Low vision rehabilitation for better quality of life in visually impaired adults.
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ABSTRACT:
SUBMITTER: van Nispen RM
PROVIDER: S-EPMC6984642 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
Publications
Low vision rehabilitation for better quality of life in visually impaired adults.
van Nispen Ruth Ma RM Virgili Gianni G Hoeben Mirke M Langelaan Maaike M Klevering Jeroen J Keunen Jan Ee JE van Rens Ger Hmb GH
The Cochrane database of systematic reviews 20200127
<h4>Background</h4>Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment.<h4>Object ...[more]
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Project description:Background aimLow vision rehabilitation optimizes the use of residual vision after severe vision loss, but also teaches skills to improve visual functioning in daily life. These skills promote independence and active participation in society. This meta-analysis was designed to evaluate the efficacy of low vision rehabilitation in improving the quality of life (QoL) in visually impaired adults.MethodsWe searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to January 1, 2020. Randomized controlled trials (RCTs) that compared rehabilitation interventions with active or inactive controls were included. The standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated to compare outcomes. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2.ResultsA total of 52 RCTs with 6,239 participants were included in this meta-analysis. Compared to inactive comparators including waiting list or no care, low vision rehabilitation improved vision-related QoL, visual functioning (QoL: psychological aspect), and self-efficacy or self-esteem (QoL: psychological aspect), with pooled SMDs of -0.61 (95% CI -0.95 to -0.26; P = .0006), -1.14 (95% CI -1.69 to -0.59; P < .0001), and -0.84 (95% CI -1.47 to -0.22; P < .0001), respectively. Compared to active comparators, low vision rehabilitation improved vision-related QoL (SMD -0.26; 95% CI -0.46 to -0.06; P = .01) and activities of daily living (QoL: physical aspect) (SMD -0.39; 95% CI -0.67 to -0.12 P < .0001). However, no significant difference in health-related QoL and adaptation to vision loss (QoL: psychological aspect) was found between low vision rehabilitation and inactive comparators.ConclusionsThis meta-analysis indicated that low vision rehabilitation interventions, particularly psychological therapies and methods of enhancing vision, may improve vision-related QoL and visual functioning in people with sight loss compared to usual care. Further studies should explore longer maintenance effects and the costs of several types of low vision rehabilitation. Studies characterizing the mechanisms of rehabilitation interventions in different settings, including low-income countries, are also required.
| S-EPMC8133190 | biostudies-literature
Project description:PurposeTo assess patient-reported quality of life outcome improvements in severely visually impaired (SVI) individuals using the Aira system over a 1-year follow-up period.MethodsAira is an on-demand assistive technology designed for SVI. Aira subscribers were recruited and administered the validated 28-item Impact of Vision Impairment-Very Low Vision Questionnaire by phone before starting Aira with follow-ups at 3 months and 1 year. Total score and validated subset scores of activities of daily living, mobility, and safety (ADLMS) and emotional well-being (EWB) were assessed. Pearson correlation analyses and paired t-tests were used to examine the data.ResultsFifty participants (mean, age, 52.5 years; 25 males, 25 females) were recruited with a mean of 401 ± 66.3 days to follow-up. The initial total score (mean, 53.1 ± 18.9) significantly improved at 1 year (mean, 63.1 ± 16.2; P = 0.0002). The initial ADLMS score (mean, 30.7 ± 11.3) significantly improved at 1 year (mean, 37.2 ± 10.7; P = 0.001). The initial EWB score (mean, 22.5 ± 8.5) significantly improved at 1 year (mean, 25.9 ± 8.0; P = 0.0001). There was no significant difference between the 3-month and 1-year total (P = 0.972), ADLMS (P = 0.897), and EWB scores (P = 0.700). There was a significant correlation between minutes used and improvement in total (r = 0.371; P = 0.009), ADLMS (r = 0.302; P = 0.035), and EWB (r = 0.439; P = 0.002) scores.ConclusionsAira use significantly improves Impact of Vision Impairment-Very Low Vision total, ADLMS, and EWB scores for SVI individuals at 3 months. This improvement is sustained at the 1-year follow-up and correlated with total minutes used.Translational relevanceAira technology may provide sustained improvement in quality of life for SVI, and further study to evaluate the usefulness of this technology to assist SVI may be beneficial.
