| | Low Vision Rehabilitation Clinic Outcome Study
Purpose:
To evaluate occupational therapy interventions in a Low Vision Clinic designed to assist patients with impaired vision to achieve their visual goals and remain as functionally independent as possible.
Background:
The Low Vision Rehabilitation Clinic (LVRC) was initiated during the fall of 1984 in the Department of Ophthalmology and Optometry to assist patients with visual impairments that cannot be corrected by medical treatment or conventional eyeglasses. The purpose of the LVRC is to provide rehabilitation services designed to improve functioning through therapy. Patients with macular degeneration, diabetic retinopathy, glaucoma, and other eye conditions are seen upon physician referral by an occupational therapist. The level of impairment could be different for each eye or it could be the same for each eye; but all patients have at least moderate visual impairment in both eyes (20/80 to 20/160). Patients work with the occupational therapist to develop goals for increased independent performance of their activities of daily living. The ability to read standard print (newspaper size type) is required for independent functioning in several activities of daily living, such as personal mail, financial tasks, meal preparation, and safety with medications. During therapy, patients read from a continuous text card to determine the size of print read comfortably with best correction. Individualized treatment goals are met with education, low vision strategies and training with optical and non-optical adaptive equipment to compensate for visual impairment. Examples of optical adaptive equipment include: high-plus spectacles, hand-held and stand magnifiers, magnifying lamps, clip-on magnifiers, and video magnification. The most functional level of magnification is determined for reading standard print. When indicated, a patient is loaned adaptive equipment for continued practice at home to determine success in the home environment for reading independently with comfort and efficiency.
In England a longitudinal study was conducted with patients having age-related macular degeneration and their use of low vision devices to attain reading related tasks and watching TV goals. Patients were seen in a Low Vision Clinic and followed for one year. Ninety-five percent of patients were using their devices one year later. The authors concluded that most patients were using the devices on a daily basis for short term reading tasks and were able to avoid a decrease in their activities. (1)
Aim:
At least 90% of all patients will achieve their goal of reading standard print with intervention from a Low Vision Occupational Therapist.
Methods/Measures:
A previous study in 1993 examined the outcome of being able to read a newspaper and 1M Sloan Reading Card for patients with age related macular degeneration following therapy in the LVRC. From May 1, 2002 to October 31, 2002, patients referred to the Low Vision Rehabilitation Clinic with the same condition and best corrected vision of 20/80 or worse determine at a vision exam within the last two years were included in this study (n=70). Both groups of patients had as their goal to read standard print. The ability to read 1M print size, an equivalent to best corrected vision of 20/50 was the endpoint used for measuring attainment of the patient goal. Patient’s visual impairments were categorized according to ICD-9-CM Codes for Visual Impairment. Fisher Exact testing was done to compare results between studies.
Benchmark: None available.
Results:
Of the five patients not achieving their goals in 2002, four patients had profound vision loss and could not benefit from magnification or found that reading was still too difficult. One patient could read with 6X magnification, but found it uncomfortable to read with that amount of magnification.
Conclusion:
In the 2002 study, 93% of patients were able to achieve their goal of reading standard size print after occupational therapy through the Low Vision Rehabilitation Clinic meeting the aim. Results between 1992 and 2002 are consistent. (p=0.67)
Over three fourths (77%) of patients receiving occupational therapy through the Low Vision Rehabilitation Clinic had a severe to profound visual impairment.
Next Steps:
Re-measure outcomes in five to ten years.
Impact:
Assisting a patient with low vision problems to maintain in their preferred environment as long as possible enhances that patient's quality of life and results in improved functional performance. The services available through the Low Vision Rehabilitation Clinic give patients that opportunity with consistently successful results.
References:
1. Harper, R.A., Russell, W, Reeves, B. Longitudinal Evaluation of Visual Function and Low Vision Device Use in People with Age-Related Macular Degeneration. International Society of Low Vision Research and Rehabilitation. Abstract for Vision 2002. Abstract number: A10 54. www.islrr.org/Vision02/584.html. 09/09/2003.
2. American Occupational Therapy Association, Inc. Occupational Therapy Practice Guidelines for Adults with Low Vision (1998) Bethesda, Maryland.
3. Lighthouse International, 111 East 59th St. New York, New York. Lighthouse “Continuous Text” Card for Adults for Near Vision
Activity Leader:
Sharon M. Bryant MS, OTR; Occupational Therapist, Low Vision Rehabilitation Clinic, Department of Ophthalmology and Optometry, Gundersen Lutheran.
Acknowledgements:
Cheryl Strom, RN, Quality & Performance Improvement |