Low Vision Rehabilitation Services Research Articles

The Four Elements in Low-Vision Rehabilitation Service

This article addresses the critical issue of low-vision rehabilitation (LVR) services, focusing on the challenges faced by visually impaired patients, particularly those with central visual field limitations and visual acuity of 3/60 or worse in the better eye. Glaucoma, a chronic progressive optic neuropathy, poses a significant threat to vision and quality of life. Despite the absence of a definitive cure, various treatment modalities aim to control and slow down its progression. However, the impact of glaucoma-related structural and functional vision loss on patients’ quality of life is profound. Visual rehabilitation plays a pivotal role in guiding patient-centered therapeutic decisions, yet it remains underutilized for glaucoma patients. Understanding the available LVR is crucial in developing new tools and approaches. This article provides an overview of LVR options for visually impaired individuals and emphasizes the importance of comprehensively assessing and addressing their needs, both in terms of visual function and overall well-being.

Barriers to the Utilization of Low-Vision Rehabilitation Services among Over-50-Year-Old People in East and Southeast Asian Regions: A Scoping Review.

East and Southeast Asia (ESEA) are facing age-related eye health issues. Low-vision rehabilitation (LVR), which is a special rehabilitation service for individuals with vision impairment, is a promising solution for these health issues; however, poor accessibility to LVR services has been reported globally, including ESEA. Therefore, this scoping review aimed to summarize and understand the barriers to accessing LVR services in ESEA. In total, 20 articles were ultimately considered eligible for this scoping review after an electronic database search using MEDLINE (PubMed), Web of Science, Academic Search Ultimate (EBSCO), and Ichushi-Web (Japanese medical literature database), and an independent review by two reviewers. Twenty-one potential barrier factors were identified in the full-text review. Notably, age, education, economic status, "previous experience using eye care service", and "knowledge, information, and awareness" were the possible barrier factors that were examined for their association with LVR utilization, with supportive evidence in many eligible studies. We also identified research gaps relating to geographical and ethnic diversity, the scope of LVR services, and barriers among eligible articles. Therefore, by conducting further studies addressing the research gaps identified in this scoping review, these findings can be used to make LVR services more accessible to people in ESEA.

Leber Optic Neuropathy and Low Vision Rehabilitation: A Case Report

Leber’s Hereditary Optic Neuropathy (LHON) is a maternally inherited mitochondrial disease, characterized by point mutations in mitochondrial DNA and subsequent mitochondrial dysfunction; which leads to a bilateral and painless loss of central vision. Unfortunately at this time, there is no proven treatment to prevent or reverse this optic neuropathy. Therefore, individualized low vision rehabilitation services and assistive devices are essential to help people with LHON regain their independence and quality of life. We highlight through a case study the importance of psychic support as well as the impact of low vision rehabilitation on a young man with LHON.

Prevalence of dry eye disease in the low vision population at the University of Colorado

PurposeTo evaluate the prevalence of diagnosed dry eye syndrome, meibomian gland dysfunction, and blepharitis amongst the low vision population. MethodsA retrospective analysis was conducted on patients seen in the University of Colorado Low Vision Rehabilitation Service between the dates of 12/1/2017 and 12/1/2022. 74 ICD-10 codes were used to identify patients as having dry eye syndrome or not having dry eye syndrome. Data was further analyzed to determine the prevalence of blepharitis and meibomian gland dysfunction using 29 blepharitis and 9 meibomian gland dysfunction ICD-10 codes. Data were also analyzed to determine the age and sex of the patients with diagnosed dry eye syndrome. ResultsThe percentage of patients with a diagnosis of dry eye syndrome by an eyecare provider was 38.02 %. The prevalence of dry eye syndrome by age group was 3.57 % for 0–19 years, 14.35 % for 20–39 years, 29.07 % for 40–59 years, 43.79 % for 60–79 years, and 46.21 % for 80 and above. The prevalence of meibomian gland dysfunction and blepharitis was 11.90 % and 9.1 % respectively. Dry eye syndrome prevalence amongst males was 31.59 % and 42.47 % for females. ConclusionThis study demonstrates that dry eye syndrome in the low vision population is a significant co-morbidity occurring in over a third of patients in the University of Colorado Low Vision Rehabilitation Service. These findings are meaningful as ocular comfort should not be overlooked while managing complex visual needs.

