Joan A. Stelmack

Quality of life of low-vision patients and outcomes of low-vision rehabilitation

Purpose. The impact of low vision on self-reported quality of life and changes after low-vision intervention are investigated. Methods. Literature reports from 1990 to 2000 are reviewed. Results. Low vision is associated with increased risk for depression and decreased functional status and quality of life. Decreased visual acuity, visual field loss, and occasional blurred vision are also associated with decreased quality of life. Improvements in both functional status and quality of life occur after low-vision service delivery. Conclusions. Self-reported quality of life is a significant outcome measure for low-vision rehabilitation. Questionnaires that are more sensitive to rehabilitation services provided as well as patient needs and goals are required to facilitate development of rehabilitation plans and to compare techniques, devices, and programs. Attention should be given to measurement properties, validity, and reliability of instruments used currently and in development of new instruments.

Computer use, symptoms, and quality of life.

Purpose. To model the effects of computer use on reported visual and physical symptoms and to measure the effects upon quality of life measures. Methods. A survey of 1000 university employees (70.5% adjusted response rate) assessed visual and physical symptoms, job, physical and mental demands, ability to control/influence work, amount of work at a computer, computer work environment, relations with others at work, life and job satisfaction, and quality of life. Data were analyzed to determine whether self-reported eye symptoms are associated with perceived quality of life. The study also explored the factors that are associated with eye symptoms. Structural equation modeling and multiple regression analyses were used to assess the hypotheses. Results. Seventy percent of the employees used some form of vision correction during computer use, 2.9% used glasses specifically prescribed for computer use, and 8% had had refractive surgery. Employees spent an average of 6 h per day at the computer. In a multiple regression framework, the latent variable eye symptoms was significantly associated with a composite quality of life variable (p = 0.02) after adjusting for job quality, job satisfaction, supervisor relations, co-worker relations, mental and physical load of the job, and job demand. Age and gender were not significantly associated with symptoms. After adjusting for age, gender, ergonomics, hours at the computer, and exercise, eye symptoms were significantly associated with physical symptoms (p < 0.001) accounting for 48% of the variance. Conclusions. Environmental variability at work was associated with eye symptoms and eye symptoms demonstrated a significant impact on quality of life and physical symptoms.

Use of Rasch person-item map in exploratory data analysis: a clinical perspective.

The National Institutes of Health (NIH) includes visual impairment in the 10 most prevalent causes of disability in America. As rehabilitation programs have the potential to restore independence and improve the quality of life for affected persons, NIH research priorities include evaluating their effectiveness. This paper demonstrates a clinical perspective on the use of the Rasch person-item map to evaluate the range and precision of a new vision function questionnaire in early analysis (prior to full sample). A self-report questionnaire was developed to measure the difficulty that persons with different levels of vision loss have performing daily activities. This 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire (VA LV VFQ-48) was administered to 117 low-vision patients. Preliminary analysis indicates that the questionnaire items are applicable to persons of differing abilities. The Rasch person-item map demonstrates that the field-test version of the VA LV VFQ-48 has good range and is well centered with respect to the person measure distribution. Construct validity and reliability are also demonstrated.

Use of prisms for navigation and driving in hemianopic patients.

Purpose:  (1) To compare the outcomes of orientation and mobility and driving training with Fresnel prisms and the Gottlieb Visual Field Awareness System for patients with homonymous hemianopsia, and (2) To determine whether the patients continue to use the optical enhancement devices at a 2‐year follow‐up point.

Is there a standard of care for eccentric viewing training

A study was conducted to determine the current Department of Veterans Affairs (VA) standard of practice for eccentric viewing (EV) training. EV training is the process of teaching patients to realign the visual image away from a diseased foveal/macular region onto healthier retina. Optometrists and Visual Skills Instructors at all VA blind rehabilitation centers (BRCs) and VICTORS (vision impairment centers to optimize remaining sight) programs were asked to rate preference for EV prescription criteria, evaluation, and training techniques. Responses were received from 70% of BRCs and 67% of VICTORS. The respondents reported that all programs include EV training. The average minutes of training per patient varied from 20 minutes to nearly 24 hours, with instructors within a single center varying by as much as two orders of magnitude. Routinely, 82% of optometrists prescribe EV training, yet no consensus was found among these practitioners as to the criteria for selecting the best EV area. The results of this survey reveal an inconsistent standard of practice across VA centers and demonstrate the need for prospective studies of the efficacy, effectiveness, and cost-effectiveness of EV training.

Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding

BACKGROUND A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. METHODS The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. RESULTS Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. CONCLUSIONS Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

Economic evaluation of blind rehabilitation for veterans with macular diseases in the Department of Veterans Affairs.

Purpose: The Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) developed an outpatient low-vision programme for patients with macular diseases providing low-vision rehabilitation comparable to VA inpatient blind rehabilitation centres (BRCs). This programme targets veterans who do not need or chose not to participate in a comprehensive inpatient blind rehabilitation programme. We examined costs and consequences using veterans in LOVIT and comparable veterans in an inpatient BRC. Methods: We compared costs and consequences between treatment patients who participated in LOVIT, a two-site randomized clinical trial, and a sample of comparable patients who received treatment at a VA inpatient BRC. We measured consequences as the change in functional visual ability from baseline to follow-up (LOVIT: 4 months after randomization; BRC: 3 months after discharge) using the VA Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). Results: There were 55 LOVIT and 121 BRC patients for our analyses. Average costs were

Clinical use of the Pepper visual skills for reading test in low vision rehabilitation

38,627.3 higher for BRC patients (

The Veterans Affairs Low Vision Intervention Trial (LOVIT): Design and Methodology

5,054.4 ±

Preliminary examination of the reliability and relation to clinical state of a measure of low vision patient functional status.

404.7 SD for LOVIT vs.