Low Vision Rehabilitation Centers Research Articles

Retrospective analysis of low vision assistive products - A 6-year review.

The purpose of the study was to analyze the demographics, visual acuity (VA), etiologies, recommended low vision assistive products (LVAP), and the acceptance rates of LVAP in various age groups. This was a long-term retrospective review of all the patients presenting to the low vision clinic of our tertiary eye care hospital from January 2011 to December 2016. Data obtained included age, gender, VA, visual fields, ocular pathology causing the low vision, and types of LVAP advised. The primary outcome was to analyze the type of LVAP prescribed in different age groups, and the secondary outcome was the acceptance rate of LVAP. We analyzed the results of 8309 patients, out of which 2844 (34%. 2) were <15 years of age, 2425 (29.5%) were between 16-40 years, and 3013 (36.3%) were above 40 years. A total of 5522 (66.4%) had best-corrected visual acuity (BCVA) ranging from 6/18-3/60, and 2796 (33.6%) had BCVA from 3/60-No PL. Approximately 38% improved with LVAPs. The most common etiology was retinitis pigmentosa in 1545 (18.6%) patients, followed by congenital nystagmus in 1482 (17.8%), and the least was albinism 383 (4.6%). Maximum prescribed and accepted LVAP were hand and stand magnifiers among 1017 (44.3%) and 512 (52.6%) patients, respectively. Products that are easy to use, require lesser adaptability, are cheap, and require lower maintenance have maximum acceptance rates. We suggest that great emphasis should be laid on training, education, and guidance for low vision rehabilitation centers.

Vision rehabilitation in elderly patients aged 80 years or over: Epidemiological profile and prescription of optical, nonoptical, and electronic devices

Purpose: The purpose of this study is to investigate the epidemiological profile and prescription of optical, nonoptical, and electronic devices in the elderly aged 80 years or older, in a low-vision rehabilitation center in Belo Horizonte, Brazil. Methods: This is a retrospective, observational, descriptive study held in a low-vision rehabilitation center in Belo Horizonte, from 1992 to 2016. A total of 448 medical records were analyzed and 375 (83.7%) were included. Age, gender, occupation, diagnosis, ocular and systemic diseases associated, best-corrected visual acuity, refractive error, goal to be achieved, optical, nonoptical, and electronic devices, and visual hallucination were considered. Results: Of the 375 medical record evaluated, 310 (82.6%) cases were of patients aged 80–89 years old, 218 cases (58.1%) were female and 262 cases (69.8%) were of retired patients. The age-related macular degeneration was the most prevalent disease, 296 (78.9%), followed by glaucoma in 31 patients (8.2%) and diabetic retinopathy in 9 (2.4%). Low myopia was the most prevalent refractive error, present in 148 (39.4%). A severe visual loss occurred in 145 patients (38.6%) while reading was the main goal, with 339 cases (90.4%). Optical and/or electronic devices were prescribed to 361 patients (96.2%), in a total of 418 optical and 66 electronic devices. Among the electronic devices, video magnifiers (CCTV) were indicated for 37 patients (9.8%) and handheld electronic magnifiers for 29 patients (7.7%). Visual hallucinations were reported in 11 cases (2.9%). Conclusions: This study shows that vision rehabilitation is possible in the elderly.

Psychometric evaluation of a new proxy-instrument to assess participation in children aged 3-6 years with visual impairment: PAI-CY 3-6.

PurposeThe Participation and Activity Inventory for Children and Youth 3–6 years (PAI‐CY 3‐6) was recently developed to assess the participation needs of children with visual impairment (VI) by means of parent‐proxy report. This study reports on its psychometric properties.MethodsParents of children aged 3–6 years registered at two low vision rehabilitation centers in the Netherlands were invited to participate and completed the 52‐item PAI‐CY. Satisfaction with the PAI‐CY 3‐6 was determined using an evaluation form. Basic item analyses was conducted, after which an item response theory (IRT) model (i.e. the graded response model, GRM) was fitted. Deletion of items was informed by results of item analyses, fulfillment of IRT assumptions, differential item functioning, fit to the GRM and item information content. Face and content validity were considered; professionals from low vision rehabilitation centers were asked for their opinion in the item deletion process. After obtaining a satisfactory set of items, known‐group validity, concurrent validity and test‐retest reliability were also investigated.ResultsData of 237 parents were included in the analyses. Various aspects of the PAI‐CY 3‐6 were perceived as neutral to positive by over 85% of the respondents. After removing 17 items, the remaining 35 items reflected satisfactory fit to the GRM. Known‐group validity was supported, since participants with more severe VI and comorbidity scored significantly worse than those with less severe VI and without comorbidity after correcting for potential confounders. Test‐retest reliability was adequate, and the PAI‐CY showed to have good concurrent validity. Feedback from professionals motivated the maintenance of 3 of the 17 deleted items, although not included in the scoring. Furthermore, two new items were added, resulting in a 40‐item instrument.ConclusionsThe PAI‐CY 3‐6 has sound psychometric properties and can now be used to assess the participation needs of children aged 3–6 years with VI by means of proxy. Implementation in routine low vision rehabilitation care enables further optimization and investigation of its acceptability and feasibility.