| S-EPMC7396172 | biostudies-literature
Project description:Italian baseball played by visually impaired and blind athletes is an adapted team sport which maintains the peculiar fast-moving features of this popular sport. It is also a mixed team game played together with sighted subjects. Here, we performed a national survey aimed at assessing the differences in psychological well-being (PWB) and quality of life (QoL) between visually impaired baseball players from Italian teams and non-players using a structured online questionnaire. Forty-three visually impaired baseball players and thirty-four visually impaired sedentary individuals completed a structured self-report survey including the validated 18-item Italian versions of the PWB (PWB-18) scale and the Short Form-12 (SF-12) questionnaire to assess the QoL. PWB-18 and SF-12 reference data from the Italian normally sighted population were also employed for comparison with the visually impaired baseball player group. Visually impaired baseball players reported better scores in all dimensions of the PWB-18 scale and significant higher scores in both physical and mental QoL evaluated by SF-12 than the non-player group. In addition, PWB-18 scale findings revealed significant differences between visually impaired baseball players and the reference normally sighted population consisting in lower scores for autonomy, environmental mastery, positive relations with others and purpose in life dimensions. Conversely, the mean scores for PWB-18 personal growth and self-acceptance dimensions were not significantly different between the two groups. The SF-12 questionnaire results demonstrated a significantly higher physical score in visually impaired players compared with the reference population. Instead, the SF-12 mental score of visually impaired athletes tended to be lower, though this difference was not statistically significant. Collectively, our findings suggest that the practice of Italian baseball may have a positive impact on PWB and QoL of visually impaired individuals.
| S-EPMC6553783 | biostudies-literature
Project description:BackgroundDepression and anxiety are common in visually impaired and blind adults, but often remain untreated in those who receive support from low vision service (LVS) organizations. This study aims to determine factors associated with discussing mental health by LVS workers.MethodsA self-administered cross-sectional survey in one hundred LVS workers was performed. Data on current practice, symptom attribution, and determinants of the Integrated Change Model (i.e. predisposing and environmental factors, awareness, attitude, self-efficacy, social influence, confidence and barriers) were investigated. Multivariable logistic regression analysis was performed to determine predictors of discussing mental health problems in this population. Subsequently, internal validation was conducted using a bootstrapping method.ResultsAround 80% of the participants often discussed mental health with clients. Five factors were found to predict discussion of mental health: female gender (OR = 4.51; 95% confidence interval (CI) 0.98 to 21.61), higher education (OR = 3.39; CI 1.19 to 9.66), intention to discuss mental health problems (OR = 3.49; CI 1.20 to 10.15), higher self-efficacy (OR = 1.11; CI 1.02 to 1.20), and higher perceived social influence (OR = 1.15; CI 1.05 to 1.27). Good discrimination after internal validation was reflected by the area under the curve (0.850).ConclusionsPrevious studies indicate clients want healthcare providers to initiate discussions about mental health. However, still 20% of LVS workers do not discuss suspected depression or anxiety. In order to improve this, LVS organizations could address mental health as part of their care and provide training to ensure intention to discuss mental health problems, improve self-efficacy and create a supportive environment between colleagues.
