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Goodman L, Hamm L, Tousignant B, Black J, Misra S, Woodburn S, Keay L, Harwood M, Gordon I, Evans JR, Ramke J. Primary eye health services for older adults as a component of universal health coverage: a scoping review of evidence from high income countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100560. [PMID: 37424679 PMCID: PMC10326716 DOI: 10.1016/j.lanwpc.2022.100560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
In pursuit of Universal Health Coverage (UHC) for eye health, countries must strengthen services for older adults, who experience the highest prevalence of eye conditions. This scoping review narratively summarised (i) primary eye health services for older adults in eleven high-income countries/territories (from government websites), and (ii) the evidence that eye health services reduced vision impairment and/or provided UHC (access, quality, equity, or financial protection) (from a systematic literature search). We identified 76 services, commonly comprehensive eye examinations ± refractive error correction. Of 102 included publications reporting UHC outcomes, there was no evidence to support vision screening in the absence of follow-up care. Included studies tended to report the UHC dimensions of access (n=70), equity (n=47), and/or quality (n=39), and rarely reported financial protection (n=5). Insufficient access for population subgroups was common; several examples of horizontal and vertical integration of eye health services within the health system were described. Funding This work was funded by Blind Low Vision New Zealand for Eye Health Aotearoa.
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Affiliation(s)
- Lucy Goodman
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Lisa Hamm
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Benoit Tousignant
- School of Optometry, Université de Montréal, 3774 Jean-Brillant, Montreal, Quebec H3T1P1, Canada
- School of Public Health, Université de Montréal, 3774 Jean-Brillant, Montreal, Quebec H3T1P1, Canada
| | - Joanna Black
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Stuti Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton 1023, Auckland, New Zealand
| | - Sophie Woodburn
- Specsavers Queenstown, 12 Hawthorne Drive, Frankton, Queenstown 9300, New Zealand
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Rupert Myers Building (M15), Southern Dr, Kensington, NSW 2052, Australia
- The George Institute for Global Health, UNSW Sydney, Level 5/1 King St, Newtown NSW 2042, Australia
| | - Matire Harwood
- Department of General Practice & Primary Health Care, School of Population Health, University of Auckland, 28 Park Ave, Grafton Auckland 1023, New Zealand
| | - Iris Gordon
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Jennifer R. Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
- Centre for Public Health, Institute of Clinical Science, Block A, Royal Victoria Hospital, Queen's University Belfast BT12 6BA, United Kingdom
| | - Jacqueline Ramke
- School of Optometry & Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Alsaqr AM. Barriers to Low Vision Services Among Optometrists in Saudi Arabia. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
This study identifies the barriers and challenges to the provision of low vision services among practicing optometrists in Saudi Arabia.
Methods:
In this study, a self-administered online structured survey for practicing optometrists was used. Responses were collected to understand the number and percentage of low vision service providers, level of awareness, and barriers to the provision of low vision services.
Results:
This study included 154 (79 females and 75 males) practicing optometrists. They were from the five regions of Saudi Arabia (23 cities). The age of the practitioners ranged from 22 to 54 years. They had Bachelor’s, Master’s, and Doctor of Philosophy degrees. Forty-four participants (30%) provided low vision services. The major barriers reported were lack of training (87%), lack of awareness about low vision services (76%), lack of availability of low vision devices (70%), lack of motivation (65%), low vision services being time-consuming (55%), being busy in providing general optometry (65%), and lack of financial sources (31%).
Conclusion:
Building an efficient model for low vision rehabilitation in Saudi Arabia is needed. Moreover, encouraging more optometrists to be involved in low vision rehabilitation is necessary. There is also a need for more low vision education, national health coverage of patients with low vision, and better collaboration between low vision service providers.
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Ryan B. Models of low vision care: past, present and future. Clin Exp Optom 2021; 97:209-13. [DOI: 10.1111/cxo.12157] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Barbara Ryan
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales,
- Department of Public Health, Welsh Government, Cardiff, Wales,
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van Nispen RMA, Virgili G, Hoeben M, Langelaan M, Klevering J, Keunen JEE, van Rens GHMB. Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database Syst Rev 2020; 1:CD006543. [PMID: 31985055 PMCID: PMC6984642 DOI: 10.1002/14651858.cd006543.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment. OBJECTIVES To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults. SEARCH METHODS We searched relevant electronic databases and trials registers up to 18 September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I2 = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I2 = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I2 = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I2 = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I2 = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I2 = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I2 = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I2 = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I2 = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I2 = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I2 = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I2 = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation. AUTHORS' CONCLUSIONS In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.
