Retinal Physician

JAN-FEB 2017

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35 R E T I N A L P H Y S I C I A N | J A N U A R Y / F E B R U A R Y 2 0 1 7 Incorporating a Low Vision Rehabilitation Service into a Retinal Practice AMD still often requires low vision referrals. Does it make sense to incorporate such a service into your practice? DONALD C. FLETCHER, MD • JAY HOLMES • TRACY RUMMANS, OCS W illie Sutton, the infamous American bank robber was once asked by a reporter why he robbed banks. His now well-known answer was reported, "I rob banks because that's where the money is." Applying this line of reasoning to providing low vision rehabilitation (LVR) care, these services should be offered in retinal practices, ie, the "low vision bank," where the greatest concentration of low vision patients can be found anywhere on the planet. A chart review in our office found that 18% of our patients had binocular acuity worse than 20/60. Of these low vision candidates, most had AMD: 51%, with exuda- tive AMD; and 16%, atrophic. Retinal conditions caused the primary impairments of 90% of our patients referred to LVR programs over the last 25 years. Roughly 25 years ago, Retina Consultants of Southwest Florida started an in-house LVR service that has functioned nonstop to the present day. While many different locations can work effectively in providing LVR care, there are some unique advantages to providing care within a retinal practice that may be worthy of emula- tion. WHY DO LOW VISION REHABILITATION? Many pathologies commonly seen in retinal practice result in patients being left with permanent vision loss — such as macular degeneration, diabetic retinopathy, retinal vascular occlusions, retinal detachments, hereditary retinopathies. If we reflect about why we are in retinal practice, it should be obvious that we want to ensure optimal care for these patients. However, in caring for these patients, is it sufficient to flatten the retina, or should we also be con- cerned with whether the person with the flattened retina can use it to read the newspaper? Treatment of these retinal pathologies is not complete if the patient is not restored to functional capacity. Is it not preposterous to think of an orthopedic surgeon amputat- ing a limb and sending the patient on his or her way with nothing more than a cheery "good luck and hop along hap- pily"? No, the physical therapist is often onsite, and a pros- thetics fitting is part of the care plan. Does this standard not seem reasonable to expect in ophthalmology as well? LVR is well documented as being effective for these patients. Below are the outcomes of one of our low vision services that provided a high level of rehabilitation care to Donald C. Fletcher, MD, is director of the Frank Stein and Paul S. May Center for Low Vision Rehabilitation at the California Pacific Medical Center Department of Ophthalmology and affiliate scientist at Smith- Kelewell Eye Research Institute in San Francisco. Jay Holmes is the CEO of Retina Consultants of Southwest Florida. Tracy Rummans, OCS, is director of the business office and patient accounts at Retina Consul- tants of Southwest Florida, in Fort Myers. None of the authors reports any financial interests in products mentioned in this article. Dr. Fletcher can be reached via e-mail at 35 R E T I N A L P H Y S I C I A N . C O M | J A N U A R Y / F E B R U A R Y 2 0 1 7

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