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Ophthalmic & Physiological Optics : the... Jul 2022To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands.
PURPOSE
To identify parameters associated with the downward trend in the uptake of Low Vision Services (LVS) in the Netherlands.
METHODS
A retrospective cohort study was conducted based on a Dutch national health insurance claims database (Vektis CV) of all adults (≥18 years) who received LVS from 2015 until 2018. Descriptive statistics were used to assess socio-demographic, clinical and contextual characteristics and other healthcare utilisation of the study population. General estimating equations trends in characteristics and healthcare utilisation were determined over time.
RESULTS
A total of 49,726 unique patients received LVS, but between 2015 and 2018, the number of patients decreased by 15%. The majority was aged 65 years or older (53%), female (54%), had a middle (38%) or low (24%) socio-economic status and lived in urban areas (68%). Between 2015-2018, significant downward trends were found for treatment with intravitreal injections and lens-related diseases for LVS patients. For physical comorbidity, utilisation of ophthalmic care, low vision aids and occupational therapy, a significant upward trend was found over time.
CONCLUSION
The decrease of Dutch LVS patients by 15% between 2015 and 2018 might be explained by a reduced distribution of patients treated with intravitreal injections and patients with lens-related diseases within the LVS. Compared to 2015, patients were more likely to have physical comorbidity, to see an ophthalmologist and to use low vision aids and occupational therapy in 2016, 2017 and 2018. This might indicate enhanced access to LVS when treated by ophthalmologists or within other medical specialties, or the opposite, i.e., less access when not treated within one of these medical specialties. Future research is needed to examine differences in patterns between LVS users and non-users further.
Topics: Acquired Immunodeficiency Syndrome; Adult; Delivery of Health Care; Female; Humans; Patient Acceptance of Health Care; Retrospective Studies; Vision, Low
PubMed: 35661209
DOI: 10.1111/opo.12982 -
Clinical & Experimental Optometry Mar 2011The current mismatch between the need for and uptake of low-vision services has been attributed to various barriers including different service delivery models and...
BACKGROUND
The current mismatch between the need for and uptake of low-vision services has been attributed to various barriers including different service delivery models and referral pathways. This study evaluates the referral pathway and low-vision service provision of the Royal Society for the Blind (RSB) in South Australia.
METHODS
All new referrals from the 2008-2009 financial year to the RSB were reviewed. Initially, patients were contacted by a triage officer within one week of referral. Initial appointments were made in the Low Vision Clinic with a multidisciplinary team. Reasons for declining the appointment or non-attendance were tracked via telephone.
RESULTS
There were 1116 patients referred over a 12-month period and 1082 (97 per cent) were reviewed in the Low Vision Clinic. Most attendees (92 per cent) lived within 50 kilometres of the clinic. There were 34 referred patients, who declined or did not attend the assessment. All non-attendees also lived within 50 kilometres of the Low Vision Centre. Concurrent major health problems (27 per cent) and patients not feeling the need for low-vision rehabilitation (27 per cent) were the most common reasons for not accessing the service. Only 125 patients (11.6 per cent) accessed volunteer transport services and only 24 patients (2.2 per cent) needed an interpreter service.
CONCLUSION
The attendance rate is significantly higher than in other published studies. The distance to travel or transport difficulties were not significant barriers. Patient perception that either the service was not required or would not help them was the main barrier. The referral and triage process appeared to be a major enabler of low-vision service uptake.
