A Qualitative Analysis of Reading Rehabilitation of Persons with Age-related Macular Degeneration

Abstract

One of the most prevalent visual impairments of people aged 60 and older is age-related macular degeneration (AMD), which ranks third globally as a cause of visual impairment (World Health Organization, 2006). With AMD, central vision is lost and some peripheral vision remains, causing difficulties with fine vision and tasks such as reading and mobility, which results in reduced satisfaction and quality of life (Mackenzie et al., 2002) and anxiety and depression (Brown, Brown, Sharma, Busbee, & Brown, 2001). Magnification devices can help to improve the reading performance of persons with AMD, but errors occur when a reader misses the ends or beginnings of words and even entire lines of text (Watson, Baldasare, & Whittaker, 1990). Eccentric viewing can be used to regain former visual abilities (Fletcher, Schuchard, & Watson, 1999) by training persons with AMD to use a preferred retinal locus (Schuchard & Fletcher, 1994). An improvement in reading skills may help these persons adjust to their loss of vision (Trudeau, Overbury, & Conrod, 1990). Qualitative assessment is limited in visual research, particularly research on AMD. Wong, Guymer, Hassell, and Keeffe (2004) reported how persons with AMD made sense of their experiences. The purpose of the study presented here was to extend Wong et al.'s findings and to conduct a tentative subjective assessment of eccentric viewing by persons with AMD. We recruited registered persons with bilateral AMD who had low vision from the Low Vision Clinic where they had received some instruction in the use of their magnification devices; all lived in London, England. In comparison, the visual acuities of 15 participants in the Wong et al. study ranged from unilateral impairment to a visual acuity greater than 6/60 (20/200) in the better-seeing eye. Eleven of these 15 participants with the lowest visual acuity received instruction in the use of magnifiers, techniques for living independently, and social interaction groups, and half resided in rural areas. METHOD Participants Seven persons with bilateral AMD and no other ocular disability were recruited through the Low Vision Clinic at Moorfields Eye Hospital in London, England. Their visual acuities ranged from 6/18 (20/60) to 6/76 (20/250) in the better eye. All lived in London and were aged 62-83 (see Table 1 for the participants' characteristics). Reading rehabilitation All the participants received one hour's instruction in eccentric viewing and page navigation with their magnifier using a method called steady eye, whereby text was optimally enlarged over their own preferred retinal loci (Collins & Davis, 1999). They completed an additional 0-8 hours of practice at home using Wright and Watson's (1995) Learn to Use Your Vision manual, which was chosen for its variety of exercises in texts ranging from 3M to 0.8M, and recorded a log of the time it took them to complete the exercises, the difficulty of the exercises, and any additional comments. Procedure Forty-minute interviews were conducted by the researcher (the first author) before and after instruction, using interpretative phenomenological analysis (Smith, 1996) aimed at capturing how the participants made sense of their experiences while acknowledging the role of the researcher's interpretative processes. The project was approved by the Moorfields Eye Hospital Research Ethics Committee. All the participants provided informed consent prior to their participation. Interview schedule and analysis Initial questions on identity, coping, and social support were adapted from Smith and Osborn's (2003) guide to qualitative research, giving the participants the opportunity to describe their life experiences. Further questions were developed to explore the psychosocial impact of AMD on quality of life (Borglin, Edberg, & Hallberg, 2004; Williams, Brody, Thomas, Kaplan, & Brown, 1998), such as whether vision loss had affected their relationships with family members and friends, and the usefulness of existing magnifiers. …