Virtual Low Vision Rehabilitation – Dr. Lewerenz Answers our FAQs

Dr. David Lewerenz, OD, FAAO, from the University of Colorado School of Medicine, Department of Ophthalmology, hosted an engaging and informative webinar about virtual low vision rehabilitation on May 14 as part of the #eSightTogether program. This is the second part of his presentation where he answered questions from the webinar participants.

Dr. David Lewerenz headshot.

FAQs

Q: How do you prescribe low vision aids via telehealth?

A: If you have a very specific problem, your healthcare provider may be able to walk you through a prioritized list of solutions to try, such as getting a head-mounted flashlight, visor magnifier, or other devices such as eSight. In general, it would likely be more about discussing potential strategies rather than prescribing something.

Q: Which EHR do you use for low vision?

A: Our entire clinic is on EPIC which is one of the 2-3 big EHRs for the country.

Q: Is the acuity measurement (from the virtual acuity testing) considered distance or near-visual acuity?

A: It is somewhere in between as it is closer than distance but further than most near-visual acuity. Theoretically, if the lighting conditions, contrast, crowding, etc. are the same and the patient is looking through the appropriate correction then there shouldn’t be a difference between the two. If you are looking for more of a distance measurement, you can always ask the patient to back up to around 10 feet for example.


Virtual acuity testing chart.

Q: How are you handling DMV renewals with or without Goldman visual fields?

A: So far, I have not done any renewals through virtual health as there is no way that I know of to do a Goldman equivalent through a virtual health visit. However, I have a patient coming in next week who has a license that will expire at the end of May, as our clinic is making exceptions to allow people in to maintain their licensure if their vision supports it. Overall, virtual health might not be valuable in this area as I do not currently know of a way to get visual fields.

Q: Are you billing for these virtual health visits?

A: Yes, although there were some phone calls that I did not bill but even phone calls can be billable. There are guidelines issued through the medical center now for how to bill virtual visits, and it is often based on time because exam elements are limited. However, this may vary with what individual institutions have decided to do.

Q: If someone is starting to experience visual issues, are there any key factors for them to look out for that would begin that first phone call?

A: If you are noticing changes in your vision, that is a good opportunity for a phone call to your provider. In our clinic, we have a telephone triage system where someone will screen the callers and get them to the appropriate specialist. Most of the time, I would defer to the specialist who’s caring for their underlying health condition first to see if they can be treated medically, and if not then they would be referred to me where I work on low vision rehabilitation.

Close-up of an eye.

Q: I just ordered a monocular for a patient after a video visit, he could not see the text on the TV from his chair so I asked him to walk forward until he could see the text and estimate the distance. I used that information to order a 2.5x monocular and I will monitor the situation going forward. What are your thoughts on this?

A: This is an excellent idea, I love it! If you did send out a 2.5x telescope and they couldn’t see it from their chair but they could see it from half the distance, then you would realize they needed a 5x monocular, so this method is easily adjustable too.

Q: Is there a way to check your eye pressure via virtual tools like the virtual field test?

A: I cannot comment right now on what devices are out there as I am no longer involved in glaucoma treatment, but I am aware that they are coming out with measuring devices that can be used from home similar to blood pressure devices being used now.

Q: We have been mailing out a continuous-text near chart prior to speaking with clients. This is useful to recommend illuminated magnifiers but direct observation is only available if we speak via Zoom, FaceTime, etc. What are your thoughts on this?

A: We routinely use continuous-text charts for prescribing near devices. There is no real substitute for that as single letter visual acuity just isn’t the same. Your method is a great idea for taking gold standard clinical practice and using it in the context of a virtual health visit – very creative, I like it!

Q: I am worried about getting a new prescription right now, are there any issues related to dilating pupils and a higher risk to COVID-19?

A: Having dilated pupils would not increase your risk to COVID-19. In terms of getting a glasses prescription, plenty of people will do refractions and prescribe for people who are dilated.

Glasses on a table.

Did you find Dr. David Lewerenz’s answers to questions about virtual low vision rehabilitation during COVID-19 interesting?

Read more here about how to manage social distancing with a visual impairment, and make sure you are caught up on the first part of his webinar, where he explains how he is performing visual acuity testing in a virtual low vision rehabilitation setting.

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