Preferred practice patternVision Rehabilitation Preferred Practice Pattern®
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VISION REHABILITATION PREFERRED PRACTICE PATTERN® DEVELOPMENT PROCESS AND PARTICIPANTS
The Vision Rehabilitation Committee members wrote the Vision Rehabilitation Preferred Practice Pattern® guidelines (PPP). The Committee members discussed and reviewed successive drafts of the document by e-mail to develop a consensus over the final version of the document.
Vision Rehabilitation Committee 2016–2017
Mary Lou Jackson, MD, Consultant
Mark D. Bona, MD
Mona A. Kaleem, MD
William M. McLaughlin, Jr., DO
Alan R. Morse, JD, PhD
Terry L. Schwartz, MD
John D. Shepherd, MD
Joseph L. Fontenot, MD,
FINANCIAL DISCLOSURES
In compliance with the Council of Medical Specialty Societies’ Code for Interactions with Companies (available at www.cmss.org/codeforinteractions.aspx), relevant relationships with industry are listed. The Academy has Relationship with Industry Procedures to comply with the Code (available at www.aao.org/about-preferred-practice-patterns). A majority (100%) of the members of the Vision Rehabilitation Committee had no financial relationship to disclose.
Vision Rehabilitation Committee 2016–2017
TABLE OF CONTENTS
OBJECTIVES OF PREFERRED PRACTICE PATTERN GUIDELINES P233
METHODS AND KEY TO RATINGS P234
HIGHLIGHTED RECOMMENDATIONS FOR CARE P235
INTRODUCTION P236
Comprehensive Multidisciplinary Model of Vision Rehabilitation P236
Disease Definition P237
Patient Population P238
Clinical Objectives for All Ophthalmologists P238
Clinical Objectives for Ophthalmologists Who Subspecialize in Vision Rehabilitation P238
BACKGROUND P238
Prevalence P238
Rationale for Treatment P239
CARE PROCESS FOR ALL OPHTHALMOLOGISTS P242
CARE
OBJECTIVES OF PREFERRED PRACTICE PATTERN® GUIDELINES
As a service to its members and the public, the American Academy of Ophthalmology has developed a series of Preferred Practice Pattern® guidelines that identify characteristics and components of quality eye care. Appendix 1 describes the core criteria of quality eye care.
The Preferred Practice Pattern® guidelines are based on the best available scientific data as interpreted by panels of knowledgeable health professionals. In some instances, such as when results of carefully conducted clinical
METHODS AND KEY TO RATINGS
Preferred Practice Pattern® guidelines should be clinically relevant and specific enough to provide useful information to practitioners. Where evidence exists to support a recommendation for care, the recommendation should be given an explicit rating that shows the strength of evidence. To accomplish these aims, methods from the Scottish Intercollegiate Guideline Network1 (SIGN) and the Grading of Recommendations Assessment, Development and Evaluation2 (GRADE) group are used. GRADE is a
HIGHLIGHTED FINDINGS & RECOMMENDATIONS FOR CARE
Ophthalmologists are encouraged to provide rehabilitation resource information to patients who have vision loss. Even early or moderate vision loss may result in disability, which can affect visual performance, cause anxiety, and interfere with everyday activities. The ophthalmologist should refer patients for multidisciplinary comprehensive vision rehabilitation services when available. There is evidence that vision rehabilitation improves reading and visual ability.
All ophthalmologists should
COMPREHENSIVE MULTIDISCIPLINARY MODEL OF VISION REHABILITATION
Vision rehabilitation is part of the continuum of eye care that extends from diagnosis to treatment and rehabilitation. Vision rehabilitation services vary greatly across the United States and around the world. For example, they may consist of a single clinician incorporating low vision devices into his or her clinical practice or they may be larger multidisciplinary teams offering a full range of comprehensive rehabilitation services in a single setting. The primary role of ophthalmologists is
PREVALENCE
Worldwide, it is estimated that 217 million people have moderate or severe visual impairment and 36 million have blindness. It is estimated that by 2050 there will be 588 million people living with moderate or severe vision impairment and 115 million with blindness.
