How effective is an integrated approach to low vision rehabilitation? Two year follow up results from south Devon.

AIMS--A survey was undertaken to assess the effectiveness of an integrated approach to the provision of low visual aids (LVAs) in south Devon over a 2 year follow up period. This integrated approach includes the assessment of patient needs by low vision therapists, followed by the provision of suitable LVAs, with particular emphasis on training in their use. METHODS--A total of 125 patients were selected at random from the 445 patients seen in the low vision clinic at Torbay Hospital in the year 1991. These patients were sent questionnaires relating to the service over a 2 year period. Questionnaires from 111 patients were analysed at 1 year and 75 questionnaires together with 46 clinical reassessments, after 2 years. RESULTS--Using a similar questionnaire to one used in a previous study in the UK from a unit where LVA training was not provided, not only was a higher rate of satisfaction found with the services provided, but also the LVAs dispensed were used more frequently. The majority of the LVAs provided were of the simple, inexpensive variety and wastage was very low. CONCLUSIONS--It was concluded that this integrated approach to low vision rehabilitation with emphasis on training in the use of less complex LVAs exceeds the performance of other types of service that rely on the dispensing of more complex LVAs.     

Developing an integrated paediatric low vision service.

A survey of usage of low vision aids (LVAs) by 56 children with visual impairment, who were attending mainstream schools in Wirral, was undertaken. A total of 25% of children owned an LVA and 5% were using these on a regular basis. These low levels of ownership and usage led to the development of a low vision service involving the collaboration of education and health care. This paper describes the development of that service, its elements and implementation. The results from the new service show that of the 29 children issued with an LVA, 82.7% are using them on a regular basis. Having an integrated service is shown to significantly improve LVA usage in the group of children seen so far. The service results are discussed with suggestions for future service development.     

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。     

Primary success with low vision aids in age-related macular degeneration.

The benefit obtained from various low vision aids (LVAs) was studied in 65 consecutive patients with atrophic (70.3%) or disciform (29.7%) age-related macular degeneration (ARMD). 13.8% were able to read newsprint with age-related reading correction under proper lighting conditions. The primary success achieved with LVAs was good, 91.4% of patients being able to read newsprint. In most cases a simple magnifier (52.3%), high-powered reading glasses (10.8%) or Fonda's glasses (12.8%) were sufficient. The magnification preferred was 5x or less in 25.6% and greater than 5x to 9x in 48.8%. Patients with disciform degeneration required higher magnification than those with atrophic degeneration. It is concluded that most patients with ARMD found low vision aids useful for reading purposes and that a simple optical device was sufficient to achieve reading vision.     

助视器对年龄相关性黄斑变性患者视功能恢复和阅读速度的影响

目的:评估助视器对年龄相关性黄斑变性(AMD)患者视功能恢复和阅读速度的影响。方法:对低视力门诊44名AMD患者进行评估。收集并分析使用助视器前和使用助视器时裸眼视力、最佳矫正视力、屈光状态、助视器类型(LVAs)以及阅读速度的相关数据。结果:共44例AMD患者,平均年龄为73±10.8岁,男性36例(82%)。其中,29例(67%)受试者视力较好的眼远视力(DVA)为1.0~1.6 LogMAR,而36例(82%)受试者近视力(NVA)小于3.2 m。使用助视器时平均DVA提高0.67±0.27 LogMAR(P=0.000)。使用LVAs时,42例患者NVA达到1 m甚至更佳,仅有2例(4.5%)没有使用LVAs的患者NVA为1 m。在使用一定时间的助视器后,有阅读能力的患者平均阅读速度从每分钟2.9±4.78字提高到每分钟71.31±29.96字(P<0.001)。15名受试者远距离视觉使用单目望远镜,而戴高倍单目镜片眼镜作为最常用的阅读辅助工具。结论:LVAs对AMD患者的视功能恢复和阅读能力的提高有一定的作用。对于AMD患者而言,接受低视力护理服务是有必要的。     

Ophthalmological rehabilitation – experience at the University Eye Hospital Heidelberg

BACKGROUND: The rehabilitation of low vision patients is of increasing importance since the number of these patients has grown rapidly. We wanted to evaluate the actual spectrum of patients concerning age and diagnoses and the appropriate low vision aids (LVA) in 1 year. METHODS: The records of the patients seen in our low-vision unit in 1996 were retrospectively evaluated. We correlated visual function, ophthalmological diagnoses and age to the magnification needed for rehabilitation and the use or prescribed LVAs. RESULTS: There was a nearly homogeneous distribution concerning age with a range from 0 to 99 years. Most patients presented with age-related macular degeneration (25.6 %) while 10 % each had retinitis pigmentosa and optic atrophy. Simple low vision aids such as high plus reading additions (29 %) and magnifiers (18.5 %) were prescribed in the majority of patients. However, closed-circuit TV (CCTV) systems were necessary in 25 %. CONCLUSIONS: Rehabilitation of low vision patients is often possible with simple LVAs. This is especially true for patients suffering from age-related macular degeneration. Since there is a tremendous-amount of different diseases, adequate diagnostic and individual counseling is of major importance.     

