Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic.

Background: In March 2020, the pandemic added a major barrier resulting in the cancelation of all low vision ocular rehabilitation services. To prevent delay of beginning low vision ocular rehabilitation services, all low vision care was switched to telerehabilitation to home. Methods: Case managers began to cancel all in-person services and offer Veterans Affairs (VA) video connect services to their home. Patients with video access scheduled a home VA video connect telerehabilitation evaluation and therapy assessment. Patients who did not have video access waited to schedule a future in-person low vision appointment (postpandemic). Results: Of the in-person canceled appointments, 54% who scheduled the new home telerehabilitation evaluation were delayed on average 25 calendar days. Patients who waited for in-person low vision care were delayed on average 98, 138, or 153 calendar days. Of the 56 new patients referred for low vision optometry services during this 4-month period (COVID-19), 91% scheduled home low vision ocular telerehabilitation evaluations without delay; 5% waited until in-person clinics were open; and 4% waited until rural VA's and community-based outpatient centers were open. Discussion: Veterans with low vision who live in rural communities have limited access to services unless they are able to travel several miles to a specialty low vision clinic. Low vision ocular rehabilitation telehealth services have been successfully provided at the VA Western New York Healthcare System (Buffalo, NY) low vision clinic. Conclusions: Home low vision ocular rehabilitation telehealth increases access as early as possible once diagnosed with ocular pathology resulting in low vision.

Travel Cost Savings and Practicality for Low-Vision Telerehabilitation.

Introduction: Veterans with low vision who live in rural communities have limited access to low-vision rehabilitation services, unless they are able to travel several miles to a specialty low-vision clinic. A low-vision optometry telerehabilitation evaluation is a thorough assessment of patient's functional vision. Following each low-vision optometry telerehabilitation evaluation is a low-vision telerehabilitation initial assessment with a blind rehabilitation therapist. Our objective was to estimate the acceptance and practicality of low-vision telerehabilitation and investigate the travel cost and time savings. Methods: Utilizing Google Maps™, round-trip travel mileage and travel time can be estimated between the veteran's home and the Buffalo Veterans Affairs (VA) and compared with the round-trip mileage and travel time between the veteran's home and local community-based outpatient center (CBOC) or local VA for low-vision telerehabilitation services. The difference is the savings in travel miles and time. Cost saving can be calculated by multiplying difference in travel miles by cost per mile. Results: Veterans who chose not to schedule face-to-face low-vision rehabilitation at the Buffalo VA due to an average round-trip travel distance of 151 miles scheduled a low-vision telerehabilitation at a local CBOC or local VA with an average round-trip travel distance of 29 miles. Adding low-vision telerehabilitation services from fiscal year (FY) 13 to FY 17 resulted in a 24% increase in low-vision patient care. The median saving of travel miles for rural veterans was 122 miles per veteran, and the median saving of travel time was 2.09 h per veteran. Overall, the median saving of the travel cost was $65.29 per veteran. Conclusions: This study shows and supports low-vision telerehabilitation as an accepted, practical, time-saving, and cost-saving alternative option to traditional face-to-face consultations with a low-vision optometrist and blind rehabilitation therapist.

Development of a mild traumatic brain injury-specific vision screening protocol: a Delphi study.

Although traumatic brain injury (TBI) can happen to anyone at any time, the wars in Iraq and Afghanistan have brought it renewed attention. Fortunately, most cases of TBI from the recent conflicts are mild TBI (mTBI). Still, many physical, psychological, and social problems are associated with mTBI. Among the difficulties encountered are oculomotor and vision problems, many of which can impede daily activities such as reading. Therefore, correct diagnosis and treatment of these mTBI-related vision problems is an important part of patient recovery. Numerous eye care providers in the Department of Veterans Affairs, in military settings, and in civilian practices specialize and are proficient in examining patients who have a history of TBI. However, many do not have this level of experience working with and treating patients with mTBI. Recognizing this, we used a modified Delphi method to derive expert opinions from a panel of 16 optometrists concerning visual examination of the patient with mTBI. This process resulted in a clinical tool containing 17 history questions and 7 examination procedures. This tool provides a set of clinical guidelines that can be used as desired by any eye care provider either as a screening tool or adjunct to a full eye examination when seeing a patient with a history of mTBI. The goal of this process was to provide optimal and uniform vision care for the patient with mTBI.

Vision rehabilitation team management of acquired monocular vision.

PURPOSE: Existing low-vision programs do not readily meet the needs of the monocular patient. This case report illustrates the implementation and benefits of an Acquired Monocular Vision Rehabilitation (AMVR) evaluation and training program from the patient's perspective. The AMVR program guides and teaches specific skills to each monocular patient. Adaptive skills are demonstrated to enhance and maximize the person's remaining monocular vision; to teach visual skills; to acquire and maintain independence, living, and functioning; and prevent depression. The purpose of this article is to illustrate the potential for monocular vision rehabilitation and justify adding monocular rehabilitation therapy to current vision rehabilitation programs and encourage future clinical case studies to measure functional outcomes. CASE REPORT: This case report illustrates one example of concurrent vision rehabilitation team management including low-vision optometrists, ophthalmologists, blind rehabilitation specialists (also known as vision rehabilitation therapist), and orientation and mobility instructors (O&M) of a later stage acquired monocular patient within a 1-year period. CONCLUSIONS: After completion of the AMVR program (detailed components available in Appendices, available at http://links.lww.com/OPX/A114), our patient expressed an increase in self-confidence, improved motor skills, and less depression since learning more about his condition and adaptations he can maintain. He stated that he feels he is a "better me." The patient's positive feedback encourages further data to be collected with future monocular patients evaluated at an earlier stage of their vision loss and to continue to structure supportive services by demonstrating new adaptive techniques and exercises to show each person "is-able" and not "dis-abled."

Acquired Monocular Vision Rehabilitation program.

Existing programs concerning patients with low vision do not readily meet the needs of the patient with acquired monocular vision. This article illustrates the development, need, and benefits of an Acquired Monocular Vision Rehabilitation evaluation and training program. This proposed program will facilitate the organization of vision rehabilitation with eye care professionals and social caseworkers to help patients cope with, as well as accept, and recognize obstacles they will face in transitioning suddenly to monocular vision.