Health Care Professionals Should Focus on Visual Impairment and Health Literacy

I’m going to go off topic today and discuss an issue that affects not only seniors and other Medicare beneficiaries, but almost 90 percent of U.S. adults: Health literacy.

According to the National Library of Medicine, health literacy is “the degree to which people can obtain, process, and understand basic health information and services they need to make appropriate health decisions.”   A 2003 U.S. Dept. of Education literacy assessment of more than 19,000 Americans found that nearly 90 percent of adults lack some level of skills in reading, understanding, and acting on medical information.

Helen Osborne, a national health literacy consultant, likes to say that health literacy is about mutual communication. She recently told American Medical News that health literacy “is when patients or anyone on the receiving end of health communication and anyone on the giving end truly understand one another.”

Visual impairments also affect health literacy

I bring this topic up today because I recently experienced a lot of difficulty reading consent forms and other health information before and after having eye surgery. Even though the nurses knew I was having trouble seeing with both eyes, not one person offered to read the forms to me, or at the very least, provide a magnifier. Following my surgery, I was given some discharge instructions and a brochure about the procedure—I had to ask my 77-year-old mother to read them to me. For the first time, I experienced what it felt like to be in the shoes of someone who struggles to read and act on medical information.

Health literacy tips and patient advocacy suggestions for health care professionals

Although many health literacy studies focus on poor reading skills, including this latest study that suggests elderly patients with poor reading skills have an increased risk of death, visual impairments can also be a barrier to communications between providers and patients. Based on my recent experiences, I’d like to make some suggestions to health care providers, and in particular, eye doctors and retina specialists who have many senior patients with macular degeneration or other visual impairments:

• Use large print (at least 14-point type) on all written materials, especially consent forms, hospital discharge instructions, and brochures that provide information about health conditions or medical procedures.
• Provide visual aids, such as magnifiers or audiotapes, in waiting rooms, examination rooms, and recovery areas. Or, offer to read information aloud if you detect a patient is having difficulty.
• Provide additional lighting options in the waiting and recovery rooms. (The waiting room at my doctor’s office had two lamps in addition to the ceiling lights, but I could not turn either one on because they are on a timer.)
• Magazines and newspapers are always welcome in the waiting room, but they’re pretty useless if one can’t read the small print! Do your patients a favor and subscribe to a few large-print magazines — Reader’s Digest and The New York Times come in large print, as do many crossword puzzle books.

On her health literacy website, Helen shares additional strategies for healthcare providers to improve communications with patients who are blind or have visual problems. She also talks with Dr. Cynthia Stuen of Lighthouse International about age-related vision loss on this very informative podcast.

Although my suggestions and Helen’s strategies are geared toward health care providers, I encourage you to speak up and ask your own doctors to take whatever steps are necessary to help you read and understand health information. I’m going to get things started by printing this blog and bringing copies to my doctors’ offices and to the local libraries for Healthy Vision Month (May 1-31).

By the way, I have asked the people at WordPress to add a feature that allows bloggers to increase the type size on their posts, but so far there is no so option.

 

To see or not to see: What type of vision care does Medicare cover?

Medicare Part B will cover eye exams that have specific medical reasons, such as AMD and Glaucoma screenings.

A week ago today, I was admitted to the hospital for emergency scleral buckle surgery. My retina in my left eye had become partially detached, and my doctor said the surgery was my best option. Click here for a short video of the surgery I had.

While sitting in the waiting room of my doctor’s office the next day following surgery, I noticed I was one of only two people in the room not eligible for Medicare (the other patient was a young male who appeared to have gotten into a fight). There were about 8 seniors in the waiting room, and as I engaged in conversations with each of them, I discovered that most of them had age-related macular degeneration (AMD). Several of these patients told me they were very fortunate that Medicare was covering their treatments.

 What type of vision care does Medicare cover?

Although original Medicare does not cover basic eye exams, it does cover basic eyeglass frames or lenses after cataract surgery as well as eye exams that have specific medical reasons. For example, if you have dry eye syndrome or blephartis (inflammation of the eyelash follicles), Medicare pays for treatment and doctor visits. Medicare also covers Glaucoma screenings for those most at risk, including:

• People with diabetes
• People with a family history of glaucoma
• African-Americans over 50
• Hispanics over 65

Does Medicare pay for the treatment of macular degeneration?

Macular degeneration (wet and dry), which can lead to the retina becoming detached and blindness, is most prevalent among those over the age of 50. Original Medicare (Part B) covers one treatment for AMD called ocular photodynamic therapy with verteporfin. For this treatment, Medicare covers 80 percent and you pay the remaining 20 percent after you have paid your Part B deductible. There are several treatment options for macular degeneration, so you will need to ask your doctor if photodynamic therapy is the best treatment for you.

Medicare Advantage and Medigap plan coverage

If you expect to need extra vision care or are prone to losing or breaking your glass, you may want to consider a Medicare Advantage plan (Medicare Part C) or a Medigap plan. These plans can offer additional coverage, which can include vision. Some plans may charge an extra fee for vision coverage, but the extra cost may be worth it if you have vision problems or are extremely nearsighted, like me.