Topics: Adolescent; Adult; Aged; Australia; Child; Child, Preschool; Critical Pathways; Female; Health Services Accessibility; Humans; Infant; Infant, Newborn; Male; Middle Aged; Patient Compliance; Referral and Consultation; Societies, Medical; Vision, Low; Young Adult
PubMed: 21175824
DOI: 10.1111/j.1444-0938.2010.00556.x -
Frontiers in Bioscience (Scholar... Jan 2018Microperimetric biofeedback training (MBFT) is a visual rehabilitative strategy based on fixation stability improvement reinforcing or creating a new preferential... (Review)
Review
Microperimetric biofeedback training (MBFT) is a visual rehabilitative strategy based on fixation stability improvement reinforcing or creating a new preferential fixation locus. The rationale consists in reeducating visual system to a new visual condition, promoting retina-brain transmission, and thus cortical plasticity. The use of MBFT found is major application in visual diseases involving central vision, but later it revealed promising functional outcomes even in myopia, inherited retinal degenerations and nystagmus. However, the use of microperimetric biofeedback is still limited due to poor knowledge of the procedure and inconsistent standards of practice, and thus an incipient skepticism on its efficacy. This review provides an overview of the rationale, current implications, procedures and future perspectives of microperimetric biofeedback training.
Topics: Biofeedback, Psychology; Fixation, Ocular; Humans; Retina; Vision, Low
PubMed: 28930518
DOI: 10.2741/s500 -
Vision Research Dec 2019In the early 20th century, reading researchers expressed optimism that scientific study of reading would improve the legibility of typefaces. Font-making was, however,...
In the early 20th century, reading researchers expressed optimism that scientific study of reading would improve the legibility of typefaces. Font-making was, however, complex, expensive and impractical for reading research, which was therefore restricted to standard commercial fonts. The adoption of computer typography in legibility studies makes the measurement, modification and creation of experimental fonts easier, while display of text on computer screens facilitates reading studies. These technical advances have spurred innovative research. Some studies continue to test fonts for efficient reading in low vision as well as normal vision, while others use novel fonts to investigate visual mechanisms in reading. Some experimental fonts incorporate color and animation features that were impractical or impossible in traditional typography. While it is not clear that such innovations will achieve the optimistic goals of a century ago, they extend the investigation and understanding of the nature of reading.
Topics: Biomedical Research; Comprehension; Humans; Ophthalmology; Reading; Vision, Low
PubMed: 31078662
DOI: 10.1016/j.visres.2019.05.003 -
Indian Journal of Ophthalmology Oct 2019For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an... (Review)
Review
For several reasons, cerebral visual impairment (CVI) is emerging as a major cause of visual impairment among children in the developing world and we are seeing an increasing number of such children in our clinics. Owing to lack of early training about CVI and it being a habilitation orientated subject, we need to become equipped to optimally help the affected children. In this paper we have explained our pragmatic approach in addressing children who present with low functioning CVI. Initially we explain briefly, how vision is processed in the brain. We then present what should be specifically looked for in these children in regular clinics as a part of their comprehensive ophthalmic examination. We discuss the process of functional vision evaluation that we follow with the help of videos to explain the procedures, examples of how to convey the conclusions to the family, and how to use our findings to develop intervention guidelines for the child. We explain the difference between passive vision stimulation and vision intervention, provide some common interventions that may be applicable to many children and suggest how to infuse interventions in daily routines of children so that they become relevant and meaningful leading to effective learning experiences.
Topics: Blindness, Cortical; Developing Countries; Humans; India; Patient Care Team; Vision, Low
PubMed: 31546476
DOI: 10.4103/ijo.IJO_2089_18 -
Arquivos Brasileiros de Oftalmologia 2017We conducted a literature review of tools used to evaluate functionality in children with low vision with the aim of analyzing the applicability, advantages, and... (Review)
Review
We conducted a literature review of tools used to evaluate functionality in children with low vision with the aim of analyzing the applicability, advantages, and disadvantages for children <6 years of age, an age at which visual development is mostly complete. Publications in Portuguese, English and, Spanish describing functional evaluation tools for children aged 0-18 years with low vision in the following databases were included: Web of Science, Virtual Health Library, Cochrane, Scielo, and PubMed. A total of 181 articles were collected, 15 of which were included in this review. Thirteen tools were identified, nine of which evaluated overall functionality and quality of life through questionnaires. The other 4 instruments, using a observational test model, evaluated functionality and they were elected. Observational tests chosen for their accuracy and lower selection bias were used to evaluate visual functionality. Of these, the Functional Vision Assessment up to 6 years seems to be promising. In conclusion, we observed a lack of tools for evaluating functionality in children with low vision. This type of evaluation is necessary for planning visual rehabilitation to improve quality of life in children with low vision.
