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Low Vision TeleEye Rehabilitation: Expansion of Low Vision Optometry Rehabilitation utilizing Telehealth
Last updated
Share PrintVeterans with low vision who live in rural communities have limited access to VA Low Vision Optometry Rehabilitation Services, unless they are able to travel several miles to a Low Vision Clinic. When you add the loss of the ability to drive, travel becomes an insurmountable obstacle to receiving Low Vision Optometry Rehabilitation Services. Low Vision TeleEye Rehabilitation Clinical Video Telehealth (CVT) currently allows Low Vision Rehabilitation with a Low Vision Optometrist and a Low Vision Therapist in a timely manner in their home, at a CBOC or rural VA.
Origin:
November 2012, Buffalo VA Medical Center (Buffalo, New York)
Adoptions:
7 successful
Awards and Recognition:
iNET Spread Investee
Partners:
Office of Rural Health, VHA Innovators Network
Recent Updates
Overview
The problem
I began to think outside the box in 2011, because I had telehealth equipment and VA low vision rehabilitation care is superior to any services available in the community. Also, family members and/or friends of the visually impaired are more willing to drive a few miles to a local VA health care facility instead of several miles to a specialty clinic.
I modified my evaluation and our hospital let me set up our Hub and Spoke low vision telehealth service with our current staff, so more low vision Veterans could receive low Vision rehabilitation care. I was thrilled when it worked in 2012.
Since 2012 my data shows by utilizing telehealth at our CBOCs, Rural VAs and EVEN to the Veterans home, our workload continues to increase by 25%. More importantly this means we were now helping 25% more Veterans throughout western New York who were going without our specialty low vision services since Family member and friends are more likely to drive them to a local rural VA, CBOC or rural Atlas clinic.
I continue to enjoy hearing how happy our partially sighted and legally blind Veterans are, when they receive our telehealth care because they tell me they did not know what they were missing.
So, if Western New York has partially sighted and legally blind Veterans who cannot travel to a low vision specialty clinic, then obviously there are several more Veterans in rural central and eastern New York State and every other state across our country who are also going without VA low vision specialty services and Telehealth can be the solution for other VA low vision specialty clinics.
But who knew, by increasing access to our partially sighted Veterans by using telehealth, for the past 12 years, would still face barriers to helping more low vision teams.
Although frustrating at times, I never gave up because there are several partially sighted and legally blind Veterans going without our specialty service so I started to work with one VA at a time.
Beginning in 2017, I worked with the Vision Center of Excellence and the Washington DC VA VISOR clinic’s Low Vision Optometrist. We have set up Low Vision Optometry Telehealth services to share VA Low vision rehabilitation with VA eligible ServiceMembers at Walter Reed Medical Center. They saw their first DOD LV patient in 2021.
In 2018, I worked with Matt Hogel who was the Chief of Blind Rehabilitation services at the VA in San Juan, Puerto Rico. He received funding so I could set up Low Vision Telehealth services following my TeleRehabilitation TEAM model in Buffalo. Their First LV Optometry telehealth evaluation was on 10/17/18
In 2021, I also worked with Dr. April Maa and the Office of Rural Health combining low vision TeleEye rehabilitation with her Technology Based Eye Care System (known as TECS) currently at the VA’s in Dublin, Georgia, Kansas City, Kansas, Erie, PA and Memphis, Tennessee
Also in 2021, I received the GoFish award, and worked with the VA in Des Moines, Iowa and Minneapolis, Minnesota spreading Low Vision TeleEye Rehabilitation services in VISN 23.
In 2023 I worked with the low vision Optometrist at the Honolulu VA in Hawaii. By utilizing their current staff, we set up low vision TeleEye rehab services at VA Honolulu (providers) and Maui CBOCs (patients). Fortunately their VA purchased demo devices or used/returned low vision devices that could be kept at the CBOCs to demonstrate and introduce magnification. I am happy to report as of May 2024 they are currently providing low vision telehealth services to their rural Veterans on their nearby islands.
I also contacted the Albany VA and explained by utilizing their current staff, low vision TeleEye rehab services can
be provided by the low vision Optometrist at the Buffalo VA to the Albany VA and their rural CBOC. In December 2023, Albany’s low vision Optometrist retired and I was able to set up low vision TeleEye rehab services by creating a service agreement to have our Buffalo VA’s low vision Optometrist provide low vision TeleEye services to the Albany VA. Our current low vision Optometrist at the Buffalo CA can offer a few clinics times each week and has the potential to increase his 20 hour work week to up to 40 hours per week.