Based on prevalence rates and 2010 U.S. census data, it was estimated that 2.9 million individuals in the United States over the age of 40 had low vision (defined as visual acuity less than 20/40 in the better-seeing eye)11 and 1.28
CARE PROCESS FOR ALL OPHTHALMOLOGISTS
All ophthalmologists should recommend vision rehabilitation as a continuation of their care and provide information about rehabilitation resources for patients with vision loss. Vision rehabilitation improves the patient's ability to compensate for vision loss.53 It prepares patients to use their remaining vision more effectively or to use compensatory strategies to facilitate reading, complete activities of daily living, ensure safety, support participation in community, and enhance emotional
CARE PROCESS FOR OPHTHALMOLOGISTS WHO SUBSPECIALIZE IN VISION REHABILITATION
The Comprehensive Multidisciplinary Vision Rehabilitation Model incorporates the vision rehabilitation care process in the continuum of ophthalmic care. Level 3 of the care process in this model includes a history, a clinical evaluation of visual functions, an assessment of the patient's performance of activities such as reading, an assessment of risks to the patient associated with vision loss such as falls or medication errors, recommendations for rehabilitation interventions that are
APPENDIX 1. QUALITY OF OPHTHALMIC CARE CORE CRITERIA
Providing quality care is the physician's foremost ethical obligation, and is the basis of public trust in physicians.
AMA Board of Trustees, 1986
Quality ophthalmic care is provided in a manner and with the skill that is consistent with the best interests of the patient. The discussion that follows characterizes the core elements of such care.
The ophthalmologist is first and foremost a physician. As such, the ophthalmologist demonstrates compassion and concern for the individual, and utilizes
APPENDIX 2. INTERNATIONAL STATISTICAL CLASSIFICATION OF DISEASES AND RELATED HEALTH PROBLEMS (ICD) CODES
Changes to the ICD-10 are courtesy of Jenny Edgar, AAO Coding Specialist
H54.0X- Blindness both eyes Visual impairment, categories 3, 4, 5 in both eyes H54.0X- Blindness both eyes Visual impairment, categories 3, 4, 5 in both eyesICD-10 CM Code any associated underlying cause of the blindness first. Total, near-total, and profound visual impairment in better eye Better eye: total impairment Lesser eye: total impairment Blindness right eye, category 3 H54.0X33 Blindness right eye, category 3; blindness
APPENDIX 3. THE ACADEMY'S MULTIDISCIPLINARY MODEL OF VISION REHABILITATION AS PART OF THE CONTINUUM OF OPHTHALMIC CARE
The American Academy of Ophthalmology model of vision rehabilitation outlines how vision rehabilitation can be incorporated in the continuum of ophthalmic care.
APPENDIX 4. THE ACADEMY'S INITIATIVE IN VISION REHABILITATION – PATIENT HANDOUT
American Academy of Ophthalmology Vision Rehabilitation Patient Handout To locate services in your area, contact the American Foundation for the Blind: www.afb.org or 1-800-232-5463
INTRODUCTION
Vision rehabilitation for children with low vision and their families is an essential component of ophthalmic care. It represents a collaborative effort of a multidisciplinary team that may include ophthalmologists, pediatric ophthalmologists, vision rehabilitation clinicians, occupational therapists, orientation and mobility instructors, teachers, and others working with the child and family. The developmental needs of children, their vulnerability to poor outcome without supports and
INTRODUCTION
Occupational therapy focuses on enabling persons with impairments to participate in their desired daily “roles, habits, and routines in the home, school, workplace, community and other settings.”148 For individuals with vision impairment, the occupational therapist helps them to develop skills and strategies to use remaining vision as effectively as possible to complete their daily occupations. Occupational therapists typically provide medically based rehabilitation services that are reimbursed
APPENDIX 7. LITERATURE SEARCHES FOR THIS PPP
Literature searches of the PubMed and Cochrane databases were conducted in June 2016; the search strategies can be found on www.aao.org/ppp. Specific limited update searches were conducted after June 2016.
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