Low vision aid–A ray of hope for irreversible visual loss in the pediatric age group

Purpose:

To analyze visual acuity (VA) improvement, causes of low vision (LV), and quality of life (QOL) following the use of low vision aids (LVAs) in children with LV.

Methods:

A prospective analysis was conducted on children with LV aged between 4 years and 18 years between March 2013 and October 2013. Children were recruited from both urban schools and rural schools. LVAs were tried for visual improvement, and improved VA was noted. All children were trained to use the aid and followed up monthly for 3 consecutive months for VA improvement; QOL through a questionnaire was analyzed after the use of LVAs.

Results:

A total of 74 children (148 eyes; 50% male; mean age, 11.8 ± 3.2 years) were analyzed, where 34 children were recruited from rural areas and 40 from urban schools. After LVA use, 101 (68.24%) eyes of 59 (79.72%) children improved for distance with telescope and 81 (54.72%) eyes of 51 (68.91%) children improved for near with magnifiers. LV due to retinal problems, optic atrophy, congenital anomalies, and amblyopia drastically reduced after use of LVA. A statistically significantly higher proportion of children had either “excellent” or “good” QOL, and a significantly lower proportion of children had either “not satisfactory” or “poor” QOL after the use of LVA (p < 0.0001).

Conclusion:

LVA is essential and effective in improving VA and QOL in children with LV.     

Low vision services in South Devon: a multi-agency, multi-disciplinary approach.

Since 1994, the Low Vision Service in South Devon has been provided by a multi-agency, multi-disciplinary team. The team comprises of staff from Devon Social Services Sensory Team, Optima Low Vision Services Ltd, Royal National Institute for the Blind (RNIB) Manor House, Devon and Torbay Special Education Services and South Devon Healthcare Trust. In the 9 years of operation this service has been independently audited twice for patient satisfaction levels and compliance level in the use of low vision aids (LVAs). The results of the most recent service audit questionnaire reveal a high and constant patient satisfaction level with 92% of patients who answered the question reporting that the service was sufficient to meet their needs. The number of patients who used LVAs at least weekly was 88% of those answering the question. Plans for the future expansion of the service include the further development of interdisciplinary working.     

Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital

Context:In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized.Aims:Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India.Results:About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001).Conclusion:Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.     

低视力康复现状与进展

低视力康复主要是通过助视器的使用配合低视力康复训练。本研究通过对成人和儿童低视力康复现状、低视力功能状态评价、助视器研究发展方向进行综述，为低视力患者和康复工作提供一定指导。运用现有的助视器，老年及儿童低视力患者的视力康复取得了较好的效果。新型助视器的研制和开发，为低视力患者的康复迈进了一步。     

不同程度视力残疾儿童应用助视器康复的研究

目的对有残余视力的视力残疾儿童在给予光学和电子助视器康复后进行远、近视力的分析和效果评估,探讨不同程度视力残疾患儿有效的康复手段及其对低视力康复对象范围界定的影响。方法对盲校及低视力门诊共206名4～14周岁（含14岁）视力残疾儿童按视力残疾的程度进行分组,比较应用国产4倍、6倍望远镜前后远视力和应用国产眼镜式助视器、国产简易电子助视器后两种助视器间阅读成功率的差异。远视力康复结果采用秩和检验,近视力康复结果采用卡方检验进行统计学分析。结果视力0．05以下至眼前指数的盲童组和0．3以下至0．05的低视力组应用远用助视器前后远视力差异均有统计学意义（P〈0．05）;视力0．05以下至光感的肓童和低视力儿童分别使用眼镜式近用助视器与简易电子助视器后,两种助视器间阅读成功率的差异均有统计学意义,使用简易电子助视器的阅读成功率均明显高于使用眼镜式近用助视器。结论助视器康复的对象可以从低视力范围扩展到0．01甚至以下的盲童。低视力助视器是视力残疾儿童视觉康复有效和必要的手段,早期视觉康复特别是使用简易电子助视器进行近视力阅读的康复,对视力残疾儿童提高学习认知能力、促进身心健康成长和回归社会具有重要意义。     

