Patient Education and Counseling

By: Michael R. Politzer, O.D., F.A.A.O., F.C.O.V.D.

Candid and thorough communication with the patient and their family is the cornerstone to successful low vision care. Patients expect and deserve an honest appraisal of their condition and accurate information regarding prognosis and treatment options.

Begin the education and counseling session with a thorough discussion of the results of the examination. Patients have questions concerning the status of their condition. Is the condition active or stable and how will that status impact the recommendations that are being made?

Patients are asked to list their goals at the beginning of the examination process.  They want to know can these goals be met? If yes, which aids are being recommended and why? If no, are there any viable alternatives?

Do not make the assumption that the patient or family members are knowledgeable about the patient’s ocular condition. Discuss the condition in detail and the associated visual implications of the condition. Review how optical aids work and how they will be used to help them meet their goals.

Often goals can only be met partially and patient compromise is required. Discuss this openly with the patient and their family. Ask the patient directly if they are willing to make these compromises or modify their listed goals. This frank discussion will eliminate many potential problems in the future.

When making recommendations, make sure that the patient and their family understands that multiple aids will be needed. One pair of glasses will not work in meeting all of their goals and objectives. Patients generally require several aids for distant, intermediate and near centered tasks.

Discuss with the patient the time constraints involved in ordering their low vision aids. Some are readily available but some custom aids may take as long as four (4) to six (6) weeks to manufacture. Ask the patient if this will become a problem. If the patient’s expectations are not achievable, this is the time for additional discussion or choosing an alternative aid. 

Address with the patient and their family the need for home modifications such as lighting and furniture placement. If these changes and modifications can be made prior to the patient receiving their aids, adaptation is enhanced and adjustment time significantly reduced.

Describe what will occur when their aids are dispensed. The aids will be properly adjusted and they will receive training in there proper use, care and handling. Also review how much time will be needed for that visit and that multiple training sessions may be needed as in the case for bioptic driving.

I recommend discussing fees at the end of the session. My experience has shown that this gives the patient and their family the opportunity for weighing the benefits and costs more objectively. Review with the patient the cost for each of the recommended aids and payment options that may be available. Be prepared to provide a good, better and best list if needed and be sure to leave plenty of time for questions.

Conclude by restating your recommendations and inform them that they will receive a written report summarizing all that has been discussed. Assure them that they will do well with the recommended aids and that the quality of their lives will be enhanced.

For most patients and their families the low vision examination process is very intense. Major lifestyle and financial decisions are required and patients are overwhelmed. By taking the time to thoroughly present the care you are recommending and giving adequate time for processing and asking questions, patients are put at ease and are more comfortable and confident with the decisions they have made.