| S-EPMC9027071 | biostudies-literature
Project description:ObjectivesCurrent cognitive screening and diagnostic instruments rely on visually dependent tasks and are, therefore, not suitable to assess cognitive impairment (CI) in visually impaired older adults. We describe the content development of the VISually Independent test battery Of NeuroCOGnition (VISION-Cog)-a new diagnostic tool to evaluate CI in visually impaired older Singaporean adults.DesignThe content development phase consisted of two iterative stages: a neuropsychological consultation and literature review (stage 1) and an expert-panel discussion (stage 2). In stage 1, we investigated currently available neuropsychological test batteries for CI to inform constructions of our preliminary test battery. We then deliberated this battery during a consensus meeting using the Modified Nominal Group technique (stage 2) to decide, via agreement of five experts, the content of a pilot neuropsychological battery for the visually impaired.SettingSingapore Eye Research Institute.ParticipantsStakeholders included researchers, psychologists, neurologists, neuro-ophthalmologists, geriatricians and psychiatrists.Outcome measurepilot VISION-Cog.ResultsThe two-stage process resulted in a pilot VISION-Cog consisting of nine vision-independent neuropsychological tests, including the modified spatial memory test, list learning, list recall and list recognition, adapted token test, semantic fluency, modified spatial analysis, verbal subtests of the frontal battery assessment, digit symbol, digit span forwards, and digit span backwards. These tests encompassed five cognitive domains-memory and learning, language, executive function, complex attention, and perceptual-motor abilities. The expert panel suggested improvements to the clarity of test instructions and culturally relevant test content. These suggestions were incorporated and iteratively pilot-tested by the study team until no further issues emerged.ConclusionsWe have developed a five-domain and nine-test VISION-Cog pilot instrument capable of replacing vision-dependent diagnostic batteries in aiding the clinician-based diagnosis of CI in visually impaired older adults. Subsequent phases will examine the VISION-Cog's feasibility, comprehensibility and acceptability; and evaluate its diagnostic performance.
| S-EPMC10565319 | biostudies-literature
Project description:People with low vision, especially those with Central Field Loss (CFL), need magnification to read. The flexibility of Electronic Vision Enhancement Systems (EVES) offers several ways of magnifying text. Due to the restricted field of view of EVES, the need for magnification is conflicting with the need to navigate through text (panning). We have developed and implemented a real-time gaze-controlled system whose goal is to optimize the possibility of magnifying a portion of text while maintaining global viewing of the other portions of the text (condition 1). Two other conditions were implemented that mimicked commercially available advanced systems known as CCTV (closed-circuit television systems)-conditions 2 and 3. In these two conditions, magnification was uniformly applied to the whole text without any possibility to specifically select a region of interest. The three conditions were implemented on the same computer to remove differences that might have been induced by dissimilar equipment. A gaze-contingent artificial 10° scotoma (a mask continuously displayed in real time on the screen at the gaze location) was used in the three conditions in order to simulate macular degeneration. Ten healthy subjects with a gaze-contingent scotoma read aloud sentences from a French newspaper in nine experimental one-hour sessions. Reading speed was measured and constituted the main dependent variable to compare the three conditions. All subjects were able to use condition 1 and they found it slightly more comfortable to use than condition 2 (and similar to condition 3). Importantly, reading speed results did not show any significant difference between the three systems. In addition, learning curves were similar in the three conditions. This proof of concept study suggests that the principles underlying the gaze-controlled enhanced system might be further developed and fruitfully incorporated in different kinds of EVES for low vision reading.
| S-EPMC5381883 | biostudies-literature
Project description:BackgroundExisting patient-reported outcome (PRO) measures may not be relevant to the full range of functional and vision-related quality of life (VR-QOL) concerns of individuals with vision impairment due to severe peripheral field loss (PFL). Measurement of VR-QOL in severe PFL is important in order to determine the effectiveness of vision rehabilitation interventions for this population. The purpose of this study was to characterize the impact of severe PFL due to retinitis pigmentosa (RP) and glaucoma on VR-QOL as the initial phase in the development of a novel PRO measure.MethodsIndividuals with severe PFL due to RP or glaucoma were recruited from the Kellogg Eye Center and the Association for the Blind and Visually Impaired. Participants completed semi-structured qualitative interviews, the Impact of Vision Impairment (IVI) questionnaire and the RAND 36-Item Health Survey. Interviews were analyzed by two coders using thematic analysis. A matrix analysis was conducted to compare VR-QOL by cause of severe PFL. Sample size was determined by thematic saturation.ResultsThe study included 37 participants (19 RP, 18 glaucoma). Median best-corrected visual acuity for those with RP and glaucoma was 20/40 and 20/27.5, while Pelli-Robson contrast sensitivity was 1.2 log contrast sensitivity (logCS) and 1.1 logCS, respectively. Median domain scores on the IVI (reading, mobility, well-being) ranged from a low of - 0.2 to a high of 0.7 logits in those with RP and from 0.5 to 1.2 logits in those with glaucoma. Qualitative interviews identified six VR-QOL themes relevant across participants with both RP and glaucoma, including activity limitations, driving, emotional well-being, reading, mobility, and social function. VR-QOL concerns were largely consistent among those with severe PFL due to RP and glaucoma. These overarching themes contained content relevant to specific challenges related to severe PFL.ConclusionsThere are commonly occurring VR-QOL concerns among individuals with severe PFL due to RP and glaucoma. The outlined themes will serve as the basis for development of the Low Vision Severely Constricted Peripheral Eyesight (LV-SCOPE) Questionnaire.
