Thursday, August 24, 2006.
People who qualify for Medicare and whose eyesight has significantly declined due to macular degeneration, diabetes or certain other conditions can now get up to nine hours of vision rehabilitation through a new Medicare-sponsored demonstration project.
The five-year project is available in six areas of the United States. It will allow the Centers for Medicare and Medicaid Services (CMS) to study the demand for - and effectiveness of - services aimed at helping visually impaired individuals make the most of their remaining vision.
"This is really good news for many older people with low vision," said Dr. Henry Greene, an optometrist who is a clinical professor in the department of ophthalmology at the University of North Carolina at Chapel Hill School of Medicine. "Now, when an ophthalmologist or optometrist prescribes therapy for those with visual impairments, Medicare will help pay for rehabilitation services in the areas selected."
After the project concludes, administrators will decide whether to extend reimbursement for those services to all Medicare recipients across the country, Greene said. "We think there's a strong possibility that they'll do that."
To be eligible, Medicare beneficiaries must live in Atlanta, Ga., New York City, New Hampshire, Kansas, North Carolina or the state of Washington or their eye doctors must practice there, he said. Visually impaired individuals are those whose vision cannot be improved with conventional eyeglasses, medications or surgery.
In the six areas chosen, Medicare will pay for therapy services provided in clinics or at home by certified vision rehabilitation therapists, orientation and mobility specialists, low vision therapists and occupational therapists but not the low vision aids themselves.
"After ophthalmologists have done as much as they can in treating patients with eye diseases medically or surgically, there are three aspects to helping patients with low vision," Greene said. "One is evaluating the level of their remaining vision and determining their personal functioning needs. Another is determining what powers and which types of magnifiers, telescopes, bioptics or hi-tech electronic devices are most appropriate. The third aspect is the training involved to help individuals be as successful with the devices as possible."
Greene is a co-founder of Ocutech, a Chapel Hill company that develops and manufactures miniaturized telescopic devices, called bioptics. As Ocutech's research director, he travels extensively to teach doctors how to evaluate and treat visually impaired patients with bioptic devices.
Ocutech made medical news around the globe in 1997 when it announced development of the world's first self-focusing bioptic glasses - the Ocutech VES-AutoFocus Telescope System. These lightweight telescopes, which sit atop regular eyeglasses, are now prescribed worldwide by low vision specialists. A less expensive manually focused version also is available.
Before development of the telescopic aides, patients would often have to sit inches away from a computer screen or television, Greene said. They had no way to see store shelves, restaurant menus, bus numbers and traffic signs while traveling or friends and family from across a room.
Macular degeneration, or failing central vision, is the most common vision-impairing disease of the elderly except for cataracts, he said. About a million new cases of the condition are diagnosed in this country each year and the numbers are growing. But, while cataracts can be surgically removed with vision usually returning to normal, vision loss from macular degeneration, even with the newest treatments, cannot be restored to normal. Other conditions that low vision aids often help include the visual complications of diabetes, nystagmus, optic atrophy, albinism, multiple sclerosis and macular holes.
"Reading is often the first challenge that visually impaired individuals face," Greene said. "Fortunately, people with low vision can get the printed word in many ways, such as by listening to television, radio and books on tape, but that's not true for personal contact.
"The world around us - our friends, family, grandchildren or a pretty flower or picture - can't be appreciated nearly so well when it's described to us," he said. "Not being able to see as well as they did before can cause folks to feel isolated and depressed. It is enormously gratifying when these bioptic telescopes help people stay more connected with their families and more engaged in life. The impact they can have on individuals' quality of life can be astounding."
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