Use of electronic devices by people attending vision rehabilitation services in Italy: A study based on the device and aids registry (D.A.Re).

To investigate the characteristics of electronic device users, specifically smartphones and tablets, in the Device & Aids Register (D.A.Re), from several low-vision rehabilitation services in Italy. We collected general and clinical information about ocular and systemic diseases, visual function, reading speed and Instrumental Activities of Daily Living (IADL) questionnaire score. Technological details of each optical and electronic device, (including screen size, touch-screen and OCR functions, text-to-speech function) were also collected. 1218 patients (752 females and 466 males) were included in our analysis, mean age 71.5 (±18.8) years. Users of electronic aids (n.237) were slightly younger (67 vs 72 years, p < 0.001) than non-users (n.981), had a worse reading speed (38 vs 65 words/minute), critical print size (43 vs 28 print size, p < 0.001), poorer visual acuity (VA)(1.0 logMAR or less: 30% non-users vs 73% users, p < 0.001) and more commonly visual field restriction within 10° (23% vs 14%, p = 0.001). A similar proportion of users and non-users were retired (about 70%) and about 16-17% were employed. The use of portable electronic devices (5″or less, p < 0.001; 6″ to 18″ screen size, p = 0.017) was associated with better IADL scores, and the use of stand devices with worse IADL score (p < 0.001); Furthermore, using smartphones and tablets (193 subjects) was strongly associated with better IADL scores. We found that using electronic devices, and especially smartphone and tablets, were associated with better vision-related quality of life in low-vision people attending rehabilitation services. While this association does not mean causality, these findings seemed robust to confounder adjustment.

Barriers and enablers of utilization of low-vision rehabilitation services among over-50-year-old people in East and Southeast Asian regions: a scoping review protocol.

This scoping review aims to explore and describe the barriers and enablers of low-vision rehabilitation service utilization among people over 50-years-old in East and Southeast Asia. Vision impairment is strongly associated with aging. East and Southeast Asia are experiencing a rapidly growing aging population and the eye-related health burdens associated with this. Despite the benefits of low-vision rehabilitation services, they are extremely underutilized in the region. Identifying the barriers and enablers of service utilization could be a crucial first step in making the services more accessible and, ultimately, easing the burden of this health issue. This review will include published articles that examine the barriers and/or enablers of low-vision rehabilitation service utilization. Inclusion criteria are people aged 50 years and older living in East and Southeast Asia; low-vision rehabilitation services (defined as any kind of intervention that aims to mitigate the impacts of disability induced by eye-related health conditions); no comparator; and information on barriers and/or enablers for service utilization. A literature search of 4 databases as well as an additional manual search will be conducted to identify eligible articles. Two independent reviewers will assess the articles for inclusion. Data extraction will focus on general information of the study, demographic or descriptive information of the study population, eye condition being studied, means of low-vision rehabilitation, and the barriers and/or enablers of service utilization. The information will be tabulated to depict the categories of barriers and enablers that influence access to services. Open Science Framework https://osf.io/8y2wp.

Reported Perceived Barriers to Low Vision Rehabilitation Services among Ophthalmic Personnel in Ethiopia

Reported Perceived Barriers to Low Vision Rehabilitation Services among Ophthalmic Personnel in Ethiopia

Provision of low-vision rehabilitation services in Saudi Arabia

The prevalence of low vision is expected to increase at the national and international levels, given the aging population and the association between the prevalence of ocular disease(s) and increasing age. Thus, it is important to establish knowledge of the distribution, adequacy, and quality of available low vision rehabilitation services nationally and internationally. This will in turn help prioritize eyecare plans and initiatives, and thus deliver effective services. This cross-sectional study enumerated and surveyed all local government and information regarding the geographic location of each participating entity, entity affiliation, availability and types of low vision rehabilitation services, types of providers, and referral patterns were determined. The results of the current study showed that only 4% of the entities provided low vision rehabilitation services and most (75%) were located in the central region. Additionally, the majority of the services (95%) were basic optometric rehabilitation services whereas other services were either rarely offered or not offered at all. Overall, the current low vision rehabilitation services in Saudi Arabia are inadequate to meet the increasing prevalence of the low vision population. Thus, careful planning of eyecare services is required to meet this demand.

Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology

Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care. To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert. Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022. Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis. LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted. Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively. In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.

Approach to primary congenital glaucoma: A perspective.

