Effectiveness of Low Vision Rehabilitation

Abstract

Purpose:: The goals for conducting an evidence-based review on low vision rehabilitation (LVR) are to locate the strongest and most current evidence for LVR programs and devices, to identify any unmet research needs, and to translate this knowledge to both research and clinical communities.

Methods:: A literature search was conducted using online databases, journals, and hand-searches of references covering the period from 1980 to 2006. Articles were reviewed and selected based on specific inclusion and exclusion criteria. Articles were assessed with a quality assessment instrument designed for both randomized and non-randomized studies, and were assigned levels corresponding to their strength of evidence and study design. Two reviewers independently reviewed all search results for inclusion in the review, evaluated study quality and extracted the data.

Results:: The strength of research evidence for the effectiveness of LVR is not consistent across all major forms of LVR intervention. Based on the research synthesis, there was strong evidence showing the effectiveness of both LVR programs and LVR programs which incorporated education in the use of low vision aids (but with no significant added benefit to receiving home visits from a LVR specialist, as measured by vision and health-related outcome measures). Strong evidence indicates that prism spectacles are no more effective than conventional glasses for individuals with AMD. Moderately strong evidence shows that computer task accuracy and performance for individuals with AMD are linked with certain measures of visual function, icon sizes, and other graphical user interface design considerations. Moderately strong evidence indicates that the effects of AMD and activity loss can cause increased depression and emotional distress. Across the majority of categories within each reviewed topic area, there were limited or weak levels of evidence, which makes it difficult to form strong conclusions regarding the effectiveness of some proposed LVR interventions.

Conclusions:: This evidence-based review identifies areas where research is deficient or undeveloped. Strategic investments in research should be targeted at areas of greatest need for evidence, and should be redirected away from interventions that are known to be relatively ineffective or that have a relatively low priority for persons with vision loss. There is a corresponding obligation for service providers to incorporate evidence-supported practices and interventions into their LVR activities as quickly as possible.

Keywords: low vision • age-related macular degeneration