Low Vision Rehabilitation In Patients Research Articles

Effectiveness of Mp-3 Microperimetric Biofeedback Fixation Training for Low Vision Rehabilitation in Patients Treated with Corticosteroid IVT in Retinal Vein Occlusions [Letter]

Effectiveness of Mp-3 Microperimetric Biofeedback Fixation Training for Low Vision Rehabilitation in Patients Treated with Corticosteroid IVT in Retinal Vein Occlusions [Letter]

Effectiveness of Mp-3 Microperimetric Biofeedback Fixation Training For Low Vision Rehabilitation in Patients Treated With Corticosteroid Ivt in Retinal Vein Occlusions.

The success of fixation training using microperimetric biofeedback (MP-3 MBFT) in the realm of visual rehabilitation for patients with central vision loss caused by macular pathologies is well established. This study aimed to assess the effectiveness and safety of visual rehabilitation with microperimetric biofeedback in consolidating the benefits obtained, with the goal of reducing the need for repeated intravitreal injections (IVT). Specifically, the focus is on the eyes of patients with central vision loss treated with slow-release corticosteroid IVT following retinal venous thrombosis (RVO), aiming to enhance and maintain postoperative efficacy. This retrospective review involved the examination of 44 eyes affected by macular edema due to RVO associated with central vision loss. Patients were divided into two groups, with only one undergoing ten sessions of 10-minute visual rehabilitation with a microperimeter (MP-3 MBFT) after IVT over a period of 20 weeks. All the treated patients demonstrated good tolerance to the procedure, with no reported complications. A comparison of best-corrected visual acuity (BCVA), retinal sensitivity recorded with a microperimeter, and pre-IVT fixation stability revealed statistically significant improvements at the end of the first month after IVT. However, the treatment group continued to exhibit superior and more enduring results at four months post-IV. The synergistic use of MP-3 MBFT rehabilitation after IVT with slow-release corticosteroids has proven particularly effective in improving BCVA and long-term fixation stability. This led to a significant reduction in the number of required IVTs, with no related adverse events. The authors argue that biofeedback utilization represents a noninvasive therapeutic option devoid of contraindications and easy to implement and that it positively contributes to the overall patient experience regarding quality of life in advanced stages of macular diseases.

Efficacy of MP-3 microperimeter biofeedback fixation training for low vision rehabilitation in patients with maculopathy

BackgroundTo evaluate the efficacy of MP-3 microperimeter biofeedback fixation training (MBFT) in vision rehabilitation of low-vision patients affected by macular disease with central vision loss.MethodsSeventeen eyes (7 age-related macular degeneration, 10 myopic maculopathy) of 17 patients were included in this prospective, interventional study. The preferred retinal locus was determined by comprehensive ophthalmoscopic fundus evaluation including fundus photography, autofluorescence, optical coherence tomography, and microperimetry. The rehabilitation consisted of three 10-min sessions per eye to be performed twice per week for 20 consecutive weeks using the MP-3 microperimeter. Best corrected visual acuity (BCVA), reading speed, mean central sensitivity, the percentages of fixation points within specified regions, bivariate contour ellipse area (BCEA) and the 25-item National Eye Institute visual function questionnaire (NEI-VFQ-25) were recorded pre- and post-training.ResultsThe final BCVA, reading speed and mean central sensitivity all showed significant improvements after rehabilitation (P < 0.0001, P = 0.0013, and P = 0.0002, respectively). The percentages of fixation points located within 2° and 4° diameter circles both significantly increased after training (P = 0.0008 and P = 0.0007, respectively). The BCEA encompassing 68.2, 95.4, 99.6% of fixation points were all significantly decreased after training (P = 0.0038, P = 0.0022, and P = 0.0021, respectively). The NEI-VFQ-25 scores were significantly increased at the end of the rehabilitation training (P < 0.0001).ConclusionRehabilitation with MP-3 MBFT is a user-friendly therapeutic option for improving visual function, fixation stability, and quality of life in advanced macular disease.Trial registrationThe prospective study was registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn/). Trial Registration Number: ChiCTR2000029586. Date of registration: 05/02/2020.

