Outcomes After Comprehensive Vision Rehabilitation Using Vision-related Quality of Life Questionnaires: Impact of Vision Impairment and National Eye Institute Visual Functioning Questionnaire

Improving access to vision rehabilitation care: implementation of the South East Ontario Vision Rehabilitation Service

OBJECTIVE

To investigate the effect of the South East Ontario Vision Rehabilitation Service (SOVRS), a centrally administered, regionally delivered vision rehabilitation service, on access to vision rehabilitation care.

DESIGN

Pre-implementation (n = 1196) and post-implementation (n = 414) observational study.

PARTICIPANTS

Patients referred for low-vision assessment at the hospital-based Kingston Health Sciences Centre Vision Rehabilitation Clinic and community-based Southeastern Vision Loss Rehabilitation Ontario clinics from 2014 to 2019.

METHODS

Markers for access to care (e.g., patient rurality, diversity of referral source, distance and time travelled, and wait times) were compared before and after SOVRS implementation.

RESULTS

After SOVRS implementation, there was a significant increase (p < 0.001) in the number of rural patients seen in the community. After SOVRS implementation, the hospital-based Vision Rehabilitation Clinic site experienced a significant increase in referrals from outside of Kingston (p < 0.001) and non-eye-care clinicians (p < 0.001), a significant reduction in patient time and distance travelled (p < 0.001), a 6% decrease in median wait time for low-vision assessments, and a significant reduction in wait time between referral and first available appointment (p = 0.011).

CONCLUSION

SOVRS, a novel service-delivery model for vision rehabilitation care, improved the delivery of and access to vision rehabilitation care in southeast Ontario through the integration of regional resources and services.

Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions

Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.

Psychometric properties and comparison of four health utility approaches among myopia patients in China

BACKGROUND

The increased prevalence of myopia creates and earlier age of onset has created public health concerns for the long-term eye health, vision impairment and carries with it a significant economic burden. The quality of the economic evaluation is dependent on the sensitivity and validity of the approaches. Nowadays, there are many approaches to measure patients' health state utility (HSU). However, little is known regarding the performance of direct approach and indirect approach in people with myopia. This study is aimed to compare the psychometric properties of four HSU approaches among patients with myopia in mainland China, including two direct approaches (TTO and SG), the generic preference-based measures (PBM) (AQoL-7D) and the disease-specific PBM (VFQ-UI).

METHODS

A convenience sampling framework was used to recruit patients with myopia who attended a large ophthalmic hospital in Jinan, China. Spearman's rank correlations coefficient was used to assess concurrent validity. Known-group validity was analyzed by: (1) whether the patients wear corrective devices; (2) severity of myopia as low or moderate to high of the better eye; (3) duration of myopia as ≤ 10 years or > 10 years. Effect size (ES), relative efficiency (RE) statistic and the largest area under the receiver operating characteristic curve (AUC) were used to assess sensitivity. The intra-class correlation coefficient (ICC) and Bland-Altman plots were used to assess agreement.

RESULTS

A valid sample size of 477 myopia patients was analyzed (median duration: 10 years). The mean HSU scores between TTO and SG were similar (0.95) and higher than AQoL-7D (0.89) and VFQ-UI (0.83). Overall, the VFQ-UI had the best performance based on the psychometric analysis. The agreement indicated that there was no pair of approaches that could be used interchangeably.

CONCLUSIONS

The VFQ-UI showed better psychometric properties than other three approaches for providing health state utility in Chinese myopia patients. Given the widespread use and its generic nature of the AQoL-7D, it could be used alongside with VFQ-UI to provide complementary health state utility from a generic and disease-specific perspective for economic evaluation. More evidence on the responsiveness of four health utility approaches in myopia patients is required.

Low vision home therapy service by occupational therapists: The effectiveness of the Seniors’ Eye Rehabilitation programme, a pilot study

Introduction:

This study aims to explore the effectiveness of the Seniors’ Eye Rehabilitation (SEER) pilot programme, a visual rehabilitation home therapy by specialised low vision occupational therapists (LVOT).

Method:

This was an interventional, longitudinal cohort study. Participants were recruited from Singapore National Eye Centre Low Vision Clinic. The occupational therapy interventions include activities of daily living retraining, activities/home modifications, functional/community mobility training and patient/family education. Each participant set two individualised goals (Priority Goal 1 and Priority Goal 2). The Wilcoxon signed-rank test was used to compare baseline and 6-month follow-up scores for Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) and the Goal Attainment Scale (GAS) ( p < 0.05).

Results:

Forty-one participants (mean age: 67, 48.8% male) completed SEER. There was statistically significant reduction in activity limitations (1 median point change (MPC), Z = −4.21, p < 0.01), participation restrictions (1 MPC, Z = −3.951, p < 0.01) and improved well-being (0.5 MPC, Z = −3.668, p < 0.01) for Priority Goal 1 using AUSTOM-OT. With GAS, there was a statistically significant improvement in Priority Goal 1 (1 MPC, Z = −3.886, p < 0.01).

Conclusion:

The SEER programme was found to be effective in improving all domains of the AusTOMs-OT and GAS for Priority Goal 1. This provides evidence that visual rehabilitation home therapy by specialised LVOT is beneficial to older adults with visual impairment.

Assessment of Low Vision Referrals before and after Establishment of a Low Vision Program at an Academic Medical Center

SIGNIFICANCE

We assessed the number of referrals for low vision (LV) services to determine if establishing an LV program at a large academic medical center impacted referral rates. Visual acuity (VA), referral outcome, location, and specialty were examined as factors that could impact referrals.

