中国大陆三级医疗机构低视力服务专业人员配置和服务提供情况分析

目的：统计分析我国三级医疗机构低视力服务专业人员配置和服务提供情况，为进一步推进我国低视力医疗康复工作提供参考依据。方法：描述性研究。于2015 年开始对全国提供眼科服务的三级医疗机构通过网上填报的方式进行普查，采用描述性统计方法和χ2检验，对我国三级医疗机构低视力服务专业人员配置和服务提供情况进行系统整理和统计分析。结果：本次调查覆盖全国1 508 家三级医疗机构，其中提供低视力诊疗康复服务的有559 家（37.07%），未提供服务的有949 家（62.93%），各级医疗机构在是否开展低视力康复服务方面差异有统计学意义（χ2=61.94，P<0.001）。在提供服务的机构中，已设立低视力专业门诊的有338家（60.47%），低视力年平均门诊量为964例。从事低视力医疗康复服务专业人员2 993 人，平均每家三级医疗机构有低视力专业医师1.98 人、护士0.46 人、技师0.41 人、辅助人员0.22 人。三级医疗机构以儿童功能性视力康复训练、低视力社区教育宣传和助视器验配为主要低视力服务类型。结论：我国三级医疗机构低视力学科建设亟待加强，专业人员总量偏低、人才梯队建设不完善，服务质量低、服务类型单一，无法满足我国低视力患者全方位的服务需求。     

Low vision service models in Alberta: innovation, collaboration, and future opportunities

As Alberta's population ages over the next 20 years, the number of older adults experiencing age-related blindness or vision loss is likely to at least double. To prevent a crisis in low vision service provision, we need to build upon, and extend, existing partnerships between the CNIB and ophthalmologists, optometrists, government policy makers, and other service providers. Future service models for low vision rehabilitation should also emphasize interventions such as counselling and peer support that enhance quality of life. With thoughtful planning, adequate funding, and involvement of all stakeholders, Alberta has the potential to become a world leader in the field of low vision treatment and rehabilitation.     

Low vision services provided by optometrists in Victoria,Australia

Background: Utilisation of low vision services remains low in Australia. This study investigates low vision service provision by optometrists in Victoria and assesses the optometric human resource potential. Methods: An eight‐item questionnaire was sent to 1,050 optometrists in Victoria in December 2006. It investigated key characteristics of the optometrists and their practices, the extent of their low vision training and service provision and the influence of Medicare item 10942 on low vision service provision. Results: Although only 97 replies were received they represented a significant proportion of optometrists who had undertaken postgraduate training in low vision. Almost 86 per cent of respondents worked in private practice settings. Although 87.6 per cent and 30.9 per cent had undergraduate and postgraduate low vision training, respectively, only 63.9 per cent of all respondents reported that they provided low vision services. The majority who replied to the impact of Medicare item 10942 question indicated that its introduction had not changed their low vision provision. Those who did not provide low vision services reported referrals to other low vision services as their main reason for not doing so. Conclusions: The majority of respondents represent a potential source of low vision service providers. Further work needs to explore their possible involvement in low vision care.     

The newly established primary care based Welsh Low Vision Service is effective and has improved access to low vision services in Wales

Aim: The aim of this study was to determine whether the new, primary care based, Welsh Low Vision Service (WLVS) improved access to low vision services in Wales and was effective. Method: The impact of the WLVS was determined by measuring the number of low vision appointments; travel time to the nearest service provider; and waiting times for low vision services for 1 year before, and for 1 year after, its establishment. Change in self‐report visual function (using the 7 item NEI‐VFQ), near visual acuity, patient satisfaction and use of low vision aids were used to determine the effectiveness of the service. Results: Following instigation of the WLVS, the number of low vision assessments increased by 51.7%, the waiting time decreased from more than 6 months to less than 2 months for the majority of people, and journey time to the nearest service provider reduced for 80% of people. Visual disability scores improved significantly (p < 0.001) by 0.79 logits and 97.42% patients found the service helpful. Conclusions: The extension of low vision rehabilitation services into primary care identified a considerable unmet burden of need as evidenced by the substantial increase in the number of low vision assessments provided in Wales. The new service is effective and exhibits improved access.     

