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The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is calling for better care coordination in VA medical centers to help prevent visual impairment in veterans with eye disease.

A March 25 VA information letter on Visual Impairment Prevention For Veteran Patients recommends that primary care physicians, optometrists, ophthalmologists and sub-specialty providers in the VA centers institute formal care coordination agreements to ensure that at-risk patients are appropriately referred for preventive eye care or specialty eye care services.

“This is a positive result that keeps the focus on patients and fully recognizes the essential care provided by hundreds of dedicated VA optometrists nationwide,” said Jon Hymes, director of the AOA Advocacy Group. “The AOA will continue working in support of the highest standards of care for America’s veterans.”

The letter specifically targets improved care for age-related macular degeneration (AMD), diabetic retinopathy and glaucoma — the three most common etiologies of permanent visual impairment and blindness among the veteran population.

It emphasizes that VA optometrists and ophthalmologists are to work “as equal partners to provide a continuum of high quality eye care services” in the treatment and management of AMD, diabetic retinopathy and glaucoma.

The information letter reminds staff that “the provision of timely and appropriate eye care is a fundamental responsibility of VHA clinicians,” requiring knowledge of indications for screening as well as risk factors and clinical symptoms that would indicate a need for referral to early testing, along with an awareness of clinical practice guidelines and appropriate treatment.

The new care coordination agreements will “facilitate referral practices and to ensure seamless continuity of care.”

The care coordination agreements are to be reviewed and mutually agreed upon by VA primary care, optometry and ophthalmology staff.

An Ongoing Professional Practice Evaluation peer-review process on AMD, diabetic retinopathy and glaucoma care is also recommended.

The letter also offers specific guidance for managing progressive eye conditions that can lead to vision loss, listing “descriptive points” on screening, diagnosis, and treatment.

The letter specifies that “the diagnosis of AMD, DR, and glaucoma can only be made by an eye care provider.”

It also specifies that the treatment of AMD, diabetic retinopathy and glaucoma must be performed in a coordinated manner by eye care specialists.

VA practitioners are referred for guidance on AMD, diabetic retinopathy and glaucoma to the Centers for Disease Control and Prevention, NEI, VA-Department of Defense Clinical Practice Guidelines as well as the AOA Clinical Practice Guidelines and American Academy of Ophthalmology Preferred Practice Patterns.