Low Vision Rehabilitation Program Research Articles

Low vision rehabilitation program in patients with myopic macular degeneration: A case series

Aims/Purpose: Patients with pathologic myopia are at risk of developing myopic macular degeneration (MMD) that leads to vision loss and irreversible visual impairment. Working age and elderly populations are affected by loss of productivity and quality of life. Low vision services should offer specialized training programs to help patients to overcome the difficulties in daily living activities. The aim of this study was to describe the results of a low vision rehabilitation program (LVR) in patients with MMD.Methods: Five patients (8 eyes) with MMD were included in the LVR at an ophthalmology clinic in Portugal. The LVR had a length of 8 weeks and was divided into two phases. The first phase included the use of prisms for image relocation (IR) with eccentric viewing exercises to stabilize the preferred retinal locus. At the second phase, training with low vision aids was performed. Best corrected visual acuity (BCVA) for distance and near, contrast sensitivity (CS), reading speed (RS) and face recognition were compared pre and post rehabilitation.Results: Patients had MMD category 3 (patchy chorioretinal atrophy) and 4 (macular atrophy) in the best eye. Vision impairment varied between mild and severe. The IR prisms varied from 2 to 6 prism dioptres. Electronic devices were the most prescribed low vision aids. At the end of the LVR, the outcomes were good in all patients. BCVA increased by two to three lines, CS increased by two to four lines, RS increased by 40 to 60 words per minute and face recognition improved in all patients.Conclusions: The LVR was beneficial, improving visual function and functional vision outcomes in all patients. LVR programs seem to be effective in patients with pathologic myopia. Longitudinal studies are necessary to ascertain the long‐term efficacy of LVR.

Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Retrospective Analysis of Vision Rehabilitation for Veterans With Traumatic Brain Injury-Related Vision Dysfunction.

Traumatic brain injury (TBI) can trigger vision-based sequelae such as oculomotor and accommodative abnormalities, visual-vestibular integrative dysfunction, visual field loss, and photosensitivity. The need for diagnosis and management of TBI-related vision impairment has increased because of the increasing frequencies of combat warfighters returning from Iraq and Afghanistan with TBIs. The purpose of this research was to learn the sequelae of rehabilitation service delivery to veterans with TBI-related visual dysfunction after they are diagnosed. To accomplish this, we investigated vision rehabilitation assessments and interventions provided to veterans with TBI-related visual dysfunction at the Department of Veterans Affairs (VA) specialty polytrauma facilities for the 2 years following their injury. The research questions asked what assessments, interventions, and prescribed assistive devices were provided by VA specialty clinics (e.g., occupational therapy, polytrauma, and blind rehabilitation) and how service delivery was affected by demographic and clinical variables. A retrospective design was used to analyze VA data using natural language processing of unstructured clinician notes and logistic regression of structured data. Participants included 350 veterans with TBI who received rehabilitation at one of the five VA Polytrauma Rehabilitation Centers (Tampa, FL; Richmond, VA; Minneapolis, MN; San Antonio, TX; and Palo Alto, CA) between 2008 and 2017 and who were administered the 2008 congressionally mandated "Traumatic Brain Injury Specific Ocular Health and Visual Functioning Exam." The outcome variables were vision assessments, interventions, and prescribed assistive technology discovered via natural language processing of clinician notes as well as the vision rehabilitation specialty clinics providing the clinical care (polytrauma, occupational therapy, outpatient blind rehabilitation, inpatient blind rehabilitation, optometry, and low vision) extracted from VA structured administrative data. Veterans receiving rehabilitation for TBI-related vision dysfunction were most frequently assessed for saccades, accommodation, visual field, and convergence. Intervention was provided most frequently for eye-hand coordination, saccades, accommodation, vergence, and binocular dysfunction. Technology provided included eyeglasses, wheelchair/scooter, walker/cane, aids for the blind, and computer. There was an overlap in the services provided by specialty clinics. Services available and delivered were significantly associated with the comorbidities of each patient and the specialty clinics available at each VA Polytrauma Rehabilitation Center. The delivery of patient services should be driven by the needs of veterans and not by system-level factors such as the availability of specific vision rehabilitation services at specific locations. Traditional low vision and blind rehabilitation programs were not designed to treat the comorbidities and symptoms associated with TBI. To address this challenge, blind rehabilitation and neurologic recovery cross training is needed. Our findings document how five VA Polytrauma Rehabilitation Centers implemented this training in 2008. The next step is to extend and standardize this new paradigm to community care, where these post-deployment patients now reside.