Psychometric properties of a new intake questionnaire for visually impaired young adults: The Participation and Activity Inventory for Young Adults (PAI-YA).

BackgroundTo be able to identify and monitor personal needs and goals of visually impaired young adults before and during rehabilitation trajectories, the Participation and Activity for Young Adults (PAI-YA) was developed involving young adults (18–25 years) and professionals as stakeholders. The psychometric properties of this new patient-reported outcome measure were investigated in order to develop an improved version.MethodsYoung adults registered at two low vision rehabilitation centers in the Netherlands were invited to complete the 141-item PAI-YA (n = 186) in a test-retest design. To select the best items for the PAI-YA, response frequencies were assessed and a graded response model (GRM) was fitted. Item reduction was informed by response frequencies, insufficient item information, and participants’ comments. Fit indices, item and person (theta) parameters were computed, after which known-group validity, concurrent validity, test-retest reliability and feasibility were studied.ResultsResponse frequencies, violation of assumptions and item information informed the elimination of 81 items, resulting in a unidimensional PAI-YA showing satisfactory fit to the GRM. Known-group validity showed significant differences for visual impairment, financial situation, sex, educational situation and employment situation. Concurrent validity with (scales of) other questionnaires showed moderate to strong expected correlations. Test-retest reliability was satisfactory for all items (kappa 0.47–0.87), as was agreement (63.1–92.0%). Four items and one response option were added to increase feasibility.ConclusionsThis study contributes to the development and assessment of psychometric properties of the PAI-YA, which resulted in an improved 64-item version. Evidence was provided for construct validity, known-group validity, concurrent validity and test-retest reliability. These results are an important step in the development of a feasible instrument to investigate and monitor rehabilitation needs of visually impaired young adults, to structure the intake procedure at low vision rehabilitation services and to evaluate the effectiveness of rehabilitation.

Ocular morbidity patterns among children in schools for the blind in Chennai.

Purpose:To identify the morbidity patterns causing blindness in children attending schools for the blind in Chennai and comparing our data with similar studies done previously.Methods:A cross-sectional prevalence study was carried out in two schools for the blind in Chennai. Blind schools were visited by a team of ophthalmologists and optometrists. Students with best-corrected visual acuity (BCVA) worse than 3/60 in the better eye were included and relevant history was noted. Every student underwent anterior segment evaluation and detailed fundus examination. Morbidity of the better eye was taken as cause of blindness. Health records maintained by the school were referred to wherever available.Results:The anatomical causes of blindness include optic nerve disorders in 75 (24.8%) cases, retinal disorders in 55 (18.2%), corneal disorders in 47 (15.6%), lens-related disorders in 39 (12.9%), congenital anomalies in 11 (3.6%), and congenital glaucoma in 20 (6.6%) cases. The whole globe was involved in six cases (1.99%). Among conditions causing blindness, optic atrophy seen in 73 (24.17%) cases was the most common, followed by retinal dystrophy in 44 (14.56%), corneal scarring in 35 (11.59%), cataract in 22 (7.28%), and congenital glaucoma in 20 (6.6%) cases.Conclusion:It was found that avoidable causes of blindness were seen in 31% of cases and incurable causes in 45%. Optic nerve atrophy and retinal dystrophy are the emerging causes of blindness, underlining the need for genetic counseling and low vision rehabilitation centers, along with a targeted approach for avoidable causes of blindness.

Depression in Visual Impairment Trial (DEPVIT): A Randomized Clinical Trial of Depression Treatments in People With Low Vision.

The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms. This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory. At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London. Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.

Prevalence and Genetics of Leber Hereditary Optic Neuropathy in the Danish Population.

