Elsevier

Ophthalmology

Volume 125, Issue 1, January 2018, Pages P228-P278
Ophthalmology

Preferred practice pattern
Vision Rehabilitation Preferred Practice Pattern®

https://doi.org/10.1016/j.ophtha.2017.09.030Get rights and content

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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

ICD-10 CM
Code any associated underlying cause of the blindness first.
Total, near-total, and profound visual impairment in better eye
  • H54.0X- Blindness both eyes

  • Visual impairment, categories 3, 4, 5 in both eyes

 Better eye: total impairment Lesser eye: total impairment
  • H54.0X- Blindness both eyes

  • Visual impairment, categories 3, 4, 5 in both eyes

 Blindness right eye, category 3H54.0X33 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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