Exploratory and confirmatory factor analysis of the Persian version of the low-vision quality-of-life questionnaire

Most of the vision quality assessment questionnaires are in English. None of the low-vision-related quality-of-life questionnaires have been translated or developed in Persian. It will help Persian optometrists and ophthalmologists to assess improvement of visual function and quality of life during their low-vision rehabilitation programs. In this study, we aimed to translate the low-vision quality-of-life (LVQOL) questionnaire in Persian language and apply exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity and fit model. Translation and cultural adjustment of the English language LVQOL questionnaire to Persian was undertaken. Overall, 100 low-vision patients were participated to validate and model the assessment questionnaire by both EFA and CFA methods. Complementary EFA and CFA results provide detailed information about item and scale performance of the Persian LVQOL. EFA showed Items 15, 16, and 21 which had factor loadings lower than 0.3. The modified model had the comparative fit index (CFI) and root mean square error of approximation (RMSEA) of 0.89 and 0.06, respectively. The translation, adjustment, and fit analysis of the LVQOL questionnaire into Persian were successful and it will be valuable in both clinical practice and research.

Implementing an Occupational Therapy Low Vision Rehabilitation Program in Singapore

Introduction: This article describes the development, implementation, and evaluation of an occupational therapy (OT) low vision rehabilitation program established in a large hospital in Singapore in 2013. Methods: A logic model was used to develop a blueprint to guide program development and evaluation of the program. The targeted short-term outcomes for the first 2 years are to demonstrate program growth through an increase in referrals and meeting of clients’ needs through expressed client satisfaction and improvement in performance of daily activities. The long-term outcomes are to expand the program’s referral base and contribute to education and research in low vision rehabilitation. The steps of the logic model are described along with program evaluation results from the first 2 years of implementation. Results: The short-term outcome for program growth was met with the increase of referrals in the first 2 years. Program evaluation, however, revealed that there was limited support from some referral sources and underutilization of OT services, which need to be addressed to ensure sustainability of the program. It was difficult to establish whether the short-term outcomes for meeting clients’ needs were met due to limited outcome measures completed. Discussion: The logic model guided the steps of developing and evaluating an outpatient low vision rehabilitation program in a hospital in Singapore to determine whether the targeted outcomes were met for the first 2 years of the program. Use of this process enabled the program providers to identify weaknesses in the program and institute steps to move the program toward achievement of its long-term goals. Implications for practitioners: This blueprint can be used to guide occupational therapists developing medically based low vision rehabilitation programs for older adults.

Occupational performance in the basic and instrumental daily activities of persons with low vision who received rehabilitation services

Introduction The objective was to describe the occupational performance in basic and instrumental daily activities of persons living in the community who have received comprehensive interdisciplinary low vision rehabilitation services. Method The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (a measure of the impact of visual impairment in daily activities) was administered at home to 102 individuals who participated in a comprehensive low vision rehabilitation program. Performance in 16 near-vision activities was measured with the person's aids and strategies; nine more global tasks were questionnaire-based. Handicap scores were obtained by multiplying performance × importance ratings. Results Average performance was satisfactory or very satisfactory for 21/25 items, even if 92% of the participants had a moderate or severe visual impairment. A severe or total handicap was present in at least one activity for 79% of the subjects. The most handicapping activities required visual searches of finely printed information on a complex or visually crowded document, or shopping and mobility. Conclusion People with low vision who took part in a comprehensive rehabilitation program generally face no or slight handicap situations in their basic and instrumental daily activities. However, major handicap situations may remain in some important activities.

Low Vision Rehabilitation on Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is the leading cause of vision loss in developed countries. For many AMD patients, the use of low vision aids and rehabilitation programs is of great help and allows them to enhance their quality of life and remain independent. In this article, the importance of visual rehabilitation methods and principles in age-related macular degeneration (AMD) is discussed, and personal experiences are noted.

A Low-Vision Rehabilitation Program for Patients With Mild Cognitive Deficits

We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment. To design and pilot-test an LVR program for patients with macular disease and cognitive deficits. The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program. Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011. Twelve patients completed the intervention, and 11 companions attended at least 1 training session. Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member). Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales. Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals. This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.