Topics: Child; Disability Evaluation; Humans; Quality of Life; Surveys and Questionnaires; Vision, Low
PubMed: 28380106
DOI: 10.5935/0004-2749.20170016 -
International Journal of Environmental... Dec 2023East and Southeast Asia (ESEA) are facing age-related eye health issues. Low-vision rehabilitation (LVR), which is a special rehabilitation service for individuals with... (Review)
Review
East and Southeast Asia (ESEA) are facing age-related eye health issues. Low-vision rehabilitation (LVR), which is a special rehabilitation service for individuals with vision impairment, is a promising solution for these health issues; however, poor accessibility to LVR services has been reported globally, including ESEA. Therefore, this scoping review aimed to summarize and understand the barriers to accessing LVR services in ESEA. In total, 20 articles were ultimately considered eligible for this scoping review after an electronic database search using MEDLINE (PubMed), Web of Science, Academic Search Ultimate (EBSCO), and Ichushi-Web (Japanese medical literature database), and an independent review by two reviewers. Twenty-one potential barrier factors were identified in the full-text review. Notably, age, education, economic status, "previous experience using eye care service", and "knowledge, information, and awareness" were the possible barrier factors that were examined for their association with LVR utilization, with supportive evidence in many eligible studies. We also identified research gaps relating to geographical and ethnic diversity, the scope of LVR services, and barriers among eligible articles. Therefore, by conducting further studies addressing the research gaps identified in this scoping review, these findings can be used to make LVR services more accessible to people in ESEA.
Topics: Humans; Asian People; Vision, Low; Health Services Accessibility
PubMed: 38063571
DOI: 10.3390/ijerph20237141 -
Medicine May 2021Low vision rehabilitation optimizes the use of residual vision after severe vision loss, but also teaches skills to improve visual functioning in daily life. These... (Meta-Analysis)
Meta-Analysis
BACKGROUND AIM
Low vision rehabilitation optimizes the use of residual vision after severe vision loss, but also teaches skills to improve visual functioning in daily life. These skills promote independence and active participation in society. This meta-analysis was designed to evaluate the efficacy of low vision rehabilitation in improving the quality of life (QoL) in visually impaired adults.
METHODS
We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to January 1, 2020. Randomized controlled trials (RCTs) that compared rehabilitation interventions with active or inactive controls were included. The standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated to compare outcomes. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2.
RESULTS
A total of 52 RCTs with 6,239 participants were included in this meta-analysis. Compared to inactive comparators including waiting list or no care, low vision rehabilitation improved vision-related QoL, visual functioning (QoL: psychological aspect), and self-efficacy or self-esteem (QoL: psychological aspect), with pooled SMDs of -0.61 (95% CI -0.95 to -0.26; P = .0006), -1.14 (95% CI -1.69 to -0.59; P < .0001), and -0.84 (95% CI -1.47 to -0.22; P < .0001), respectively. Compared to active comparators, low vision rehabilitation improved vision-related QoL (SMD -0.26; 95% CI -0.46 to -0.06; P = .01) and activities of daily living (QoL: physical aspect) (SMD -0.39; 95% CI -0.67 to -0.12 P < .0001). However, no significant difference in health-related QoL and adaptation to vision loss (QoL: psychological aspect) was found between low vision rehabilitation and inactive comparators.
CONCLUSIONS
This meta-analysis indicated that low vision rehabilitation interventions, particularly psychological therapies and methods of enhancing vision, may improve vision-related QoL and visual functioning in people with sight loss compared to usual care. Further studies should explore longer maintenance effects and the costs of several types of low vision rehabilitation. Studies characterizing the mechanisms of rehabilitation interventions in different settings, including low-income countries, are also required.