Primary congenital glaucoma (PCG) occurs worldwide and has a broad range of ocular manifestations. It poses a therapeutic challenge to the ophthalmologist. A proper diagnostic evaluation under anesthesia is advisable for all children who do not cooperate for an office examination. Medical therapy only serves as a supportive role, and surgical intervention remains the principal therapeutic modality. Angle incision surgery such as goniotomy or trabeculotomy ab externo is the preferred choice of surgery in the Caucasian population. Primary combined trabeculotomy-trabeculectomy with or without antifibrotic therapy is the preferred choice in certain regions such as India and the Middle East where the disease usually presents with severe forms of corneal edema along with megalocornea. In refractory cases, trabeculectomy with antifibrotic therapy or glaucoma drainage devices are available options in the armamentarium. Cycloablative procedures should be reserved for eyes with poor visual potential. Myopia is common among children with PCG, and appropriate optical refractive correction in the form of glasses or contact lenses should be provided. Amblyopia therapy should be instituted to ensure overall visual development in the early developmental years. Low-vision rehabilitation services should be provided to children with vision impairment. Long-term follow-up is mandatory and carers of children with PCG should be counseled and educated about this need. Regardless of the visual outcomes, clinicians should emphasize the need for education of these children during the clinic visit. The overall goal of the management should be to improve the overall quality of life of the children with PCG and their carers.

Using Electronic Clinical Decision Support to Examine Vision Rehabilitation Referrals and Practice Guidelines in Ophthalmology.

PurposeTo examine ophthalmologist use of an electronic health record (EHR)-based clinical decision support system (CDSS) to facilitate low vision rehabilitation (LVR) care referral.MethodsThe CDSS alert was designed to appear when best documented visual acuity was <20/40 or hemianopia or quadrantanopia diagnosis was identified during an ophthalmology encounter from November 6, 2017, to April 5, 2019. Fifteen ophthalmologists representing eight subspecialties from an academic medical center were required to respond to the referral recommendation (order, don't order). LVR referral rates and ophthalmologist user experience were assessed. Encounter characteristics associated with LVR referrals were explored using multilevel logistic regression analysis.ResultsThe alert appeared for 3625 (8.9%) of 40,931 eligible encounters. The referral rate was 14.8% (535/3625). Of the 3413 encounters that met the visual acuity criterion only, patients who were worse than 20/60 were more likely to be referred, and 32.4% of referred patients were between 20/40 and 20/60. Primary reasons for deferring referrals included active medical or surgical treatment, refractive-related issues, and previous connection to LVR services. Eleven of the 13 ophthalmologists agreed that the alert was useful in identifying candidates for LVR services.ConclusionsA CDSS for patient identification and referral offers an acceptable mechanism to apply practice guidelines and prompt ophthalmologists to facilitate LVR care. Further study is warranted to optimize ophthalmologist user experience while refining alert criteria beyond visual acuity.Translational RelevanceThe CDSS provides the framework for multi-center research to assess the development of pragmatic algorithms and standards for facilitating LVR care.

Providing Accessible Fall Prevention Education for Older Adults With Low Vision

This study modified the educational content of an evidence-based fall prevention intervention to make it visually accessible for older adults with low vision. We piloted the intervention on 9 older adults receiving low vision rehabilitation services. Following the intervention, participants demonstrated increased comprehension of the content, perceived a greater understanding of fall prevention strategies, and reported high satisfaction with the intervention's accessibility. Individuals with low vision may have difficulty reading and comprehending printed educational materials. Modifying print materials to improve readability may result in greater understanding of the educational content.

Characteristics of individual low-vision rehabilitation counseling among older adults: A qualitative 2-year follow-up study

Visual impairments (VI) burden particularly the aging population globally. To ensure healthy aging despite disability, the health care systems must provide effective low-vision rehabilitation services (LVR) for those in need. Low-vision rehabilitation counseling (LVRC) requires specialized multidisciplinary teamwork and has not been studied in detail among the elderly. This study aims to provide a comprehensive picture of individual LVRC actions and introduce a LVRC classification to use for attempts to improve the LVRC processes. This study employed a qualitative follow-up design. Data describing the individual LVRC processes in a prospective cohort of elderly patients with VI ( n = 39) were collected individually over 2 years during the years 2016–2019. The data were analyzed through deductive content analysis. The analyzed LVRC provided assistive devices, services, and home modifications, but problems related to independent movement in the living environment, psychosocial burdens, adaptation to disability, and learning new compensatory skills received less attention. To ensure effective LVRC, the multiprofessional team providing the rehabilitation should emphasize goal-setting and continuous assessment. LVRC should be seen as a process of adaptation, adherence, and learning. LVRC should support and promote older adults to participate and function to their full potential in the modern society, which includes utilizing digital technologies.

