Graham Strong

Age-related macular degeneration and low-vision rehabilitation: a systematic review

BACKGROUND Because of the prevalence and devastating consequences of age-related macular degeneration (AMD), a systematic review devoted to low-vision rehabilitation and AMD seems timely and appropriate. METHODS Several electronic databases were searched for studies from 1980 to 2006 involving individuals with low vision or visual impairment and rehabilitation interventions. Studies were assessed for quality and level of evidence. RESULTS The findings indicate that standard low-vision rehabilitation programs, conventional in-clinic assessments, and optical devices are effective ways of managing and living with vision loss. Areas of unmet need include determining which types of orientation and mobility programs and devices are most effective and developing methods of matching assistive technologies with the individuals visual and environmental requirements. INTERPRETATION Additional randomized controlled trials with similar intervention comparisons and outcome measures are needed to form stronger conclusions for the most effective low-vision rehabilitation interventions for individuals with AMD.

The Waterloo vision and mobility study: postural control strategies in subjects with ARM

Binocular vision function and standing balance control was assessed in 16 subjects with age-related maculopathy (ARM) (mean age 73.9 +/- 7.4 years) and 19 controls (mean age 69.1 +/- 5.5 years). Balance control was assessed using the center of pressure signal from force plate data. It was quantified using the root mean square (RMS) error of the amplitude, sampled over a 1 min period. This was evaluated during normal standing, and while the input from the kinesthetic and/or visual systems were disrupted. The two subject groups showed significantly different RMS values across conditions (P < 0.005). The differences in RMS between ARM and control groups were only significant when the input to the kinesthetic sensory system was disrupted. Our results suggest that in the normal standing condition, the kinesthetic and vestibular systems compensated for the lack of useful information from the visual system in ARM subjects. When kinesthetic system input was disrupted, balance control of the ARM group was significantly poorer than the control. There was a weak correlation between postural control and contrast sensitivity. Various strategies for preventing falls in elderly patients with low vision are suggested.

The stability of impact of assistive devices

PURPOSE Abandonment of an assistive device (AD) is a frustrating issue yet is very common. An important reason for abandonment is that the device fails to improve the quality of life of the adopter. METHOD By means of a new questionnaire, the Psychosocial Impact of Assistive Devices Scale (PIADS) the impact on quality of life of any AD can be measured. This study tested the hypothesis that the impact of the adoption of an AD would wane with time, as the user becomes more adapted to the AD. The study attempted to do a one year follow up on all patients at a leading Canadian clinic who had received first-time prescriptions for eyeglasses. RESULTS The results showed that the positive impact, present on adoption, did not diminish significantly for those who retained the use of the device. CONCLUSION The PIADS provides clinicians with a reliable and economical method for assessing the role of psychosocial factors in the retention or abandonment of an AD.Purpose: Abandonment of an assistive device (AD) is a frustrating issue yet is very common. An important reason for abandonment is that the device fails to improve the quality of life of the adopter. Method: By means of a new questionnaire, the Psychosocial Impact of Assistive Devices Scale (PIADS) the impact on quality of life of any AD can be measured. This study tested the hypothesis that the impact of the adoption of an AD would wane with time, as the user becomes more adapted to the AD. The study attempted to do a one year follow up on all patients at a leading Canadian clinic who had received first-time prescriptions for eyeglasses. Results: The results showed that the positive impact, present on adoption, did not diminish significantly for those who retained the use of the device. Conclusion: The PIADS provides clinicians with a reliable and economical method for assessing the role of psychosocial factors in the retention or abandonment of an AD.

The psychosocial impact of closed-circuit television low vision aids

Low vision service providers undertake to prescribe assistive devices that redress a clients vision disabilities that have been verified by organized assessment protocols. Evaluating the functional outcomes of this process provides a tangible validation of the integrity of the component assessment, prescribing and dispensing activities, but this does not necessarily provide a comprehensive picture about associated or attributed changes in the individuals quality of life. The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26-item self-rating scale designed to measure the impact of an assistive technology device on psychological well-being and subjective quality of life. The current study used the PIADS to assess the psychosocial impact of closed-circuit television CCTV devices on a cohort of 36 patients annually for the first three years following device adoption. Patients reported consistently high positive impacts during the first and second years post-adoption. The subjective psychosocial...

A comparison of low vision clinic data with low vision survey and blindness registration information

Purpose. To determine whether low vision demographic data provided by low vision clinic data are comparable to that provided by blindness registration and disability questionnaire information. Methods. Low vision demographic data for Canada and Ontario within the postcensus Health and Activity Limitation Survey (HALS 1991) were obtained from Statistics Canada. These data were compared with 4744 reports of low vision examinations obtained in a multi-center low vision clinic study in Ontario, Canada (1991-1994) and appropriate annual figures from the Canadian National Institute for the Blind (CNIB). Results. Data from the low vision clinic study and the CNIB were similar. The low vision clinic study (and CNIB) reported far fewer adults (15 to 64 years) and far more seniors (65+ years) obtaining low vision examinations than suggested by HALS. Conclusions. HALS does not report on patients with low vision, as defined in low vision clinics. The differences between survey, low vision clinic, and blindness registration data are presented.