| S-EPMC7806695 | biostudies-literature
Project description:A study involving older New Zealanders (aged 65+) explored levels of life satisfaction reported by groups with and without impaired vision as well as factors contributing to and detracting from quality of life (QOL). Those with impaired vision (n = 135) had a visual acuity of 6/24 (i.e., 20/80) or worse in the better eye with corrective lenses, or a field of vision not greater than 20° at its widest diameter and had a mean age of 82.3 (SD = 6.76). Those with no significant impairment of vision (n = 425) were able read newsprint and legally drive and had a mean age of 74 (SD = 6.49). Overall, those with impaired vision reported a significantly lower level of life satisfaction in comparison to their sighted peers. There was a significant interaction effect of vision status and age, such that those with impaired vision aged 85+ reported life satisfaction scores higher than those reported by their sighted peers. Family and friends emerged as most important contributors to QOL for the vision-impaired group, where good health was the primary contributor to those with sight. Detractors to QOL reported by those with impaired vision included poor vision, inability to drive and poor health. Those with no significant impairment of vision reported poor health, physical impairment and poor finances detracted from QOL. Results could enable ageing and rehabilitation service providers to design rehabilitation programmes addressing areas reported to be most important to older adults with and without impaired vision.
| S-EPMC5546331 | biostudies-other
Project description:PurposeTo report piloting and initial validation of the VQoL_CYP, a novel age-appropriate vision-related quality of life (VQoL) instrument for self-reporting by children with visual impairment (VI).MethodsParticipants were a random patient sample of children with VI aged 10-15 years. 69 patients, drawn from patient databases at Great Ormond Street Hospital and Moorfields Eye Hospital, United Kingdom, participated in piloting of the draft 47-item VQoL instrument, which enabled preliminary item reduction. Subsequent administration of the instrument, alongside functional vision (FV) and generic health-related quality of life (HRQoL) self-report measures, to 101 children with VI comprising a nationally representative sample enabled further item reduction and evaluation of psychometric properties using Rasch analysis. Construct validity was assessed through Pearson correlation coefficients.ResultsItem reduction through piloting (8 items removed for skewness and individual item response pattern) and validation (1 item removed for skewness and 3 for misfit in Rasch) produced a 35-item scale, with fit values within acceptable limits, no notable differential item functioning, good measurement precision, ordered response categories and acceptable targeting in Rasch. The VQoL_CYP showed good construct validity, correlating strongly with HRQoL scores, moderately with FV scores but not with acuity.ConclusionsRobust child-appropriate self-report VQoL measures for children with VI are necessary for understanding the broader impacts of living with a visual disability, distinguishing these from limited functioning per se. Future planned use in larger patient samples will allow further psychometric development of the VQoL_CYP as an adjunct to objective outcomes assessment.
| S-EPMC4768881 | biostudies-literature
Project description:PurposeTo describe the various types of head-mounted display technology, their optical and human-factors considerations, and their potential for use in low-vision rehabilitation and vision enhancement.DesignExpert perspective.MethodsAn overview of head-mounted display technology by an interdisciplinary team of experts drawing on key literature in the field.ResultsHead-mounted display technologies can be classified based on their display type and optical design. See-through displays such as retinal projection devices have the greatest potential for use as low-vision aids. Devices vary by their relationship to the user's eyes, field of view, illumination, resolution, color, stereopsis, effect on head motion, and user interface. These optical and human-factors considerations are important when selecting head-mounted displays for specific applications and patient groups.ConclusionsHead-mounted display technologies may offer advantages over conventional low-vision aids. Future research should compare head-mounted displays with commonly prescribed low-vision aids to compare their effectiveness in addressing the impairments and rehabilitation goals of diverse patient populations.
| S-EPMC5580828 | biostudies-literature