PURPOSE

This study aimed to identify gaps in the referral process to LV services.

METHODS

Electronic medical records of patients were reviewed to ascertain the referral rate among those who qualified for services, both before (2014 to 2016) and after (2017 to 2019) the establishment of an LV program. The medical records were further subdivided into two categories based on VA in the better-seeing eye: 20/70 to 20/200 and 20/200 to worse vision.

RESULTS

A total of 2014 patient records with VA qualifying for LV services were reviewed. The proportion of patients who had a VA of 20/70 to 20/200 inclusive in their better eye was 91.7%. A majority (89.8%) of patients with VA of 20/70 to 20/200 and 74.4% of patients with VA worse than 20/200 were never referred. Before establishing an LV program, only 2.2% of patients with VA of 20/70 to 20/200 were referred for services on their first visit, which improved to 8% after the program was established (odds ratio [OR], 3.88; 95% confidence interval [CI], 2.37 to 6.33; P < .001). Also, before the program's establishment, 12.5% of patients with VA worse than 20/200 were referred on their first visit, which increased to 31.9% after the program's establishment (OR, 3.29; 95% CI, 1.50 to 7.19; P = .002). Patients with VA worse than 20/200 were more likely to be referred (before: OR, 6.34 [95% CI, 3.03 to 13.28; P < .001]; after: OR, 5.38 [95% CI, 3.09 to 9.37; P < .001]). Our data also showed that 10.3% of patients in this study declined referral to LV services.

CONCLUSIONS

Referral rates to LV services are low among patients who qualify. The establishment of an LV program at the medical center significantly increased referral rates. However, more improvement is necessary to connect patients to LV services.

The NEI VFQ-25C: Calibrating Items in the National Eye Institute Visual Function Questionnaire-25 to Enable Comparison of Outcome Measures

Purpose

To improve the usefulness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) by enabling estimation of measures on an invariant scale and comparisons between patients and across studies.

Methods

Datasets of baseline NEI VFQ-25 responses from nine studies (seven retina randomized trials, n = 2770; two low vision studies, n = 572) were combined. The method of successive dichotomizations was applied to patient ratings of the main NEI VFQ-25 and six supplemental items to estimate Rasch model parameters using the R package 'msd.' Calibrated item measures and rating category thresholds were estimated for the NEI VFQ-25, as well as for two domain-specific versions: the NEI VFQ-VF that includes only visual function items and the NEI VFQ-SE that includes only socioemotional items.

Results

Calibrated item measures were estimated from study participants (n = 3342) ranging in age from 19 to 103 years, with mean (SD) age of 69.3 (11) years and a mean logMAR visual acuity of 0.30 (Snellen 20/40). Item measure estimates had high precision (standard error range, 0.026-0.085 logit), but person measure estimates had lower precision (standard error range, 0.108-0.499 logit). Items were well targeted to most persons, but not to those with higher levels of function.

Conclusions

Calibrated item measures and rating category thresholds enable researchers and clinicians to estimate visual, socioemotional, and combined measures on an invariant scale using the NEI VFQ-25.

Translational Relevance

Applying NEI VFQ 25C calibrated item measures (software provided) to the NEI VFQ-25, users can estimate overall, visual, and socioemotional function measures for individual patients.

Quality of life study in ophthalmic practice

The article discusses various methods for studying the quality of life in all kinds of eye diseases. General and special questionnaires used in modern ophthalmological practice are presented. The presence of a sufficiently large amount of data indicating the relationship between the quality of life and objective indicators of the visual system was established. A fairly good comparability of results obtained in the assessment of various quality of life questionnaires in a patient with ophthalmic condition was revealed.

Modern aspects of computer visual syndrome

The review presents the pathogenetic, diagnostic, therapeutic and rehabilitation aspects of computer visual syndrome. The importance of an integrated approach to the implementation of treatment and rehabilitation measures is emphasized. The promising directions of scientific and practical activity on the problem of treating patients with computer visual syndrome symptoms from the standpoint of modern requirements for medical rehabilitation have been determined.

The impact of vision impairment on vision-related quality of life of patients with neovascular age-related macular degeneration

PURPOSE

To investigate the validity and reliability of the Greek Impact of Vision Impairment Questionnaire (IVI) and to explore the predictors of vision-related quality of life (VRQoL) in individuals with neovascular age-related macular degeneration (nAMD).

METHODS

About 191 patients completed the IVI and the SF-12 Health Survey, and were assessed on visual exams. A random group of 20 participants completed the IVI twice with a 2 weeks interval, to assess test-retest reliability. About 102 patients completed the IVI 1 year later in a follow-up examination. Rasch analysis was used to evaluate response category functioning, scale precision, unidimensionality, scale targeting and differential item functioning. Stepwise multiple linear regression analyses identified predictors of VRQoL.

RESULTS

Test-retest reliability of IVI items was calculated from 0.86 to 0.98. The six response categories were merged into four to figure out disordered thresholds. Rasch analysis concluded in three scales: Mobility and Independence, Reading and Accessing Information, and Emotional Wellbeing. Regarding convergent validity, the IVI scores had significant associations with SF-12 components (ρ = 0.28-0.47) and measurements of visual acuity (ρ = 0.39-0.66). Worse VRQoL at 1 year follow-up was correlated with decline in distance and near VA. Distance VA and the SF-12 components were common predictors for all three subscales. The duration of disease was a significant predictor for the emotional subscale.

CONCLUSION

The Greek IVI was found to assess AMD patients' perceptions of VRQoL in a valid, reliable and responsive to eyesight manner. VRQoL was mainly established by patients' distance VA and mental health.