Referral to low vision services by ophthalmologists

Purpose: People in need of low vision rehabilitation services often experience delays in referral to services. This study investigated referral criteria of Australian ophthalmologists, the frequency of referral of their patients with low vision and their perceptions of low vision services.
Methods: A survey was sent to a representative, random sample of 200 ophthalmologists. They were asked about criteria used for the referral of their patients with low vision. The survey included questions on the frequency with which they prescribed low vision devices (LVD) and referral of their patients to low vision and rehabilitation services and peer support groups. Perceptions of the quality and availability of low vision services were also investigated.
Results: The response rate was 82%. Approximately 11% of ophthalmologists' patients have low vision. It is uncommon for ophthalmologists to prescribe LVD but 67% refer most of their patients with low vision. It is less common for them to refer to rehabilitation services (29%) or peer support services (18%). The perceived local availability of services influences the rate of referral. Ophthalmologists who used the criteria of moderate low vision (<6/21 to <6/60) are more likely to refer more of their patients than those who use the criteria of severe low vision.
Conclusions: Australian ophthalmologists refer most of their visually impaired patients to low vision services, but infrequently to rehabilitation services or peer support groups. Differences in perceived need for low vision services indicated by the criteria used for referral, and the perceived availability, influence the rate at which ophthalmologists refer their patients for services. Ophthalmologists are encouraged to refer patients with permanent visual loss to low vision services earlier.     

低视力康复:我们面临的挑战

低视力的本质是患者减退的视功能不能满足其日常生活视功能需求的一种状态.低视力的康复是一个系统工程,涉及医疗、康复、教育、社会保障等多个领域的工作.目前,我国的低视力康复工作已经经历了20余年的探索发展过程,取得了不少成就,但所面临的问题和挑战仍然很多.笔者对我国低视力康复工作发展的历程和成就进行了简要总结,对当前我国低视力康复工作中所面临的主要问题和挑战进行了分析,认为低视力康复专业技术、低视力康复辅助器具可用资源、社会保障体系的完善等问题是影响我国低视力康复服务工作有效性的重要因素,但并不是制约我国低视力康复工作健康发展的主要因素;医疗机构低视力门诊的建设及可为全社会提供开放性服务的非医疗性专业康复机构的建设,是我国低视力康复服务体系建设必须解决的两个关键性、基础性的问题.     

Quebec model for low vision rehabilitation

The increase in longevity (and secondary morbidity) in the Quebec population adds social and financial pressure to society, as it does elsewhere in Canada and in many western countries. This article gives a brief history of the evolution of vision rehabilitation services in Quebec and describes how services are provided for people with low vision throughout the province. Although numerous groups, associations, centres, and resources are available to assist people with vision impairments, such as the Canadian National Institute for the Blind-Québec, the majority of visual rehabilitation services are provided by government-sponsored rehabilitation centres, namely the Centres régionaux de réadaptation en déficience physique that are located strategically throughout the province. Low vision clinical evaluations in these centres are shared by 36 optometrists throughout the province. Between 5 and 7 ophthalmologists are involved in low vision care, half in university-affiliated hospitals, primarily in Montreal. There may be delays of up to 6 months to be seen in a funded low vision clinic. Statistics obtained from la Régie de l'assurance maladie du Québec show that there are approximately 8,000 requests for low vision aids every year, and that 80% of clients retain at least some level of visual function. Services are covered by Medicare and low vision aids are provided at no cost, although ophthalmologists cannot prescribe low vision aids through the Medicare-funded system. We must ensure that the capacity of our system continues to provide adequately for clientele in the future.     

A holistic model of low vision care for improving vision-related quality of life

Vision impairment can have a significant impact on the wellbeing and quality of life of an individual. Vision rehabilitation has the potential to improve these areas; however, four in five patients with vision impairment are not being referred to the appropriate services. Barriers to on-referral include, but are not limited to: (1) misunderstandings by both practitioners and patients alike regarding which individuals with vision impairment might benefit or qualify for low vision services; (2) lack of awareness of available services; (3) unfamiliarity with practice guidelines; (4) miscommunication between practitioners and patients; (5) required patient travel or limitations in access; and (6) the perceived costs of goods and services. Further, current referral patterns do not represent a holistic patient-centric approach. Vision-related quality of life questionnaires are tools which can assist health professionals in providing optimal individualised care. This review explores current evidence regarding low vision service delivery within Australia and globally, the impact of vision impairment on activities of daily living, the instruments used for the assessment of vision-related quality of life (VRQOL), competing priorities of individual needs in low vision services and rehabilitation, and provides recommendations for a more patient-centred model of care.     

