June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Developing a care delivery framework for older adults with visual impairment: A mixed methods study on ophthalmologist perspectives
Author Affiliations & Notes
  • Judith E Goldstein
    Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Catherine Kerr-Niermann
    Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Fahd Naufal
    Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Xinxing Guo
    Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Judith Goldstein None; Catherine Kerr-Niermann None; Fahd Naufal None; Xinxing Guo None
  • Footnotes
    Support  Raab Foundation
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3088. doi:
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      Judith E Goldstein, Catherine Kerr-Niermann, Fahd Naufal, Xinxing Guo; Developing a care delivery framework for older adults with visual impairment: A mixed methods study on ophthalmologist perspectives. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3088.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To examine the ophthalmologists’ perspective on providing care to older adults with visual impairment (VI), aiming to better understand and improve healthcare delivery to this unique group of patients.

Methods : Ophthalmologists from glaucoma, retina and neuro-ophthalmology subspecialities from Johns Hopkins Wilmer Eye Institute participated in an observational mixed-methods study. Interviews and surveys covered major themes including identification of and methods used to screen for vision-related functional deficits, counselling practices, and low vision rehabilitation (LVR) provision to enhance function.

Results : Participating ophthalmologists (N=20, 65% male) were mostly over the age of 40 (60%) and had 9 years of experience (median) in their respective subspeciality. Most (55%) reported spending 5-10 minutes face-to-face with the patient per encounter and estimated that 36% (5%-67%) of older patients on average have difficulty with visual function. Most (70%) did not systematically screen for visual function difficulty, but when initiated relied on the following parameters: asking the patient directly (90%), visual acuity (70%), visual field (60%), and diagnosis criteria (25%). Time available to screen and counsel patients on visual function and LVR was reported as inadequate (70%), and only one-fifth noted that use of ophthalmic technicians or trainees was a viable option to identify and refer patients to LVR. Use of a reminder within the electronic health record (EHR) to prompt identification and referral to LVR was of interest in over half (55%) surveyed. Most ophthalmologists (70%) referred to LVR when patients expressed difficulty with visual function; over half of ophthalmologists (55%) reported that most patients were interested in pursuing LVR and found LVR beneficial.

Conclusions : Most ophthalmologists recognized the importance of querying about patients’ visual function and referring to LVR, however screening approaches were not routine and time constraints often preclude adequate counselling. Relinquishing this responsibility to trainees or technicians was not considered viable given the effect on clinic workflow. An EHR reminder triggered by patient-reported vision concerns and visual acuity offers an initial framework where ophthalmology practices can be standardized to enhance healthcare delivery to older adults with VI.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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