Outcomes of low-vision services using optometric and multidisciplinary approaches: a non-randomized comparison

Consecutive patients (n = 215) who were referred to optometric (55%) or multidisciplinary (45%) low-vision services and above 50 years of age were recruited from four hospitals in the Netherlands. They completed two vision-related quality of life questionnaires, the Vision Quality of Life Core Measure (VCM1) and the Low Vision Quality of Life Questionnaire (LVQOL), before their first visit with low-vision services and 1 year later. At follow-up, patients referred to multidisciplinary low-vision services had lower scores on the mobility subscale of the LVQOL than patients referred to optometric low-vision services [5.3 points; 95% confidence interval (CI): 0.2-10.5]. Paired sample t-tests for the two groups of patients taken together show improvement for the VCM1 (3.1 points; 95% CI: 0.6-5.6) and deterioration for the basic aspects of vision (3.5 points; 95% CI: 1.1-5.9) and the mobility (6.6 points; 95% CI: 3.7-9.5) subscales of the LVQOL. In conclusion, people referred to optometric services showed less deterioration in mobility than those referred to multidisciplinary services. No differences were observed for any of the other subscales of the LVQOL and the VCM1. Future research in this field should include randomized controlled designs comparing low-vision services with no treatment or placebo.     

Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation

PURPOSE: To design and validate a vision-specific quality-of-life assessment tool to be used in a clinical setting to evaluate low-vision rehabilitation strategy and management. METHODS: Previous vision-related questionnaires were assessed by low-vision rehabilitation professionals and patients for relevance and coverage. The 74 items selected were pretested to ensure correct interpretation. One hundred and fifty patients with low vision completed the chosen questions on four occasions to allow the selection of the most appropriate items. The vision-specific quality of life of patients with low vision was compared with that of 70 age-matched and gender-matched patients with normal vision and before and after low-vision rehabilitation in 278 patients. RESULTS: Items that were unreliable, internally inconsistent, redundant, or not relevant were excluded, resulting in the 25-item Low Vision Quality-of-Life Questionnaire (LVQOL). Completion of the LVQOL results in a summed score between 0 (a low quality of life) and 125 (a high quality of life). The LVQOL has a high internal consistency (alpha = 0.88) and good reliability (0.72). The average LVQOL score for a population with low vision (60.9 +/- 25.1) was significantly lower than the average score of those with normal vision (100.3 +/- 20.8). Rehabilitation improved the LVQOL score of those with low vision by an average of 6.8 +/- 15.6 (17%). CONCLUSIONS: The LVQOL was shown to be an internally consistent, reliable, and fast method for measuring the vision-specific quality of life of the visually impaired in a clinical setting. It is able to quantify the quality of life of those with low vision and is useful in determining the effects of low-vision rehabilitation.     

Measuring low-vision rehabilitation outcomes with the NEI VFQ-25

PURPOSE: To evaluate the sensitivity of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) to change in visual abilities after low-vision rehabilitation in two different Veterans Administration (VA) low-vision programs METHODS: Seventy-seven legally blind veterans from the Blind Rehabilitation Center (BRC) at Hines VA Hospital and 51 partially sighted veterans from the Visual Impairment Center to Optimize Remaining Sight (VICTORS) program at the Chicago Health Care Network, West Side Division, were administered the NEI VFQ-25 plus supplement in interview format at admission and discharge. Instructions for administration were modified to have study participants answer all the questions as if they were wearing glasses or contact lenses or were using low-vision devices. Interval measures of person ability and item difficulty were estimated from the patients' responses to 34 of the 39 items on the VFQ-25 plus supplement before and after rehabilitation, by the polytomous rating scale measurement model of Wright and Masters. RESULTS: In VICTORS patients, item order by difficulty before rehabilitation agreed with item order for BRC patients. Visual ability scales are used similarly by different patients with different degrees of low vision. Based on prerehabilitation person measure distributions, VICTORS patients were less disabled, as would be predicted by visual acuity, than were BRC patients. After rehabilitation, estimated item difficulty for 4 of the 34 items decreased significantly in both BRC and VICTORS patients. CONCLUSIONS: The present study demonstrates that the NEI VFQ-25 plus supplement can be used to measure the effects of low-vision rehabilitation; however, only 7 of the 34 items tested are sensitive to change after rehabilitation. Targeted activities, such as reading ordinary print, small print, and street signs are easier to perform for graduates of both programs after rehabilitation. The patients' visual ability also shows improvement in both BRC and VICTORS. Improvement in visual ability is independent of change in difficulty of targeted items. Although this was not a controlled clinical trial, the decrease in difficulty of targeted items may reflect the use of low-vision aids and training to make tasks easier. The change in visual ability may reflect positive outcomes of rehabilitation or may be the consequence of patients' overestimates of their functional ability at the time of discharge.     

