None listed
Conditions
Brief summary
Vision impairment which affects macular vision has a severe impact upon a person’s ability to perform skills relating to activities of daily living. This ranges from ability to perform simple tasks such as self-grooming, to more complex skills such as reading or writing. The traditional method of vision rehabilitation for these patients has been the use of magnifiers. This intervention is widely used and is considered very successful. Nevertheless, it does have some limitations and is not necessarily appropriate for use in all situations. Another method of vision rehabilitation and one that can be used in conjunction with magnification is eccentric viewing strategy. Although there has been some research into the efficacy of this technique, it has not been widely studied. This study is unique in that it has investigated the impact of magnification intervention, eccentric viewing strategy and a combination of the two strategies, upon clinical measures. A non-intervention control group has been incorporated in this study. Use of a control group has not been reported in previous studies of vision rehabilitation interventions. A repeated measures random control investigation of 48 participants was undertaken. The participants were divided equally among 4 study groups. The Magnification group received assessment and instruction in the use of magnification, the Eccentric Viewing group received training in eccentric viewing strategy, the Combination group received both interventions and the Non-intervention group received no intervention for the 8-week study period. Outcome measures included reading print size, reading speed, comprehension, performance of activities of daily living and self-reported goal achievement measures. Whilst economic studies into the costs of medical treatments, screening programs and costs of vision impairment have been reported, no study to date has investigated the direct cost of providing vision rehabilitation in the form of magnification or eccentric viewing intervention. A comparative cost analysis was conducted as a component of this study in order to measure the direct costs involved with each rehabilitation strategy. Results indicate that, whilst both magnification intervention and eccentric viewing training are effective rehabilitation strategies, a combination of both techniques is the most effective and cost efficient.
Interventions
The duration of the study was 8 weeks. Each training session lasted approximately 1 hour, spaced 1 week apart for the 8 study weeks. Participants were divided into 4 study groups.
Group 1 received training in the use of magnification aids, with up to 3 sessions during the study, with a telephone call from the researcher during the weeks when there was no training. Each telephone call lasted approximately 15 minutes. Group 2 received training in eccentric viewing (a method of moving the eyes in a
The duration of the study was 8 weeks. Each training session lasted approximately 1 hour, spaced 1 week apart for the 8 study weeks. Participants were divided into 4 study groups. Group 1 received training in the use of magnification aids, with up to 3 sessions during the study, with a telephone call from the researcher during the weeks when there was no training. Each telephone call lasted approximately 15 minutes. Group 2 received training in eccentric viewing (a method of moving the eyes in a different direction in order to use remaining healthy retina to look at objects in the visual field), Group 3 received both magnification and eccentric viewing and Group 4 did not receive any vision rehabilitation for the duration of the study, except for a weekly telephone call from the researcher lasting approximately 15 minutes. This part added according to your query note: The form of training varied from weekly sessions in person to telephone contact only. • The Magnification group received assessment and instruction in the use of magnification over three formal sessions with the researcher. For the remainder of the program these participants were telephoned on a weekly basis to discuss use of the magnifier. • The Eccentric Viewing group received eight training sessions in eccentric viewing. Eight training sessions was chosen, as pilot-study data indicated that initially patients demonstrate an improvement with eccentric viewing but this progress stalls at session 4 or 5 (Vukicevic and Fitzmaurice, 2002) Persistence beyond this plateau results in continued improvement if eccentric viewing training continues beyond 6 sessions. • The Combination group received both magnification and training in eccentric viewing as per group 1 and 2.
Sponsors
Dr Meri Vukicevic
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Educational / counselling / training
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
62 Years to 96 Years
Healthy volunteers
No
Inclusion criteria
• Generally healthy persons, aged 50 years and over. • Legal blindness according to Australian Social Security classifications, which equates to a level of acuity of 6/60 or less, fully corrected in the better eye. • A diagnosis of age-related macular degeneration, Stargardt disease or any other ocular disorder resulting in profound macular vision loss with an absolute central scotoma, present bilaterally, for which no further ophthalmological treatment was available, as determined by an ophthalmologist.
Exclusion criteria
Poor general health, secondary ocular pathology affecting their visual acuity, diagnosed dementia, previous vision rehabilitation.
Outcome results
None listed