Kendra Farrow, CVRT
 VRTs
address the physical, emotional,
and social implications of vision loss
 Provides counseling and training in NEW
skills and adaptive techniques
 Success is based on level of
independence and emotional adjustment
 Work to enhance vocational
opportunities, independent living, and
educational development
 OTs
address physical, cognitive, psychosocial
and sensory performance
 Provides activities with an aim towards
improving health, well-being, and quality of life
 Success is based on increasing participation
and performance
 Engagement in daily life activities
(occupations) that support health and
participation in home, school, the workplace,
and community life (AOTA, 2008)
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OT
Work with all impairments
as well as states of wellness
If billing insurance,
Treatment is defined in the
Plan of Care (POC) written by
the OT & authorized by the
physician
• OT must perform an
evaluation to identify medical
necessity of services
•
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Anyone can refer.
•
If utilizing medical insurance
requires physician
involvement
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VRT
Focuses on blindness and
vision impairment
Has community B/VI
connections
Free services, generally
Flexibility in service hours
Anyone can refer
1. OTs with training to
work with Low Vision and
may also work in the
Blindness Stream.
• Services are directed at
LV patients
2. OTs who work in other
settings and may
occasionally have a
patient who is also
experiencing vision loss.
• OTs in hospitals and
nursing homes without LV
training frequently provide
vision services to clients
with field limitations and
loss secondary to brain
injury
If
we don’t use the same words with the
same meanings, it leads to;
misunderstandings, confusion, and
frustration.
If we can’t communicate, we can’t work
together.
Disability and Health (ICF)
Developed by the World Health
Organization to help communication
Offers specific terminology and
definitions to describe disability and
functioning
OTs use this language
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OT
Patient
SNF (skilled nursing
facility)
MCB
Physician Prescription or
Orders
Plan of Care (POC)
Training, Participation
Eccentric Viewing
Training (EVT) Using
Preferred retinal locus
(PRL)
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VRT
Client
Nursing Home
Medicare part B
Referral
Individualized service
plan
Teaching
Eccentric viewing
Vision – OT uses
this phrase to
describe vision
rehabilitation,
including legal
blindness.
 Low
Vision – VRT
uses this phrase to
describe specific
training
 Low
Terms
 Blindism
 Acuity
 Photophobic
 Charles Bonnet
Syndrome
 Lumens
 Diopter
Concepts
 Perceived brightness
 Color perception
 Contrast sensitivity
 Focal distance
 Color temperature
 Principles of task
lighting
Reading
an eye report
Measuring low vision using near and
distance charts
Knowledge of low vision aids and
appliances
 Braille
instruction
 Transition services
 Advocacy skills
 Concept development
 Training under blindfold
 Adjustment to vision loss counseling
 Link to vocational services
 Sighted guide and protective technique
 OT
referrals must have:
• Visual acuity of 20/70 or worse
• Must have doctors’ orders and use medical
codes, CPT and ICD9
 VRT
referrals are for clients who:
• Want to learn Braille
• Are not eligible for OT services
• Need only one appointment
http://www.mdsupport.org/deliverymodel/deliverymodel.html
 Model
developed 2007 by a group of
professionals representing:
• Ophthalmology
• Low Vision, optometry
• Vision Rehabilitation
• Occupational Therapy
• The Consumer
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In 2002, Medicare issued transmittal AB-02-78: Medicare
Coverage of Rehabilitation Services for Beneficiaries
With Vision Impairment
All licensed rehabilitative therapists eligible to provide
and bill services provided to those with vision impairment
• “Medicare beneficiaries who are blind or visually impaired are
eligible for physician-prescribed rehabilitation services from
approved health care professionals on the same basis as
beneficiaries with other medical conditions that result in reduced
physical functioning.” (Centers for Medicare & Medicaid
Services, 2002)
Diagnosing
Physician
Low Vision
Evaluation
Older Blind or
Vocational
Occupational
Therapy
VRT O&M
Community
Services
Keep
a positive attitude
Respect the OT
Offer training
Offer shadowing opportunities
Give resources
Keep the door open for further
communication
Using
a hand squeeze to detect
tremors and strength
Exercises for hand-eye coordination
improvement
Awareness of tripping hazards like
throw rugs
Occupational Therapists
Over 100,000 OTs
Vision Rehabilitation Therapists
Approximately 600 CVRTs
Up to 2,500 working in the field
Overview
of types of vision loss
• Causes
• Different patterns of vision loss
• LV devices are not one size fits all
What
is a Low Vision Exam?
• The importance of LV exam
• LV doctors in your area
• Stress the importance of using the correct
device for each task
Blindness
Services
• Your services and how to make a referral
• Funding for LV devices
• Courtesy rules for blindness
• Other specialized services
• NLS, Newsline
• O&M services
• Support groups
Introduction
to Functional vision
impairment assessments & screens
Consideration of co-morbidities
Centralized OT domain articulating
occupational roles, participation &
performance
Treatment, progress & discharge notes
Introduction
to functional and acuity
assessment tools
Implications of other disabling
conditions
Scope of work of the OT
Documentation
AFB
eLearning
The Carroll Center
Lighthouse
University of Alabama at Birmingham
Hadley School
The NRTC on Blindness and Low
Vision
Low
Vision Rehabilitation: A Practical
Guide for Occupational Therapists,
Second Edition
Occupational Therapy Interventions for
Adults with Low Vision
Be
proud of what you do
Keep up your certification
Educate yourself about medical
terminology
Take opportunities to talk with OTs
Provide education when appropriate
Your
role is valuable and needed
VRTs can be a great resource
Referring your patient to the VRT does
not mean your services are
unnecessary
Keep learning, you can never learn
everything about vision loss
Communicate
with your staff
Have specific expectations and goals
Support the VRT staff
Require LV qualifications from OT staff
Debrief and assess service delivery
Communicate with staff
Carmen Garcia-Hommel, OTL
Occupational Therapist
VisionCorps
244 N. Queen Street
Lancaster, PA 17603
717.205.4145
717.291.9183 fax
www.visioncorps.net
Number of OTs
 http://www.bls.gov/ooh/healthcare/occupational-therapists.htm
AOTA overview of LV Certification
 https://www.aota.org//media/Corporate/Files/EducationCareers/CE/SCLV%20Overv
iew.pdf
VRT Scope of Practice
 www.acvrep.org
OT Scope of Practice
 www.aota.org
International Classification of Functioning
 http://www.who.int/classifications/icf/en/
kfarrow@colled.msstate.edu
662-325-8694
The National Research and Training
Center on Blindness and Low Vision
at Mississippi State University
www.blind.msstate.edu