HomeVA ProstheticsVA Handbook 1173.5 - Aids for the Blind and Visually ImpairedDefinitions

5.3. Definitions

a. An Aid for the Blind. An aid for the blind is any prosthetic device, item of equipment, or animal used in assisting a beneficiary in overcoming the impairments associated with blindness and vision loss, including, but not limited to:

(1) Devices or items specially designed for use by persons who are blind or visually impaired, such as long canes, writing guides, Braille writers, Braille or low-vision talking watches, signature guides, talking calculators, and optical character readers.

(2) Devices usually used by sighted persons, but which have been approved for use by blind or visually impaired beneficiaries for the specific purpose of assisting them in overcoming functional deficits related to vision loss, in addition to ensuring safety, e.g., electric razors, voice- activated organizers, typewriters, recording devices, computers, Brett guards (plastic corner cover for saws), and large-print playing cards.

(3) Guide dogs specially trained to assist blind persons.

(4) Any device or item requiring evaluation and/or training by a low-vision specialist or blind rehabilitation professional with the exception of optical low-vision devices.

(5) Specially-adapted medical devices such as glucometers, blood pressure monitors, thermometers, and audible prescription reading devices.

b. Basic Low-Vision Services. Basic low-vision services are provided at all VA eye clinics. These services include, but are not limited to, clinical low-vision examinations and changes to spectacle prescriptions that may include separate reading spectacles or increased bifocal aids, simple magnifiers or telescopes, absorptive lenses, lamps, reading stands and other optical and non-optical devices that meet the needs of patients that are transitioning to visual impairment but do not require extensive specialized training.

c. Competencies. VA staff with a degree in blind rehabilitation or certification in an area of expertise (i.e., low vision) will be deemed competent to evaluate and train on various devices for which they have demonstrated educational or on-the-job experience. NOTE: Blind Rehabilitation Service (BRS), VA Central Office, encourages competency training on specific equipment for interested staff that otherwise do not have a professional background in blind rehabilitation.

d. Continuum of Care Program. The Continuum of Care Program is a comprehensive nationwide system for visually impaired veterans which integrate rehabilitation services for those patients with visual impairments into VA health care services.

(1) This program encompasses the full range of vision rehabilitation services from basic low-vision care to inpatient blind rehabilitation. Basic low-vision services are provided at all VA eye clinics. Intermediate low-vision clinics deal with more advanced devices and training for performance of everyday tasks such as reading, writing, and meal preparation. Advanced low-vision clinics provide a full range of devices where treatment extends beyond vision rehabilitation to address other functional deficits such as hearing loss and mobility problems. Advanced blind rehabilitation clinics offer short term comprehensive rehabilitation programs for veterans who do not require intensive inpatient programs. Blind Rehabilitation Centers (BRC) provide intensive and comprehensive inpatient blind rehabilitation.

(2) Continuum of Care programs that are monitored by the Blind Rehabilitation Service include:

(a) Visual Impairment Services Team (VIST). VIST is a team comprised of health care and allied health care professionals charged with the responsibility of ensuring that blind veterans are identified, evaluated, and provided health and rehabilitation services to maximize their adjustment to sight loss. A designated VIST coordinator provides case management, prosthetic devices, counseling, referrals, and benefits for veterans who are legally blind or who have excess visual disability. VIST team representatives may include, but are not limited to the following specialties: social work, ophthalmology, optometry, prosthetics, primary care, vocational rehabilitation, nursing, audiology, podiatry, nutrition, psychology, Veterans Benefits Administration (VBA), blind veterans' consumer organizations, blind consumers, and state or community agencies for persons who are blind.

(b) Blind Rehabilitation Outpatient Specialist (BROS). A BROS is a multi-skilled college or university trained (bachelor or masters degree in blind rehabilitation) and experienced blind rehabilitation specialist who has advanced technical knowledge and competencies in at the journeyman level in at least two of the following disciplines: orientation and mobility; living skills (vision-rehabilitation therapy) and visual skills (low-vision therapy). BROS have been cross-trained to acquire broad-based knowledge in each of the BRC disciplines. BROS provide assessment and training on-site in patients' homes, communities, and job sites.

(c) Intermediate Low-vision Clinic. Intermediate low-vision clinics are staffed by an eye care professional and a low-vision therapist. In this clinic, a moderate breadth and level of complexity of low-vision services are provided. Services include a thorough low-vision functional assessment of daily tasks along with training on the use of devices and limited to Activities of Daily Living (ADL) training.