Social Networks May Shape Visually Impaired Older Adults' Occupational Engagement: A Narrative Inquiry.

Age-related vision loss (ARVL) has been shown to interfere with older adults' occupational engagement. The primary purpose was to examine the role social networks play in facilitating/constraining engagement in desired occupations for older adults with ARVL. This study adopted a constructivist narrative methodology. Five older adults, ≥ 60 years of age with ARVL, participated in three virtual interviews, which were coded using thematic analysis. Three overarching themes were identified: (a) Diverse Social Networks Fulfill Different Occupational and Psychosocial Needs, (b) Retaining a Sense of Independence through Seeking Reciprocity in Social Relationships, and (c) Community Mobility and Technology Support as Essential for Preserving Social Relationships. Findings broaden understandings of how informal/formal social networks are involved in shaping visually-impaired older adults' adaptation to ARVL and related occupational changes. Findings may help improve the quality and delivery of low-vision rehabilitation services to optimize their contribution to occupational engagement.

Change in rehabilitation needs and activity limitations over time of adults with acquired visual impairment following entry to a low vision rehabilitation service in England.

Longitudinal changes in priority rehabilitation needs, vision-related activity limitation and importance of visual goals were evaluated in a sample of people with a visual impairment over a year following entry to low vision rehabilitation services in England. Participants were adults with newly registered visual impairment within Leicestershire. Priority scores, indicating the level of rehabilitative need, were determined from the importance and difficulty scores of the 48goals of the Participation and Activity Inventory (PAI). Rasch analysis of the difficulty and importance scores examined activity limitation and importance separately. PAI outcome measures were assessed on entry to rehabilitation services and at 4 and 12months thereafter. Forty-eight participants (mean age 74.2, SD 14.1years) completed three visits. Overall, there was a statistically significant reduction in the perceived need for rehabilitation over time (p<0.001, ηp2 =0.29), driven by reduced perceived difficulty (p<0.001, ηp2 =0.32) but stable importance (p=0.73) of goals, with most change occurring between baseline and 4months. PAI goals with greatest rehabilitative need at study entry were reading, mobility and writing, and these remained of highest priority over time. The greatest priority score decrease was for the goal 'Hobbies and crafts'. The largest decrease in importance was for 'Mobility outdoors', whereas 'Relationship with loved ones' increased most. Despite a decline in the perceived need for rehabilitation over the study period, there remains a need for continued support and intervention at 12months following registration with rehabilitation services, particularly for the key goals of reading, writing and mobility. Early identification and support for individuals' important but difficult goals could prevent such goals being relinquished. Goals concerning relationships and communication became more important over time, indicating that re-evaluation of needs at follow-up is necessary to inform ongoing service provision.

Optical Coherence Tomography (OCT) Diagnostic of Retinitis Pigmentosa - Case Study.

