VA Low Vision Intervention Trial
The primary purpose of this research study is to evaluate the effectiveness of a new outpatient low vision rehabilitation program that is targeted to serve legally blind veterans with central vision loss. The hypothesis is that veterans in the treatment group will self-report less difficulty performing daily activities than veterans in the control group who are on a waiting list for VA low vision or blind rehabilitation programs.
Abstract: Research Question:
Estimates are that there will be 854,000 severely visually impaired veterans in the year 2005 and 890,000 in the year 2010. Statistics, based upon the 2000 census, suggest that it will be well into the next decade before the number of severely visually impaired veterans begins to decrease. Waiting time for admission to VA blind rehabilitation centers (BRCs) is often a year or more. Low vision services are an important aspect of blind rehabilitation, as 85% of veterans admitted to BRCs have useful remaining vision. In the private sector, low vision services are provided in outpatient settings. Yet, legally blind veterans are still encouraged, if not required, to attend regional inpatient programs to obtain therapy with low vision devices because a reimbursement model is not available for outpatient blind rehabilitation and few low vision outpatient clinics have rehabilitation professionals to provide this training. The VA system needs alternative service delivery options for veterans who are unable to participate in inpatient rehabilitation. Outpatient low vision programs should provide continuity of care with the regional BRC programs and insure local access to low vision care that is high quality, timely, and cost-effective. Currently, the VERA Reimbursement Model allocates $27,826 per blind rehabilitation admission. Outpatient low vision programs have the potential to substitute for inpatient low vision services and more costly inpatient rehabilitation programs may not be necessary for higher functioning veterans. The purpose of the proposed research is to measure the effectiveness of a low vision outpatient program for legally blind veterans with central vision loss from macular diseases that could be provided at local VA facilities.
Specific Objectives are to:
1. Compare the mean change in self-report of difficulty performing daily activities measured with the Veteran's Affairs Low Vision Visual Function Questionnaire - 48 (VA LV VFQ-48) reading domain scores from baseline to 4 months after randomization [two months after veterans participate in a low vision outpatient program or usual care (waiting list) control group].
2. Determine if the mean change in VA LV VFQ-48 composite and reading domain scores from baseline to 4 months after randomization [two months after veterans participate in a low vision outpatient program or usual care (waiting list) control group] can be predicted by baseline measures of visual impairment, functional status and life state or explained by measures of functional status after rehabilitation.
3. Perform an economic evaluation of costs and cost-effectiveness of the low vision outpatient program.
4. Compare the mean change in VA LV VFQ-48 scores from the clinical trial from baseline to 4 months after randomization (two months after veterans participate in a low vision outpatient program) to historical data on the mean change in VA LV VFQ-48 scores from the Hines BRC program.
Hypothesis: Compared to the usual care (waiting list) control group, veterans in the treatment group will self-report a reduction of .78 logits or more in difficulty performing daily living activities measured by the VA LV VFQ-48 reading domain scores from baseline to 4 months after randomization (two months after veterans participate in a low vision outpatient program).The .78 logit change is clinically significant, as this improvement corresponds to the change in visual ability that would accompany a 6-line improvement on an EDTRS visual acuity chart.
Significance: The NIH includes visual impairment, chronic visual deficiencies that impair everyday function that are not correctable by ordinary glasses, among the 10 most prevalent causes of disability in America. Persons confronted with vision loss often feel limited and frustrated performing everyday activities such as reading, traveling from place to place, and recognizing objects or people. As a result, they may experience loss of self esteem, social isolation, difficulty working and reduced independence. The low vision team evaluates the level of remaining vision, prescribes special lenses or devices and techniques for using remaining vision more effectively. Low vision rehabilitation restores independence by enabling persons with vision loss to perform daily living tasks independently at home, at work or within the community.
Research Design: the proposed study is a randomized clinical trial conducted at two sites. Subjects are 122 legally blind veterans from Hines Hospital and Heffner VAMC. Veterans will be randomized to treatment from a new low vision outpatient program or a usual care (waiting list) control group. Following a low vision examination, veterans in the treatment group will receive 5 (2-2 1/2 hour) therapy sessions at the local VA sites and one home visit to evaluate the home environment and set up prescribed devices. The primary outcome measure is change in reading domain scores on the VA LV VFQ-48, a telephone questionnaire where subjects self-report their difficulty performing daily living activities in the community. Other measures include, instructors rating of veteran's visual skills and use of low vision devices after rehabilitation, visual skills for reading (PEPPER VSRT), health status (SF-36), and symptoms of depression (CES-D). Outcomes will be compared with T tests. Multiple linear regression models will be used to identify predictors and explain outcomes. Costs and cost effectiveness of outpatient treatment compared to treatment in an inpatient BRCwill be evaluated.
Allocation: Randomized, Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
Low Vision Intervention - Outpatient Training Program
Edward Hines, Jr. VA Hospital
Department of Veterans Affairs
Results (where available)
- Source: http://clinicaltrials.gov/show/NCT00223756
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Vision considered to be inferior to normal vision as represented by accepted standards of acuity, field of vision, or motility. Low vision generally refers to visual disorders that are caused by diseases that cannot be corrected by refraction (e.g., MACULAR DEGENERATION; RETINITIS PIGMENTOSA; DIABETIC RETINOPATHY, etc.).
Application of tests and examinations to identify visual defects or vision disorders occurring in specific populations, as in school children, the elderly, etc. It is differentiated from VISION TESTS, which are given to evaluate/measure individual visual performance not related to a specific population.
Color Vision Defects
Defects of color vision are mainly hereditary traits but can be secondary to acquired or developmental abnormalities in the CONES (RETINA). Severity of hereditary defects of color vision depends on the degree of mutation of the ROD OPSINS genes (on X CHROMOSOME and CHROMOSOME 3) that code the photopigments for red, green and blue.
Failure or imperfection of vision at night or in dim light, with good vision only on bright days. (Dorland, 27th ed)
Partial or complete loss of vision in one half of the visual field(s) of one or both eyes. Subtypes include altitudinal hemianopsia, characterized by a visual defect above or below the horizontal meridian of the visual field. Homonymous hemianopsia refers to a visual defect that affects both eyes equally, and occurs either to the left or right of the midline of the visual field. Binasal hemianopsia consists of loss of vision in the nasal hemifields of both eyes. Bitemporal hemianopsia is the bilateral loss of vision in the temporal fields. Quadrantanopsia refers to loss of vision in one quarter of the visual field in one or both eyes.
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