(d) Advanced Low-Vision Clinic. Advanced Low-vision Clinics include a licensed eye care practitioner or provider trained in low-vision rehabilitation as well as low-vision therapists, orientation and mobility (O&M) specialists and others working as an interdisciplinary team to provide low-vision care. Visual skills assessment and training is more extensive than that provided in the intermediate low-vision care program. Limited O&M training and ADL skills are also taught. Psychosocial counseling for adjustment to blindness is available on a limited basis and audiology services are available to eligible veterans.

(e) Advanced Outpatient Blind Rehabilitation Clinic. Advanced Outpatient Blind Rehabilitation Clinics are staffed with a small team of blind rehabilitation and low-vision professionals along with an optometrist or ophthalmologist trained in low-vision rehabilitation. They offer short term comprehensive rehabilitation programs similar to BRC programs but are designed for veterans who do not require intensive inpatient programs. Advanced low-vision services are provided. Training to enhance independent function is more intense than those provided in the advanced low-vision clinics. Additional adjustment counseling and audiology services are available. Training for computer access for e-mail, Internet, and word processing is provided.

(f) Visual Impairment Services Outpatient Rehabilitation Program (VISOR). An outpatient intermediate rehabilitation program that provides comfortable, safe, overnight accommodations (hospital hotel setting) for beneficiaries who are visually impaired and requiring temporary lodging in order to access services provided through the program. The program offers skills training, orientation and mobility, and low-vision therapy. VISOR programs are currently located at the VA Medical Center in Lebanon, PA, and the VA Medical Center in West Haven, CT.

(g) Blind Rehabilitation Centers (BRC). A BRC is a special organizational unit established at select VA medical centers to provide comprehensive rehabilitation of veterans who have functional deficits related to vision loss. BRAC services include, but are not limited to: training in orientation and mobility, communication skills, activities of daily living, manual skills, low- vision and computer access training. This comprehensive training is provided through a residential or inpatient program model, generally lasting several weeks for each admission.

e. Legal Blindness. Legal blindness exists when a person's best corrected central visual acuity in the better eye is less than or equal to 20/200, or if the central visual acuity in that eye is better than 20/200, but the visual field dimension is less than or equal to 20 degrees at the widest diameter.

f. National Program Consultant. Professional field representatives of the Director of Blind Rehabilitation Service who provide ongoing support and consultative services to the BRC, BROS, and VIST.

g. National Standards for Issuance. PSAS, in collaboration with BRS, Optometry, Ophthalmology, VA Central Office, and other stake holders, develops and publishes VHA Prosthetic Clinical Management Program (PCMP) Clinical Practice Recommendations for prescription and issuance of various types of prosthetic equipment.

h. Optical Low-Vision Devices. Optical low-vision devices alter the image focus, size (magnification or minification), contrast, brightness, color, or directionality of an object through the use of lenses or other technology. Such devices include, but are not limited to: prescription eyeglasses or spectacles (with or without tint), specialty contact lenses, microscopic spectacles, hand-held magnifiers, stand magnifiers, telescopes (monocular or binocular), head-borne lenses, magnifiers, minifiers, prisms, and closed-circuit televisions (CCTVs) and electronic optical enhancements devices (EOEDs). These optical low-vision devices must be prescribed by an appropriately credentialed and privileged optometrist or ophthalmologist.

i. Non-Optical Low-Vision Devices. Non-optical low-vision devices are those that use senses other than vision to enlarge. Examples include, but are not limited to large phone dials, touch watches, larger print books, audible clocks, and alarms. These devices do not require a prescription by an eye care provider

j. Visual Impairment Center to Optimize Remaining Sight (VICTORS). VICTORS is a comprehensive low-vision program developed by VHA Directors of Optometry, Blind Rehabilitation and Social Work Services to complement existing inpatient Blind Rehabilitation Centers (BRCs) to care for veterans with significant visual impairment. The interdisciplinary VICTORS outpatient program represents a unique team approach to vision rehabilitation using the disciplines of optometry, ophthalmology, social work, psychology, and low-vision therapists. VICTORS provides rehabilitation through definitive medical diagnosis, functional vision evaluation, prescribing, and training in use of low-vision aids, counseling and follow-up. Frequently, other necessary patient care services (e.g., social work, psychology, audiology and ophthalmology) are provided at the local station. There are currently four VICTORS programs located in Kansas City, MO; Chicago, IL; Northport, NY; and Lake City, FL.


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