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Xinxing Guo, Bonnielin K Swenor, Judith Goldstein; Visual Acuity Improvement by Refraction of Low Vision Patients in an Academic Medical Center. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1061.
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© ARVO (1962-2015); The Authors (2016-present)
We aim to determine the change in visual acuity (VA) based on refraction alone in new patients seeking low vision rehabilitation (LVR) services in this observational clinical study.
All patients new to LVR services at 5 locations (main hospital and 4 satellite clinics) in the ophthalmology department of an academic medical center from August 1, 2013 to December 31, 2015 were identified through the electronic health record system. Clinical information on the first encounter available with refraction information was included. Patient demographics, VA, and contrast sensitivity (CS) were extracted. VA was categorized as near normal (≥20/40), mild visual impairment (VI) (<20/40 to ≥20/60), moderate VI (<20/60 to >20/200), severe VI (≤20/200 to >20/500), and profound VI (≤20/500). VA improvement was defined as a change in the category from HVA to best-corrected VA in the better-seeing eye. Multivariable logistic analysis was performed to evaluate the determinants of worse VI categories and VA improvement.
A total of 2,775 patients 5 years and older were included for analysis. Median age was 70 years (range, 5 to 105 years), with females representing 58.1% of the sample. Among patients with available HVA (n=2,759), proportions of patients with no, mild, moderate, severe, and profound VI were 35.5%, 18.0%, 26.0%, 12.5%, and 8.1%, respectively. In patients with mild VI or worse (n=1779), VA improved in 37.3% with refraction alone. VA improvement was seen in 52.9% mild VI, 36.9% moderate VI, 31.4% severe VI, and 12.6% profound VI patients. Median CS was 1.24 logCS (interquartile range, 0.92-1.50 logCS), and CS impairment (< 1.30 logCS) was observed in 30.9% patients with HVA≥20/40 and 68.3% of those with HVA<20/40. After adjusting for age, sex, race, and ethnicity, worse HVA categories were associated with more impaired CS (OR=25.33, 95% CI: 20.30-31.61). VA improvement by refraction was most likely (OR=2.33, 95%CI: 1.37-3.96) to be seen in patients with mild VI (<20/40 to ≥20/60) as compared to profound VI (≤20/500).
VA improvement can be achieved by refraction alone in over one-third of new patients presenting to LVR services in this population. Patients with mild VI are most likely to benefit in VA improvement from refraction.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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