A Common Approach and Low Vision Rehabilitation in Patients with Hereditary Retinal Diseases

The goal of low vision rehabilitation is to produce people who are independent, have an economically viable profession or skill, and are able to enjoy their lives. Patients with hereditary retinal dystrophies are candidates for low vision rehabilitation from the time of diagnosis, since their disease shows a progressive course, there is no proven precise treatment and the disease especially seriously affects the vision of individuals of school age and productive age. The stages of modern low vision rehabilitation include the intake interview, assessment of residual visual functions, assessment of residual functional vision, interventions and recommendations, and vision rehabilitation therapies.

Eccentric viewing training for low-vision rehabilitation in patients with central scotoma

Objective The aim was to evaluate the value of subjective eccentric viewing (EV) training in vision rehabilitation in patients with central scotoma. Background EV, also known as eccentric fixation, involves identifying a functioning area of the retina that has reasonable sensitivity, and is as close to the fovea as possible, and to learn to use it effectively, which is known as preferred retinal locus. Materials and Methods The direction of EV was monitored in 33 low-vision patients with bilateral central scotomas, the preferred retinal locus was identified, and the preserved visual field was found. The patients were divided randomly into two groups regarding their use of optical low-vision devices with EV training. After 2 months of training, changes in near and far best-corrected visual acuity (BCVA) and reading speed were evaluated. Results After 2 months of EV training, near BCVA and mean reading speed significantly improved. Regarding the use of low-vision devices, the group that used low-vision devices with EV training showed significant improvement in the near and far BCVA than the group that did not use low-vision device. Conclusion EV training can be used as a very effective method for low-vision rehabilitation in patients presented with central scotomas, and it can give very good results using simple and inexpensive equipment.

Refraction and Low Vision Rehabilitation in Patients with Oculocutaneous Albinism

Purpose: To evaluate the types of refractive errors and compliance of patients of Oculocutaneous Albinism (OCA) to low vision aids.&#x0D; Study Design: Descriptive observational study.&#x0D; Place and Duration of Study: Provincial Directorate of Health, Adana City Education and Research Hospital, from 2010 to 2018.&#x0D; Material and Methods: Seven hundred and fifteen patients attended the hospital between 2010 and 2018 with the complaint of low vision and 31 patients with OCA were included in this study by convenient sampling. Best corrected distance and near visual acuity (VA) was measured along with the complete ocular examination. Patients were classified according to low vision and refraction degrees. High degree near eyeglasses, Galilean and Keplerian telescopes, magnifiers and special filter glasses were used as low vision aids (LVA).&#x0D; Results: Mean age was 16.45 ± 12.72 years. On admission, mean distance VA was 0.12 ± 0.07 [mean log MAR 0.9], near VA was 1.48M ± 0.74M, astigmatism was 4.02 ± 1.45 diopters (D), and spherical equivalents were 1.54 ± 4.96 D. Hypermetropia was seen more frequently than myopia. Twenty-seven (87%) patients were prescribed telescopes for distance. Near visual acuity increased from 1.4M ± 0.7M to 0.9M ± 0.4M after rehabilitation. There was an increase in distance visual acuity in all patients (p &lt; 0.001). Seventeen (63%) patients bought the telescope, and 15 (55%) patients used the device. The most preferred special filter glasses were 450nm (39%) and 540 nm (25%).&#x0D; Conclusion: Astigmatism in oculocutaneous albinism was with the rule and the most commonly detected refractive error was hypermetropia. Patients are non-compliant in buying telescopes in which case tablet and computers with special applications for low vision can be better options.

