Abstract
Purpose :
To assess the clinical and patient-centered effectiveness of a novel residential ocular care (ROC) model compared to usual care in Australian residential care residents.
Methods :
In this prospective, multi-centered, cluster randomized controlled trial, participants from residential care facilities in Victoria (Australia) were randomized to ROC (N=95), comprising a tailored and comprehensive within-site eye care rehabilitation pathway,or usual care (N=83), comprisingreferral to an external eye care service. Outcomes included presenting distance and near visual acuity (PDVA and PNVA assessed using LogMAR distance and near charts, respectively); Rasch-transformedvision-related Reading, Emotional and Mobility scores from theImpact of Vision Impairment scale); quality of vision (QoV, comprising frequency, severity and bother ratings from the QoV questionnaire); and depressive symptoms (Cornell Scale for Depression), assessed at baseline and 6 months post intervention. Within- and between-group comparisons were conducted using paired t-tests and linear mixed models, adjusted for within-facility correlation and baseline differences in characteristics between the two arms, respectively.
Results :
From the 38 participating residential care facilities, 178 visually impaired (PDVA >6/12 and/or PNVA≥N8) residents were enrolled (mean age±SD: 83.9±8.6 years; 65.7% women; 95.8% without depressive symptoms). There were no differences in any outcomes at baseline (P>0.05). At 6-months, intention-to-treat analyses showed significant between-group improvements in ROC residents compared to usual care for PNVA (mean difference [95% confidence interval]: -0.12 [-0.19, -0.04] log units)and QoV (0.79 [0.27, 1.31], 0.68 [0.16, 1.19] and 0.60 [0.09, 1.10] logits for frequency, severity and bother, respectively). Per protocol analyses also revealed improvements in Reading (0.73 [0.03, 1.44] logits)and Emotional (0.41 [0.03, 0.79] logits)scores. As few individuals reported depression, no between-group change in depressive symptoms was observed.
Conclusions :
Our ROC model is effective in improving near vision and associated perceived burden on vision-related symptoms and quality of life in residential care residents in Australia. Future studies to evaluate the cost-effectiveness and implementation of ROC are warranted.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.