The OT and OD Relationship
An Interdisciplinary Team Approach: OD / OT / Vision Rehabilitation Professionals working with Low Vision Patients
By: Amy Rebovich OTR/L, CLVT
Occupational Therapy continues to emerge as a provider of low vision in the world of Low Vision Optometrists and Vision Rehabilitation Professionals. It is extremely important for Occupational Therapists to recognize the entire Low Vision Team as a resource in order to provide the best possible treatment to our low vision patients.
Imagine if you just suddenly lost your vision. How would you get to work if you typically drove and no longer could see the road or signs safely? How would you perform your job tasks accurately and efficiently as well as safely if you had sudden partial or total vision loss? How would you cook and prepare meals if you could not see the stove dials safely? How would you match colors and get dressed if all dark or light colors looked the same? How would you properly take and manage your medication if you could not read the prescription bottle? And the questions we would ask ourselves would go on and on…..
Low vision could happen to any one of us at any time, and could forever dramatically change our entire daily routine negatively. The impact that low vision has on an individual can affect independence and safety with daily tasks and functional mobility resulting in increased frustration and anxiety.
Losing vision can disrupt a person’s daily routine, functional mobility and independence. It can affect not only a physical aspect of a person’s life, but an emotional and spiritual component as well. Occupational Therapy is a profession that is based on providing the necessary skills, compensatory strategies and adaptive techniques in order to improve occupational performance as a holistic approach. The Optometry profession, as well as the Vision Rehabilitation Professionals, initially have been the major component of the low vision world when addressing these needs. As Occupational Therapy becomes increasingly a part of this interdisciplinary team with the Low Vision Optometrists and Vision Rehabilitation Professionals, it is important to note we must all work together as a team approach. We must all understand each discipline in the area of low vision and the skills that we each offer our patients as well as the proper sequence of events for the referral. Making sure we acknowledge that the Low Vision Optometrist is the gatekeeper to initiating low vision services through measuring visual acuity, assessment of vision, and evaluation of optical devices prior to prescribed Occupational Therapy for Low Vision Rehab.
Occupational Therapists work in a variety of different settings and have an extreme versatility. One important factor that Occupational Therapists need to understand is that referring to a Low Vision Optometrist is the key initial component when working with a patient with low vision. As an Occupational Therapist, you may be the first team member to recognize the need for a Low Vision Optometrist to see the patient for a Low Vision Comprehensive Evaluation. This is so important to recognize due to the fact that the Low Vision Optometrist measures the patient’s vision through refraction as well as assessment and evaluation of optical / electronic magnification devices as appropriate. Through the Low Vision Comprehensive Evaluation, the Low Vision Optometrist will be able to identify the need for Occupational Therapy as well as for Vision Rehabilitation such as Orientation and Mobility Instructors, Certified Low Vision Therapists, Vision Rehabilitation Teachers, Teachers of the Visually Impaired, etc. Occupational Therapists need to understand that when working in the area of low vision, the Low Vision Optometrist is the professional that determines the optical device and power along with the electronic magnification. Following a prescribed Occupational Therapy order from the Low Vision Optometrist, the OT will initiate an evaluation and provide treatment within the plan of care as established by Low Vision Optometrist, Occupational Therapist and patient. The Occupational Therapist should never randomly select optical devices. This can cause great harm to your patient by creating needless frustration, anxiety and stress along with feelings of hopelessness that nothing can help to assist with seeing again to do daily tasks.
Historically, Occupational Therapists do not have prior training in optics, electronic magnification or blindness techniques. Receiving further training as a low vision therapist is important when recognizing low vision as a specialty in the area of Occupational Therapy. The profession of Occupational Therapy has so much to offer patients in understanding the neurology component of visual field loss, contrast and lighting needs. Also, Occupational Therapists understand the importance of independence and safety with functional mobility by reducing risk of falls and increase independence with activities of daily living. Occupational Therapists are trained in incorporating compensatory and adapted techniques due to sensory loss and decreased eye hand coordination as well as being trained in dealing with visual perceptual/cognitive impairments.
Depending on the type of setting for Occupational Therapy: acute care, inpatient rehab, transitional care unit, nursing home, outpatient, pediatrics, etc. that will determine the proper sequence of events for working with your patients with significant vision loss, blindness, etc. In an acute care setting or inpatient rehab setting, Occupational Therapists may evaluate and treat patients with sudden vision loss due to trauma or brain injury. Occupational Therapists also may be treating patients that are consulted for OT with the primary diagnosis of decreased functional mobility/ADLs due to cardiac, orthopedic issues, etc. The Occupational Therapist may identify through the Occupational Therapy evaluation that the patient may also be recently diagnosed with Glaucoma or macular degeneration along with the additional medical complications. The patient may have peripheral or central field loss that complicates Occupational Therapy treatment when working with activities such as a light meal prep activity in a kitchen setting. The Occupational Therapist needs to understand the various eye conditions and how it can impact and affect the success of the long-term Occupational Therapy goals and potentially discharge recommendations.
Making sure vision is assessed appropriately through recommendations for a Low Vision Comprehensive Evaluation with a Low Vision Optometrist must come prior to the Occupational Therapy Evaluation. In the visual hierarchy model, visual acuity needs to be assessed first prior to treatment techniques of fixation, scanning, tracing, tracking for eye hand coordination to perform ADLs. Examples include self-grooming tasks such as seeing to put toothpaste on a brush, finding clothes in the closet, preparing meals in kitchen etc. This structured model is the building block for achieving success and increased independence with ADLs and functional mobility with Occupational Therapy. By the Low Vision Optometrist providing a comprehensive Low Vision Evaluation and determining visual acuity through refraction, assessment of optical and electronic magnification devices, the Occupational Therapist will be able to provide the treatment needed for the patient to achieve goals of independence.
Occupational Therapy is a very important addition to the original Vision Rehabilitation Professionals as long as each discipline understands the role they play as an integral part of the interdisciplinary team. Understanding each discipline, such as Low Vision Optometrists, Occupational Therapists, and Vision Rehabilitation Professionals, when working together will help our patients achieve their highest goals. Together our professions will be able to provide outstanding success to individuals with low vision and provide the hope and strength to never give up life’s most valued dreams.