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Affiliation(s)
- Ruth MA van Nispen
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Palagi, 1FlorenceItaly50134
| | - Mirke Hoeben
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Maaike Langelaan
- Netherlands institute for health services, NIVEL researchP.O. Box 1568UtrechtNetherlands3500 BN
| | - Jeroen Klevering
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Jan EE Keunen
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Ger HMB van Rens
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
- Elkerliek HospitalDepartment of OphthalmologyHelmondNetherlands
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Macnaughton J, Latham K, Vianya-Estopa M. Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England. Ophthalmic Physiol Opt 2019; 39:113-126. [PMID: 30776848 DOI: 10.1111/opo.12606] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/04/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. METHODS Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. RESULTS Sixty people (mean age ± S.D. = 75.8 ± 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 ± 2.91), mobility outdoors (6.55 ± 3.92), mobility indoors within an unfamiliar environment (5.52 ± 3.93) and writing (5.27 ± 3.02). Greater rehabilitative need was associated with younger age (β = -0.46, p < 0.001), and with higher depressive symptomatology (β = 0.35, p < 0.01; model R2 34%). Goals with greatest difficulty were mending clothing (-1.95 ± 0.35 logits) and hobbies and crafts (-1.32 ± 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (β = 0.39, p < 0.001), lower visual acuity (β = 0.42, p < 0.001) and lower adjustment of visual loss (β = 0.31, p < 0.01; model R2 53%). CONCLUSIONS Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need.
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Affiliation(s)
- Jane Macnaughton
- Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK
| | - Keziah Latham
- Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marta Vianya-Estopa
- Department of Vision & Hearing Sciences, Anglia Ruskin University, Cambridge, UK
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6
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Demir E, Southern D, Rashid S, Lebcir R. A discrete event simulation model to evaluate the treatment pathways of patients with cataract in the United Kingdom. BMC Health Serv Res 2018; 18:933. [PMID: 30514277 PMCID: PMC6278024 DOI: 10.1186/s12913-018-3741-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. METHODS We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. RESULTS Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. CONCLUSIONS Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.
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Affiliation(s)
- Eren Demir
- University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK
| | | | - Syed Rashid
- Johnson & Johnson Vision, Wokingham, RG40 3EW, UK
| | - Reda Lebcir
- University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK.
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Taylor JJ, Bambrick R, Brand A, Bray N, Dutton M, Harper RA, Hoare Z, Ryan B, Edwards RT, Waterman H, Dickinson C. Effectiveness of portable electronic and optical magnifiers for near vision activities in low vision: a randomised crossover trial. Ophthalmic Physiol Opt 2017; 37:370-384. [PMID: 28497480 DOI: 10.1111/opo.12379] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/28/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the performance of near vision activities using additional portable electronic vision enhancement systems (p-EVES), to using optical magnifiers alone, by individuals with visual impairment. METHODS A total of 100 experienced optical aid users were recruited from low vision clinics at Manchester Royal Eye Hospital, Manchester, UK, to a prospective two-arm cross-over randomised controlled trial. Reading, performance of near vision activities, and device usage were evaluated at baseline; and at the end of each study arm (Intervention A: existing optical aids plus p-EVES; Intervention B: optical aids only) which was after 2 and 4 months. RESULTS A total of 82 participants completed the study. Overall, maximum reading speed for high contrast sentences was not statistically significantly different for optical aids and p-EVES, although the critical print size and threshold print size which could be accessed with p-EVES were statistically significantly smaller (p < 0.001 in both cases). The optical aids were used for a larger number of tasks (p < 0.001), and used more frequently (p < 0.001). However p-EVES were preferred for leisure reading by 70% of participants, and allowed longer duration of reading (p < 0.001). During the study arm when they had a p-EVES device, participants were able to carry out more tasks independently (p < 0.001), and reported less difficulty with a range of near vision activities (p < 0.001). CONCLUSIONS The study provides evidence that p-EVES devices can play a useful role in supplementing the range of low vision aids used to reduce activity limitation for near vision tasks.