In Denmark, the occurrence of Leber hereditary optic neuropathy (LHON) has continuously been monitored since 1944. We provide here a summary of 70 years of data collection including registered lines and subjects by the end of 2012. Affected individuals were identified from a national register of hereditary eye diseases at the National Eye Clinic (NEC), a tertiary low vision rehabilitation center for the entire Danish population. The assembling of LHON pedigrees was based on the reconstruction of published families and newly diagnosed cases from 1980 to 2012 identified in the files of NEC. Genealogic follow-up on the maternal ancestry of all affected individuals was performed to identify a possible relation to an already known maternal line. A full genotypic characterization of the nation-based LHON cohort is provided. Forty different lines were identified. The number of live affected individuals with a verified mitochondrial DNA mutation was 104 on January 1, 2013, which translates to a prevalence rate of 1:54,000 in the Danish population. Haplogroup distribution as well as mutational spectrum of the Danish LHON cohort do not deviate from those of other European populations. The genealogic follow-up reveals a relatively high turnover among families with approximately 15 newly affected families per century and the dying out of earlier maternal lines.

Validation of a Reading Assessment for Persons With Homonymous Hemianopia or Quadrantanopia

ObjectiveTo preliminarily validate the Visual Skills for Reading Test (VSRT) for assessing reading performance in persons with homonymous hemianopia (HH) or quadrantanopia. DesignRetrospective chart review. SettingUniversity-based outpatient low vision rehabilitation center. ParticipantsPersons (N=38) with HH or quadrantanopia who completed the VSRT. InterventionsValidation procedures included testing for equivalence of the 3 test versions, estimation of internal consistency reliability, and known-group comparison using VSRT results from previous studies of adults with normal vision and central field loss. Main Outcome MeasuresCorrected reading rate, reading accuracy rate, type and number of reading errors, and completion time were recorded and evaluated. ResultsCronbach α for the VSRT across all participants was .80, which indicated good internal consistency. A known-group comparison showed that persons with a visual field deficit read significantly slower than did normally sighted adults (t580=10.13; P<.0001). Persons with quadrantanopia read significantly faster than did persons with HH (t36=2.25; P=.03) or those with central field loss (t48=3.17; P=.0027). These findings confirmed that the VSRT correctly discriminated between groups in terms of reading performance. ConclusionsPreliminary validation results indicate that the VSRT demonstrates adequate evidence of reliability and validity to evaluate reading performance in adults with HH or quadrantanopia.

Effects of a Dual Sensory Loss Protocol on Hearing Aid Outcomes: A Randomized Controlled Trial.

Dual sensory loss (DSL; concurrent vision and hearing loss) negatively affects quality of life. As speechreading is hampered, use of hearing aids (HAs) is important for older adults with DSL. However, due to vision loss, use of small and complex HAs is assumed to be difficult. An integrative DSL protocol that addresses rehabilitative care for older adults with DSL, including proper HA use, was implemented in low vision rehabilitation centers. The present study aims to evaluate the effectiveness of the DSL protocol among HA owners on HA outcomes (i.e., HA use, benefit, satisfaction with HAs, and hearing with HAs). In a randomized controlled trial, the DSL protocol was compared to a waiting list control group among clients (aged ≥50 years) of low vision rehabilitation centers with DSL. The International Outcome Inventory for Hearing Aids (IOI-HA) and the HA Fitting Questionnaire (HAFQ) were administered at baseline and 3 months follow-up. Participants (n = 128) were randomly allocated to either the intervention (n = 63) or control group (n = 65). Intention-to-treat analyses showed a near significant effect on IOI-HA Residual problems (effect size, 0.35; p = 0.063). Per-protocol analyses showed similar (nonsignificant) results on the main outcomes, and a ceiling effect was found on the HAFQ. Significant effects were found in subgroups of patients: among patients with low HAFQ scores (HAFQ-Use: effect size = 0.56, p = 0.046; HAFQ-Hearing with HAs: effect size = 0.64, p = 0.019), male participants (effect size = 0.80; p = 0.003), and those with moderate hearing loss (effect size = 0.72; p = 0.028), significantly better IOI-HA scores were found in the intervention group at 3 months follow-up. Although the per-protocol and subgroup analyses need to be interpreted with caution, DSL patients who experience HA difficulties could benefit from the DSL protocol by making better use of their HAs. The increasing prevalence and impact of DSL on a person's independence and social participation call for more awareness of concurrent sensory impairments in both low vision and audiology rehabilitation. Interdisciplinary training for rehabilitation professionals could be an important step, followed by integration of vision and hearing services using the DSL protocol.

Major depressive and anxiety disorders in visually impaired older adults.

