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Hannah M. Dunbar, Michael D. Crossland, Catherine Egan, Gary S. Rubin; The Effect of Low Vision Rehabilitation in Diabetic Eye Disease: A Randomised Controlled Trial. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3153.
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To determine, by randomised controlled trial, the effectiveness of low vision rehabilitation in those with diabetic eye disease.
100 subjects with varying degrees of diabetic eye disease were recruited and randomised to immediate intervention (1-2 weeks after enrolment) or delayed intervention (3 months after enrolment). Intervention was a standard low vision assessment performed in a hospital clinic. All subjects completed the Activity Inventory (AI) at baseline and 3 and 6 months after enrolment. The AI was scored by Rasch analysis providing a measure of visual ability in logits. The primary outcome measure, AI score 3 months after enrolment and the secondary outcome measures, AI score 6 months after enrolment and 3 months after intervention were examined by analysis of covariance adjusted for baseline AI score. Subgroup analyses were conducted to examine whether visual acuity (VA) or disease severity influence intervention success.
92 (44 immediate: 47 delayed) subjects completed the study. Mean AI score in intervention and delayed groups were 2.11 and 2.44 logits respectively at baseline, 2.39 and 2.56 logits at 3 months and 2.52 and 3.03 logits at 6 months. Mean change in AI score (adjusted for baseline AI score) in the immediate group was not significantly different to the delayed group 3 months after enrolment (-0.05 logits, p = 0.67), 6 months after enrolment (0.11 logits, p = 0.40) or 3 months after intervention (0.15 logits, p = 0.25). Considering only those with VA ≥ 0.1 LogMAR, mean improvement in AI score was significantly greater in the immediate group than the delayed group 6 months after enrolment (0.44 logits, p = 0.02) and 3 months after intervention (0.49 logits, p = 0.01). Disease severity was not related to intervention success (p < 0.08).
Low vision rehabilitation did not improve visual ability in the study group as a whole. However, subgroup analyses suggest a significant benefit for those with reduced central vision. Additionally, visual ability improves significantly less if intervention is delayed, implying earlier referral of those with reduced vision may be warranted.
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