Amanda Wilde (Host): Welcome to UK HealthCast, a podcast presented by UK HealthCare. Today, we're focusing on eyecare, because eye health is critically important to overall health. Eyecare and low vision services are available through UK HealthCare Advanced Eyecare, and we'll talk about how they can help you and how to access those services as well with guests from UK HealthCare Advanced Eyecare optometrist and Assistant Professor of Ophthalmology, Courtney Couch, and optometrist, Alexis Showalter D’Arsie.

I'm Amanda Wilde, your host, and welcome to you all. So good to have you here. Alexis, I am going to start with you. For a person who is newly diagnosed with permanent vision loss, what's the first step they should take to access services?

Alexis Showalter D’Arsie, OD, FAAO: Yes. I think the big first step is to communicate with their ophthalmologist that gave them the diagnosis about a referral to low vision services. Low vision providers are harder to come by, but we are fortunate enough at UK to have four. Two of us go to the Georgetown location in Kentucky, And then, the one goes to Turfland location in Kentucky.

And then, we have Dr. Couch in Ashland, which helps serves the Eastern Kentucky population. So, having that resource to be able to get that referral in order for us to kind of bridge the gap to get the referrals to the Kentucky Office of the Blind, the Bluegrass Council for the Blind and other community organizations around the state as well.

Host: So, Courtney, to you, what are the biggest barriers that prevent people from utilizing low vision services?

Courtney Couch, OD: It's pretty common for someone with low vision to have to rely on someone else for transportation. So oftentimes, the first barrier is being able to get to the appointment and where they need to go.

Another barrier would be financial. So often times, low vision devices aren't covered by insurance. And depending on the device, that can be pretty pricey. So, we may find something that works great for them, but the funds just aren't here to cover it. There's several different resources and oftentimes we can find ways to help the patient get the devices that they may need. For example, if a patients a veteran, typically, we can get in contact with VA and they can help the patient get what they need.

Host: And how do you coordinate care with a person's primary ophthalmologist or retina specialist to ensure nothing falls through the cracks, Alexis?

Alexis Showalter D’Arsie, OD, FAAO: Yeah. We are very fortunate at UK as well to have such a great working relationship with our ophthalmologist. So, our low vision clinic is on their radar, and they're very good about referring patients to us at the low vision Clinics. Additionally, through Epic, we are able to access the patients records from the ophthalmologist visits. And then, if they're coming from an outside ophthalmologist, outside of UK, we could request records and they're usually pretty good about faxing over records so we can see what the patient's diagnosis is, what is their starting vision, and how we can move forward. They will sometimes even give us a little bit more information about what the patient may be struggling with already, so we have an idea going into that exam what we can do and what our plan is to get them the goals and reach the goals that they need.

Host: So, you really have a built-in. Powerful structure for coordinating care. In a low vision service setting, Courtney, how do you define success for a patient? Is it a number on a chart or how do you look at that?

Courtney Couch, OD: For a patient with low vision, success definitely is not a number on a chart. It would be great if we can get everyone a little bit closer to that perfect 20/20 with a device, but really what we aim for is functionality. So, what I typically start off an exam with is what are your goals for your vision, meaning what would you like to be able to do with your vision that you're really struggling with right now? A common answer typically is, "I want to be able to read again" or "I want to be able to watch TV a little easier," or maybe a hobby that they haven't been able to do since their vision started to decline.

So, we take those goals and trial different devices to see if we can find something that may make that a little bit easier for them. It would be great if we can get everyone to 20/20, but what we really aim for, like I said, is functionality.

Host: Well, Alexis, can you walk us through the rehabilitation plan and how it's customized based on a patient's specific goals, like the kind Courtney you just mentioned?

Alexis Showalter D’Arsie, OD, FAAO: Absolutely. This actually transitions really well from Courtney's answer. But I will start out asking the patient their ADLs or activities of daily living. I kind of go through the same lists that are very common, such as mobility, if they have trouble seeing the TV, reading bills, writing checks. Are they light-sensitive, glare is a problem? And based on their answers and what their goals are, we will tackle what their goals are throughout the exam.

Typically, we will start with an updated glasses prescription for distance and for near, depending on what the starting vision is. And we do that through a trial frame refraction, which essentially means the patient is able to move their head around as needed, around any potential blurry spots in their vision, instead of being stuck behind the traditional phoropter like you're probably used to at the eye doctor. And then, we go into trialing devices that we may think would be best for. The patient and their goals and achieving those activities of daily living. And then, we talk about the resources at the very end and make those referrals to the Office of the Blind or the Bluegrass Council of the Blind, and give them all that information printed out, easily accessible for them as they leave the exam as well.

Host: It's such an amazing service to improve quality of life so drastically. Courtney, if a patient's insurance won't cover a specific device or service, what alternative resources do you typically point them toward? Is there a safety net in place?

Courtney Couch, OD: So, like you said, insurance typically doesn't cover low vision devices, which is really unfortunate. But there are several resources out there like Dr. Showalter was mentioning, the Kentucky Department of the Blind, each state has a Department of the Blind, that can help each patient with different resources.

So, there's several resources out there, but just one for an example is the Kentucky Talking Book Library. It's a free library service that helps individuals that can't typically read traditional print. It's a great resource. There's also several other apps that you can have on your phone that you can download for free. Almost everyone has a smartphone or a computer, and those also have built-in aids to help people with low vision, like increased text magnification or changing the contrast. It seems like every day they're coming out with new things to help patients with low vision, which is great.

Host: Well, Courtney, Alexis, this is very impressive. Thank you both for sharing all this information on the comprehensive services you provide and especially how to use and resources to access those services and for all you do to promote vision care. Courtney Couch is optometrist and Assistant Professor of Ophthalmology and Alexis Showalter D’Arsie is Optometrist at UK HealthCare Advanced Eyecare. For more information, visit ukhealthcare.com. And if you enjoyed this podcast, please share it on your social channels and check out the entire podcast library for topics of interest. Thanks for listening to UK HealthCast, a podcast from UK HealthCare.