Implementation of an Evidence-Based Guideline for the Referral of Adults Who are Visually Impaired in the Netherlands: Potential Barriers (Research Report‪)‬

Throughout the Western world, 1%-2% of the population is visually impaired (that is, is blind or has low vision) (Thylefors, Negrel, Pararajasegaram, & Dadzie, 1995). In the Netherlands, of the 200,000 people who are visually impaired, the majority (85%) are aged 65 or older (Melief & Gorter, 1998). The most important cause of visual impairment is age-related macular degeneration (Klaver, Wolfs, Vingerling, Hofman, & de Jong, 1998; van Rens, Chmielowski, & Lemmens, 1991). Rehabilitation for individuals with a permanent visual impairment can foster their self-efficiency and improve the quality of their lives. Low vision devices and special rehabilitation centers offer methods for rehabilitation. With the aging population, the demand for visual rehabilitation will increase. However, not all visually impaired persons who could benefit from rehabilitation are aware of the possibilities. Individuals, members of consumer organizations, and personnel of rehabilitation centers have all pointed out that referrals for rehabilitation services for adults who are visually impaired could be more efficient. The Dutch government gives scientific organizations financial support to develop evidence-based guidelines. The Dutch Society of Ophthalmology (Nederlands Oogheelkundig Gezelschap, or NOG) recognized that the problem of irreversible visual impairment should have a higher priority within the field of ophthalmology. A new referral guideline was needed because the existing guidelines for the referral of persons who are visually impaired were not evidence based. The exception is the evidence-based guideline of the American Academy of Ophthalmology (2001), which was not suitable for use in the Netherlands because of differences in the organization of health care services in the two countries. In 2001, a NOG commission was formed to develop an evidence-based guideline on the referral for rehabilitation of individuals who are visually impaired. The draft was discussed with representatives of patient organizations, personnel of rehabilitation centers, and Dutch ophthalmologists. In November 2004, NOG released the guideline, which was later published in two journals (de Boer, Langelaan, Jansonius, & van Rens, 2005a, 2005b).