Research Reports: Knowledge and use of Low Vision Services among Persons with Age-related Macular Degeneration

Abstract

Visual impairment (blindness or low vision) is a leading cause of disability among older adults and is most often due to age-related macular degeneration (AMD). The prevalence of AMD is rapidly increasing with the aging of the population; from 1991 to 1997, it increased from 5.0% to 27.1% in a cohort of Medicare beneficiaries (Crews, 1991; Lee, Feldman, Ostermann, Brown, & Sloan, 2003). It is predicted that 2.95 million people will have AMD by 2020 (Eye Diseases Prevalence Research Group, 2004). Compared to older people with typical vision, those with AMD report greater difficulty with a variety of daily activities (Williams, Brody, Thomas, Kaplan, & Brown, 1998). For example, in a community sample of 872 older people, those with AMD were 9.7 times more likely to have impairments in instrumental activities of daily living (such as taking medication and shopping) than were people with typical vision (Rovner & Ganguli, 1998). Unfortunately, there is no cure for AMD, nor can lost vision be restored. Although there are interventions to slow the progression of the condition, treatment is primarily rehabilitative. Services for people with low vision include low vision rehabilitation, occupational therapy, social support programs, and orientation and mobility training. Assistive devices include magnifiers, large-print materials (such as books, clocks, and calculators), audio materials (such as books and magazines), electronic reading devices, and speech-output systems. Despite the availability of these rehabilitative services and devices, they are underutilized. A series of focus groups that were conducted by the National Eye Institute (NEI) indicated that many older persons with low vision have little or no awareness of these services, and, as a consequence, few take advantage of them (National Eye Institute, 2001). Similar findings were reported in the Lighthouse National Survey on Vision Loss (Lighthouse International, 1995). Among adults with low vision, only 30% were using optical devices, 21% were using large-print reading materials, and 6% received rehabilitation. The most common reason for the lack of utilization of low vision devices and services was the participants’ unawareness of them. Ophthalmologists may not be informing and educating their patients about these resources. Some studies have reported that ophthalmologists refer only 28%–35% of appropriate patients to low vision rehabilitation services (Greenblat, 1988). Leinhaas and Massof (2001) found that only 15% of ophthalmologists and 21% of optometrists “always or often” prescribed low vision devices, and only 44% of ophthalmologists and 27% of optometrists “always or often” referred patients for low vision services. The goal of the current study was to obtain more detailed information on the use of low vision services and devices by older adults with AMD and to determine whether knowledge and use of such services are related to the severity of vision loss.