At the Buffalo VA, our low vision telehealth illustrates a HUB and SPOKE system.
The providers on the TEAM are at a centralized location (called a HUB) and depending on how many CBOC’s or rural VA’s where their rural low vision Veterans can travel to, each site (called a Spoke) needs to purchase a minimal number of optical and non-optical devices for demonstration only and near visual acuity charts.
In our CBOC’s, the telehealth technician stores these devices and brings them out during the low vision telehealth session with the low vision Optometrist and low vision therapist. (the providers)
With the help of the technician who is with the patient, the Provider (Low Vision
OD) can record the Veteran’s near visual acuity with their glasses and introduce magnification by demonstrating and training each Veteran on the proper use of selected devices.
In Buffalo, immediately following my low vision telehealth evaluation, I review the results and recommendations for training with one of our low vision Therapists. In my opinion, Two Low Vision Rehab appts back-to-back (LV Optometrist & therapist) reinforces recommendations and increases success with additional and consistent training.
A Telehealth low vision rehabilitation assessment by a therapist consists of low vision therapy and home adaptive skills training which includes Meal, Home and Financial management, areas of Family care, Communications, Personal Care, areas of recreation, Orientation & Mobility, Low vision devices, and worksite if applicable.
In general, most of our telehealth patient’s receive a follow up home visit with the therapist. For home visits, the therapist may also need to purchase a customized low vision travel kit to take with to the home visit.
If the Low Vision Optometrist does not have a therapist to assess the Veteran, the low vision Optometrist can assess and provide non-optical devices as needed.
Studies have shown the advantage to provide low vision rehabilitation as soon after diagnosis prevents potential decline in functional ability over time.
My goal now is to work on establishing a national funding source to continue to help other low vision Optometry Teams set up telehealth services because several Veterans risk continuing to be denied help adjusting to their vision loss to prevent depression and risk being denied help to remain safe and independent. See more
Files
- My article published in 2016 titled: Steps to Offering Low Vision Rehabilitation Services Through Clinical Video Telehealth Steps to Offering Low Vision Rehabilitation Services Through Clinical Video Telehealth
The solution
I began to think outside the box in 2011, because I had telehealth equipment and VA low vision rehabilitation care is superior to any services available in the community. Also, family members and/or friends of the visually impaired are more willing to drive a few miles to a local VA health care facility instead of several miles to a sp ... see articles attached
I began to think outside the box in 2011, because I had telehealth equipment and VA low vision rehabilitation care is superior to any services available in the community. Also, family members and/or friends of the visually impaired are more willing to drive a few miles to a local VA health care facility instead of several miles to a specialty clinic.
I modified my evaluation and our hospital let me set up our Hub and Spoke low vision telehealth service with our current staff, so more low vision Veterans could receive low Vision rehabilitation care. I was thrilled when it worked in 2012.
Since 2012 my data shows by utilizing telehealth at our CBOCs, Rural VAs and EVEN to the Veterans home, our workload continues to increase by 25%. More importantly this means we were now helping 25% more Veterans throughout western New York who were going without our specialty low vision services since Family member and friends are more likely to drive them to a local rural VA, CBOC or rural Atlas clinic.
I continue to enjoy hearing how happy our partially sighted and legally blind Veterans are, when they receive our telehealth care because they tell me they did not know what they were missing.
So, if Western New York has partially sighted and legally blind Veterans who cannot travel to a low vision specialty clinic, then obviously there are several more Veterans in rural central and eastern New York State and every other state across our country who are also going without VA low vision specialty services and Telehealth can be the solution for other VA low vision specialty clinics.
But who knew, by increasing access to our partially sighted Veterans by using telehealth, for the past 12 years, would still face barriers to helping more low vision teams.
Although frustrating at times, I never gave up because there are several partially sighted and legally blind Veterans going without our specialty service so I started to work with one VA at a time.
Beginning in 2017, I worked with the Vision Center of Excellence and the Washington DC VA VISOR clinic’s Low Vision Optometrist. We have set up Low Vision Optometry Telehealth services to share VA Low vision rehabilitation with VA eligible ServiceMembers at Walter Reed Medical Center. They saw their first DOD LV patient in 2021.