Eye movements and reading with large print and optical magnifiers in macular disease.

PURPOSE: Reading rate has been the main performance measure in studies that have compared reading with large print and optical magnifiers; eye movement characteristics have not been considered. We compared both eye movement characteristics and reading rates for subjects with macular disease reading without and with a range of low-vision devices. METHODS: Silent reading rate and eye movement characteristics for text passages at critical print size of 21 subjects aged 14 to 88 years with macular disease were measured with and without their preferred low-vision device. Saccadic frequency was determined from a sequencing task comprising five letters each separated by 5 degrees. Eye movements were recorded using an infrared limbal reflection system. RESULTS: There were no significant differences in reading rate, fixation durations, saccade numbers per word, or percent retrace time when using a low-vision device compared with reading without a low-vision device. The percentage of regressions was, however, lower with the low-vision device. Saccadic frequency in the sequencing task was predictive of reading performance with and without a low-vision device. CONCLUSIONS: When reading at critical print size, in terms of reading rate or saccades per word, there was no advantage to using large print over an optical low-vision device.     

Disparities in awareness and use of low-vision rehabilitation

Objective: To describe the demographic, visual, health, and psychological variables associated with awareness and use of low-vision rehabilitation services in Montreal, Que.Study Design: Hospital-based cross-sectional study.Participants: Four hundred forty-eight patients with best-corrected visual acuity worse than 20/70 in their better eye recruited from 4 ophthalmology departments.Methods: Patients answered questions about their awareness and use of low-vision services. Visual acuity was recorded and patients answered the Brief Cope and Center for Epidemiologic Studies - Depression Scale questionnaires and provided information on demographics and health status. Multiple logistic regression was used to identify independent predictors of awareness and use of low-vision rehabilitation services.Results: A majority of patients in the sample (71%) were aware of low-vision rehabilitation. Of those who were aware, 81% reported participating in low-vision rehabilitation. Black patients, those whose first language was French, those with less severe visual acuity loss, and those who reported less acceptance on the Brief Cope questionnaire were less likely to know about low-vision services (p < 0.05). Of those who knew about low-vision services, those with less severe visual acuity loss were less likely to have participated in low-vision services (p < 0.05).Conclusions: It is important that all those who qualify for low-vision rehabilitation services can access them. Although the patients in this Montreal area study showed a high rate of awareness and use of low-vision rehabilitation, awareness and use could be improved in certain demographic populations and in those with less severe vision loss.     

Reading with a head-mounted video magnifier.

PURPOSE: This study compared the effectiveness of a head-mounted video magnifier, low-vision enhancement system (LVES), with closed-circuit TV (CCTV) and large print as a device or means of improving reading performance in people with low vision. METHODS: The reading performance of ten low-vision participants was assessed in two ways: (1) By measuring reading speed as a function of print size with LVES and without LVES, and (2) by comparing reading speed and comprehension of news articles using the LVES vs. a popular non-head-mounted video magnifier, the CCTV. RESULTS: Maximum reading speeds with LVES matched the maximum reading speeds with unaided vision attained by enlarging print. The critical print size (the smallest print size that could be read at maximum reading speed) improved significantly for all participants using LVES compared with unaided vision. When comparing reading performance using LVES and CCTV, we found that reading speed and comprehension for the two conditions were equivalent. The two low-vision participants with lowest acuities (20/640 and 20/960) could not read the 10-point newspaper articles with LVES, even with an 8 D auxiliary reading lens that permitted a very close reading distance. CONCLUSIONS: Head-mounted video magnifiers, such as LVES, can support good low-vision reading performance, but the restricted range of magnification may limit the usefulness of the device as a reading magnifier for people with very low acuity.     

