Basic Versus Basic Plus Advanced Low Vision Rehabilitation Services and Impact on Vision-Targeted Health-Related Quality of Life

Abstract

Purpose: : We are planning a clinical trial to examine the effectiveness of low vision rehab services in the US as provided to adults not receiving health care through the VA. In a national survey we characterized what usual care services are in the US (Arch Oph 2009). We next examined the preliminary responsiveness of a vision-targeted HRQoL questionnaire to low vision rehab services; the questionnaire was phone-administered from a coordinating center. We also compared the impact of basic services (assessment and optical rehab) vs basic plus advanced services (eg, OT, social work, resource education).

Methods: : Persons were recruited from 7 sites (AL, 2 in CA, FL, MI, MN, PA) providing low vision rehab services. Entrance criteria were >18yo, spoke English, and no low vision rehab services in the past 2 years. The NEI VFQ-25 was administered by the AL coordinating center at baseline before rehab and 3 months after care was complete. Medical records provided clinical and rehab information.

Results: : 467 persons enrolled; 333 completed both baseline and follow-up interviews. 66% were women; 84% were white, 11% Black, 5% other. Subjects ranged in age from 18-98 yo (M age 75). Visual acuity in the better eye averaged 20/90. 92% of participants had AMD, glaucoma, diabetic retinopathy, or other retinal degenerations. At follow-up VFQ subscales for general vision, near vision, and mental health were improved (p<.01). Those receiving basic services plus OT had greater improvement in the VFQ’s general vision subscale than did those receiving basic services only (p<.04). Those receiving basic services plus any other kind of advanced service had greater improvement on the general vision and distance activity subscales (p<.05) than those getting basic services only.

Conclusions: : The VFQ is responsive to low vision rehab interventions when the VFQ is administered remotely from a coordinating center. Although sample sizes were small for subgroup analyses, results suggest that the type/level of care may lead to different magnitudes of improvement. This information is useful for planning clinical trials.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • low vision • quality of life