We assessed the prevalence of subthreshold depression and anxiety, and major depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and general anxiety disorder) in visually impaired older adults and compared these estimates with those of normally sighted peers. Cross-sectional data were analyzed based on telephone interviews with visually impaired older adults aged ≥ 60 years (n = 615) with a visual acuity of ≥ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face interviews with community-dwelling normally sighted peers (n = 1232). To determine prevalence rates, the normally sighted population was weighted on sex and age to fit the visually impaired population. Logistic regression analyses were used to compare the populations and to correct for confounders. The prevalence of major depressive disorder (5.4%) and anxiety disorders (7.5%), as well as the prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%), were significantly higher in visually impaired older adults compared to their normally sighted peers (P < 0.05). Agoraphobia and social phobia were the most prevalent anxiety disorders in visually impaired older adults. This study shows that depression and anxiety are major public health problems in visually impaired older adults. Research on psychotherapeutic and psychopharmacologic interventions to improve depression and anxiety in this population is warranted. (http://www.trialregister.nl number, NTR3296.).

Dual sensory loss: A major age‐related increase of comorbid hearing loss and hearing aid ownership in visually impaired adults

Despite increasing interest in visual and hearing impairment in the older population, little attention has been paid to concurrent hearing and vision loss, also known as dual sensory loss. The aim of the present study was to investigate the prevalence of comorbid hearing disability and hearing aid ownership in visually impaired older adults. In a cross-sectional survey, a self-report hearing disability screener was administered to 1396 visually impaired patients (aged ≥ 50 years) of outpatient low vision rehabilitation centers in the Netherlands and Belgium. Of all participants, 44.8% (95% CI 42.2-47.5) had insufficient or poor hearing; the prevalence increased quadratically with age. Of all dual sensory impaired participants, 31.2% in the Netherlands and 55.7% in Belgium did not own hearing aids. The high prevalence of dual sensory loss calls for more awareness of related problems in these patients. Differences between the Netherlands and Belgium regarding hearing aid ownership might be due to different criteria used for hearing aid referral and insurance policies. For patients with dual sensory loss, specialized care implemented in low vision rehabilitation seems warranted.

Dual sensory loss: development of a dual sensory loss protocol and design of a randomized controlled trial

BackgroundDual sensory loss (DSL) has a negative impact on health and wellbeing and its prevalence is expected to increase due to demographic aging. However, specialized care or rehabilitation programs for DSL are scarce. Until now, low vision rehabilitation does not sufficiently target concurrent impairments in vision and hearing. This study aims to 1) develop a DSL protocol (for occupational therapists working in low vision rehabilitation) which focuses on optimal use of the senses and teaches DSL patients and their communication partners to use effective communication strategies, and 2) describe the multicenter parallel randomized controlled trial (RCT) designed to test the effectiveness and cost-effectiveness of the DSL protocol.Methods/designTo develop a DSL protocol, literature was reviewed and content was discussed with professionals in eye/ear care (interviews/focus groups) and DSL patients (interviews). A pilot study was conducted to test and confirm the DSL protocol. In addition, a two-armed international multi-center RCT will evaluate the effectiveness and cost-effectiveness of the DSL protocol compared to waiting list controls, in 124 patients in low vision rehabilitation centers in the Netherlands and Belgium.DiscussionThis study provides a treatment protocol for rehabilitation of DSL within low vision rehabilitation, which aims to be a valuable addition to the general low vision rehabilitation care.Trial registrationNetherlands Trial Register (NTR) identifier: NTR2843

The Effectiveness of a Multi-Disciplinary Group Rehabilitation Program on the Psychosocial Functioning of Elderly People who are Visually Impaired

Introduction The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods The single-group pretest–posttest pilot study included 29 persons with visual impairments (aged 55 and older) who were referred to a low-vision rehabilitation center. The VIPP intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counseling, and training in problem-solving skills; individual and group goal setting; and a home-based exercise program). Psychosocial adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling were used as indicators of psychosocial functioning and were assessed at the baseline, halfway, immediately after completion of the intervention, and at the six-month follow-up. Results Directly after the intervention, the participants’ adaptation to vision loss (ES = 0.57), self-efficacy (ES = 0.50), and mental health (ES = 0.39) improved compared to the baseline. Moreover, helplessness and a generic and vision-specific fear of falling decreased (ES = 0.26, ES = 0.20, and ES = 0.24, respectively). The six-month follow-up measure indicated improved adaptation to vision loss (ES = 0.54), a lesser feeling of helplessness (ES = 0.53), better mental health (ES = 0.22), and a lesser vision-specific fear of falling (ES = 0.27). In contrast, a decrease in self-efficacy (ES = 0.14) and an increase in the generic fear of falling (ES = 0.18) were found. Discussion The tentative conclusion of this small-scale pilot study is that the VIPP program benefits psychosocial functioning in both the short and long term. Implications for practitioners The study showed that low-vision rehabilitation centers could implement multidisciplinary group rehabilitation programs, such as VIPP, to improve the psychosocial functioning of elderly people who are visually impaired.

