O.D. TO O.D.
Professional Turf
Get ready. Low vision is next.
BY NEIL B. GAILMARD, O.D., M.B.A., F.A.A.O., Chief Optometric Editor

Be honest. Have you ever heard of the Capuano Bill introduced by Rep. Michael Capuano (D-Mass.)? Does the Medicare Vision Rehabilitation Services Act of 2001, H.R. 2484, ring any bells?

I'd be surprised if you said yes. Yet this legislation, which was introduced to the U.S. House of Representatives this past July, could have a profound effect on optometry. It seems like a great bill -- the kind we should all be excited about.

Highlighting therapy

The new bill seeks to expand Medicare coverage of low vision services. And because so many low vision patients are Medicare recipients, this would help many people to receive much needed care.

This effort, which isn't directed as much at the exam portion of a low vision visit, really focuses on therapy. Medicare already covers at least a portion of the evaluation -- although differentiating between the refractive portions and the eye health portions is difficult. Also, I'd like to see the reimbursement for exams increased because this work is highly specialized and time-intensive.

What is low vision therapy?

When you think of low vision therapy, you may easily picture low vision aids and the dispensing and instructing services that accompany them. No doubt, they're at the forefront of low vision care, but this bill is aimed at a low vision service that may be new to some optometrists -- that is, the work often done by occupational therapists, vision rehabilitation counselors and social workers. This is low vision rehabilitation.

In the future, optometrists could regularly employ these professionals to provide the important links between prescribing and implementing care within the patient's environment.

If H.R. 2484 is passed, in-office and in-home sessions would be scheduled to teach patients to:

• effectively use remaining vision
• manipulate the environment to his or her benefit
• compensate for vision loss with other sensory systems.

Then, we'd bill these services to Medicare under the 97000 codes, which are set aside specifically for rehabilitation.

What profession should lead low vision care?

Well, that question is obvious. Optometry, of course. Our training and expertise make us the ideal professionals for understanding the melding of eye disease, visual function, refraction and the optics of magnification.

Why then was this bill initially proposed and crafted by the American Academy of Ophthalmology? It seems too good to be true to be getting help from a group that we can't see eye to eye with on pre-school eye exams or surgical co-management, or a whole host of other topics.

I won't look a gift horse in the mouth; this is a good thing no matter who's behind it. But it does feel like a wake-up call. I once thought low vision care would never be of interest to ophthalmologists because it was so time-intensive and so optically based. I thought this was one field that would remain exclusively optometric, and a specialty where we could actually hope for referrals from our eye M.D. friends.

This bill makes it clear that this isn't the case. Ophthalmologists will simply delegate the time-intensive refractive part -- and the rehabilitation part that would be covered under H.R. 2484.

Be assured, they see a place for low vision in ophthalmology, just as they do for optical dispensing, contact lens fitting and primary eye care.

Low vision is an eyecare specialty that's growing fast, and the need for services will only become greater. We should embrace this field because we're uniquely qualified to provide the care and to lead the team of allied health professionals who can help assimilate therapy into patients' lives.

Giving credit where credit is due

I first learned about H.R. 2484 on the Academy of Ophthalmology's Web site (www.aao.org). I've only seen anything written about this in ophthalmology sources (except for OM's August news item about it). The AOA, along with 27 other organizations, also endorsed the bill. But that seems rather secondary to the major effort by the AAO. I commend the Academy for its support of this important bill, and I'm glad we see eye to eye on this one.

Feel free to contact Dr. Gailmard at neil@gailmard.com.