Topics: Humans; Quality of Life; Randomized Controlled Trials as Topic; Vision, Low
PubMed: 34106601
DOI: 10.1097/MD.0000000000025736 -
Optometry and Vision Science : Official... Dec 2022We assessed the number of referrals for low vision (LV) services to determine if establishing an LV program at a large academic medical center impacted referral rates....
SIGNIFICANCE
We assessed the number of referrals for low vision (LV) services to determine if establishing an LV program at a large academic medical center impacted referral rates. Visual acuity (VA), referral outcome, location, and specialty were examined as factors that could impact referrals.
PURPOSE
This study aimed to identify gaps in the referral process to LV services.
METHODS
Electronic medical records of patients were reviewed to ascertain the referral rate among those who qualified for services, both before (2014 to 2016) and after (2017 to 2019) the establishment of an LV program. The medical records were further subdivided into two categories based on VA in the better-seeing eye: 20/70 to 20/200 and 20/200 to worse vision.
RESULTS
A total of 2014 patient records with VA qualifying for LV services were reviewed. The proportion of patients who had a VA of 20/70 to 20/200 inclusive in their better eye was 91.7%. A majority (89.8%) of patients with VA of 20/70 to 20/200 and 74.4% of patients with VA worse than 20/200 were never referred. Before establishing an LV program, only 2.2% of patients with VA of 20/70 to 20/200 were referred for services on their first visit, which improved to 8% after the program was established (odds ratio [OR], 3.88; 95% confidence interval [CI], 2.37 to 6.33; P < .001). Also, before the program's establishment, 12.5% of patients with VA worse than 20/200 were referred on their first visit, which increased to 31.9% after the program's establishment (OR, 3.29; 95% CI, 1.50 to 7.19; P = .002). Patients with VA worse than 20/200 were more likely to be referred (before: OR, 6.34 [95% CI, 3.03 to 13.28; P < .001]; after: OR, 5.38 [95% CI, 3.09 to 9.37; P < .001]). Our data also showed that 10.3% of patients in this study declined referral to LV services.
CONCLUSIONS
Referral rates to LV services are low among patients who qualify. The establishment of an LV program at the medical center significantly increased referral rates. However, more improvement is necessary to connect patients to LV services.
Topics: Humans; Vision, Low; Referral and Consultation; Visual Acuity
PubMed: 36594756
DOI: 10.1097/OPX.0000000000001958 -
Indian Journal of Ophthalmology Apr 2014To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population.
AIM
To evaluate the prevalence and causes of low vision and blindness in an urban south Indian population.
SETTINGS AND DESIGN
Population-based cross-sectional study. Exactly 3850 subjects aged 40 years and above from Chennai city were examined at a dedicated facility in the base hospital.
MATERIALS AND METHODS
All subjects had a complete ophthalmic examination that included best-corrected visual acuity. Low vision and blindness were defined using World Health Organization (WHO) criteria. The influence of age, gender, literacy, and occupation was assessed using multiple logistic regression.
STATISTICAL ANALYSIS
Chi-square test, t-test, and multivariate analysis were used.
RESULTS
Of the 4800 enumerated subjects, 3850 subjects (1710 males, 2140 females) were examined (response rate, 80.2%). The prevalence of blindness was 0.85% (95% CI 0.6-1.1%) and was positively associated with age and illiteracy. Cataract was the leading cause (57.6%) and glaucoma was the second cause (16.7%) for blindness. The prevalence of low vision was 2.9% (95% CI 2.4-3.4%) and visual impairment (blindness + low vision) was 3.8% (95% CI 3.2-4.4%). The primary causes for low vision were refractive errors (68%) and cataract (22%).
CONCLUSIONS
In this urban population based study, cataract was the leading cause for blindness and refractive error was the main reason for low vision.
Topics: Adult; Aged; Aged, 80 and over; Blindness; Cataract; Cross-Sectional Studies; Female; Glaucoma; Humans; India; Male; Middle Aged; Prevalence; Refractive Errors; Retrospective Studies; Urban Population; Vision, Low; Visual Acuity
PubMed: 23619490
DOI: 10.4103/0301-4738.111186