Vision rehabilitation for Canadians with less than 20/40 acuity: the SmartSight model

Traditionally, vision rehabilitation was directed towards patients who were blind or had very low vision. There is increasing evidence that less severe vision loss is associated with increased risk of falls, hip fractures, medication errors, poor nutrition, reduced physical activity, social isolation, clinical depression, longer hospitalizations, and mortality. The American Academy of Ophthalmology (AAO) 2003 SmartSight initiative in low vision rehabilitation outlined a model of graduated low vision interventions. This paper is a review of the AAO SmartSight model and how it can apply in the Canadian setting. All patients with visual acuity less than 20/40, a scotoma, field loss, or loss of contrast sensitivity would be offered information about available low vision rehabilitation. Eye physicians would be encouraged to communicate with other health care providers to coordinate existing services and integrate graduated services. Enhanced communication among caregivers about the consequences of vision loss, such as depression, falls, and visual hallucinations, could help ensure that all patients who would benefit receive appropriate vision rehabilitation.     

Use of eye care services and need for assistance in the visually impaired.

PURPOSE: To assess the use of eye care services and unmet need for assistance in visually impaired people. METHODS: Cross-sectional population-based survey on a sample representing the Finnish population aged 30 years and older. Of the 7979 eligible people, 6645 (83.3%) were both interviewed and had their distance visual acuity (VA) assessed. One hundred forty-seven people were classified as visually impaired (VA < or = 0.25). A home interview included an assessment of the use of eye care services, need for assistance, sociodemographic variables, cognitive functioning, and mobility. Binocular VA for distance was measured with the participants' current spectacles, if any, as a part of a comprehensive health examination. RESULTS: One-half (58%) of visually impaired people had had a recent vision examination and 79% had received some vision rehabilitation services, mainly in form of spectacles (70%). Only one third (31%) had received formal low vision rehabilitation. People with moderate visual impairment (VA 0.1 to 0.25) were less likely to have received low vision rehabilitation, magnifying glasses, or other low vision aids compared with people with severe low vision (VA < 0.1). Furthermore, low cognitive capacity and living in an institution were associated with limited use of vision rehabilitation services. Of the visually impaired people living in the community, 71% reported need for assistance and 24% of them had unmet need for assistance in everyday activities. Although need for assistance was more common in people with severe low vision (83% vs. 67%, p = 0.09), unmet need for assistance seemed to be more common in people with moderate low vision (20% vs. 9%, p = 0.23). CONCLUSIONS: Many visually impaired people, older persons in particular, have not had a recent vision examination and lack adequate low vision rehabilitation. This highlights the need for regular evaluation of vision function in elderly people and for actively supplying information about rehabilitation services.     

Teaching ophthalmology residents about rehabilitation

Ophthalmology is a medical specialty which deals with large numbers of patients who have irreversible impairments. A survey of all ophthalmology residency programs in the United States found that most programs require that residents receive training in low vision aids and devices, but they do not require training in seven other topics concerning the rehabilitation of visually impaired and blind patients. Those programs that do offer training in rehabilitation rely heavily on clinical training. Since practicing ophthalmologists themselves have an incomplete knowledge of the rehabilitation system, it is unlikely that the clinical model will provide residents with sufficient information about rehabilitation. Ophthalmologists need formal training about the rehabilitation process in order to ensure that their patients receive adequate referrals.     

Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital

Context:In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized.Aims:Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India.Results:About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001).Conclusion:Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.     

Models of low vision care: past,present and future

Over the last 50 years, the concept of a low vision service has changed considerably. It has moved away from just the optometrist or optician dispensing magnifiers, to having a large team working across the health and social/ community care sectors, with voluntary organisations often playing an important role. This paper reviews how low vision rehabilitation services have evolved and what models of low vision care are currently available. It goes on to consider the effectiveness and accessibility of low vision care. Finally it explores what the future might hold for low vision services, to be better prepared for the increase in the number of people with low vision and their evolving needs and what role(s) an optometrist might have within these anticipated developments.     

