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Alice Y. Zhang, Donald H. Watanabe, Walter Wittich, Julius E. Gomolin, Olga Overbury; Determinants In Access To Low Vision Services - A Montreal Study. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4410.
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Patients with vision impairment are frequently referred to low vision centers by eye care professionals. However, various factors may hinder their decision to access low vision rehabilitation services. We investigate the determinants which may influence such a decision in patients from a Montreal retina practice.
We conducted a retrospective chart review study at a large academic institution. A selection of consecutive patient records from one medical retina specialist’s practice were reviewed in alphabetical order, for a total of 2,470 charts, spanning 22 years from 1988 to 2010. We identified 100 referrals to the MAB-Mackay Rehabilitation Centre (MMRC), one of the two major centers that provide vision rehabilitation services in the Greater Montreal Area. Demographic and clinical characteristics, such as age at time of referral, gender, visual acuities at time of referral, diagnosis, and distance from the MMRC, were collected and analyzed for relationships to successful access to low vision services.
Of the 100 patients referred to the MMRC, the retina specialist successfully obtained compliance from 78% of patients. Of those referred, 68 patients had a diagnosis of age-related macular degeneration (AMD), 17 had diabetic retinopathy, and 15 had other ocular conditions. Data analysis showed that there is an association between diagnosis and utilization of low vision rehabilitation services, X²(2) = 7.600, p<.05. In particular, patients with a diagnosis of AMD were more likely than those with diabetic retinopathy or other ocular diseases to access the MMRC. However, the visual acuity and level of visual impairment in patients with AMD did not correlate with decision to access the MAB. Factors such as age at time of referral, gender, and distance from the center were not related to whether or not an individual sought assistance from a low vision rehabilitation center.
The Montreal Barriers Study reported that 54% of people who were eligible for rehabilitation services actually received them. The source of participants was much broader including ophthalmologists in all subspecialties, other than pediatrics. This study demonstrates a higher success rate (78%) of utilization of low vision rehabilitation services. It appears that a retina specialist would be more likely to refer patients and that the recommendation may be more seriously considered, especially by patients diagnosed with AMD who are more likely to accept low vision services, compared to those with diabetic retinopathy or other visual disorders.
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