Understanding decision making factors influencing referrals to vision rehabilitation services at a tertiary medical center

Functional vision loss at any stage affects quality of life even before clinically quantified to be moderate or severe. Eye care providers as the gatekeepers to vision rehabilitation services often underestimate how small variations in functional vision loss can have a significant impact in a patient's life. Greater provider-patient communication about vision loss is an opportunity to build trust and increase access to vision rehabilitation services to improve quality of life. Tertiary eye care centers serve the greatest number of visually impaired patients. The purpose of this study was to find what factors influenced eye care providers with vision rehabilitation service referral decision-making at a tertiary medical center. We also further studied whether decision making was influenced by the eye care provider's specialty, volume of practice, years of practice, number of practicing locations, gender and continuing education status. Our survey found that about 77% of respondents were early (<10 years) in their career and 75% of posterior segment specialists agreed that people with any functional vision complaint should be referred to services regardless of visual acuity. Fifty-two percent of all respondents indicated the reason for low referrals to services was due to a lack of inquiry from patients. Inquiry about driving status by patients was an important factor for referral to services for 35% of respondents. Forty-five percent of respondents reported lack of vision rehabilitation providers and long wait times as a barrier to referrals. However, only 61% of respondents reported "never" to "sometimes" referring to community services. Posterior specialists attended more continuing education courses related to low vision/ vision rehabilitation than anterior segment specialists. By understanding influencers on eye care providers decision making, we will be able to make more targeted recommendations on workflow changes, continuing education and quality improvement processes to increase access to vision rehabilitation services.