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

Mondal, Sanbrita1; Peterson, Kyle1; Thomas Virnig, Christina1; Verges, Bonnie1

Published May 08, 2026 on Dryad. https://doi.org/10.5061/dryad.7m0cfxq9r

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Abstract

Functional vision loss at any stage affects quality of life (QOL) even before clinically quantified to be moderate or severe. Eye care providers (ECP) are the gatekeepers to vision rehabilitation services (VRS) and often underestimate how small variations in functional vision loss can have a significant impact in a patient’s life. Greater patient-provider communication about vision loss is an opportunity to build trust and increase access to VRS to improve QOL. Tertiary eye care centers serve the greatest number of visually impaired (VI) patients. The purpose of this study was to find what factors influenced ECPs with VRS referral decision-making at a tertiary medical center. We also further studied whether decision making was influenced by the ECP’s specialty, volume of practice, years of practice, number of practicing locations, gender, and continuing education (CE) status. Our survey found that about 77% of respondents, early (<10 years) in their career, and 75% posterior segment (PS) specialists agreed that people with any functional vision complaint should be referred to VRS regardless of visual acuity status. Fifty-two percent of all respondents indicated the reason for low referrals to VRS was to a lack of inquiry by patients about vision services. Inquiry about driving status by patients was an important factor for referral to VRS for 35% of respondents, and especially for PS specialists. Forty-five percent of respondents reported lack of VRS providers and long wait times as a barrier to referrals; however, 68% respondents reported never referring to community services. PS specialists attended more CE courses related to low vision/ vision rehabilitation than anterior segment (AS) specialists. By understanding influencers on ECPs' 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.