Quality of life of low-vision patients and outcomes of low-vision rehabilitation.

PURPOSE: The impact of low vision on self-reported quality of life and changes after low-vision intervention are investigated. METHODS: Literature reports from 1990 to 2000 are reviewed. RESULTS: Low vision is associated with increased risk for depression and decreased functional status and quality of life. Decreased visual acuity, visual field loss, and occasional blurred vision are also associated with decreased quality of life. Improvements in both functional status and quality of life occur after low-vision service delivery. CONCLUSIONS: Self-reported quality of life is a significant outcome measure for low-vision rehabilitation. Questionnaires that are more sensitive to rehabilitation services provided as well as patient needs and goals are required to facilitate development of rehabilitation plans and to compare techniques, devices, and programs. Attention should be given to measurement properties, validity, and reliability of instruments used currently and in development of new instruments.     

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。     

Visual function in patients with choroidal neovascularization resulting from age-related macular degeneration: the importance of looking beyond visual acuity.

PURPOSE: A detailed understanding of overall quality of vision may help primary care physicians, optometrists, and general ophthalmologists to improve the care of patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD). METHODS: Published literature was reviewed using Medline searches and the authors' knowledge of the field. RESULTS: Both visual acuity and contrast sensitivity are strongly associated with the ability to perform vision-related activities of daily living. CNV resulting from AMD often leads to scotoma, which is also strongly associated with the ability to perform everyday activities such as reading and driving. Contrast sensitivity and visual field extent may be better predictors of many abilities than visual acuity. Laser photocoagulation, verteporfin therapy, and pegaptanib sodium have been proven to reduce the risk of visual acuity loss in patients with CNV resulting from AMD. Laser photocoagulation frequently causes scotoma, but data on its effects on other aspects of overall quality of vision are scarce. Verteporfin therapy has been shown to also reduce the risk of contrast sensitivity loss and has been associated with stabilization or reduction of scotoma size. Treatment effects beyond visual acuity have not been investigated for pegaptanib. Detailed assessment of overall quality of vision also aids the design of vision rehabilitation programs tailored to the needs of individual patients. CONCLUSIONS: Understanding the impact of vision loss on patients with CNV resulting from AMD and assessing treatment benefits requires assessment of overall quality of vision. Primary care physicians and optometrists have an important role in ensuring that patients receive the best possible care, which can be aided by prompt referral to an ophthalmologist or retina specialist and collaboration with low-vision specialists and optometrists who together can make detailed assessments of overall quality of vision, implement appropriate treatment, and design effective rehabilitation strategies.     

Low-vision rehabilitation of age-related macular degeneration patients with retrofoveal choroidal new-vessels treated with photodynamic therapy with verteporfin

PURPOSE: To demonstrate the rehabilitation benefit and immediate optical magnification and electronic equipment advantage in an age-related macular degeneration population with retrofoveal choroidal new-vessels treated by photodynamic therapy using Visudyne. PATIENTS AND METHODS: Sixty seven consecutive patients with retrofoveal choroidal new-vessels treated by Photodynamic Therapy using Visudyne were referred to an orthoptist for low-vision rehabilitation. The criteria investigated for this study were: long distance visual acuity, reading ability, contrast sensitivity, (before treatment and during post-treatment examinations), and fixation localization and optical equipment model. RESULTS: This study showed and studied visual acuity variations, mostly for patients with good visual acuity at inclusion. Contrast sensitivity stayed more or less the same. Retinal fixation was foveolar most of the time (68.7%). Optical or electronic devices for low-vision patients are numerous and video systems were the most currently used among our population. 62.7% des patients had low-vision rehabilitation with optic aids. DISCUSSION: AND CONCLUSION: This study threw light on patient optic aids which must be prescribed according to his needs and difficulties, without delay. This equipment will then be readapted at each stage of the patient evolution. PDT treatment gives an important role to low-vision rehabilitation associated with optic magnification aids.     

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.     

