Low-vision service provision by optometrists: a Canadian nationwide survey.

PURPOSE: To document the degree to which Canadian optometrists are involved in the provision of low-vision (LV) care and their referral patterns. To investigate the barriers to providing optometric low-vision services (LVS). METHODS: Practicing optometrists across Canada were randomly sampled and invited to participate in a questionnaire that included questions on personal profile, primary practice profile, levels of LV care offered, patterns of referral, and barriers to provision of LV care. Questions included a combination of multiple choice and open-ended formats, and included hypothetical cases. RESULTS: A total of 459 optometrists responded (response rate, 24.8%). Optometrists estimated that 1% (range, 0 to 100%) of their patients were LV patients yet also estimated that 10% of their patients had acuity equal to or worse than 20/40. Thirty-five percent of respondents indicated that their primary practice offered LV care, 75.6% would manage a patient with minimum disability and simple goals themselves, whereas 10.7% would manage a patient with more than minimal visual disability who needed more specialized LV devices (e.g., telescopes, electronic aids, and custom-designed microscopes); 84.3% of optometrists would assess for basic magnification and lighting in a hypothetical patient with early age-related macular degeneration, whereas 15% would undertake full LV rehabilitation in advanced age-related macular degeneration. Optometrists commonly referred to CNIB (formerly the Canadian National Institute for the Blind), yet only 10.7% of respondents almost always received a written report after referral. Those who would not undertake LV assessment stated that they lacked the knowledge, equipment, or experience; that LV assessment is too time consuming; and that the cost is too prohibitive. CONCLUSIONS: This is the first comprehensive study of LVS provision by optometrists in Canada. In order for optometrists to become more involved in LVS, there is a need for more LV education, provincial health coverage of optometric LVS, and better collaboration communication between LV providers.