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Low Vision Assessment and Rehabilitation

State Agency

All state governments in the United States fund an agency to coordinate the visual rehabilitation of its citizens who are visually impaired. They undertake much of the rehabilitative efforts, either directly or via subcontractors. In Missouri, the state agency is:

Rehabilitation Services for the Blind
Division of Family Services
615 Howerton Court
P O Box 2320
Jefferson City, MO 65102
Telephone: 573-751-4249 or 1-800-592-6004
Fax: 573-751-4984

Information about state blindness or vocational rehabilitation agencies is available for specific states at here or here. In situations where the visual impairment is insufficient to meet eligibility guidelines for the state blindness agency, but where the individual's employment abilities are still adversely affected, the state vocational rehabilitation agency will often provide rehabilitative services.

Referral Mechanism

The referral mechanism varies somewhat between states. Generally, a referral can be requested by any individual, family, or friend, as well as by eye care professionals, rehabilitation specialists, or social workers.

Specific levels of visual loss are established by state statutes that have to be met, but these are often open to some interpretation in situations such as when work-related visual requirements cannot be met conventionally, or when there is rapid visual worsening. Generally speaking, vision is assessed in both eyes for purposes of entitlement. Documentation of the current best-corrected visual acuities of each eye and of the visual fields is required. This may be provided by the referring eye doctor or obtained after assessment by a panel doctor subcontracted to the state agency.

Financial Environment for Low Vision Rehabilitation

State visual rehabilitation agencies work under financial constraints. Traditionally in the United States, Medicare, Medicaid, and private medical insurance have grossly underfunded the activities of vision rehabilitation professionals, with the result that there is a national shortage of health care providers willing to undertake comprehensive visual rehabilitation services. Furthermore, insurance does not generally contribute to the purchase of the multiple low vision aids that are necessary to enhance visual functioning.

The state agencies attempt to plug this gap in medical care as best they can with limited funding. State support varies from state to state, but no state remotely meets the need for vision rehabilitation with current funding levels. Inevitably, funding has concentrated on specific subgroups of the visually impaired, such as children, students, and the employed. The availability of funding varies from year to year, and is often comprised of state and federal dollars committed to individual programs, such as Independent Living (IL), Rehabilitation Services Administration (RSA), and Older Blind Services (OBS) for your state. Overall funding limitations often impair the purchase of necessary services and equipment.

In larger metropolitan areas, some comprehensive centers, such as Lighthouse, may offer the complete array of low-vision services. The team approach in small urban areas can often be accomplished through a network of individual providers or agencies. Most rural counties have little provision, if any, and considerable distances must often be traveled to obtain care.

A vocational counselor from the state Rehabilitation Services for the Blind visited Dr. Cole in his home and office several times. Otherwise, Dr. Cole traveled two hours each way for his ophthalmic visits, low vision assessments, and residential rehabilitation visits.

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Last Update: Nov 29 2012