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Affiliation(s)
- John J Taylor
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rachel Bambrick
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Brand
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Nathan Bray
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Robert A Harper
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Barbara Ryan
- Wales Optometry Postgraduate Education Centre, School of Optometry & Vision Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon T Edwards
- Centre for Health Economics & Medicines Evaluation, Bangor University, Bangor, UK
| | - Heather Waterman
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK.,School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Christine Dickinson
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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McAlinden C, Corson H, Sheen N, Garwood P. Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service. EYE AND VISION 2016; 3:14. [PMID: 27195305 PMCID: PMC4870803 DOI: 10.1186/s40662-016-0045-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/10/2016] [Indexed: 11/18/2022]
Abstract
Background The Primary Eyecare Acute Referral Service (PEARS) and the Wales Eye Health Examination (WEHE) operate as enhanced optometry services for patients residing in Wales, enabling the examination of a patient presenting with an acute eye problem (PEARS) or the examination of patients at higher risk of eye disease (WEHE). The purpose of the study is to assess the demographics of patients accessing these services, referral patterns and clinical management in one Health Board in Wales (Aneurin Bevan University Health Board). Methods Information from 2302 patients accessing the services was prospectively collected. The following information was obtained: type of examination (PEARS or WEHE), patient age, gender, self-referral or general practitioner (GP) referral and clinical management (no further action, monitor by optometrist or ophthalmic medical practitioner [OMP], refer to the Hospital Eye Service [HES], or refer to GP). Results There were 1791 (77.8 %) PEARS examinations and 511 (22.2 %) WEHE. There were 1379 (59.9 %) females with a mean age of 58.61 (±19.75) and 923 (40.1 %) males with a mean age of 56.11 (±20.42). The majority of patients were self-referrals compared to GP-referrals (1793 [77.9 %] versus 509 [22.1 %] respectively). Sub-analysis indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only (297 [58.1 %] versus 214 [41.9 %] respectively) but greater numbers of self-referrals for the PEARS examinations only (1496 [83.5 %] versus 295 [16.5 %] respectively). For management, 75 % of patients were monitored by their optometrist or OMP, 17 % required referral to the HES and 8 % required referral to their GP. Conclusions Higher numbers of females accessed both PEARS and WEHE services and the majority of patients self-referred. These findings have important implications for public health campaigns both for targeting specific groups (e.g. male patients) and increasing awareness among GPs.
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Affiliation(s)
- Colm McAlinden
- Public Health Wales, Floor 11, The Oldway Centre, 36 Orchard Street, Swansea, SA1 5AQ UK
| | - Helen Corson
- Public Health Wales, Cwmbran House, Mamhilad Park Estate, Pontypool, Torfaen, NP4 0XS UK
| | - Nik Sheen
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4 LU UK
| | - Peter Garwood
- Public Health Wales, Cwmbran House, Mamhilad Park Estate, Pontypool, Torfaen, NP4 0XS UK
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Acton JH, Molik B, Binns A, Court H, Margrain TH. Effect of rehabilitation worker input on visual function outcomes in individuals with low vision: study protocol for a randomised controlled trial. Trials 2016; 17:105. [PMID: 26908153 PMCID: PMC4765130 DOI: 10.1186/s13063-016-1235-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 02/16/2016] [Indexed: 12/03/2022] Open
Abstract
Background Visual Rehabilitation Officers help people with a visual impairment maintain their independence. This intervention adopts a flexible, goal-centred approach, which may include training in mobility, use of optical and non-optical aids, and performance of activities of daily living. Although Visual Rehabilitation Officers are an integral part of the low vision service in the United Kingdom, evidence that they are effective is lacking. The purpose of this exploratory trial is to estimate the impact of a Visual Rehabilitation Officer on self-reported visual function, psychosocial and quality-of-life outcomes in individuals with low vision. Methods/design In this exploratory, assessor-masked, parallel group, randomised controlled trial, participants will be allocated either to receive home visits from a Visual Rehabilitation Officer (n = 30) or to a waiting list control group (n = 30) in a 1:1 ratio. Adult volunteers with a visual impairment, who have been identified as needing rehabilitation officer input by a social worker, will take part. Those with an urgent need for a Visual Rehabilitation Officer or who have a cognitive impairment will be excluded. The primary outcome measure will be self-reported visual function (48-item Veterans Affairs Low Vision Visual Functioning Questionnaire). Secondary outcome measures will include psychological and quality-of-life metrics: the Patient Health Questionnaire (PHQ-9), the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Adjustment to Age-related Visual Loss Scale (AVL-12), the Standardised Health-related Quality of Life Questionnaire (EQ-5D) and the UCLA Loneliness Scale. The interviewer collecting the outcomes will be masked to the group allocations. The analysis will be undertaken on a complete case and intention-to-treat basis. Analysis of covariance (ANCOVA) will be applied to follow-up questionnaire scores, with the baseline score as a covariate. Discussion This trial is expected to provide robust effect size estimates of the intervention effect. The data will be used to design a large-scale randomised controlled trial to evaluate fully the Visual Rehabilitation Officer intervention. A rigorous evaluation of Rehabilitation Officer input is vital to direct a future low vision rehabilitation strategy and to help direct government resources. Trial registration The trial was registered with (ISRCTN44807874) on 9 March 2015.