Prevalence and causes of functional low vision and implications for services: the Pakistan National Blindness and Visual Impairment Survey

PURPOSE: To determine the prevalence and causes of functional low vision (FLV) and total blindness and to estimate the assessment needs for low-vision services in Pakistan. METHODS: Multistage, cluster random sampling was used to select a nationally representative sample of adults (age, > or =30 years). Participants underwent visual acuity measurement and detailed ophthalmic examination. Functional low vision was defined as a corrected visual acuity in the better eye of less than 6/18 to more than no perception of light (NPL) in individuals with untreatable causes of visual loss. Total blindness was defined as NPL in both eyes. Needs assessments were categorized into three groups: optical services, nonoptical/environmental interventions, and rehabilitation. RESULTS: A sample of 16,507 adults (95.3% response rate) was examined. The standardized prevalence of FLV and total blindness were 1.7% (95% CI: 1.5%-1.9%) and 0.2% (95% CI: 0.1%-0.2%), respectively. More than 90% of those with FLV were illiterate and 35.3% were of working age (i.e., <60 years). An estimated 727,000 (586,000-891,000) adults in Pakistan had FLV. Retinal conditions were the commonest cause in urban populations (39.8% vs. 26.5% rural) compared with corneal opacity in rural areas (38.0% vs. 25.5% urban). It was estimated that 565,000 adults require assessment for optical services, 735,000 for nonoptical interventions, and 424,000 for rehabilitation. CONCLUSIONS: As VISION 2020 enters its second 5-year phase, the provision of low-vision services and their integration into national eyecare programs is a priority. In Pakistan, planning must take account of the magnitude along with the demographic and educational characteristics of those affected.     

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.     

The impact of cataract surgery on patients from a low-vision clinic

Objective

To evaluate the effects of cataract extraction with intraocular lens implantation (CE-IOL) in low-vision patients.

Design

Prospective, interventional case series.

Participants

Twenty low-vision patients (30 eyes) underwent CE-IOL by 1 surgeon at an academic institution.

Methods

Pre- and post-CE-IOL visual acuities and responses to a 23-page survey (self-reported functioning in general vision, mobility, illumination, and ability to see faces) were compared.

Results

Sixteen patients had age-related macular degeneration (AMD); 1 patient each had rod-cone dystrophy, oculocutaneous albinism, retinitis pigmentosa, or cerebrovascular accident. The average age was 78 years (range: 53-96 years). Preoperative best-corrected visual acuity (BCVA) ranged from 20/70 to count fingers; postoperative BCVA at 8 weeks was 20/40 to 20/400, with improvement in 25 (83%) eyes of 15 patients, and no change in the rest. The average change in logMAR of BCVA in the 1 eye or in the eye with better preoperative vision in bilateral surgery was an improvement of 0.6 logMAR units (p = 0.0001). Seventeen (85%) patients noted an improvement in visual function and would consent to CE-IOL again. Twelve patients completed the survey pre- and post-CE-IOL at 3 months. More patients could read with a magnifier after surgery. On average, self-reported functioning was improved.

Conclusions

In this small study, CE-IOL offered subjective and objective benefits to patients from a low vision clinic, many of whom may have been dissuaded from CE-IOL. Most patients had moderately dense cataracts and moderate to advanced AMD, and these features may help form clinical recommendations. Expectations are important to elicit preoperatively. Postoperatively, patients may be more receptive to low-vision services and devices when the prognosis for visual rehabilitation is better.     

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.     

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.     

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.     

Identification of fixation location with retinal photography in macular degeneration

BACKGROUND: Identification of fixation location is an integral part of low vision assessment and subsequent rehabilitation. We performed a study to determine whether retinal photography is able to identify fixation location in eyes with age-related macular degeneration (AMD). METHODS: In a prospective, observational case series, consecutive patients with AMD attending a low-vision clinic underwent monocular fixation attempts at a fixation target of a standard ophthalmic fundus camera. Inclusion criteria included AMD with documented macular disease, low vision in both eyes and best-corrected visual acuity of 20/50 to 20/200 in the tested eye. Retinal photography was used to document retinal location of attempted fixation. Macular perimetry was used to confirm acceptable fixation maintenance behaviour. Outcome measures included acceptable fixation maintenance during retinal photography and retinal location of fixation pattern. RESULTS: Twenty-one patients (14 women and 7 men with an average age of 78 [range 53 to 86] years) met the inclusion criteria. In nine cases both eyes met the study criteria, for a total of 30 eyes. Of the 30 eyes, 24 (80%) had acceptable fixation maintenance with retinal photography (p = 0.939). In 17 (71%) of the 24 eyes the retinal fixation location was superior to the macular scar. INTERPRETATION: The results suggest that retinal photography may provide a reliable method to identify retinal location of fixation in eyes with AMD.     