Occupational Therapy Interventions to Improve the Reading Ability of Older Adults With Low Vision: A Systematic Review

This systematic review of the literature examined available evidence regarding the effectiveness of occupational therapy interventions for improving the reading performance of older adults with low vision. We reviewed 32 studies and found strong evidence supporting low vision programs that included occupational therapy and moderately strong evidence supporting the use of electronic magnification. Moderate evidence supported the influence of illumination on reading ability. Limited evidence was found to support eccentric viewing training and optical magnification. More evidence of higher quality is needed to validate the effectiveness of optical magnifiers, text eccentric viewing, characteristic preferences, and line guides within optical magnification. Additionally, further research is needed to develop a standard low vision rehabilitation program. The results of this review support the need for occupational therapy to be included in low vision rehabilitation. The implications of the findings for occupational therapy practice, research, and education are discussed.

The Prevalence and Causes of Visual Impairment in an Elderly Chinese Bai Ethnic Rural Population: The Yunnan Minority Eye Study

To assess the prevalence and causes of visual impairment in the elderly Bai ethnic group in rural China. Random cluster sampling was used to identify the Bai ethnic group 50 years and older living in the Dali county of Yunnan, China. Presenting visual acuity (PVA) and best-corrected visual acuity (BCVA) were measured using the Early Treatment Diabetic Retinopathy Study visual chart. Blindness and low vision were defined according to World Health Organization criteria. The major cause of visual impairment was identified for all participants who were visually impaired. Of the 2742 eligible individuals, 2133 (77.8%) participated in the study, and 2115 (77.1%) had visual acuity data available. With the PVA, the prevalence of blindness and low vision was 3.59% and 15.22%, respectively. When the BCVA was used, these rates were reduced to 2.88% and 7.75%. Blindness and low vision were associated with older age and lack of education, but no sex difference was seen. Based on the BCVA, the predominant causes of blindness were cataract (70.5%), corneal opacity (8.2%), and glaucoma (6.6%). The majority of PVA-defined low vision cases were attributable to cataract (53.0%) and uncorrected refractive error (22.0%). A higher rate of visual impairment was seen in this Bai nationality sample than has been reported from the Han nationality population in rural China. Since potentially treatable eye disease, cataract, and uncorrected refractive error were the most important causes of visual impairment in this population, affordable provision of surgery and low-vision rehabilitation programs would help to address this problem.

Categorizing the Effect of Comorbidity: A Qualitative Study of Individuals’ Experiences in a Low‐Vision Rehabilitation Program

To identify generalizable ways that comorbidity affects older adults' experiences in a health service program directed toward an index condition and to develop a framework to assist clinicians in approaching comorbidity in the design, delivery, and evaluation of such interventions. A qualitative data content analysis of interview transcripts to identify themes related to comorbidity. An outpatient low-vision rehabilitation program for macular disease. In 2007/08, 98 individuals undergoing low-vision rehabilitation and their companions provided 624 semistructured interviews that elicited perceptions about barriers and facilitators of successful program participation. The interviews revealed five broad themes about comorbidity: (i) "good days, bad days," reflecting participants' fluctuating health status during the program because of concurrent medical problems; (ii) "communication barriers." which were sometimes due to participant impairments and sometimes situational; (iii) "overwhelmed," which encompassed pragmatic and emotional concerns of participants and caregivers; (iv) "delays," which referred to the tendency of comorbidities to delay progress in the program and to confer added inconvenience during lengthy appointments; and (v) value of companion involvement in overcoming some barriers imposed by comorbid conditions. This study provides a taxonomy and conceptual framework for understanding consequences of comorbidity in the experience of individuals receiving a health service. If confirmed in individuals receiving interventions for other index diseases, the framework suggests actionable items to improve care and facilitate research involving older adults.

Psychological outcomes following interventions for people with low vision: a systematic review

Psychological distress and depression is common in people with vision loss and is associated with heightened disability. It is therefore important to determine if current low-vision rehabilitation services meet the psychological needs of people with vision impairment. The aim of this article is to describe and summarize current evidence on psychological outcomes following low-vision rehabilitation programs, as well as the impact of novel interventions designed specifically to address psychological outcomes. Several electronic databases were searched to identify studies assessing the impact of vision rehabilitation services on psychological outcomes and 35 reports from 30 studies were reviewed. Findings suggested that multidisciplinary low-vision rehabilitation services may improve aspects of psychological well-being such as vision-specific quality of life, but have limited impact on depressive symptoms. Specifically designed psychological group and individual programs based on cognitive-behavioral techniques have been shown to improve a range of psychological outcomes and may be able to prevent depressive symptoms in people with vision impairment. Further studies with sophisticated designs and well-validated outcome measures are required to understand the effectiveness, mechanisms, moderators and cost–effectiveness of existing and new low-vision rehabilitation programs on psychological well-being in people with low vision.

