Data from the WHO indicate that approximately 285 million individuals worldwide contend with low vision problems, a substantial portion of which stems from age-related macular degeneration (AMD). Furthermore, AMD prevalence is anticipated to surge to an estimated 300 million cases in the US by 2040, a trend attributed to increasing life expectancy. Thus, further studies are needed on the efficacy of low vision rehabilitation methods for patients with geographic atrophy (GA) due to AMD and their subsequent impact on the individuals’ QOL.
With GA having profound implications on visual function and, consequently, significant influences on vision-related quality of life (VRQoL), Damla Erginturk Acar, MD, and colleagues conducted a study to comprehensively assess low vision rehabilitation methods and their impact on the QOL of individuals with AMD-related GA. The assessment employed the National Eye Institute visual functioning questionnaire (NEI-VFQ-25) as a robust tool for evaluating the multifaceted aspects of visual functioning and the resulting QOL. Results were published in the Journal of Ophthalmology.
The Big Picture on Low Vision Rehab
Low vision rehabilitation is a critical facet of managing patients with AMD, seeking to enhance their happiness, independence, and productivity by optimizing their current levels of vision. The concept of success in low vision rehabilitation is nuanced, often defined as the point at which a patient effectively uses a device to address one or more vision-related challenges. A pivotal aspect of this process is using QOL questionnaires, with the NEI-VFQ-25 serving as an key tool in gauging the effectiveness of various rehabilitation strategies.
Activities of daily living that patients with low vision find most challenging are often centered around near vision tasks, such as reading newspapers, books, and using cell phones. Hyperocular glasses, providing an expansive field of view, are frequently preferred aids for near vision, while telescopes are the go-to optical devices for distance vision. The selection of low vision aids is individualized, considering the specific needs and preferences of each patient.
Low Vision Aid Device Use Vs No Device
Use The study cohort consisted of 78 patients presenting with GA due to AMD, all reporting difficulties in their daily tasks related to vision. Ethical considerations precluded the formation of a traditional control group; however, patients who were prescribed low vision aid devices but opted not to use them were considered a comparative control group. Comprehensive ophthalmological examinations, including low vision aid trials and administration of the NEI-VFQ-25 questionnaire, formed the foundation of the study protocol.
The results demonstrated that rehabilitation significantly improved visual acuity, reduced the area of atrophy, and contributed positively to QOL, as evidenced by substantial increases in NEI-VFQ-25 scores across various subscales (Table). Indeed, “statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (P=0.009 for general vision, P<0.001; for others),” wrote Dr. Acar and team.
The control group exhibited lower educational levels, poorer visual acuity, diminished NEIVFQ- 25 scores, and larger GA areas. This dichotomy underscores the efficacy of rehabilitation in improving patient outcomes.
Findings Underscore Effectiveness of Low Vision Rehab
Despite inherent limitations, such as the absence of a matched control group and potential participant selection bias, the study underscores the significance of integrating low vision rehabilitation into the broader treatment paradigm for AMD-related GA. The study findings emphasize the need for dedicated time in retina clinics to educate and motivate patients for the optimal use of low vision aid devices. Anxiety in patients with AMD is intense and debilitating, dramatically affecting their QOL, and as the study authors conclude, “Using their current functional vision capacity in the best way will enable them to become independent, self-sufficient, productive, self-confident, and happy individuals by enabling them to have social lives and increasing their quality of life.” Consequently, the study authors conclude that along with a multivitamin supplement and intravitreal injection, “Low vision patients with [AMD]-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.” concluded the study authors.