Barriers to accessing low-vision care: the patient’s perspective

Objective

To review the literature regarding barriers that hinder access to low-vision (LV) care from the perspective of individuals with vision impairment.

Design

Literature review.

Methods

PubMed and Scopus were used to identify relevant cross-sectional studies of awareness of, and barriers to, LV rehabilitation. Studies were included if they met the following criteria: (i) year of publication within the past 20 years (between 1992 and 2012), and (ii) participants of the study included individuals with vision impairment. Fourteen studies met the criteria for inclusion and were included in this review.

Results

Barriers to accessing low-vision service (LVS), from the perspective of individuals with vision impairment, included the following: misconceptions of LVSs, miscommunication by eye care professionals, lack of awareness, location and transportation, the need to appear independent, negative societal views, influence of family and friends, insufficient visual impairment to warrant services, cost of LVS, and reduced perception of vision loss relative to other losses in life. Other factors that were associated with lower use of LVS included income level, comorbidities, and education level.

Conclusions

The reasons for not accessing LV rehabilitation are complex, and some may be more easily addressed than others. A heightened awareness of LV rehabilitation may be achieved with better communication by eye care professionals and with public education. The stigma associated with the usage of LV aids and admitting a disability still seems to exist, but may be reduced by increasing societal understanding of LV.     

Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: a US multisite retrospective study

PURPOSE: Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). MATERIALS AND METHODS: A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. RESULTS: Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. CONCLUSIONS: End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.     

Low vision aid in exudative macular degeneration treated by photodynamic therapy and thermal laser photocoagulation

To determine the efficacy of low vision rehabilitation (LVR) in patients with age-related macular degeneration (AMD) treated by photodynamic therapy (PDT) compared to those treated by thermal laser photocoagulation (TLP). · METHODS: A retrospective study was performed examining the files of 42 patients (42 eyes) with AMD who had been treated either by TLP (Group 1) and PDT (Group 2). Once AMD was considered to be inactive they underwent visual rehabilitation in the LVR Unit in order to increase their ability for distant and near vision. · RESULTS: Eighteen eyes had received PDT and 24 had received TLP. Average corrected visual acuity after laser therapy was 0.14 in Group 1, and 0.16 in Group 2. No statistically significant differences were found between both groups before and after laser therapy. Both groups showed improvement after LVR; however, statistically significant differences between both groups were found only for near vision. · CONCLUSION: Our findings suggest that even though both PDT and TLP are associated to a decreased visual acuity after treatment, LVR may be more successful for near vision among patients treated by PDT     

光动力治疗和热激光光凝治疗渗出性黄斑变性所致低视力

目的:比较观察光动力治疗(PDT)和热激光光凝(TLP)治疗对年龄相关性黄斑变性(AMD)患者低视力(LVR)的临床疗效。方法:对 42 例(42 眼)AMD 患者资料进行回顾性研究,其分别行 TLP 治疗(组 1)或 PDT 治疗(组 2)。一旦确定 AMD 处于非活动期,患者在 LVR 部进行视力康复,以提高其远、近视功能。结果:18 眼接受了 PDT 治疗,24 眼进行 TLP 治疗。激光治疗后,组 1 患者的平均最佳矫正视力为0.14,组 2 平均为 0.16。两组比较,视力于激光治疗前后都没有统计学差异;两组的 LVR 都有提高,但两组中只有近视力比较有统计学差异。结论:本研究结果表明,PDT 和 TLP 治疗后患者的视力均有所下降,PDT 治疗时,LVR 患者近视力改善更为有效。     

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.     

重视老年性黄斑变性患者的视觉康复治疗

目前,老年性黄斑变性(AMD)已成为我国老年人群不可逆视力损伤的主要原因。该疾病可导致患者中心视力下降、视物变形甚至视力丧失,造成不同程度的视力残疾,使患者的生活质量受到极大影响。当AMD患者出现双眼视功能损伤时,应积极开展视觉康复治疗,通过验配适宜的辅助器具,进行必要的视觉训练和心理支持,以提高患者的独立生活能力,改善其生活质量。本文中笔者就AMD对患者视功能和生活质量的影响、视觉康复的基本原则及康复治疗在AMD患者中的应用进行评述。