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    ABSTRACT: To evaluate the effectiveness of a low-vision rehabilitation program. A multicenter randomized clinical trial was conducted from November 2004 to November 2006 with a 4-month follow-up. A total of 126 patients were included, 98% of whom were white and male. The patients were referred from eye or low-vision clinics and blind rehabilitation centers with a visual acuity in the better-seeing eye worse than 20/100 and better than 20/500 and were eligible for Veterans Affairs (VA) services. Telephone interviews of patients were conducted in their homes before and after participation in an outpatient low-vision program at a VA medical care facility or a (waiting list) control group. The interviewer administering questionnaires by telephone was masked to patients' assignments. Interventions included low-vision examination, counseling, and prescription and provision of low-vision devices and 6 weekly sessions provided by a low-vision therapist to teach use of assistive devices and adaptive strategies to perform daily living tasks independently. Change in patients' visual reading ability estimated from participant responses to the Veterans Affairs Low-Vision Visual Functioning Questionnaire (LV VFQ-48) reading items completed at baseline compared with 4 months after enrollment for the treatment and control groups. The secondary outcomes were changes in other visual ability domains (mobility, visual information processing, visual motor skills) and overall visual ability from baseline to 4 months estimated from VA LV VFQ-48 difficulty ratings for subsets of items. The treatment group demonstrated significant improvement in all aspects of visual function compared with the control group. The difference in mean changes was 2.43 logits (95% confidence interval [CI], 2.07-2.77; P < .001; effect size, 2.51) for visual reading ability; 0.84 logit (95% CI, 0.58-1.10; P < .001; effect size, 1.14) for mobility; 1.38 logits (95% CI, 1.15-1.62; P < .001; effect size, 2.03) for visual information processing; 1.51 logits (95% CI, 1.22-1.80; P < .001; effect size, 1.82) for visual motor skills; and 1.63 logits (95% CI, 1.40-1.86; P < .001; effect size, 2.51) for overall visual function. The program effectively provided low-vision rehabilitation for patients with macular diseases. APPLICATIONS TO CLINICAL PRACTICE: At least 10 hours of low-vision therapy, including a home visit and assigned homework to encourage practice, is justified for patients with moderate and severe vision loss from macular diseases. Because the waiting-list control patients demonstrated a decline in functional ability, low-vision services should be offered as early as possible. clinicaltrials.gov Identifier: NCT00223756.
    Archives of ophthalmology 06/2008; 126(5):608-17. DOI:10.1001/archopht.126.5.608 · 4.40 Impact Factor
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    ABSTRACT: Falls are a serious and preventable problem in older adults. Impaired vision has been linked to risk of falls; however, the impact of deficits in specific components of vision on the risk of falls is not well known. Data on falls for up to 20 months were provided by 2375 individuals participating in the Salisbury Eye Evaluation (SEE). Visual acuity, contrast sensitivity, visual field, and stereoacuity were tested by using standard measures. To aid in the assessment, each participant recorded falls on a calendar that was sent every month to the SEE clinic. beta-Binomial regression analysis was used. Worse visual field scores were associated with the risk of falling (OR = 1.08 for a 10-point loss of points, 95% CI 1.03-1.13). When both central (</= 20 degrees radius) and peripheral visual fields were in the same model, only the peripheral visual field was associated with falls (OR = 1.06, 95% CI 1.01-1.10). Visual acuity, contrast sensitivity, and stereoacuity were not associated with falls after adjustment for demographic and health variables. Visual field loss is the primary vision component that increases the risk of falls. This finding highlights the importance of visual field deficits in the risk of falls and supports other findings on decrements in mobility and increased risk of bumping with worsening visual field function. Persons with visual field loss may benefit from mobility training to reduce the risk of falling.
    Investigative Ophthalmology &amp Visual Science 11/2007; 48(10):4445-50. DOI:10.1167/iovs.07-0326 · 3.40 Impact Factor
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    ABSTRACT: To evaluate the sensitivity to change, in patients who undergo vision rehabilitation, of the Veteran Affairs (VA) Low Vision Visual Functioning Questionnaire (LV VFQ-48), which was designed to measure the difficulty visually impaired persons have in performing daily activities and to evaluate vision rehabilitation outcomes. Before and after rehabilitation, the VA LV VFQ-48 was administered by telephone interview to subjects from five sites in the VA and private sector. Visual acuity of these subjects ranged from near normal to total blindness. The VA LV VFQ exhibited significant differential item functioning (DIF) for 7 of 48 items (two mobility tasks, four reading tasks, and one distance-vision task). However, the DIF was small relative to baseline changes in item difficulty for all items. Therefore, the data were reanalyzed with the constraint that item difficulties do not change with rehabilitation, which assigns all changes to the person measure. Subjects in the inpatient Blind Rehabilitation Center (BRC) program showed the largest changes in person measures after vision rehabilitation (effect size = 1.9; t-test P < 0.0001). The subjects in the outpatient programs exhibited smaller changes in person measures after rehabilitation (effect size = 0.29; t-test P < 0.01). There was no significant change in person measures for the control group (test-retest before rehabilitation). In addition to being a valid and reliable measure of visual ability, the VA LV VFQ-48 is a sensitive measure of changes that occur in visual ability as a result of vision rehabilitation. Patients' self-reports of the difficulty they experience performing daily activities measured with this instrument can be used to compute a single number, the person measure that can serve as an outcome measure in clinical studies. The VA LV VFQ-48 can be used to compare programs that offer different levels of intervention and serve patients across the continuum of vision loss.
    Investigative Ophthalmology &amp Visual Science 08/2006; 47(8):3253-61. DOI:10.1167/iovs.05-1319 · 3.40 Impact Factor


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