Division Policy 8.17
Low Vision assistance for clients
August 15, 2007
This procedure will be reviewed and updated as required.
To provide guidelines regarding the provision of low vision services.
The Division of Blind Services (DBS) defines low vision as being a level of vision that with standard correction impedes an individual in the planning or execution of tasks. Enhancement of functional vision through the use of optical or non-optical environmental modifications and/or techniques may be possible. This definition is expressed in functional terms; therefore, the Division’s low vision service delivery addresses the client’s functional vision limitations.
This policy covers services to children and Independent Living and Vocational Rehabilitation.
The Division of Blind Services rehabilitation counselors will make all low vision clients aware of the benefits of low vision evaluations and how the division can assist in obtaining these exams if the client does not have similar benefits and has not had a recent (within 1 year) examination. All low vision clients will be provided a list of low vision specialists in their area they can seek out for assistance. Maximizing residual vision is extremely critical in the provision of quality services and this policy is designed to assist in ensuring that this service is offered to all clients that will benefit.
School aged children who have been determined eligible for DBS services may require low vision services. Prior to providing any low vision services to a client of the children’s program, a rehabilitation specialist must ensure that the child is not eligible for services under the Florida Low Vision Initiative Project.
The Florida Department of Education, Division of Special Education funded the Florida Low Vision Initiative Project for the purpose of providing technical assistance to school personnel who work with grade K-12 students with visual impairments and their parents. Through this project, students with visual impairments throughout the state have access to low vision clinical evaluations and are encouraged to improve their use of low vision. Teachers are provided with training, through workshops and individual support, in working with students who have low vision and techniques for motivating their students to use their vision and low vision devices (magnifiers and telescopic lenses) efficiently.
Additionally, if the child is sponsored through the program, DBS will not sponsor a low vision examination. However, if the child needs low vision aids or equipment and is not provided such or if the assigned equipment is not meeting the needs of the child, the DBS counselor should discuss the client’s needs with the assigned project optometrist to assure that equipment being purchased by DBS will not be in direct conflict with the devices that are already assigned to them by the Project and or, if the project will reassess the client for the use of the device, or if the project will possibly purchase the equipment for the client. This discussion must be documented in a case note titled Low Vision Project (LVP). This report should outline the conversation with the optometrist pertaining to their acceptance of the DBS purchase or any objections they may have before completing any prior authorizations for the client.
Independent Living and Vocational Rehabilitation
The Division’s low vision service delivery offers several categories of assistance to clients with functional low vision who meet DBS eligibility criteria. All low vision services are goal oriented in that the needs of the client must first be identified and then addressed by providing the appropriate low vision service.
The Division’s low vision service is comprised of the following components:
- Low Vision Assessment
- Low Vision Examination
- Low Vision Training
LOW VISION ASSESSMENT / TRAINING WITH PRESCRIBED LOW VISION DEVICES
Functional low vision assessments are part of a comprehensive functional assessment of non-medical services that do not require approval or supervision of a licensed eye care specialist. This pre-clinical assessment is an observation by DBS IL specialist staff or a Rehabilitation Teacher from a Community Rehabilitation Program (CRP) of how the individual uses their remaining vision and his/her adjustment to their visual impairment. This functional assessment is usually conducted as part of the observational portion of the initial assessment in the individual’s home, observing their ability to utilize their remaining vision.
LOW VISION EXAMINATION
A low vision examination is used to maximize an individual's ability to perform visual tasks with maximum ease. The client's eye condition should be relatively stable before a low vision examination is performed. In addition to prescribing and dispensing low vision devices, a full low vision examination may result in discovery of otherwise unknown eye medical conditions that should be addressed.
The Division will only use M.D., O.D. or D.O. licensed and in good standing with the Florida Department of Professional Regulation. A Low Vision Examination should include a thorough history; careful measurement of the acuity of distance and near vision, a current refraction; determination of eccentric viewing points; lighting evaluation; distance and near low vision devices evaluation; and confrontation visual fields.
The basic Low Vision Examination fee includes a Level 4 consultation, Low Vision refraction and initial Device Training (Max 30 minute training session) if device issued. Other types of field tests requested outside the basic low vision examination require authorization. Measurement for and initial training with any prescribed systems (e.g., mounted telescopes/microscopes) are also included in the evaluation. Additional necessary test and Device Training beyond the initial training will require prior DBS authorization.
LOW VISION TRAINING
Certified Rehabilitation Teachers, Orientation/Mobility Instructors, Low Vision Occupational Therapist, DBS IL-Specialists provide instruction and training, which include teaching visual and tactile adaptive techniques to the individual with low vision and introduce the proper use of prescribed low vision aids. Client training in the proper use of low vision devices may also be provided as a follow-up to the assessment. Individual low vision devices costing over $1,000 must have a recommendation by a licensed eye care specialist. The exception to this requirement is when a device has been previously prescribed, but subsequently lost or damaged by the client, and documentation of a previous low vision examination is in the client record. The client’s visual condition must also be stable.
LOW VISION OPTICAL AND NONOPTICAL AIDS REQUEST
1. Requested aids and appliances directly address the needs identified and prioritized during an assessment or training process.
2. Documentation through a low vision examination that the recommended device is the most practical and appropriate device to individuals needs.
3. Documentation that the individual demonstrated good skills or could reasonably achieve a practical skill level with practice and /or training using the device for specific preferred tasks and that the device was preferable when compared to other systems. (Not able to benefit from use of a magnifier)
DBS reimbursements for purchases follow the Medicare Fee Schedule. Counselors are to document AWARE prior to purchasing devices to indicate the device(s) being purchased was discussed with the client and client agrees to the item and states how they will benefit from the item(s) in relation to their vocational goal.
The DBS Specialist has the ability to purchase basic magnification devices that cost under $1,000.00 with out having to secure a Low Vision Examination. Before the purchase of a high cost device, (over $1000) it must be justified through a low vision examination and for job-reengineering (VR) request, that the recommended device is the most practical and appropriate device to meet the individuals’ needs. A specific training and/or vocational opportunity must be identified, available and included in the client’s plan of rehabilitation. For each device requested, there should be documentation that the client demonstrated good skills or could reasonably achieve a proficient skill level with training for the task identified in the plan.
When request for purchase of prescriptive low vision items (such as CCTV’s) costing over $3,000, DBS will contact a minimum of three vendors on the clients’ behalf so that clients have an appropriate choice. The purpose is so that vendors will meet with clients to introduce product(s) that meet the requirements of the evaluation. Vendors should be selected to ensure that clients can also review at least three different models.
In the VR Program, if an individual’s placement encounters a delayed or impeded, a temporary loaner CCTV or device may be provided until a prescribed one is justified.
Individuals qualifying for spectacles or contact lenses should be provided aids only after all other resources have been explored. When purchasing low vision services or aids and appliances, districts must comply with the most current fee schedule.
For all low vision devices, the Division will pay the usual and customary fees/Manufactures Suggested Retail Price (MSRP) for devices.
The Division will pay for glasses or contacts if medically necessary and when recommended by an ophthalmologist or optometrist. An individual who qualifies for the provision of glasses or contact lenses can select either glasses or contact lenses. DBS will not authorize replacement lenses (if lost, broken) or disposable contacts. The exception is only when there is a significant change in acuity that requires a new prescription.
All CCTV purchases are approved only after the use of magnifiers or other aids and devices have been explored and only with a recommendation from a low vision examination.
Signed by Robert L. Doyle, III, DBS Director, on October 20, 2014