Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice

Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened ( n  = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient's overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.