Pilot Study on Activities of Daily Living Limitations in Adults With Hemianopsia

I sought to obtain a general understanding of the limitations in activities of daily living (ADLs) experienced by adults with hemianopsia and quandrantanopsia from acquired brain injury. A semistructured interview addressing the perception of difficulty completing ADLs because of vision loss and a reading performance test were administered to 46 participants referred to a low vision rehabilitation program. Participants reported difficulty completing two basic ADLs, personal hygiene-grooming and feeding, and several instrumental ADLs, including driving, shopping, financial management, telephone usage, and meal preparation. ADL limitations appear to be related to the amount of visual search needed to complete the ADL and disruption of the performance skills of reading, writing, and mobility. People with hemianopsia experience limitations in specific ADLs as a direct result of the disruption of the visual field. Further investigation is needed to confirm these findings and explore interventions to improve ADL performance.

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

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. …

Successful Outcomes from a Structured Curriculum Used in the Veterans Affairs Low Vision Intervention Trial

A low vision rehabilitation program with a structured curriculum was evaluated in a randomized controlled trial. The treatment group demonstrated large improvements in self-reported visual function (reading, mobility, visual information processing, visual motor skills, and overall). The team approach and the protocols of the treatment program are described.

The Veterans Affairs Low Vision Intervention Trial (LOVIT): Design and Methodology

Visual impairment is a major public health problem. Vision rehabilitation programs have the potential to restore independence and improve quality of life for persons with permanent vision loss, and few have been evaluated in randomized controlled trials. The Veterans Affairs (VA) Low Vision Intervention Trial is a multicenter randomized clinical trial to evaluate the effectiveness of a new outpatient low vision rehabilitation program. 126 patients with moderate and severe vision loss due to macular diseases are randomized to low vision treatment in an outpatient setting or a usual care control group at two VA facilities in Hines, Illinois, and Salisbury, North Carolina. The primary outcome is the change in visual reading ability from baseline to four months measured with the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes compare the mean change in visual ability measured with the VA LV VFQ-48 (overall ability, mobility, visual information processing, visual motor skills) for the treatment and control groups. Costs and cost effectiveness of outpatient treatment are evaluated. The low vision rehabilitation setting, use of a waiting list control group to address ethical issues, development of the treatment protocol, development of a vision function questionnaire for patients to self-report the difficulty they experience performing daily activities, and the use of Rasch analysis to develop and estimate this outcome measure are described. If the new low vision rehabilitation program is proven effective, studies will be needed to determine which of the multiple aspects of the intervention are necessary and sufficient. The challenges of conducting clinical trials in a rehabilitation setting and use of a waiting list (deferred treatment) control group extend beyond LOVIT. The design and methods of LOVIT may be applicable to other trials of rehabilitation services and to outcomes for which reliable and valid measurement tools must be developed.

Using the VA LV VFQ-48 and LV VFQ-20 in Low Vision Rehabilitation

This study was conducted to demonstrate use of a simple scoring algorithm for the 48-item Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ-48) that approximates the measure of persons' visual ability that would be calculated with Rasch analysis and to provide a short form version of the questionnaire for clinical practice and outcomes research. Items were eliminated from the VA LV VFQ-48 to reduce redundancy and shorten the instrument. The approximation of persons' visual ability calculated with the scoring algorithm for vision function questionnaires developed by Massof was compared with the person measure estimated from Rasch analysis for a sample of 126 subjects entering a low vision rehabilitation program. The approximation captures 98% of the variability in the Rasch measure estimate of persons' visual ability and 97% of the variability in the change score estimate. The relationship does not hold in circumstances where patients with high visual ability find most items to be easy. A 20-item short form of the instrument was constructed for use in low vision service delivery. The scoring algorithm can be used with the VA LV VFQ-48 or short form versions of the questionnaire. Clinicians can use the algorithm to score the VA LV VFQ from examination of individual patients or as an outcome measure for their low vision rehabilitation programs. Research investigators can use the scoring algorithm with small samples when Rasch analysis is not reliable or in studies where Rasch analysis is not practical. Rasch analysis is still recommended for research studies that require more accurate assessments.