Reading performance with various lamps in age-related macular degeneration

The purpose of this study was to determine if there was an objective difference in reading between four commonly available lamps, of varying spectral radiance, for 13 subjects with age-related maculopathy (ARM) or non-exudative age-related macular degeneration (AMD)--logMAR visual acuity between 0.04 and 0.68. At a constant illuminance of 2000 lux, there was no interaction between ARM and AMD subgroups and no statistically significant difference between the lamps: standard (clear envelope) incandescent, daylight simulation (blue tint envelope) incandescent, compact fluorescent and halogen incandescent, for any reading outcome measure (threshold print size p = 0.67, critical print size p = 0.74, acuity reserve p = 0.84 and mean reading rate p = 0.78). For lamps typically used in low-vision rehabilitation, a clinically significant effect of spectral radiance on reading for people with ARM or non-exudative AMD is unlikely.     

助视器提升低视力患者生活质量

目的：调查低视力助视器（LVAs）在提高低视力患者生活质量方面的有效性。方法：前瞻性临床研究。选取2017年1月至2018年2月在温州医科大学附属眼视光医院就诊的符合低视力诊断标准的患者55例，给患者验配远用、近用助视器。在低视力患者配戴LVAs前和配戴30 d后采用中文版低视力患者生活质量量表（CLVQOL）评估低视力患者的生活质量，问卷内容涉及远视力、移动和光感，心 理调节能力，阅读和精细工作能力及日常生活能力。对各组LVQOL评分结果进行配对t检验，对影 响因素进行回归分析。结果：55例低视力患者中，44例完成了基线和随访时的生活质量问卷调查。经过低视力助视器等辅助后，生活质量评分从77.8±19.0上升到82.3±22.5，差异具有统计学意义（t=4.56，P=0.001）。性别、识字率、学习状况和视力等因素不影响低视力患者生活质量。结论：低视力助视器可以提高不同年龄段、不同性别的低视力人群的生活质量。     

土耳其文版低视力生活质量量表的效度和信度研究

目的:把低视力相关的生活质量(LVQOL)文书改编为土耳其文,并评估其效度和信度。方法:这项研究是在387位参加安卡拉大学医学院,低视力康复中心的患者中进行的。使用Spearman相关系数,Cronbachα系数和验证性因素分析(CFA)进行统计分析。结果:根据CFA结果,在"调节能力"维的条目,因为有低于0.40的因子负荷故被排除在调查问卷之外。根据Cronbachα系数,对量表的信度进行了评估。"远视力,移动和光感"维的信度是α=0.863;"调节能力"维是α=0.694;"读和精细工作"α=0.791,"日常生活能力"α=0.770。因此,这些结果表明,用量表来衡量低视力患者的视力相关的生活质量是可靠的。对维之间的相关性也进行了分析,"调节能力"和"读和精细工作"之间的相关性被认为是最低的(rs=0.336,P<0.01),而"读和精细工作"与"日常生活能力"之间的相关性被发现是最强的。此外,"调节能力"仅与"远视力,移动和光感"表现最强的相关性。结论:删除第二个维中最后一个条目后,对LVQOL所有维的土耳其文改编已被证明是可靠的,有效的,适合在土耳其的低视力患者中使用。     

Overcoming barriers to low-vision rehabilitation services: improving the continuum of care

Objective

Low-vision rehabilitation is beneficial for patients with uncorrectable vision impairment, specifically in tasks such as reading and activities of daily living. However, referral to and use of these services remain less than optimal. Inspired by the findings of the Montreal Barriers Study, this article reports on an alternative way of introducing low-vision rehabilitation to clients within an ophthalmology department through the presence of an optometrist.

Design

The Department of Ophthalmology at the Jewish General Hospital and the 2 Montreal low-vision rehabilitation agencies established a shared satellite office within the department to overcome administrative barriers, reduce the need for travel, and provide services within a familiar environment for patients.

Participants

From June 2011 to December 2012, 35 patients with low vision were seen by 1 of the optometrists within the ophthalmology department.

Methods

The optometrist was available on a part-time basis for a total of 20 half days.

Results

Seven patients (20%) were already clients of a rehabilitation agency and were seen for follow-up, whereas 3 (9%) did not qualify for rehabilitation based on their level of visual function. A further 6 patients (17%) were treated whereby their needs were met within that appointment, and 19 clients (54%) received initial examination and were referred to the rehabilitation agency for additional services.

Conclusions

The presence of a vision rehabilitation agency in an ophthalmology department through its optometrists helps triage patients, increases the integration of this service, and facilitates the continuum of care. Further fine-tuning will focus on increasing staff awareness and expansion of assistive technologies available at the satellite office.     

