Ability to Read Medication Labels Improved by Participation in a Low Vision Rehabilitation Program

Abstract

Demographic projections indicate that the population of the Western world is aging, and evidence suggests an increase in the incidence of conditions, such as age-related macular degeneration (AMD), that produce visual impairments and result in low vision (Maberley et al., 2006). It is expected that in the United States and Canada, the annual number of new cases of visual impairment will double that of the current rate by 2025 (Massof, 2002). In light of these expected demographic changes and the expected increase in the demand for services, it is critical to assess low vision rehabilitation outcomes for interventions on various tasks that are commonly performed in activities of daily living. Data in this regard have been incomplete and sketchy. Low vision rehabilitation interventions include prescription and training in the use of low vision devices, such as magnifiers, telescopes, selective transmission lenses, electronic devices, and computers; training in skills, such as reading, writing, driving, orientation and mobility, and other activities of daily living; and counseling and social support (Markowitz, 2006). In addition, one can analyze the impact of low vision rehabilitation interventions on selected tasks that are widely performed by people with low vision. Reading labels on prescription medicine bottles is an everyday task that virtually all persons attempt to perform accurately. There have been no reports in the literature on the impact of low vision rehabilitation interventions on this specific task. Thus, the purpose of this study was to assess the impact of low vision rehabilitation interventions on the ability of individuals with low vision to read standard labels on medication packages. METHODS The study was designed as a prospective nonrandomized interventional case series. Patients were recruited from the clinical offices of some of the authors who provide low vision rehabilitation services. All the patients who were considered for the study received routine complete low vision assessments and were prescribed low vision interventions. Criteria for inclusion in the study were a confirmed diagnosis of low vision that is not amenable to any further medical or surgical treatments and no history of a neurological disease or cognitive impairment. Only patients who were prescribed and received low vision rehabilitation interventions were included in the study. Data were collected on the patients' demographic characteristics, diagnosis of low vision, ocular and medical histories, and details on the low vision rehabilitation interventions that were prescribed and implemented. The study protocol included assessments of the patients' distance best-corrected visual acuities using ETDRS charts (Ferris, Kassoff, Bresnick, & Bailey, 1982). A low vision rehabilitation intervention was counted as such if a device (magnifiers of any kind, reading glasses of any power, and any kind of electronic magnification) was prescribed and was used by the patient for self-help with the study task. Nonvisual techniques for identifying medication were not included in the study. The outcome measure was the ability to read unfamiliar standard labels on prescription medication bottles. Assessments of the use of prescribed medications and of sample medication bottles with standard labels that the patients had not previously used were performed during the initial low vision rehabilitation evaluation and before any devices were prescribed. Sample medication bottles with standard labels were used during testing when the patients' own medication bottles were not available. The patients were asked about the medications they take, the frequency and number of medications that they need to take, and the devices they use to identify the medications, if any. They were allowed to use their own reading devices, if any, for the initial evaluation. Additional sessions before discharge from the study were dedicated to dispensing devices and providing vision rehabilitation training. …