Eccentric viewing training for low-vision rehabilitation in patients with central scotoma

Background Eccentric viewing (EV), also known as eccentric fixation, involves identifying a functioning area of the retina that is as close to the fovea as possible and to learn to use it effectively, which is known as the preferred retinal locus. Objective The aim of this study was to evaluate the value of subjective EV training in vision rehabilitation in patients with central scotoma. Patients and methods The direction of EV was monitored in 33 low-vision patients with bilateral central scotomas. The preferred retinal locus was identified, and the preserved visual field was found. The patients were divided randomly into two groups regarding their use of optical low-vision devices with EV training. After 2 months of training, changes in near and far best-corrected visual acuity (BCVA) and reading speed were evaluated. Results After 2 months of EV training, the near BCVA and mean reading speed significantly improved, whereas the far BCVA did not significantly improve (0.1 LogMar on average). The mean near BCVA improved from 0.97±0.19 to 0.63±0.26 LogMar (P Conclusion EV training can be used as a very effective method for low-vision rehabilitation in patients presenting with central scotomas. It can give very good results by using simple and inexpensive equipment.

Exploring the Role of Telemedicine in Low Vision Rehabilitation in Patients with Heredomacular Degeneration – A Novel Concept

Background Teleophthalmology is widely used for screening and diagnosis of many eye disorders. But its role in low vision rehabilitation is unexplored. The purpose of this study was to explore the feasibility of teleophthalmology for visual rehabilitation. Methods We prospectively enrolled 15 patients (age range 12-30 years, mean 16±3.2 years) with heredomacular degeneration with reduced central vision but healthy paracentral retina. We used visual stimulation and biofeedback with video game play. After the baseline investigations, the patients were given a compact disc with the video game and were trained to play the game. Subsequently, they did 40 hours of the visual training at home which was monitored using teleophthalmology by us at our tertiary institute. We used video chat and screen sharing software to guide the patients and monitor compliance. The primary outcome was feasibility of monitoring visual training remotely and secondary outcome was improvement in visual function. Results Seven patients returned for follow up after completing the training. The visual acuity improved from 0.74±0.29 to 0.66±0.32 logMAR (p=0.043). There was significant improvement in contrast sensitivity (p=0.023) and fixation stability (p=0.018). The vision related quality of life questionnaire showed improved scores. The ease of communication, patient comfort were high. The office visits were limited to two. Conclusions Our study showed preliminary evidence of benefit of teleophthalmology in visual rehabilitation and monitoring. The reduced visits would likely promote compliance and reduce economic burden of the rehabilitatory training.

Low Vision Rehabilitation in Patients with Hereditary Retinal Dystrophy

Low Vision Rehabilitation in Patients with Hereditary Retinal Dystrophy

Low Vision Depression Prevention Trial in Age-Related Macular Degeneration: A Randomized Clinical Trial

To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD). Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months. Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188). Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Questionnaire-9 (primary outcome), Activities Inventory, National Eye Institute Vision Function Questionnaire-25 plus Supplement (NEI-VFQ), and NEI-VFQ quality of life (secondary outcomes). At 4 months, 11 BA+LVR subjects (12.6%) and 18 ST+LVR subjects (23.4%) developed a depressive disorder (relative risk [RR], 0.54; 95% CI, 0.27-1.06; P = 0.067). In planned adjusted analyses the RR was 0.51 (95% CI, 0.27-0.98; P = 0.04). A mediational analysis suggested that BA+LVR prevented depression to the extent that it enabled subjects to remain socially engaged. In addition, BA+LVR was associated with greater improvements in functional vision than ST+LVR, although there was no significant between-group difference. There was no significant change or between-group difference in quality of life. An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to standard outpatient LVR in patients with AMD. As the population ages, the number of persons with AMD and the adverse effects of comorbid depression will increase. Promoting interactions between ophthalmology, optometry, rehabilitation, psychiatry, and behavioral psychology may prevent depression in this population.