Implementation methods for vision related quality of life questionnaires

AIM: To determine the most reliable and consistent method and time interval over which to implement a vision impairment quality of life assessment tool. METHODS: 117 patients with low vision aged 9-101 years were assigned into three age, sex, and visual function matched groups (n = 39 in each) to answer the Low Vision Quality of Life (LVQOL) questionnaire by post, telephone, or in person. The LVQOL questionnaire was completed on four occasions, each separated by four weeks. RESULTS: Postal implementation was the most cost effective method, showed the highest internal consistency of LVQOL items, but resulted in a lower apparent quality of life score than either telephone or in-person interviews (p<0.001). There was no difference in test-retest reliability between the three methods of implementation (p = 0.12). The profile of LVQOL scores showed a trend towards reduced quality of life scores 3 months after the baseline measures, although this was not significant. CONCLUSION: Posting may be the method of choice for clinical measurement of vision related quality of life. Patients with greater visual impairment were no less likely to complete a questionnaire when implemented by post and there was no apparent bias from other people assisting them. The quality of life measure can occur at any time up to 2 months after low vision rehabilitation for the progressive nature of conditions causing low vision not to cause a decreased baseline score. The LVQOL was shown to be a highly internally consistent and reliable method for measuring quality of life in the visually impaired.     

Ophthalmologische und soziale Rehabilitation sehbehinderter Patienten

BACKGROUND: In addition to medical care, the visual and social rehabilitation of low-vision patients is of increasing importance. The aim of our study was to evaluate the actual spectrum of patients concerning diagnoses and appropriate low-vision aids at a low-vision clinic. METHODS: In a retrospective study, the medical records of 4,711 patients treated at our low-vision clinic from January 1999 to December 2005 were reviewed and analyzed. The main outcome measurements were age, ophthalmologic diagnoses, magnification requirement, and prescribed low-vision aids, as well as social and professional rehabilitation measures. To evaluate the efficiency of visual rehabilitation, reading speed was measured in a subgroup of 930 patients before and after administration of low-vision aids. RESULTS: Age-related macular degeneration was, at 40%, the most frequent diagnosis. Other main diagnoses were tapetoretinal dystrophies, optic atrophy, and diabetic retinopathy. The median magnification need was 4x. A highly significant correlation existed between the measured magnification power and the magnification factor of the prescribed low-vision aids. Visual rehabilitation was frequently sufficient with simple optical low-vision aids such as high-plus reading additions and magnifiers. Closed-circuit television systems were necessary in 26%; however, 85% of these patients had a high magnification need of more than 6 x. For distance vision, a monocular telescope was the low-vision aid prescribed most often. A high proportion of patients needed more than two low-vision aids for different application areas. Forty percent of patients needed special social and professional rehabilitation measures. In a subgroup of 930 patients, the mean reading speed was 35+/-50 words/min before the use of low-vision aids, which increased significantly to 81+/-46 words/min with the use of such aids. Therefore, the reading speed essentially doubled following the use of low-vision aids. CONCLUSION: Our results provide actual, quantitative data about the need for and success of rehabilitation for visually impaired patients. A large number of patients suffer from age-related macular degeneration. Independent from the causal ophthalmologic diagnoses, most patients benefited greatly from the rehabilitation measures provided by the low-vision service and were thus able to improve their quality of life. In the face of the increasing number of visually impaired elderly patients, rehabilitation should start as early as possible.     

A retrospective study of low-vision cases in an Indian tertiary eye-care hospital

PURPOSE: To obtain data on the characteristics of low-vision patients seen at a tertiary eye care hospital in India. METHODS: Records of 410 patients were retrospectively reviewed at the Centre for Sight Enhancement, L.V. Prasad Eye Institute, Hyderabad, India. Patient underwent a comprehensive clinical low-vision examination. Data obtained included age, gender, consanguinity, visual acuity, visual fields, ocular conditions causing low vision and types of low-vision devices and methods prescribed. RESULTS: Two hundred and ninety seven (72%) of 450 patients were male. One-fifth were in the 11-20 years age group (21%). Visual acuity in the better eye was < 6/18-6/60 in almost half these patients (49.3%). One hundred and twenty two patients (29.9%) referred with a visual acuity of > or = 6/18, either had difficulty in reading normal print or had restricted visual fields. The main causes for low vision were: retinitis pigmentosa (19%), diabetic retinopathy (13%), Macular diseases (17.7%), and degenerative myopia (9%). Visual rehabilitation was achieved using accurate correction of ametropia (174 patients), approach magnification (74 patients) and telescopes (45 patients) for recognising faces, watching television and board work. Spectacle magnifiers (187 patients), hand/stand magnifiers (9 patients), closed-circuit television (3 patients), overhead illumination lamp (143 patients) and reading stand (24 patients) were prescribed for reading tasks. Light control devices (146 patients) were used for glare control, and cane (128 patients) and flashlight (50 patients) for mobility. Patients were trained in activities to improve their daily living skills, (54 patients); counselled in environmental modification (144 patients) and ancillary care (63 patients) for educational and vocational needs. CONCLUSION: Data obtained from this study elucidates the characteristics of low-vision patients. This information is likely to help in the development of appropriate low vision services.     