Individual’s recollections of their experiences in eye clinics and understanding of their eye condition: results from a survey of visually impaired people in Britain

Background/aims: Network 1000 is a UK‐based panel survey of a representative sample of adults with registered visual impairment, with the aim of gathering information about people’s opinions and circumstances. Method: Participants were interviewed (Survey 1, n = 1007: 2005; Survey 2, n = 922: 2006/07) on a range of topics including the nature of their eye condition, details of other health issues, use of low vision aids (LVAs) and their experiences in eye clinics. Results: Eleven percent of individuals did not know the name of their eye condition. Seventy percent of participants reported having long‐term health problems or disabilities in addition to visual impairment and 43% reported having hearing difficulties. Seventy one percent reported using LVAs for reading tasks. Participants who had become registered as visually impaired in the previous 8 years (n = 395) were asked questions about non‐medical information received in the eye clinic around that time. Reported information received included advice about ‘registration’ (48%), low vision aids (45%) and social care routes (43%); 17% reported receiving no information. While 70% of people were satisfied with the information received, this was lower for those of working age (56%) compared with retirement age (72%). Those who recalled receiving additional non‐medical information and advice at the time of registration also recalled their experiences more positively. Conclusions: Whilst caution should be applied to the accuracy of recall of past events, the data provide a valuable insight into the types of information and support that visually impaired people feel they would benefit from in the eye clinic.     

Clinical performance of electronic, head-mounted, low-vision devices

This study compared four electronic head-mounted devices (HMDs) (Jordy, Flipperport, Maxport and NuVision) with conventional optical low-vision aids (LVAs). The aim was to determine any performance differences for laboratory-based clinical measurements and practical visual tasks for patients with macular disease. Possible factors influencing success were explored. Ten patients with early onset macular disease (EOMD) and 10 with age-related macular disease (AMD) used the four HMDs, habitual spectacles and previously prescribed optical LVAs to complete a range of clinical measurements and everyday visual tasks. The clinical measurements were distance, intermediate and near acuities, and contrast sensitivity. The visual tasks were to read text of three sizes, to write a cheque and to identify grocery items on a shelf. Following the initial evaluation, each subject took home two randomly selected HMD devices for 2 weeks, after which performance measures were repeated. No single HMD stood out as being superior overall. Flipperport and Jordy provided significantly better distance and intermediate acuity than the previously prescribed optical LVAs but near acuity and contrast sensitivity were not consistently better with any of the HMDs. Practice at home provided some improvement in performance with HMDs, nevertheless, optical aids remained the best devices for optimum functioning for the majority of tasks. Younger patients and those with better distance acuity were more likely to benefit from HMDs, particularly when reading small print. In low vision clinics, practitioners should continue to show patients conventional optical aids and demonstrate these electronic HMDs only when appropriate for the individual patient.     

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.     

矫正屈光不正对儿童低视力康复的意义

目的 探讨有屈光不正的低视力儿童戴矫正眼镜后对应用助视器提高视的效果。方法 经散瞳验光 后视力有提高或改善者,予以配镜。然后再应用远用双筒与单筒望镜式助视器。结果 ３５０例中有９００例（占２５％）经验光配镜后视力均有一定程度的提高与改善,在这９０例中不戴镜直接用助视器时,其脱残率（视力提高到０．３以上）为５４．４％,而在戴镜基础上再应用助视器,则脱残率为８３．３％,两者之间差异有着非常显著性意义（     

视觉训练对低视力儿童阅读速度的影响

目的评价视觉训练对已有助视器的低视力儿童阅读速度的影响。方法共有9位有助视器使用经验的低视力儿童,先测量其阅读速度,再进行一系列的视觉训练和阅读训练,2个月后,当他们完成训练时,再次测量对相同文章的阅读速度,并比较训练前后患儿阅读速度的变化。结果在训练前后患儿阅读四号字的速度差异有显著性(P=0.003);在训练前后患儿阅读小五号字的速度差异有显著性(P=0.002)。结论视觉训练和阅读训练对提高低视力儿童的阅读速度是有效的,在临床低视力康复工作中,我们不应仅仅只把助视器提供给低视力儿童,同时还应进行适当的视觉训练和阅读训练来提高患儿的阅读速度,这对于正在学习阶段的儿童尤为重要。