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Ashley Deemer, Robert W Massof, Barry Rovner, Robin Casten; Functional Outcomes of the Low Vision Depression Prevention Trial (VITAL) in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Depression and decreased visual function are common in patients with age-related macular degeneration (AMD). A RCT was conducted to determine if treatment effects of optometric low vision rehabilitation services (LVR) in conjunction with either behavior activation (BA) and occupational therapy, provided in the patient’s home by an occupational therapist (OT), or supportive therapy (ST), an attention control condition provided by a social worker in the patient's home, reduces the risk of depression. Here we analyze and report baseline and 4 month follow-up Activity Inventory (AI) responses to compare the functional outcomes of in-home BA vs ST treatment after standard optometric low vision services.
Data from the VITAL study were used to analyze the functional outcomes of BA+LVR vs ST+LVR treatment. 188 subjects with AMD were randomized into the two groups. Eligibility criteria required patients to be at risk for developing depression based on sub-threshold depressive symptoms measured with the Patient Health Questionnaire-9. The AI was used to assess self-reported visual function and outcome variables for functional vision domains were estimated using Rasch analysis.
Improvements in functional vision measures were seen in both the BA and ST groups at the goal level (d=0.71; d=0.56 respectively). At the task level, BA patients showed more improvement in reading, inside the home tasks and outside the home tasks when compared to ST patients. When comparing the functional vision outcomes and group effects of BA to ST, small differences between groups were seen with only measures of outside the home tasks reaching statistical significance (d=0.27, p=0.029).
Based on the AI data, we conclude that post-optometric care by an OT results in greater improvement in visual function at the task level. The improvements shared by the two groups may be attributed to the optometric services both received. Both groups also received attention in the home, which could account for the lack of difference in outcomes observed at the goal level. The primary outcome of VITAL study concluded that BA is more effective than ST at preventing depression in an at risk group of AMD patients. The results of this secondary study lends support to the conclusion that in-home BA+LVR is more effective at improving functional vision than attention alone after optometric low vision services.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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