Evidence-based recommendations for the diagnosis, treatment, functional rehabilitation, and follow-up of people over 7 years of age with low vision

Abstract

Purpose:The aim of the study was to develop evidence-based recommendations for the diagnosis, functional rehabilitation, and follow-up of people with low vision between 7 and 18 years of age and > 18 years of age. Methods: A development group was formed with the participation of patients. A systematic search was performed, and the quality of the studies and the body of evidence were evaluated. Recommendations were made using the Grade Evidence to Decision Framework, and then validated by national experts. Results: In the diagnostic section, the quality of evidence regarding visual acuity and visual field was low; in these tests, a weak recommendation was made favorable to the use of the Early Treatment Diabetic Retinopathy Study and Microperimetry primer, respectively. Regarding contrast sensitivity, the quality of evidence was very low, and a weak recommendation was given favorable to the use of the Pelli-Robson test. Regarding treatment, the quality of evidence on electronic optical aids was moderate, and a weak recommendation was given favorable to their use. Regarding manual and electronic magnifiers, telescopes, and tablets, the quality of evidence was very low and a weak recommendation favorable to their use was given. In the rehabilitation section, the quality of evidence regarding this aspect for people > 16 years of age was moderate, and there is a strong recommendation favorable to multidisciplinary and multicomponent rehabilitation. On the other hand, the quality of evidence regarding rehabilitation for people between 7 and 16 years of age was low, and there is a strong recommendation favorable to its use. The quality of evidence for occupational therapy interventions was low and a weak recommendation was given favorable of its use. Regarding psychology, the quality of evidence on interventions like this was low and a strong recommendation was given favorable to their use. Finally, the quality of evidence for the use of follow-up scales was high and a strong recommendation was given favorable to the use of the National Eye Institute Visual Function Questionnaire-25. Conclusions: The recommendations issued facilitate establishing general practice guidelines for the comprehensive management of low vision to reduce unwanted variability regarding diagnosis, functional rehabilitation, and follow-up.