The elusive low vision patient.

Last month I wrote about how optometrists might help the many visually impaired remain functionally independent by maximizing their ability to see. To accomplish this mission requires a comprehensive evaluation with a functional goal in mind. However, I am reasonably certain that such an evaluation is not offered to every visually impaired individual, at the very least to give them the opportunity to refuse any rehabilitative assistance. Part of the problem may lie in how we are defining these individuals. According to the World Health Organization, the hierarchy of health problems is: 1) disease, 2) impairment, 3) disability, and 4) handicap. It may be that many of these visually impaired patients are characterized simply by the disease and perhaps the impairment, but are not queried as to the attendant disability (the inability to perform certain tasks). As a result, they are not asked the ‘‘right’’ questions to get them to an optometrist who can attempt to minimize the disability through vision rehabilitative management and therapy. A few examples might help to support this thought. In Allegheny County (one of 67 counties in Pennsylvania), the estimated number of visually impaired and blind individuals is approximately 41,000 (out of a population of approximately 1,282,000) based on data from the Pennsylvania Association for the Blind (2007). A quickly estimated calculation would suggest that it would take many eye care practitioners (not only those emphasizing vision rehabilitation) seeing only visually impaired patients all day, every day, to begin to make a dent in the numbers of this population. That being