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Vijaya Gothwal, Rebecca Sumalini, Seelam Bharani; Evaluating the Effectiveness of Low Vision Rehabilitation in Children. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2771. doi: https://doi.org/.
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Approximately 90% of patients with visual impairment (VI) have adequate residual vision to benefit from low vision rehabilitation (LVR). However, good evidence on LVR outcomes is required to guide service development and improve the lives of people with VI. Studies in adults with VI have demonstrated an improvement in the overall visual functioning (VF) and quality of life after LVR. Nonetheless, such effects are yet to be demonstrated in children with VI. The aim of this study was to evaluate the effectiveness of a multidisciplinary LVR program on VF using the LV Prasad-Functional Vision Questionnaire II (LVP-FVQ II).
First-time referrals to the Centre for Sight Enhancement were assessed before and after LVR (3-4 months). Children were administered the LVP-FVQ II before low vision assessment and at 3-4 months follow-up to assess the outcomes of LVR. Recently, a second version of the LVP-FVQ (LVP-FVQ II) was developed and was demonstrated to be a reliable and valid measure of VF using Rasch analysis. Rasch analysis was used to estimate the LVP-FVQ II scores on an interval scale. Cohen d values were used to estimate the magnitude of the change and the standardized response mean (SRM) was selected to determine the clinical change of the LVR induced changes.
Sixty-three participants completed the rehabilitation (mean age, 11.9 years; male, 62%). Approximately one-half had retinal disorders (48%, 30) and most were moderately visually impaired (<20/60-20/200, 74.6%, 47). Using the LVP-FVQ II, significant improvement in VF was recorded (p<0.0001) after rehabilitation and the increase in VF (SD) was 2.03 (1.68) logits (equivalent to an 8-line improvement in visual acuity on an Early Treatment of Diabetic Retinopathy Study chart). The magnitude of the improvement in LVR intervention at follow-up was found to be relatively large (Cohen’s d = 1.27, SRM = 1.21) indicating large treatment effects both statistically and clinically. By comparison, there was no significant change in VF for the control group (n=41).
This is the first study to provide strong evidence that LVR services are effective in children with VI. Significant (both statistically and clinically) improvements in the overall VF in children with VI were found using the LVP-FVQ II. The LVP-FVQ II is responsive to changes in VF resulting from LVR and has the potential to be used as a measure of LVR outcomes in future studies.
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