Jennifer B. Hassell

Impact of age related macular degeneration on quality of life

Aims: To describe the impact of age related macular degeneration (AMD) on quality of life and explore the association with vision, health, and demographic variables. Methods: Adult participants diagnosed with AMD and with impaired vision (visual acuity <6/12) were assessed with the Impact of Vision Impairment (IVI) questionnaire. Participants rated the extent that vision restricted participation in activities affecting quality of life and completed the Short Form General Health Survey (SF-12) and a sociodemographic questionnaire. Results: The mean age of the 106 participants (66% female) was 83.6 years (range 64–98). One quarter had mild vision impairment, (VA<6/12–6/18) and 75% had moderate or severely impaired vision. Participants reported from at least “a little” concern on 23 of the 32 IVI items including reading, emotional health, mobility, and participation in relevant activities. Those with mild and moderate vision impairment were similarly affected but significantly different from those with severe vision loss (p<0.05). Distance vision was associated with IVI scores but not age, sex, or duration of vision loss. Conclusion: AMD affects many quality of life related activities and not just those related to reading. Referral to low vision care services should be considered for people with mild vision loss and worse.

An Evaluation of the 10-item Vision Core Measure 1 (VCM1) Scale (the Core Module of the Vision-Related Quality of Life scale) Using Rasch Analysis

Purpose: To assess and re-engineer the Vision Core Measure 1 (VCM1) questionnaire in low vision (LV) and cataract participants using Rasch analysis. Methods: 295 participants drawn from a low vision clinic and 181 from a cataract surgery waiting list completed the 10-item VCM1. Unidimensionality, item fit to the model, response category performance, differential item functioning (DIF) and targeting of items to patients were assessed. Category collapsing and item removal were considered to improve the questionnaire. Results: The initial fit of the VCM1 (combined populations) to the Rasch model showed lack of fit (χ 2 = 83.3, df = 50, p = 0.002). There was evidence of DIF between the two populations which could not be resolved. Consequently, each population was assessed separately. Irrespective of the population, disordering of response category thresholds was evident. However, collapsing categories produced ordered thresholds and resulted in fit to the Rasch model for the LV (Total χ 2 = 41.6, df = 30; p = 0.08) and cataract population (Total χ 2 = 17.9, df = 20, p = 0.59). Overall, the VCM1 behaved as a unidimensional scale for each population and no item showed evidence of DIF. Item targeting to patients was however sub-optimal particularly for the cataract population. Conclusion: The VCM1 questionnaire could be improved by shortening the response scale, although different response categories are required for cataract and LV populations. Calibration of items also differed across populations. While the VCM1 performs well within the Rasch model, in line with its initial purpose, it requires the addition of items to satisfactorily target low vision and cataract populations.

Detection of vision impairment in people admitted to aged care assessment centres

Vision is not routinely tested when the health of older people is assessed, and the aim of this study was to detect older people with vision impairment for referral to appropriate eye care services. People admitted for assessment and or rehabilitation in three aged care assessment centres had distance and near visual acuity assessed with a simplified vision test. A pinhole test was used when necessary. Referral criteria were distance visual acuity of less than 6 / 12; near vision of less than N8, and people with diabetes who had not attended a dilated fundus examination in the last 2 years. Visual acuity results were obtained in 93% of patients (685 / 735). Those unable to perform the vision test were very ill or had severe cognitive impairment. Forty‐three per cent of patients (266 / 646) had impaired vision and, of these, 70.6% (188 / 266) were referred to eye care specialists. Forty‐five per cent were referred to ophthalmologists, 36% to optometrists and 20% to low vision services. This significant proportion of patients with poor vision suggests that vision screening is warranted.

A randomised controlled trial of a self-management programme for low vision implemented in low vision rehabilitation services ☆

OBJECTIVE To investigate the effectiveness of a low vision self-management programme (LVSMP) in older adults. METHODS Participants (n=153) were existing clients of a national low vision rehabilitation organisation randomly allocated to usual services (n=60) or usual services plus LVSMP (n=93). The LVSMP was an 8-week group programme facilitated by low vision counsellors. The primary outcome was vision-specific quality of life (QoL) measured using the Impact of Vision Impairment (IVI) questionnaire. Secondary outcomes emotional well-being, self-efficacy and adaptation to vision loss were measured using the depression, anxiety, stress scale (DASS), general self-efficacy scale (GSES), and short form adaptation to age-related vision loss scale (AVL12). RESULTS At one and six month follow-up assessments, no significant between-group differences were found for vision-specific QoL, emotional well-being, adaptation to vision loss or self-efficacy (p>0.05). Univariate and multivariate analyses revealed no impact of the intervention on outcome measures. CONCLUSIONS In contrast to previous work, our study found limited benefit of a LVSM programme on QoL for older adults accessing low vision services. PRACTICE IMPLICATIONS When implementing self-management programmes in low vision rehabilitation settings, issues of client interest, divergence of need, programme accessibility and fidelity of intervention delivery need to be addressed.

Psychological outcomes following interventions for people with low vision: a systematic review

Psychological distress and depression is common in people with vision loss and is associated with heightened disability. It is therefore important to determine if current low-vision rehabilitation services meet the psychological needs of people with vision impairment. The aim of this article is to describe and summarize current evidence on psychological outcomes following low-vision rehabilitation programs, as well as the impact of novel interventions designed specifically to address psychological outcomes. Several electronic databases were searched to identify studies assessing the impact of vision rehabilitation services on psychological outcomes and 35 reports from 30 studies were reviewed. Findings suggested that multidisciplinary low-vision rehabilitation services may improve aspects of psychological well-being such as vision-specific quality of life, but have limited impact on depressive symptoms. Specifically designed psychological group and individual programs based on cognitive-behavioral techniques have been shown to improve a range of psychological outcomes and may be able to prevent depressive symptoms in people with vision impairment. Further studies with sophisticated designs and well-validated outcome measures are required to understand the effectiveness, mechanisms, moderators and cost–effectiveness of existing and new low-vision rehabilitation programs on psychological well-being in people with low vision.