Retinitis pigmentosa (RP) is a set of inherited rod-cone degenerative diseases that clinically presents with similar signs and symptoms. Mutations in one of more than 70 genes are involved. Patients will commonly present with bone-spicule pigment formation, waxy optic nerve pallor, and attenuated blood vessels in the posterior pole.Symptoms often begin with progressive night blindness, mid-peripheral visual field defects, and eventual tunnel vision. Central vision loss will ultimately occur following loss of rod function. Complete blindness is uncommon. The aim of this article is to present two cases of retinitis pigmentosa (mother and daughter) trough optalmologic exams in our clinic. The next aim it to show how to menage a low vision service and to treat cystoid macular oedema as a complication of retinitis pigmentosa. All medical reports are shown in this article. Every diagnostic tool as well as report is a part from our archived history of the patients and has been throughly analysed. We also reviewed available literature using the key words retinitis pigmentosa, cystoid macular oedema, gene therapy. A 38 year old female patient for a low vision consultation. The patient was legally blind secondary to retinitis pigmentosa, which was diagnosed in her late 20s. She reported gradually progressive hazy central vision and decreasing peripheral vision in both eyes as well as severe night blindness. Other than the diagnosis of retinitis pigmentosa in both eyes,the patient had no other remarkable ocular conditions. Findings at that visit included unaided distance visual acuities VOD: 0,04 VOS: 0,06. Pupils were round with brisk responses. Extraocular muscle motility was full in both eyes. Confrontation methode visual fields were noted as temporal loss in the right eye and superior and temporal loss in the left eye. The perimetry test could not be performed due to the lack of correspondece of the patient even after a couple repetitions of the perimetry. She had normal ocular adnexa and quiet lids, conjunctiva, and sclera in both eyes. Corneas in both eyes were noted as clear epithelium, clear stroma, and clear endothelium. Anterior chambers had normal depth, iris with no pathological findings in both eyes; lens incipient sclerotic. Intraocular pressures were noted as 22 mmHg in both eyes with Icare, 21mmHg and 19 mmHg with aplanation tonometry; pahimetry corretional factor was +1 on both eyes. The vitreous was clear in both eyes. Both optic nerves were measured as 0.4 cup-to-disc ratios with no disc edema, disc hemorrhages, notching, or thinning noted.Waxy disc pallor and attenuated blood vessels were observed in both eyes. The macula in both eyes had retinal pigment epithelium (RPE) changes with no edema or hemorrhages. Bone spicule changes were noted 360 in the periphery of both eyes with no holes or tears(Figure 1a+1b+1c+1d). We presented two cases of retinitis pigmentosa - the mother with diagnosed RP more than 15 years ago in need for low vision rehabilitation service and the daughter that got diagnosed after our initial examination and with complications in visual impairment through cystoid macular oedema.

Barriers to Low-Vision Rehabilitation Services for Visually Impaired Patients in a Multidisciplinary Ophthalmology Outpatient Practice.

Low-vision rehabilitation (LVR) has significant benefit in improving the quality of life of visually impaired patients. However, these services are highly underutilized in ophthalmology practices. A quality improvement study was performed to investigate barriers to LVR services for patients at the University of Texas Medical Branch (UTMB) between 2010 and 2020. Low vision was defined as the best corrected visual acuity of 20/70 or worse in the better-seeing eye or a visual field less than 20 degrees. Potential subjects were screened (n = 577) from the electronic medical record using International Classification of Disease (ICD) codes for legal blindness, impaired vision, and low vision. Chart review identified 190 subjects who met criteria for low-vision analysis. Patients who received LVR referrals to attend at least one LVR service visit from the eligible subjects were contacted for participation in phone interviews regarding their LVR experience. Practicing eye care providers (ECPs) at UTMB completed a questionnaire to capture their referral patterns. Of the eligible subjects, 64% were referred to LVR services by ECPs. Reported patient barriers included mental health issues (76%), denial of need for low-vision aid (71%), poor physical health (67%), lack of transportation (57.1%), and lack of referrals (36%). EPCs reported patient's overall health (67%), older age (44%), lack of social support (44%), poor cognitive function (44%), and low likelihood of follow-up (44%) as barriers to referring patients to LVR. This study identified several modifiable barriers that can be addressed to access LVR services for low-vision patients. Changing referral patterns, eliminating variations in referral criteria, and increasing patient awareness and knowledge of LVR resources may tremendously improve the quality of life of low-vision patients.

Prevalence and Causes of Low Vision and Blind in Ophthalmology Department, Miri Hospital, Sarawak

Prevalence and causes of low vision and blind have been studied nationally and globally. However, similar studies have not been conducted locally in Sarawak. This study aims to identify the prevalence and causesof low vision and blind patients of different gender, age, and race in the Ophthalmology Department, Miri Hospital, Sarawak, for five years from 2016 to 2020. This study is a retrospective observational study. A total of 17,868 patients’ clinical records were screened. The clinical records with fulfilled inclusion criteria will be extracted and reviewed. In this study, 269 (1.50%) patients were diagnosed with irreversible visual impairments. The prevalence of low vision and blindness was 0.78% and 0.72%, respectively. Most subjects (187, 69.5%) were more than 50 years old. Furthermore, 151 (56.13%) subjects were male, while 118 (43.87%) were female. Race Iban has a higher prevalence of low vision and blind (88, 32,7%), followedby Chinese (81, 30.1%), Malay (53, 19.7%), and other local natives (17, 5%). The four leading causes of low vision and blind were diabetic retinopathy (68, 25.3%), glaucoma (62, 23.0%), retinitis pigmentosa (26, 9.7%),and age-related macular degeneration (17, 6.3%). Low vision and blind due to diabetic retinopathy, glaucoma, and age-related macular degeneration could be avoided if eye health screening is conducted as early as age 40. For patients diagnosed with low vision and blind, integrated low vision and blind rehabilitation training should be accessible in all public healthcare systems. For the stakeholder, enforcing low vision and blind registry, fortifying low vision rehabilitation services, and precise mechanism of welfare intervention are the measures for more holistic low vision and blind management.