The Effectiveness of Low-Vision Rehabilitation on Participation in Daily Living and Quality of Life

To evaluate the effectiveness of a multidisciplinary low-vision rehabilitation program on quality of life evaluated by the Impact of Vision Impairment (IVI) instrument. First-time referrals to low-vision clinics were assessed before and after rehabilitation (3-6 months). Rasch analysis was used to estimate the three IVI subscale and overall values on an interval scale. A mixed between-within subjects ANOVA was used to identify whether presenting visual acuity had an interaction effect with rehabilitation change. Cohen d values were used to estimate the magnitude of the change and the standardized response mean (SRM) procedure was selected to determine the clinical significance of the rehabilitation-induced changes. One hundred twenty-four women and 68 men (mean age, 80.3 years) completed the rehabilitation. Most had age-related macular degeneration (62%, 119) and were moderately to severely vision impaired (<6/18; 78%, 149). After rehabilitation, significant improvements were recorded for the overall IVI score (P = 0.006) and two subscales: reading and accessing information and emotional well-being (P = 0.007 and 0.009, respectively). No significant improvement was found on the mobility and independence subscale (P = 0.07). The magnitude of the post-intervention improvement was found to be relatively moderate (Cohen d = 0.17-0.30) and clinically modest (SRM = 0.22-0.42). Significant improvements in overall quality of life and two specific areas of daily living in people with low vision were found, although the magnitude and clinical significance of the rehabilitation-induced gains were modest. Further investigation in other models of low-vision rehabilitation is needed to optimize quality of life gains in people with low vision.

The Impact of Vision Impairment Questionnaire: An Assessment of Its Domain Structure Using Confirmatory Factor Analysis and Rasch Analysis

To assess and validate the subscale structure of the 28-item Impact of Visual Impairment (IVI) Scale by using confirmatory factor analysis (CFA) and Rasch analysis for use as an outcome measure. Three hundred nineteen participants completed the IVI questionnaire, and the responses then were subjected to Rasch analysis by RUMM2020 software. With the person estimates for each item, CFA was used to assess two hypothesized structures: three-and four-factor models. The subscales of the model with the best fit were then further validated by Rasch analysis. CFA supported a three-factor model that included items from the emotional well-being, reading and accessing information, and mobility and independence subscales. Almost all the selected goodness-of-fit statistics for the three-factor model were better than the recommended values. The factor loadings of the items on their respective domains were all statistically significant (P < 0.001) and ranged between 0.54 and 0.81. The three subscales individually fitted the Rasch model according to the item-trait interaction test (mobility and independence chi(2) [df] = 45.9 [44], P = 0.39; emotional well-being = 28.4 [32], P = 0.65; and reading and accessing information = 43.5 [36], P = 0.18). The item-fit residuals values of the three subscales were <2.5 and showed mean and standard deviations approximating 0 and 1, respectively. The internal consistency reliability of the subscales (alpha) was substantial, ranging between 0.89 and 0.91. An examination of the IVI dimension confirmed a three-subscale structure that displays interval measurement characteristics likely to provide a valid and reliable assessment of restriction of participation. The findings provide an opportunity for a more detailed measurement of the effects of different types of low-vision rehabilitation programs.

Tactile analogue scale instrument for investigation of low vision patient psychological characteristics

PurposeExamination information gained from a simple tactile analogue scale technique (10 cc syringe) of measuring psychological aspects of coping in a low vision patient population. MethodsIn routine low vision rehabilitation evaluations, patients were asked to estimate the impact of their vision loss on emotional factors. A 10 cc syringe was used by the patient with closed (0 cc level) indicating no problem and totally open (10 cc level) indicating greatest difficulty. ResultsThe sample included 25 male and 29 female low vision patients. Mean scores (x/10) for emotional distress variables were frustration 7.4, anxiety 5.5, depression 4.8, fear 4.1, and anger 4.1. Mean scores (x/10) for cognitive appraisal variables were: interference 7.8 and intolerance 4.4. Younger age was associated with greater anger (r=−0.45, p<0.01). No other significant correlations between age or gender and emotional reactions were found. The two cognitive appraisals were better predictors of emotional distress than visual acuity or demographic information. DiscussionThis technique demonstrated patients to have a noteworthy amount of distress which is important clinical information in low vision rehabilitation programs. Visual acuity and demographic factors did not predict the distress. This 10 cc syringe technique is inexpensive and easy to administer. It opens a helpful dialogue that may not occur otherwise. SupportHelen Keller Foundation for Research and Education