Breaking Through the Barriers in Availing the Low Vision Care Services

Vishal Biswas, M. Optom

Assistant Professor, Department of Optometry, School of Allied Health Sciences, Noida International University, India

Visual impairment (VI) refers to significant loss of function in the visual system. ⁽¹⁾ Nearly 2.2 billion individuals worldwide are affected by distant or near vision impairment, ⁽¹⁾ and the number is expected to rise in coming decades owing to an ageing population and a rising prevalence of illnesses that might impair vision, such as diabetes, and stroke. ⁽²⁾ Low-vision patients often experience issues with quality of life and daily activities when not receiving proper care and interventions from specialists. ⁽³⁾

An optometrist’s primary field of practice is low-vision care. For those who suffer with persistent vision loss, optometrists are crucial in delivering low-vision care treatments and/or other accessible rehabilitative therapies. However, not all people with vision impairment receive the right care or training. There is a serious shortage of knowledge on low-vision management and the information that eye care professionals must provide. ⁽⁴⁾

Barriers for low vision services

There are several significant challenges when it comes to providing low vision care services. First, not all optometrists are equipped to offer independent low vision care, and those who do may lack the necessary tools for comprehensive services. ^(5,6) Second, insufficient training among eye care professionals often results in a lack of expertise in providing these crucial services to patients. ⁽⁷⁾ Moreover, a lack of awareness and knowledge among patients themselves is a hurdle, as many individuals are unaware of the benefits of low vision care services. ^(8,9) 

Additionally, there is a problem of inadequate referrals, as eye care professionals may not refer eligible patients to low vision care services due to various factors like health issues, cognitive decline, ageing, or a lack of social support. ⁽¹⁰⁾ Furthermore, financial concerns can impede access to low vision care, as the expensive aids and equipment needed for treatment may not be maintained by independent practitioners, preventing patients from receiving the necessary care. ⁽¹¹⁾ Social acceptance is also an issue, with low-vision patients sometimes facing rejection from their family and friends, particularly when using assistive technology, which can deter them from seeking low vision therapy services. ^(6,10)

Lastly, transportation and travel pose a significant barrier, as patients with vision impairment often find it challenging to travel independently, making access to low vision care services even more difficult. ^(9,10) These challenges collectively hinder the provision and utilisation of essential low vision care services.

Conclusion:

In this blog, we aim to highlight and describe the various barriers that hinder the accessibility of low vision care services. These challenges include a lack of training, improper referrals, limited availability of low vision care services and resources, and perhaps the most significant issue, a lack of awareness. Many of these obstacles can be easily addressed, and our objective is to identify and define them to pave the way for improved low vision care.

References:

1. World Health Organization. WHO global report on blindness and visual impairment. World Health Organization; 2023 August10.
   https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment
2. Bourne, R. R., Flaxman, S. R., Braithwaite, T., Cicinelli, M. V., Das, A., Jonas, J. B., … & Zheng, Y. (2017). Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. The Lancet Global Health, 5(9), e888-e897.
3. Lamoreux, E. L., Chong, E., Wang, J. J., Saw, S. M., Aung, T., Mitchell, P., & Wong, T. Y. (2008). Visual impairment, causes of vision loss, and falls: the Singapore Malay Eye Study. Investigative ophthalmology & visual science, 49(2), 528-533.
4. Lam, N., & Leat, S. J. (2013). Barriers to accessing low-vision care: the patient’s perspective. Canadian Journal of Ophthalmology, 48(6), 458-462.
5. Malkin, A. G., Ross, N. C., Chan, T. L., Protosow, K., & Bittner, A. K. (2020). US optometrists’ reported practices and perceived barriers for low vision care for mild visual loss. Optometry and Vision Science, 97(1), 45-51.
6. Kyeremeh, S., & Mashige, K. P. (2021). Availability of low vision services and barriers to their provision and uptake in Ghana: practitioners’ perspectives. African Health Sciences, 21(2), 896-903.
7. Dilkash, M., Banerjee, S., Dubey, G., Kumari, V., Kumari, R., & Gupta, D. (2021). Awareness, knowledge, and barriers to low vision services among eye care practitioners in Maharashtra. International Journal of Research in Medical Sciences, 9(10), 3124.
8. Sarika, G., Venugopal, D., Sailaja, M. V. S., Evangeline, S., & Kumar, R. K. (2019). Barriers and enablers to low vision care services in a tertiary eye care hospital: A mixed method study. Indian journal of ophthalmology, 67(4), 536.
9. Kaldenberg J. Low vision rehabilitation services: Perceived barriers and facilitators to access for older adults with visual impairment. British Journal of Occupational Therapy. 2019 Aug;82(8):466-74.
10. Khimani, K. S., Battle, C. R., Malaya, L., Zaidi, A., Schmitz-Brown, M., Tzeng, H. M., & Gupta, P. K. (2021). Barriers to low-vision rehabilitation services for visually impaired patients in a multidisciplinary ophthalmology outpatient practice. Journal of Ophthalmology, 2021.
11. Kumar, H., Monira, S., & Rao, A. (2016, September). Causes of missed referrals to low-vision rehabilitation services causes in a tertiary eye care setting. In Seminars in Ophthalmology (Vol. 31, No. 5, pp. 452-458). Taylor & Francis.