Interventions in the Scope of Occupational Therapy to Improve Psychosocial Well-Being in Older Adults with Low Vision and Mental Health Concerns: A Systematic Review

Research has found that occupational therapy practitioners focus on functional and participation outcomes in the low vision population, but overlook corresponding psychosocial outcomes in rehabilitation. The purpose of this systematic review is to answer the PICO question: “What is the evidence to support interventions within the scope of occupational therapy for improving psychosocial well-being or quality of life in adults experiencing depression or anxiety as a result of low vision?” The team conducted a search of literature published between 2008 and 2020. Inclusion criteria consisted of interventions within the scope of occupational therapy for patients with low vision, and which measured mental health or quality of life factors. Eleven articles met inclusion criteria. The majority of the evidence consisted of 1B (45%) and 2B (36%) level randomized control trials. Two studies were 3B level evidence. Mental health outcomes were measured primarily using depression rating scales, although a number of studies also utilized vision-specific quality of life questionnaires. Established intervention themes included behavioral activation plus occupational therapy low vision rehabilitation, cognitive problem-solving approaches, usual care ‘plus’ skill-based training, and group service delivery approaches. Moderate evidence supports behavioral activation plus occupational therapy low vision rehabilitation, problem-solving approaches, and group service delivery approaches for improving mental health outcomes. There is moderate evidence that does not support usual treatment ‘plus’ skill-based training to improve mental health.

Association Between Visual Impairment and Depression in Patients Attending Eye Clinics

Given that depression is treatable and some ocular diseases that cause visual loss are reversible, early identification and treatment of patients with visual impairment who are most at risk of depression may have an important influence on the well-being of these patients. To conduct a meta-analysis on the prevalence of depression in patients with visual impairment who regularly visit eye clinics and low vision rehabilitation services. MEDLINE (inception to June 7, 2020) and Embase (inception to June 7, 2020) were searched. Studies that obtained data on the association between acquired visual impairment and depression among individuals aged 18 years or older were identified and included in this review. Exclusion criteria comprised inherited or congenital eye diseases, review studies, unpublished articles, abstracts, theses, dissertations, and book chapters. Four independent reviewers analyzed the results of the search and performed the selection and data extraction to ensure accuracy. Meta-analyses of prevalence were conducted using random-intercept logistic regression models. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Proportion of depression. A total of 27 studies were included in this review, and all but 2 included patients older than 65 years. Among 6992 total patients (mean [SD] age, 76 [13.9] years; 4195 women [60%]) with visual impairment, in 1687 patients with depression, the median proportion of depression was 0.30 (range, 0.03-0.54). The random-effects pooled estimate was 0.25 (95% CI, 0.19-0.33) with high heterogeneity (95% predictive interval, 0.05-0.70). No patient characteristic, measured at the study level, influenced the prevalence of depression, except for the inclusion of patients with cognitive impairment (0.33; 95% CI, 0.28-0.38 in 14 studies vs 0.18; 95% CI, 0.11-0.30 in 13 studies that excluded this with major comorbidities; P = .008). The prevalence of depression was high both in clinic-based studies (in 6 studies, 0.34; 95% CI, 0.23-0.47) and in rehabilitation services (in 18 studies, 0.25; 95% CI, 0.18-0.33 vs other settings in 3 studies, 0.15; 95% CI, 0.05-0.38; P = .17), and did not vary by visual impairment severity of mild (in 8 studies, 0.24; 95% CI, 0.14-0.38), moderate (in 10 studies, 0.29; 95% CI, 0.21-0.39), and severe (in 5 studies, 0.29; 95% CI, 0.12-0.56; P = .51). The results of this meta-analysis suggest that depression in patients with visual impairment is a common problem that should be recognized and addressed by the health care professionals treating these patients.