/50  “I can read but it’s a strain and I never wore those strong glasses you prescribed last time.”  “The crawler on the TV is too small to read and goes by too fast.”  “Driving is OK as long as I stay local…I can’t read signs as far off as I’d like.”

20/60 – 20/160  “I can only read in natural sunlight and on certain days…usually just large print.”  “My daughter has to take care of my check register and read my mail.”  “I can only make out details on the TV when I walk up to it.”  “Dr. Retina said I probably shouldn’t be driving, but that he wouldn’t turn me in.  What do you think?”  “My job has become very difficult, especially certain programs on the computer that I can’t use the built-in magnifier with.”  “I’m afraid people think I’m rude because I don’t recognize them when I’m out.”

20/200 – 20/400  “I quit driving after a scare, but I would at least like to be able to read my own mail and see my iPad.”  “The text size on my phone is maxed-out and it’s still tough to read, and forget about seeing the pictures!”  “Mostly, I listen to the TV.”

20/500 +  “I’m looking for anything that’s available.  Do you know anyone that might have something that could help me see?”

Visual field loss (e.g., retinitis pigmentosa, hemianopsia) and Traumatic Brain Injury symptoms  “I feel anxious at the grocery store.”  “I’m very sensitive to certain lighting conditions.”  “Can I drive?!”  “Reading and computer work are real chores! ”  “I bump into people and they think I’m just rude or clumsy.”  “Sometimes I see double.”

Please don’t wait to refer until prompted by the patient at the “20/500+” level of vision.  If you’re just not sure, there’s certainly no shame in referring for what turns-out-to-be simply a good trial frame refraction.  And remember, she is YOUR patient.  I’m sending her back to you for her “regular” glasses and/or routine medical eye care.  I’ll only see her again when you tell me her low vision needs have changed.

Whether at my main office in Bloomington, Indiana, or at a satellite location, I am practicing as a specialist.  Your patient is YOUR patient…just the way it should be.  Now, if nothing else, simply make sure they know low vision care exists.

By the way, when I see a patient you have referred, I often tell them:

“Your Doctor is a ‘Five-Percenter’ (meaning you are part of the minority of primary care eye doctors

who refer for low vision care) and you should be grateful for such a thoughtful doctor!”

Thank you and please share our information, or share a well-qualified low vision provider’s information in your area, with your patients or loved ones with vision loss.  While we see most of our patients by referral, all calls are welcome to see if we can help.  Call 1-877-577-2040 and speak directly with me or our low vision technician, Holly.

Dr. Jarrod Long

Is there such a thing as a typical day of low vision care?

When caring for the functional vision wants and needs of patients who are partially-sighted and legally blind, it takes knowledge, expertise, and experience. Simply having a technician hand a patient different magnifiers, filters, and the like just doesn’t cut it in my opinion.

Come with me in the video and visit with a couple of patients who are thrilled as they pick up the glasses we chose together in order to help them see and function better!

The first young man has a very limited field of vision (traumatic brain injury, TBI) and he particularly wanted help in seeing downward for mobility purposes. The second patient needed to see details at a distance more clearly secondary to having 20/100 vision from macular degeneration.

Thanks for reading and watching.  Give us a call if you have any questions or would like to schedule a low vision evaluation.

Introducing our newest Midwest Low Vision employee, Holly! 👋
Casey has been working closely with Holly as she will be taking over as Dr. Jarrod’s Low Vision Technician (don’t worry, Casey’s not going anywhere!).  Holly started her career in Optometry in 2006 and has held many roles in the field since then.
In 2013, Holly was diagnosed with Stargardt’s Disease, which is a retinal disease similar to Macular Degeneration & results in a loss of central vision. Since then, Holly has developed a great passion for helping those with Low Vision.  She has volunteered for The Foundation Fighting Blindness & assists with their annual Vision Walk each year.  When Holly isn’t working, she enjoys spending time with her husband, 3 children & their dog. She looks forward to meeting and working with all of our wonderful patients! 💙👁

Practicing maximally effective low vision care requires open-minded empathy coupled with knowledge and creativity.
To be maximally effective I feel that you need to be able to “put yourself in the patient’s shoes” to the fullest extent that you are able.
THEN, you must have done your homework and have the experience to know what is available that might be able to meet their needs.
FINALLY…(and this is the fun part!)…you must “think outside the box” and ask yourself if there might be a better way to solve this patient’s particular problem(s).

— Dr. Jarrod Long

Come along with Dr. Long on an office tour!

We’ll start outside and work through the low vision patient experience from the patient’s perspective.  Dr. Long narrates and explains various details and expectations of the visit.

Every day we see patients who need the various glasses and devices described in the video, such as bioptics and bioptic telescopic glasses.

Take a look at the link to learn why your doctor should be referring you for low vision care.  In 2018, the CEO of the American Academy of Ophthalmology declared that “referral for low vision rehabilitation is now the standard of care in ophthalmology.”

https://mailchi.mp/0cfe85983363/l-v-c-c-10-hd-11190415

July 13, 2005 (I checked his chart), I remember examining my buddy, Dave, near the end of the day. He complained of blurred and distorted vision in one eye.

As doctors, through careful questioning, about 90% of the time we know, or think we know, what’s going on before we ever examine the patient. I knew my buddy had Idiopathic Central Serous Chorioretinopathy (ICSC). I had seen it before in another friend.

me: “Dave, I think I know what’s going on. Any extra stress in your life lately?”
Dave: “I’m not sure, not really…”
me: “Well anyway, I think I know what’s going on, but let’s get you dilated and take a look.”

Dave had active inflammation in one macula and suspicious lesions in the other. However, he did not have ICSC. The diagnosis was easy once I looked…he had Presumed Ocular Histoplasmosis Syndrome (POHS).

Dave’s story sticks in my mind because I was near tears when I gave him my diagnosis. I referred him to a retinal specialist and I knew that he would get laser treatment and would eventually be one of my low vision patients. But his case also sticks in my mind because there was something I didn’t know…

Rather than using a laser, the retinal specialist reported that he had injected a new cancer medication, Avastin, into Dave’s eye. Whaaat???!!! How would this help save his vision? Of course, now we know. His vision did improve and, despite eventually needing injections in both eyes, he still has good vision to this day. Amazing.

I believe there is a corollary here with low vision care:

There are new and unimaginable ways to help patients see better or even use other senses to complement poor vision. There are also often ways to acquire funding for expensive devices and to overcome other perceived obstacles.

If not me, seek another effective low vision provider via a Google search or other means. Low vision referral is the Standard of Care for good reason — there just might be some things that you didn’t know that you didn’t know.