Vision Rehabilitation in Patients with Age-related Macular Degeneration

Background The aim of this study was to investigate the rehabilitative process and visual rehabilitation outcomes in patients with central vision loss due to age-related macular degeneration (AMD). Methods Ninety-five subjects with AMD selected from the attendees of the National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients—International Agency for Prevention of Blindness—IAPB Italia Onlus, were evaluated for this retrospective study. Low vision examination included psychological counseling, best corrected visual acuity (BCVA), near visual acuity, Pelli-Robson contrast sensitivity, and fixation stability analysis. Once the clinical assessment was completed, patients attended a low-vision rehabilitative pathway based on visual stimulation, devices training and, if needed, psychological support. Required magnification and reading speed were also evaluated. Results For the whole sample, the mean BCVA of the better eye was 0.7 (±0.2) LogMAR and of the worse eye was 1 (±0.2) LogMAR. Restoring reading ability was the most important focus for the patients examined as it was requested by 85% of the whole sample. Mean power of optical magnifying aids for near activities was 10.6 (±9.1) positive spherical diopters. Mean reading speed for the whole sample was 33.1 (±18.2) words per minute (wpm) before visual rehabilitation sessions and increased to 55.2 (±33.1) wpm after visual rehabilitation path. To cope with distance difficulties, 78 distance refractive correction, 10 Galilean telescopes, and 7 Keplerian telescopes were prescribed. For intermediate distance activities, 22 compensation lenses and 10 Galilean telescopes were suggested. Moreover, PC magnifier softwares were prescribed to nine patients. Sixty-five polarized medical filters were prescribed to reduce glare of sunlight. Because of unstable fixation in their better eye (32.3% (±19.7) within 2° circle and 54.8% (±22.9) within 4° circle) and visual acuity &lt; 1.2 LogMAR in the fellow eye, 38 subjects, before starting the devices training sessions, attended a bio-feedback rehabilitation session with flickering pattern stimulus. In these subjects, fixation stability increased significantly to 75.6 (±14.9) within 2° and 89.4 (±19.5) within 4° ( P &lt; 0.05), respectively. Conclusions Attending a customized low-vision intervention based on a multidisciplinary approach seems to be effective for improving visual functions in AMD. Both optical/electronic magnifiers and specific visual stimulation program can enhance visual performances.

A Study of Eccentric Viewing Training for Low Vision Rehabilitation

PurposeThe definition of eccentric viewing (EV) is using non-foveal preferred retinal loci (PRL) for viewing. The purpose of the present study was to investigate the clinical effect of EV training for low vision rehabilitation in patients with central scotomas.MethodsThe direction of EV was monitored in 30 low vision patients with central scotomas by moving the patient's view. The PRL was found by using a direct ophthalmoscope and retinal camera; the preserved visual field was identified using a kinetic visual field analyzer. The relationships between EV, PRL, and visual field were evaluated. The patients and their guardians were educated regarding EV. After 2 weeks of self-training, maintenance of EV was checked and changes in best-corrected visual acuity (BCVA), reading speed, and satisfaction questionnaire were evaluated.ResultsA relationship between EV, PRL, and visual field was in accordance in half of the patients. There were no significant differences in demographics and basic visual characteristics in patients where the relationship was not in accordance. EV was maintained in two-thirds of the patients, but there were no significant differences in demographics and basic visual characteristics in patients who discontinued EV. There were no significant improvements in BCVA; however, reading speed and the satisfaction scores increased significantly with EV.ConclusionsThe direction of EV was effectively detected by convenient access using an inexpensive method. Functional vision and satisfaction significantly improved following EV training. EV training can be used as an effective method for low vision rehabilitation in patients with central scotomas.

A review of rehabilitation of low vision patients

It hasbeen estimated that in 2002, there were about 124 million people worldwide who had low vision1. These people have best visual acuity (VA) ranging from worse than 6/18 but equal or betterthan 3/60 in the better eye after treatment and or standard refraction. In terms of visual field (VF), they have VF loss of less than 20 degrees in the better eye with best possible correction2. Low vision may result from congenital or acquired diseases, trauma, uncorrected refractive error or other ocular disorders. Although such people may beamenable to medical or surgical interventions, they may be assisted to maximize their remaining vision by using optical, non-optical or electronic devices or combinations of these. Illumination control or environmental modifications may also assist. As a result of the low vision, the patient may have social, psychological, economic and other related problems which need to be addressed along withthe visual problems. For effective rehabilitation of the low vision patient therefore, a multidisciplinaryteam approach needs to be employed. In this approach, professionals from a number of disciplinesare independently involved in the assessment and management of the patient. The purpose of this review article is to highlight the importance of a multidisciplinary approach to low vision rehabilitation, the various professionals and their roles that may be involved in the rehabilitation of the low vision patient. This article will increase knowledge of rehabilitation of patients with low vision and may improve the services offered to such patients.