北京市医疗机构低视力康复服务状况调查

目的 了解北京市医疗机构低视力康复服务能力及现状,为政府低视力康复工作提供政策依据。设计 横断面研究。研究对象 北京市二级及以上医院90家。方法 通过问卷形式对90家医疗机构低视力康复工作进行调查,调查问卷由各调查机构视光和眼科负责人填写。收集的资料进行统计分析。主要指标 问卷应答率、是否开展低视力服务、不能开展低视力服务的原因、低视力康复年服务量、种类、人员状况及助视器的种类。结果 90家医疗机构中,做出有效应答的医疗机构86家,应答率95.56%。可提供低视力康复服务的医疗机构6家（6.98%）。医疗机构未开展低视力康复服务的原因依次是缺乏基本设备和助视器、缺乏资金、缺乏低视力专业人员以及没有患者来源。各家医疗机构提供的年服务量少者为0~49例,多者大于250例,年总服务量不足600人。低视力工作人员仅有19位。6家医院可提供光学近用助视器,3家医院可提供光学远用助视器,2家医院可提供电子助视器,6家医院均不能提供非视觉助视器,均未开展儿童功能性视力康复训练、日常生活能力和技能康复训练、职业训练、适应及行走训练等康复服务。购买助视器的资金来源有患者自费或非政府机构的资金支持,各种助视器的支付均未纳入医保范围。结论 北京市医疗机构低视力康复服务能力远远不能满足低视力患者的需求,应加强北京市低视力康复服务能力。（眼科, 2015, 24： 348-351）     

Low vision rehabilitation services in Michigan viewed against the national backdrop

The diagnosis and treatment (including low vision rehabilitation) of permanent vision impairment due to ocular disease and trauma are gaining increased emphasis around the world. In the United States, this emphasis is due to both changing demographics and emerging policies issued by the US Centers for Medicare and Medicaid Services (CMS). In this de facto report, we trace the evolution of low vision rehabilitation service in Michigan, highlighting the role of public appropriations initiated in the mid 1960s and continuing today. An array of state, private, nonprofit, and clinical services for vision rehabilitation in Michigan are described in the context of the historical roots, current roles, and future trends related to emerging policies and systems of care.     

Detection of vision impairment in people admitted to aged care assessment centres

Vision is not routinely tested when the health of older people is assessed, and the aim of this study was to detect older people with vision impairment for referral to appropriate eye care services. People admitted for assessment and or rehabilitation in three aged care assessment centres had distance and near visual acuity assessed with a simplified vision test. A pinhole test was used when necessary. Referral criteria were distance visual acuity of less than 6/12; near vision of less than N8, and people with diabetes who had not attended a dilated fundus examination in the last 2 years. Visual acuity results were obtained in 93% of patients (685/735). Those unable to perform the vision test were very ill or had severe cognitive impairment. Forty-three per cent of patients (266/646) had impaired vision and, of these, 70.6% (188/266) were referred to eye care specialists. Forty-five per cent were referred to ophthalmologists, 36% to optometrists and 20% to low vision services. This significant proportion of patients with poor vision suggests that vision screening is warranted.     

低视力康复现状与进展

低视力康复主要是通过助视器的使用配合低视力康复训练。本研究通过对成人和儿童低视力康复现状、低视力功能状态评价、助视器研究发展方向进行综述，为低视力患者和康复工作提供一定指导。运用现有的助视器，老年及儿童低视力患者的视力康复取得了较好的效果。新型助视器的研制和开发，为低视力患者的康复迈进了一步。     

The Developmental History and an Evaluation of the Queensland Low Vision Care Centre

ABSTRACT: The decisive shift in attitute from partial blindness and conservation of residual vision towards partial sightedness and maximal use of residual vision in the last fifteen years has resulted in low vision care being a relatively new field of particular concern to health care professionals. In Australia, the first multi-disciplinary clinic providing a comprehensive low vision service was established at the Association for the Blind, Kooyong, Victoria in 1972. Since then, a number of low vision clinics in a variety of locations have developed throughout Australia, with the establishment of the Low Vision Care Centre in Brisbane, Queensland occurring in 1979. This paper describes the developmental history of this service and evaluates the comprehensive low vision care which this clinic provides to the Queensland population. The effectiveness and future considerations of this service are also discussed.