This story originally appeared in our March 2008 issue.
For some ODs, it’s pediatric care. For others, it’s sports vision, or vision development or co-management of LASIK patients. For yet others, it’s cradle-to-grave primary care. The aspect of practice Karin Meng, OD, Sunnyvale, CA, enjoys most is low vision. Several times a week she works with a low vision patients. “Even in optometry school, I loved it immediately. It was my peak experience,” says the 1986 graduate of University of California Berkeley School of Optometry.
Following graduation, she practiced in an ophthalmology office and taught low vision to residents at a VA hospital. “Every OD knows quite a bit about low vision, and every OD can do some low vision as far as increased reading prescriptions.”
There’s little special equipment needed for a low vision practice. “I’ve had most of my devices since optometry school,” she says, listing the basic hand and stand magnifiers and monocular telescopes. “There have been significant improvements in the lighted magnifiers. Those now have LED lights that last longer and provide a brighter light. And there have been wonderful electronic advances in magnification software, voice recognition and voice output software and portable camera systems. Today, people who are completely blind can be very successful in the workplace because of this adaptive equipment, she says.
One of her best resources—and referral sources—is the state’s department of rehabilitation, which pays for adaptive equipment. Insurance carrier VSP also covers a low vision evaluation and provides coverage for some adaptive equipment. Medi-Cal covers the exam and low vision devices, but not adaptive equipment. Medicare doesn’t pay for any low vision devices, she says.
Beyond evaluating the patients’ needs and recommending devices that can help, Dr. Meng says low vision practitioners become counselors. Sudden or gradual vision loss “is a big loss,” she says.
“When I have older Medicare patients with low vision, I encourage them to bring a son or daughter with them. Some very useful low vision devices cost less than $100—but to a lot of people in this age group, they think that’s too much to spend on themselves. That’s where the family member can help. Some children buy it for their parents or can convince the parent how it would be useful in their daily tasks.”
It’s important to address the depression that comes with reduced vision. “That’s often the hardest part. If you avoid that discussion, it becomes the elephant in the room,” she says. So she talks about how the patient’s transportation needs are being met and who does the cooking and changes that can make daily tasks a little easier. She makes sure they know about Social Security and disability payments and that they’re eligible for Medicare and Medi-Cal. “I had one patient who lost his job the day he lost his vision. The family went through their entire savings in the two years that passed before someone hooked him up with assistance. That’s why I wish more ODs provided low vision,” she says.
“They’re great patients because they’re so motivated. A patient in his or her 30s or 40s wants to work,” she says. ODs who can help them achieve that goal gain their respect and thanks.