In 2018, I worked with Matt Hogel who was the Chief of Blind Rehabilitation services at the VA in San Juan, Puerto Rico. He received funding so I could set up Low Vision Telehealth services following my TeleRehabilitation TEAM model in Buffalo. Their First LV Optometry telehealth evaluation was on 10/17/18
In 2021, I also worked with Dr. April Maa and the Office of Rural Health combining low vision TeleEye rehabilitation with her Technology Based Eye Care System (known as TECS) currently at the VA’s in Dublin, Georgia, Kansas City, Kansas, Erie, PA and Memphis, Tennessee
Also in 2021, I received the GoFish award, and worked with the VA in Des Moines, Iowa and Minneapolis, Minnesota spreading Low Vision TeleEye Rehabilitation services in VISN 23.
In 2023 I worked with the low vision Optometrist at the Honolulu VA in Hawaii. By utilizing their current staff, we set up low vision TeleEye rehab services at VA Honolulu (providers) and Maui CBOCs (patients). Fortunately their VA purchased demo devices or used/returned low vision devices that could be kept at the CBOCs to demonstrate and introduce magnification. I am happy to report as of May 2024 they are currently providing low vision telehealth services to their rural Veterans on their nearby islands.
I also contacted the Albany VA and explained by utilizing their current staff, low vision TeleEye rehab services can
be provided by the low vision Optometrist at the Buffalo VA to the Albany VA and their rural CBOC. In December 2023, Albany’s low vision Optometrist retired and I was able to set up low vision TeleEye rehab services by creating a service agreement to have our Buffalo VA’s low vision Optometrist provide low vision TeleEye services to the Albany VA. Our current low vision Optometrist at the Buffalo CA can offer a few clinics times each week and has the potential to increase his 20 hour work week to up to 40 hours per week.
At the Buffalo VA, our low vision telehealth illustrates a HUB and SPOKE system.
The providers on the TEAM are at a centralized location (called a HUB) and depending on how many CBOC’s or rural VA’s where their rural low vision Veterans can travel to, each site (called a Spoke) needs to purchase a minimal number of optical and non-optical devices for demonstration only and near visual acuity charts.
In our CBOC’s, the telehealth technician stores these devices and brings them out during the low vision telehealth session with the low vision Optometrist and low vision therapist. (the providers)
With the help of the technician who is with the patient, the Provider (Low Vision
OD) can record the Veteran’s near visual acuity with their glasses and introduce magnification by demonstrating and training each Veteran on the proper use of selected devices.
In Buffalo, immediately following my low vision telehealth evaluation, I review the results and recommendations for training with one of our low vision Therapists. In my opinion, Two Low Vision Rehab appts back-to-back (LV Optometrist & therapist) reinforces recommendations and increases success with additional and consistent training.
A Telehealth low vision rehabilitation assessment by a therapist consists of low vision therapy and home adaptive skills training which includes Meal, Home and Financial management, areas of Family care, Communications, Personal Care, areas of recreation, Orientation & Mobility, Low vision devices, and worksite if applicable.
In general, most of our telehealth patient’s receive a follow up home visit with the therapist. For home visits, the therapist may also need to purchase a customized low vision travel kit to take with to the home visit.
If the Low Vision Optometrist does not have a therapist to assess the Veteran, the low vision Optometrist can assess and provide non-optical devices as needed.
Studies have shown the advantage to provide low vision rehabilitation as soon after diagnosis prevents potential decline in functional ability over time.
