Change in Rehabilitation Needs and Activity Limitations Following Low Vision Rehabilitation Among Adults With Acquired Visual Impairment in England

Written by  Bruce P. Rosenthal OD, FAAO, Chief of Low Vision Services, Lighthouse Guild

TAKE-HOME MESSAGE

• This study utilized the Participation and Activity Inventory (PAI) to assess changes in priority rehabilitation needs, vision-related activity limitations, and goal importance in adults with acquired visual impairment over a year following entry into a low vision rehabilitation service. Utilizing scores from the PAI, visually impaired adults were asked about the difficulty of selected activities once they began receiving low vision rehabilitation interventions. For the top priority goals (including reading, outdoor mobility, and writing), the perceived difficulty was reduced over the study period for most adults.
• The results of the study indicate that continued follow-up, even after 1 year of low vision rehabilitation, is needed to address changing goals.

The demand to manage persons with visual impairment, especially in facilities offering comprehensive low vision rehabilitation services, continues to expand with the global increase in the world population. More significantly, is a parallel growth in the aging population, affected by an increase in debilitating eye disorders, which in turn may affect an individual’s quality of life as well as their independence. This study set-out to evaluate, over one year, “longitudinal changes in priority rehabilitation needs, vision related activity limitations and importance of visual goals.”

The research followed forty-eight adult participants (age 30-91) over 1 year, using the Participation and Activity Inventory (PAI). The subjects who volunteered in the study, received services from Vista, the largest low vision and rehabilitation service in the English counties of Leicestershire and Rutland. There were “no restrictions to participation due to the cause or level of visual impairment.”

The visually impaired participants in the study completed the PAI, a self-reporting instrument, “on the importance and difficulty of “48” visual goals. The goals are available in the WHO Classification of Functioning, Disability, and Health.

A member of the Vista team, rehabilitation officers for the visual impaired (RVOI) followed up at their home for an assessment within 6 weeks. The participants were then scheduled for a low vision examination as well as recommendations for low vision devices by low vision clinicians in Leicester or at their home.

The breakdown of eye diseases of participants in the study included 48% with age-related macular degeneration (exudative 35%/nonexudative 10%), primary open angle glaucoma 13%, retinal vascular occlusions 8%, visual cortex disorder, cerebral vascular disease (4%), hereditary retinal dystrophy (4%), diabetic retinopathy (4%), optic atrophy (4%) and other (8%).

The mean age was 30-91, ethnicity was 96% white British, 67% in the study were female, while 54% were living with others.

The major outcome of the goals, with the highest priority, were the importance of reading, mobility outdoors, and writing. And one notable advantage of being in the study was the access to vision rehabilitation services.

The authors note that “potential limitation of the study is that the sample size was relatively small, and the participants were volunteers”.  From a low vision clinician’s viewpoint, other shortcomings include the homogeneous ethnicity of participants which were 95% white, the high percentage of patients with exudative (wet) age-related macular degeneration (35%) in the study (approximately 10-15% in US studies) and the fact that no spectacles (hands free devices) were among the low vision devices prescribed (as noted, perhaps due to budgetary constraints).  It would be interesting to include other vision rehabilitations services for comparison in a follow-up study, as well comparing the outcomes to scheduled patients in a low vision service, not a volunteer. And it would be interesting to compare the volunteer case history to that of a low vision clinician, on patient objectives as well.

With that said, this is a major comprehensive study which significantly adds to needed “evidence-based medicine” on the importance of the longitudinal management of patients with acquired visual impairment, as well as the change over time in rehabilitation needs. And from a low vision clinicians’ point of view, the outcome of reading and mobility are indeed at the top of the high priority list as well.

The abstract is available on the publisher’s site

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