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Ryan Larochelle, Jennifer Patnaik, Anne Lynch, Naresh Mandava, Kara Hanson; Low Vision Referral Patterns in Intermediate AMD. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3600.
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© ARVO (1962-2015); The Authors (2016-present)
Low vision (LV) services are underutilized, but sparse data exist regarding referral patterns. In this retrospective chart review, we examined our institution’s intermediate age-related macular degeneration (iAMD) database to determine factors influencing referral.
We determined which patients in our iAMD registry had been referred to LV, excluding patients with neovascularization or geographic atrophy in either eye. Visual acuity (VA) was collected at the time of LV referral or the most recent visit for patients not referred. Visual Function Questionnaire (VFQ-25) scores (composite and 12 subscales) were collected at enrollment into the iAMD study. We compared patients referred to LV and patients not referred with Chi-square testing and the Wilcoxon rank sum test. Multivariable logistic regression analysis was used to examine each subscale of the VFQ-25 separately (P<0.05).
We found 36 (16%) of the 232 iAMD patients were referred to LV (Table 1). Referred patients were significantly more likely to be older, have worse VA in both eyes, and have lower VFQ-25 composite scores. Univariate analysis of VFQ-25 subscales demonstrated significantly worse scores for LV patients in general vision, near, distance, mental health, role limitations, dependency, and driving (Table 2). In the multivariable analysis, significant subscales included lower scores in general health, general vision, and driving.Referred patients had a median VA of 20/40 in the better eye and a median VFQ-25 score of 84. We found 46 (48%) of the non-referred patients had VA of 20/40 or worse and/or VFQ-25 score of 84 or lower. Factors identified as reasons for not referring included cataract or posterior capsular opacification amenable to a procedure, fluctuating vision, and extensive comorbidities. However, two thirds of these patients had no documented or discernable reason for not receiving referral.
LV services help AMD patients maximize the function of their remaining vision. This study demonstrates that our institution refers patients with worse objective and functional vision, but that many more patients might benefit from LV services. This study was limited in that VA and VFQ-25 data were not obtained simultaneously. Future studies should aim to identify specific metrics that should prompt LV referral and apply this approach to other diseases.
This is a 2021 ARVO Annual Meeting abstract.
Table 1. LV referral patterns among iAMD patients.
Table 2. VFQ-25 subscales for iAMD patients.
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