Validity and reliability study of Turkish version on low vision with quality of life questionnaire

AIM: To adapt the low vision-related quality of life (LVQOL) instrument into Turkish language and to assess its validity and reliability. METHODS: The study was conducted in 387 patients attending the Centre of Low Vision Rehabilitation, Faculty of Medicine, Ankara University. For statistical analyses, the Spearman's correlation coefficient, Cronbach's alpha coefficient and Confirmatory Factor Analysis (CFA) were used. RESULTS: According to results of CFA, the item in the "Adjustment" subscale because of having the factor loading below 0.40, was excluded from the questionnaire. The reliability of the questionnaire was assessed according to Cronbach’s alpha coefficients. The reliability of the “Distance Vision, Mobility, and Lighting” subscale was α=0.863; of the “Adjustment” subscale wasα=0.694; “Reading and Fine Work” wasα=0.791, and “Activities of Daily Living” wasα=0.770. So these results indicate that the questionnaire is reliable to measure the vision related quality of life of low-vision patients. The correlations between the subscales were also analyzed, and the correlation between "Adjustment" and "Reading and Fine Work" was found to be the lowest (rs=0.336, P<0.001), whereas the strongest correlation was found between the "Reading and Fine Work", and "Activities of Daily Living". Additionally, the "Adjustment" dimension showed the strongest correlation with only "Distance Vision, Mobility, and Lighting" dimension. CONCLUSION: After removing the last item in the second dimension, the Turkish adaptation of all dimensions of the LVQOL has been shown to be reliable, valid and suitable for use in patients with low vision in Turkey.     

The effectiveness of low-vision rehabilitation on participation in daily living and quality of life

PURPOSE: To evaluate the effectiveness of a multidisciplinary low-vision rehabilitation program on quality of life evaluated by the Impact of Vision Impairment (IVI) instrument. METHODS: First-time referrals to low-vision clinics were assessed before and after rehabilitation (3-6 months). Rasch analysis was used to estimate the three IVI subscale and overall values on an interval scale. A mixed between-within subjects ANOVA was used to identify whether presenting visual acuity had an interaction effect with rehabilitation change. Cohen d values were used to estimate the magnitude of the change and the standardized response mean (SRM) procedure was selected to determine the clinical significance of the rehabilitation-induced changes. RESULTS: One hundred twenty-four women and 68 men (mean age, 80.3 years) completed the rehabilitation. Most had age-related macular degeneration (62%, 119) and were moderately to severely vision impaired (<6/18; 78%, 149). After rehabilitation, significant improvements were recorded for the overall IVI score (P = 0.006) and two subscales: reading and accessing information and emotional well-being (P = 0.007 and 0.009, respectively). No significant improvement was found on the mobility and independence subscale (P = 0.07). The magnitude of the post-intervention improvement was found to be relatively moderate (Cohen d = 0.17-0.30) and clinically modest (SRM = 0.22-0.42). CONCLUSIONS: Significant improvements in overall quality of life and two specific areas of daily living in people with low vision were found, although the magnitude and clinical significance of the rehabilitation-induced gains were modest. Further investigation in other models of low-vision rehabilitation is needed to optimize quality of life gains in people with low vision.     