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Affiliation(s)
- Jennifer H Acton
- School of Optometry & Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK.
| | - Bablin Molik
- School of Optometry & Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK.
| | - Alison Binns
- School of Optometry & Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK. .,Division of Optometry, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, England, UK.
| | - Helen Court
- School of Optometry & Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK.,Institute of Health and Wellbeing, University of Glasgow, 1st floor, Administration Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, Scotland, UK
| | - Tom H Margrain
- School of Optometry & Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK
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Goldstein JE, Jackson ML, Fox SM, Deremeik JT, Massof RW. Clinically Meaningful Rehabilitation Outcomes of Low Vision Patients Served by Outpatient Clinical Centers. JAMA Ophthalmol 2015; 133:762-9. [PMID: 25856370 DOI: 10.1001/jamaophthalmol.2015.0693] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To facilitate comparative clinical outcome research in low vision rehabilitation, we must use patient-centered measurements that reflect clinically meaningful changes in visual ability. OBJECTIVE To quantify the effects of currently provided low vision rehabilitation (LVR) on patients who present for outpatient LVR services in the United States. DESIGN, SETTING, AND PARTICIPANTS Prospective, observational study of new patients seeking outpatient LVR services. From April 2008 through May 2011, 779 patients from 28 clinical centers in the United States were enrolled in the Low Vision Rehabilitation Outcomes Study. The Activity Inventory, a visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline and 6 to 9 months after usual LVR care. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaires were also administered to measure patients' psychological, cognitive, and physical health states, respectively, and clinical findings of patients were provided by study centers. MAIN OUTCOMES AND MEASURES Mean changes in the study population and minimum clinically important differences in the individual in overall visual ability and in visual ability in 4 functional domains as measured by the Activity Inventory. RESULTS Baseline and post-rehabilitation measures were obtained for 468 patients. Minimum clinically important differences (95% CIs) were observed in nearly half (47% [95% CI, 44%-50%]) of patients in overall visual ability. The prevalence rates of patients with minimum clinically important differences in visual ability in functional domains were reading (44% [95% CI, 42%-48%]), visual motor function (38% [95% CI, 36%-42%]), visual information processing (33% [95% CI, 31%-37%]), and mobility (27% [95% CI, 25%-31%]). The largest average effect size (Cohen d = 0.87) for the population was observed in overall visual ability. Age (P = .006) was an independent predictor of changes in overall visual ability, and logMAR visual acuity (P = .002) was predictive of changes in visual information processing. CONCLUSIONS AND RELEVANCE Forty-four to fifty percent of patients presenting for outpatient LVR show clinically meaningful differences in overall visual ability after LVR, and the average effect sizes in overall visual ability are large, close to 1 SD.