My goal now is to work on establishing a national funding source to continue to help other low vision Optometry Teams set up telehealth services because several Veterans risk continuing to be denied help adjusting to their vision loss to prevent depression and risk being denied help to remain safe and independent. See more
Files
- My article published in 2018 titled: Travel Cost Savings and Practicality for Low Vision Rehabilitation Travel Cost Savings and Practicality for Low Vision Rehabilitation
- My article published online titled: Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic
The results
Since 2012 my data shows by utilizing telehealth at our CBOCs, Rural VAs and EVEN to the Veterans home, our workload increased by 25%. More importantly this means we were now helping 25% more Veterans throughout western New York who were going without our specialty low vision services since Family member and friends are more likely to ... see articles attached
Since 2012 my data shows by utilizing telehealth at our CBOCs, Rural VAs and EVEN to the Veterans home, our workload increased by 25%. More importantly this means we were now helping 25% more Veterans throughout western New York who were going without our specialty low vision services since Family member and friends are more likely to drive them to a local rural VA, CBOC or rural Atlas clinic. See more
Images
![Chart showing the increase in access for low vision and legally blind Veterans to receive low vision Optometry rehab services](https://prod-dm.s3.us-gov-west-1.amazonaws.com/practice_results_resources/attachments/000/000/446/thumb/telehealth_data.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Credential=ASIAR2ERFC2NAJ2MMECF%2F20240901%2Fus-gov-west-1%2Fs3%2Faws4_request&X-Amz-Date=20240901T060630Z&X-Amz-Expires=2700&X-Amz-Security-Token=FwoDYXdzEID%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaDLs5wq5lZGIQfXHvJSLkBA0fAzgPYbXWbx35a0XwkeXg6Q9TWD2AZGAzwoQ5VAxEZiNlO%2BtHbFqBbSleqSDsPZBrSDdFEAeIToIyZFNi4fIYcprBdCVHYU%2BXp80pWUeEn6xljmeMVoQ4kf4x08igYaqzZ29Y4WcpWjZ8irEm0RgFsejzb0TwTNV7oqRWVM2S%2BztVoN%2FQLuqj0kg7KYY4GmM8M2QH2FVnd0TaSyVV1loQPB8d%2FeF9OpKpYLs6G78lYQHQmN8i1bg2NIj4kYvI7lwmBy710uKhihNN255Qcly6%2FBubDv9p%2BWTHgOZPfCgWw0pvyH8m9zaZY7duXKjFoivgD5iwvpZIC0qsltTV2ZuaEqHb%2FnGSZwYSiUj7Z3caD71fXx6h6Qha28mCJ9712CBKihALT0eBIVdlotBmvzD%2Bc0SSQmjFKuAwuIIARKF8lcVWH7tPZxQEn4kCbirfMOd5UpgFbHRyQQTGEAiorbZB2l6lBp5PLVM0B6gn2LseDjYLRBQlmSHcsQMy9Eqv88rAjVJkf9xreUSD9bjketjn5GswVy1SPGXeiM%2FFm7ww4QjcUwjBMaeyH5NNXqCYRsV7hKLy%2BoCWBSIobq6vVFgIQo5iHuruL1YRrpYpCXhdYfbeEg96Lxkf%2BbSWpNEMUVhap0TnS5ZpP04OHnMwCXv0ufqRFJ%2Fae6uABJ8e7DHbrrMM6zGJpdLbBLRgW3lB1MTKFf%2B2Pd3615Y0lFHSDS1u2MbzcOsGNhqlzakfPCCxGwcxv9I5%2B9KZf7IVtV6tqxP8PAWeXsqbWCMgyS3WqmwIEHqSM2Rwh9DRmUcQwbjRjiE8rCjmis%2B2BjJBepT9Qjlu5Wtb%2FPilOxwn8ciH3NsJS3X8k9qoxja8ljhatovPkrGLuX2pD98gaYFMmDQvnJPntBP4rtuQ9%2FXNcUk%3D&X-Amz-SignedHeaders=host&X-Amz-Signature=c54306650bc62b57646e997db33b289aed4e64408b8c5d75b4f1079621b1260c)
Above:
Low Vision TeleEye Rehab data Buffalo VA
Files
- My article published in 2018 titled: Travel Cost Savings and Practicality for Low Vision Rehabilitation Travel Cost Savings and Practicality for Low Vision Rehabilitation
- My article published online titled: Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic Home Low Vision Ocular Rehabilitation Telehealth Expansion Due to COVID-19 Pandemic
- travel mileage & cost savings; travel time savings and national accomplishmnet Buffalo VA VISOR telehealth data and national accomplishment
Links
- low vision clinical video telehealth Low Vision Blind Rehab - Module 9-Clinical Video Telehealth
- video how to Low Vision Home Tele-Eye Rehabilitation Video
Metrics
- increase low vision rehab access to Veterans who cannot travel to a specialty low vision clinic.
- travel mileage and travel cost savings
- travel time savings for Veteran and their driver
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
-
6 months to 1 year
Low Vision Rehab TeamLow Vision OptometristLow Vision Therapist, Blind Rehabilitation specialist or Blind Rehabilitation Outpatient SpecialistVisual Impairment Service Team CoordinatorProvider site (HUB)Patient sites (SPOKES): rural VA community based out-patient center, rural VA or non-VA community based out-patient centerHome VA video connect low vision services
Departments
- Rehabilitation and prosthetics
- Optometry
- Low vision and blind rehabilitation
Core Resources
Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email carolyn.ihrig@va.gov with questions about this innovation.
About
Origin story
Original team
Carolyn Ihrig, OD
Chief: Visual Impairment Outpatient Service Rehab services
My manuscript is being published in Telemedicine and eHealth which includes our data.