Visual function and subjective quality of life compared in subjects with acquired macular disease

PURPOSE: To determine the objective measures of visual function that are most relevant to subjective quality of vision and perceived reading ability in patients with acquired macular disease. METHODS: Twenty-eight patients with macular disease underwent a comprehensive assessment of visual function. The patients also completed a vision-related quality-of-life questionnaire that included a section of general questions about perceived visual performance and a section with specific questions on reading. RESULTS: Results of all tests of vision correlated highly with reported vision-related quality-of-life impairment. Low-contrast tests explained most of the variance in self-reported problems with reading. Text-reading speed correlated highly with overall concern about vision. CONCLUSIONS: Reading performance is strongly associated with vision-related quality of life. High-contrast distance acuity is not the only relevant measure of visual function in relation to the perceived visual performance of a patient with macular disease. The results suggest the importance of print contrast, even over print size, in reading performance in patients with acquired macular disease.     

Is the high contrast visual acuity chart a good predictor of improvement in visual acuity with low vision aids?

Purpose:To assess whether the objective improvement seen with HCVA chart using LVAs correlates with subjective improvement in the quality of life as measured on low vision quality of life (LVQOL) questionnaire of such patients.Methods:This was a prospective, consecutive, observational study. Objective improvement in visual function was assessed using LVAs with high contrast LogMAR visual acuity chart for near and distance. Subjective improvement for distance was assessed using LVQOL score for “distance mobility and lighting”, whereas for near it was assessed using the LVQOL score for “near and fine work”. A total of 46 patients completed one follow-up after low vision trial and were included in the study.Results:Improvement in objective visual acuity was highly significant for both near and distance (P < 0.001) with LVAs. LVQOL score improved from 65.85 to 76.83 after one of using low vision aids (P < 0.001). The improvement in LVQOL score for distance and mobility was also highly significant (2.55; P < 0.001); and so was for near and fine work (5.89; P < 0.001). However, Spearman rank correlation coefficient showed no correlation between improvement in visual acuity for distance and LVQOL score improvement for distance (r_s = –.086; P = 0.57). For near also, improvement in acuity did not correlate with the LVQOL score improvement for near and fine work (r_s = 0.036; P = 0.81).Conclusion:No statistical correlation was observed between the improvements measured by objective HCVA charts and subjective improved as perceived by the patient after use of low vision devices.     

Quality of life of low-vision patients and the impact of low-vision services.

PURPOSE: To investigate the functional status and quality of life of patients at a low-vision clinic and to evaluate the impact of low-vision services. METHODS: Interviews, including the Medical Outcomes Study 36-Item Short Form (SF-36), the Visual Function-14 (VF-14), and the 51-item Field Test Version of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), were administered to 156 consecutive patients 1 week before and 3 months after their low-vision clinic visit. RESULTS: Low-vision patients scored lower (P < .001) in physical functioning and role limitations caused by physical and emotional health problems than published SF-36 scores of the age-appropriate United States normal population, patients with congestive heart failure, and clinically depressed patients. Low-vision services were associated with improvement in the subjective functional status of 150 patients (98.7%) and were rated "very useful" by 82 (53.9%) patients. The SF-36 scores did not change significantly after low-vision services. The VF-14 mean score improved from 35.8 to 41.2 (P < .001). Four NEI-VFQ subscale scores improved significantly (P < .001): general vision, near activities, distance activities, and peripheral vision. CONCLUSIONS: The SF-36, VF-14, and NEI-VFQ demonstrate that low-vision clinic patients perceive marked impairment of functional status and quality of life. Low-vision services are associated with high patient satisfaction. Vision-targeted questionnaires are more sensitive than general health-related quality of life questionnaires to changes in functional status and quality of life after low-vision services, and they may help elucidate the outcomes of low-vision services.     

Visual results with low-vision aids in age-related macular degeneration

We reviewed the records of 61 patients with age-related macular degeneration who had an exudative or a dry macular scar and who had received low-vision rehabilitation. Exudative scars resulted from the natural course of sub-retinal new vessels, and dry scars from successful photocoagulation to the new vessels. Low-vision aids consisted of high-power positive lenses. Eyes were divided into three groups according to their distance visual acuity before using low-vision aids: Group 1, 20/100; Group 2, 20/200 to 20/300; and Group 3, 20/400 or poorer. The print size resolution on the Rosenbaum pocket vision screener and power of the low-vision aid in each group were compared for the eyes having exudative scars and those with dry photocoagulation scars. In Groups 2 and 3, eyes with dry macular scars reached a similar resolution of print size but with significantly (P less than .01) lower-power visual aids than eyes with exudative macular scars. In Group 1, eyes with dry macular scars achieved a better print size resolution using significantly (P less than .01) lower-power visual aids than eyes with exudative scars.