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Steps to Offering Low Vision Rehabilitation Services through Clinical Video Telehealth

Telehealth clinical applications, which allow medical professionals to use telecommunications technologies to provide services to individuals remotely, continue to expand in areas such as low vision rehabilitation, where evaluations are provided to patients who live in rural areas. As with face-to-face low vision rehabilitation, the goal of clinical video telehealth is to help patients cope with a loss of vision, as well as accept and recognize challenges and provide skills to maintain independence and safety, and to prevent depression. Important aspects of implementing clinical video telehealth are increasing access, building capacity, saving time, and decreasing travel costs for patients and providers in several clinical specialties. Reducing barriers to care is achieved through telehealth by enabling patients to avoid traveling long distances when they feel they are unable to drive safely or when they rely on family or friends for transportation. The purpose of this article is to illustrate the development, need, and benefits of establishing a low vision clinical video telehealth clinic, and to increase access to low vision rehabilitation among the aging population with vision loss. Uncorrectable vision loss due to conditions such as macular degeneration and diabetic retinopathy often restricts mobility and travel of older adults (especially by automobile), which is one of the barriers to receiving low vision rehabilitation faced by partially sighted individuals who live in rural areas. Telehealth is defined as the use of electronic communication and information technologies to provide or support long-distance clinical health care, patient and professional health-related education, public health, and health administration (National Advisory Committee on Rural Health and Human Services, 2015). In order to provide better care to veterans with visual impairments, especially those residing in rural or highly rural areas, in 2011 the U.S. Department of Veterans Affairs (VA) Blind Rehabilitation Services began pursuing innovative care delivery strategies. Federal funding was allocated to VA low vision clinics throughout the United States to purchase telehealth equipment, which challenged providers to develop protocols and best practices for low vision clinical video telehealth rehabilitation. This expansion of telehealth services improved access to care and increased patient satisfaction (U.S. Department of Veterans Affairs, 2015). Nonprofit rehabilitation agencies that provide low vision rehabilitation services to older adults within their own communities also have challenges regarding innovative care delivery strategies, especially in rural or highly rural areas. By using this rapidly expanding technology, other public and private sectors can also improve access to care for patients with visual impairments who live in rural areas. Telemedicine continues to advance and has been critical to improving health outcomes in rural regions in the United States. Rural regions are those outside of urban areas that generally have populations smaller than 2,500 (U.S. Department of Health & Human Services, 2015). Residents in rural regions often experience challenges in accessing medical and rehabilitation services because of the vast distances that may separate them from more densely populated regions, where services are typically located. To address the problem of access to health care, VA telehealth service clinics are set up around the United States for cardiology, neurology, psychiatry, and a range of other medical services that patients can access electronically without being physically in the presence of the health professional. Ophthalmology and optometry clinics within several VA hospitals utilize "store and forward" telehealth technology for virtual encounters by which they capture digital retinal images and then send them electronically to physicians for medical opinions or diagnoses (U. …