Randomized Controlled Trial on the Effects of Training in the Use of Closed-Circuit Television on Reading Performance

To investigate the effectiveness of training in the use of closed-circuit television (CCTV) on reading performance in visually impaired patients. In a multicenter masked randomized controlled trial, 122 patients were randomized either to a treatment group that received usual delivery instructions from the CCTV supplier combined with concise outpatient standardized training, or to a control group that received delivery instructions only. The main outcome measure was reading performance, which was obtained by measuring reading acuity, reading speed, reading errors, column-tracking time, and technical reading, approximately two weeks after patients had received their CCTV and 3 months later. Videotapes of all measurements were rated by two investigators. Training effects were analyzed with linear mixed modeling. There were no statistically significant differences in results between the treatment and control group. However, introducing a CCTV increased reading acuity (mean difference [MD] 0.93 logRAD; P < 0.01) and maximum reading speed (MD 15 wpm; P < 0.01), and decreased the number of errors (MD 0.33; P = 0.04), compared to reading without CCTV. Average reading speed (P = 0.05), number of errors (P = 0.04), and column-tracking time (P = 0.01) improved over time. Prescribing a CCTV and the delivery instructions by the supplier seemed sufficient to improve reading performance. Additional training in the use of this device did not result in further improvement. Based on these results, outpatient low-vision rehabilitation centers may consider reallocating part of the training resources into other evidence-based rehabilitation programs. (trialregister.nl number, NTR1031.).

Determinants of social participation of visually impaired older adults.

PurposeTo assess determinants of social participation among visually impaired older adults.MethodsThis cross-sectional study included visually impaired persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation center. Determinants (i.e., sociodemographic, physical, social and psychological factors, and personal values) of participation were identified in four domains of participation: (1) domestic life; (2) interpersonal interactions and relationships; (3) major life areas; and (4) community, social, and civic life. Study participants completed telephone interviews.ResultsAge, physical fitness, and helplessness were determinants of participation in domestic life. Social network size was associated with participation in major life areas. The personal value attached to participation (i.e., perceived importance) was a determinant of participation in interpersonal interactions and relationships, major life areas, and community, social and civic life. Vision-related characteristics (i.e., self-perceived vision and degree of visual impairment) were not associated with participation.ConclusionsAcross the participation domains, perceived importance is a major determinant of social participation among visually impaired older adults. Physical health along with social and psychological status, also affect participation. Knowing how participation is determined can be used to develop rehabilitation interventions to enhance participation of visually impaired older adults.

La mise en place de zone rétinienne préférentielle. Partie II : Quand ? Où ? Pourquoi s’installe-t-elle ?

The mechanisms underlying the localization of the preferred retinal locus (PRL) for visually impaired people has brought raised a number of hypotheses. In Part 1 we dissociated localizing the PRL from reading and writing tasks. Part 2 presents new hypotheses. and methods: This study was conducted on 100 partially sighted people consulting at our low-vision rehabilitation center. The technique used compares angiofluorographies with images recorded with the scanning laser ophthalmoscope during fixation tasks. It localizes the PRL with respect to the fovea. The PRL position was related to the size of the scotoma and the patient's visual damage. When there was only slight damage, the PRL was located on the left side or possibly in the superior position. When it worsened, the right position was significantly dominant; when it was severe, the PRL was generally located in the superior position or on the right. These positions were nearly always available for a given person. The new visual message must be integrated into the most suitable cerebral locations for low spatial frequencies, damaged forms, messages transmitted by retinal rods, and finally global visual perception. It must favor the peri-personal space and near vision. These elements correspond to the new visual surroundings of the visually impaired. We believe that these data are better processed if they are transmitted by the lower and left visual fields. The rehabilitation program must take into account the above considerations. If the vision therapist orients the PRL location using eccentric view training or by having the patient wear a prism, he must keep in mind that the partially sighted's activities of daily life are the most important. At first, the superior side position, which leaves the field open to a maximum of visual tasks, must be trained, followed by the right position. Of course, when this localization has already been achieved, it must be respected.