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Affiliation(s)
- Judith E Goldstein
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Lou Jackson
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston
| | - Sandra M Fox
- San Antonio Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio4Lions Low Vision Center of Texas, The University of Texas Health Science Center School at San Antonio
| | - James T Deremeik
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert W Massof
- Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract
PURPOSE This article presents a theoretical interpretation of patient-reported outcomes of low-vision rehabilitation (LVR) using rating scale questionnaires and uses previously published results of LVR outcome studies to illustrate theoretical points and validate assumptions. THEORY Patients' judgments of the difficulty they have performing tasks are interpreted as magnitude estimates of their functional reserve for each task, which is the difference between their visual ability and the visual ability demanded by the task. We assume that improvements in functional reserve can occur by increasing the patient's visual ability with medical, surgical, or refractive interventions or decreasing the visual ability demanded by the item with activity-specific vision assistive equipment, adaptations, and environmental modifications. Activity-specific interventions cause differential item functioning (intervention-related DIF). Intervention-related DIF makes the measured size of the treatment effect dependent on the item content and the mix of responsive and unresponsive items to intervention. CONCLUSIONS Because intervention-related DIF depends on the choice of items, the outcome measure selected should be appropriate to the aims of the intervention and the impairment level of the sample to demonstrate the full effects of an intervention. Items that are given extreme positive ratings at preintervention baseline (e.g., "not difficult") have no room for improvement. These items must also be filtered out because they will dilute the measured effect of the activity-specific interventions of LVR.
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Wolffsohn JS, Jackson J, Hunt OA, Cottriall C, Lindsay J, Gilmour R, Sinclair A, Harper R. An enhanced functional ability questionnaire (faVIQ) to measure the impact of rehabilitation services on the visually impaired. Int J Ophthalmol 2014; 7:77-85. [PMID: 24634868 DOI: 10.3980/j.issn.2222-3959.2014.01.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/25/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To develop a short, enhanced functional ability Quality of Vision (faVIQ) instrument based on previous questionnaires employing comprehensive modern statistical techniques to ensure the use of an appropriate response scale, items and scoring of the visual related difficulties experienced by patients with visual impairment. METHODS Items in current quality-of-life questionnaires for the visually impaired were refined by a multi-professional group and visually impaired focus groups. The resulting 76 items were completed by 293 visually impaired patients with stable vision on two occasions separated by a month. The faVIQ scores of 75 patients with no ocular pathology were compared to 75 age and gender matched patients with visual impairment. RESULTS Rasch analysis reduced the faVIQ items to 27. Correlation to standard visual metrics was moderate (r=0.32-0.46) and to the NEI-VFQ was 0.48. The faVIQ was able to clearly discriminate between age and gender matched populations with no ocular pathology and visual impairment with an index of 0.983 and 95% sensitivity and 95% specificity using a cut off of 29. CONCLUSION The faVIQ allows sensitive assessment of quality-of-life in the visually impaired and should support studies which evaluate the effectiveness of low vision rehabilitation services.
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Affiliation(s)
- James Stuart Wolffsohn
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, B4 7ET, UK
| | - Jonathan Jackson
- Australian College of Optometry, Melbourne 3053, Australia ; Royal Victoria Hospital, Belfast BT12 6BA, UK
| | - Olivia Anne Hunt
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, B4 7ET, UK
| | | | | | | | - Anne Sinclair
- Low Vision Clinic, Fife Low Vision Centre for the Blind, Fife KY2 5EF, UK
| | - Robert Harper
- Manchester Royal Eye Hospital and Manchester Academic and Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Greater Manchester M13 9WL, UK
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Integration of health and social care – what can Wales learn … and contribute? QUALITY IN AGEING AND OLDER ADULTS 2013. [DOI: 10.1108/14717791311311102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Binns AM, Bunce C, Dickinson C, Harper R, Tudor-Edwards R, Woodhouse M, Linck P, Suttie A, Jackson J, Lindsay J, Wolffsohn J, Hughes L, Margrain TH. How Effective is Low Vision Service Provision? A Systematic Review. Surv Ophthalmol 2012; 57:34-65. [DOI: 10.1016/j.survophthal.2011.06.006] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 06/16/2011] [Accepted: 06/21/2011] [Indexed: 12/31/2022]
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A profile of low vision services in England: the Low Vision Service Model Evaluation (LOVSME) project. Eye (Lond) 2011; 25:829-31. [PMID: 21753802 DOI: 10.1038/eye.2011.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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