Low-Vision Rehabilitation in Patients with Visual and Cognitive Impairment

Purpose: To evaluate the prevalence of cognitive impairment among patients at a low-vision clinic and to determine whether low-vision rehabilitation (LVR) strategies improve visual function in these patients. Methods: We studied 50 consecutive patients presenting to a low-vision clinic. Folstein's Mini-Mental State Examination (MMSE) was administered to screen for cognitive impairment. During the low-vision examination, visual acuity was measured with and without the use of optical low-vision aids. The percentage visual acuity improvement with the use of low-vision aids was calculated for each patient. Results: Of the 50 patients examined, 16 (32%) had an MMSE score less than 24. Of these 16 patients, 14 (87.5%) experienced an improvement in visual acuity using low-vision devices. The visual acuity improvement with low-vision aids was statistically significant (p < 0.0001). Five of the 50 (10%) patients had MMSE scores less than 21. All five of these patients had improved visual acuity and function with l...

Low vision rehabilitation in patients with age‐related macular degeneration at a tertiary eye care centre in southern India

To evaluate the specific needs and types of low vision devices (LVDs) in patients with age-related macular degeneration (AMD) so as to use the residual vision effectively. One hundred consecutive patients with diagnosis of AMD were evaluated to ascertain the degree of visual disability. Different LVDs were used to suit the specific needs of individual patients. The distribution of LVDs for distance and near and other rehabilitation measures were stratified for vision >or=6/18 and <6/18. Statistical analysis was performed using chi2 test/Fisher's exact test and paired t-test. The percentage of patients with visual acuity <6/18 reduced from 72.2% (26/36) to 47.2% (17/36) with the use of standard spectacles (P = 0.03). Similarly, the percentage of patients with visual acuity <6/18 reduced from 85.7% (6/7) to 14.3% (1/7) with the use of a telescope (P = 0.029). The optical devices for near tasks included spectacle magnifiers (n = 59), stand magnifiers (n = 19), and hand magnifiers (n = 18). With these LVDs, the near vision improved from 0.13 (decimal notations) to 0.39 (P < 0.001). Eighty-six patients were given at least one of the LVDs and 20% were prescribed more than one near device (bifocals, spectacle magnifiers, hand magnifiers, stand magnifiers). Additionally, patients also needed counselling (n = 89) and training on eccentric viewing (n = 39), coin identification (n = 45), and independent mobility (n = 41). The overall management of a patient with AMD must include counselling, prescription of appropriate LVDs and training to utilize the residual vision to its fullest advantage. This is expected to improve the patient's quality of life.

Ophthalmological rehabilitation - experience at the University Eye Hospital Heidelberg

The rehabilitation of low vision patients is of increasing importance since the number of these patients has grown rapidly. We wanted to evaluate the actual spectrum of patients concerning age and diagnoses and the appropriate low vision aids (LVA) in 1 year. The records of the patients seen in our low-vision unit in 1996 were retrospectively evaluated. We correlated visual function, ophthalmological diagnoses and age to the magnification needed for rehabilitation and the use or prescribed LVAs. There was a nearly homogeneous distribution concerning age with a range from 0 to 99 years. Most patients presented with age-related macular degeneration (25.6 %) while 10 % each had retinitis pigmentosa and optic atrophy. Simple low vision aids such as high plus reading additions (29 %) and magnifiers (18.5 %) were prescribed in the majority of patients. However, closed-circuit TV (CCTV) systems were necessary in 25 %. Rehabilitation of low vision patients is often possible with simple LVAs. This is especially true for patients suffering from age-related macular degeneration. Since there is a tremendous-amount of different diseases, adequate diagnostic and individual counseling is of major importance.