Intersectionality and access to visual rehabilitation services: Experiences of people with low vision, a qualitative study

Cáceres, María del Pilar Oviedo; Arias-Valencia, Samuel; Quirama, Andrea Hernández; Ruiz-Rodríguez, Myriam; València, Laura Guisasola

doi:10.1177/02646196221104902

Cited by 5 publications

(7 citation statements)

References 26 publications

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“…Las ayudas electrónicas no se encuentran disponibles fácilmente en el mercado en Colombia; la mayoría deben ser importadas y no están cubiertas por el sistema de salud 51 . Los costos varían entre una lupa electrónica de US$ 190, un circuito cerrado de televisión de US$ 280 y un dispositivo montado en la cabeza de US$ 2796.…”

Section: Consideraciones Para La Implementaciónunclassified

“…Los costos varían entre una lupa electrónica de US$ 190, un circuito cerrado de televisión de US$ 280 y un dispositivo montado en la cabeza de US$ 2796. Existen estudios de otros países en los que se demuestran que son costo-efectivos 51 . Los pacientes podrían aceptar la intervención con ayudas ópticas electrónicas si ellos pudieran evaluar su efectividad y la aceptaran de acuerdo con el tamaño, la portabilidad y la accesibilidad.…”

Section: Consideraciones Para La Implementaciónunclassified

“…Es necesario fortalecer el Sistema de Salud, pues la fragmentación en la atención no permite la integralidad, la continuidad y la oportunidad para los procesos de rehabilitación de la visión. Así mismo, debe aumentar el número de instituciones y de profesionales de la salud capacitados para llevar a cabo estas recomendaciones relacionadas con procesos de rehabilitación multidisciplinaria 51 .…”

Section: Consideraciones De Implementaciónunclassified

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Recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento, la rehabilitación y el seguimiento de personas mayores de 7 años con baja visión

Oviedo-Cáceres¹,

Lugo-Agudelo²,

Vélez³

et al. 2023

Revista Mexicana De Oftalmología

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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 over 18 years of age. Method: 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, which were validated with national experts. Results: In the diagnostic section, the quality of the evidence regarding visual acuity and visual field was low; in these tests, a weak recommendation was generated in favor of the use of the Early Treatment Diabetic Retinopathy Study and Microperimetry primer, respectively. Regarding contrast sensitivity, the quality of the evidence was very low and a weak recommendation was given in favor of the use of the Pelli-Robson test. As for treatment, the quality of evidence regarding electronic optical aids was moderate and a weak recommendation is given in favor of their use. Regarding manual and electronic magnifiers, telescopes and tablets, the quality of evidence was very low and a weak recommendation in favor of their use is given. In the section on rehabilitation, the quality of the evidence regarding this aspect for persons over 16 years of age was moderate, and there is a strong recommendation in favor of multidisciplinary and multicomponent rehabilitation. On the other hand, the quality of the evidence regarding rehabilitation for people between 7 and 16 years of age was low, and there is a strong recommendation in favor of its use. The quality of evidence for occupational therapy interventions was low and a weak recommendation is given in favor of its use. Regarding psychology, the quality of the evidence for interventions of this type was low and a strong recommendation is given in favor of their use. Finally, the quality of evidence for the use of follow-up scales was high and strong recommendation is given in favor of the use of the National Eye Institute Visual Function Questionnaire-25. Conclusions: The recommendations issued allow giving a general guideline for the comprehensive management of low vision, reducing unwanted variability in diagnosis, rehabilitation, and follow-up.

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Section: Consideraciones Para La Implementaciónunclassified

Section: Consideraciones De Implementaciónunclassified

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Recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento, la rehabilitación y el seguimiento de personas mayores de 7 años con baja visión

Oviedo-Cáceres¹,

Lugo-Agudelo²,

Vélez³

et al. 2023

Revista Mexicana De Oftalmología

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“…Electronic aids are not readily available in the market in Colombia. Most of them need to be imported and are not covered by the health-care system 51 . Price goes from USD 190 for electronic magnifiers, USD 280 for closed-circuit TVs, and USD 2796 for head-mounted devices.…”

Section: Implementation Considerationsmentioning

confidence: 99%

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

Oviedo-Cáceres¹,

Lugo-Agudelo²,

Vélez³

et al. 2023

RMOE

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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.

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“…However, Khimani, Redmon [ 32 ] and Sarika, Venugopal [ 33 ] recently showed that investigating both point of views can be beneficial as it generates a broad perspective, which contributes to a better understanding about factors influencing the referral pathways to LVS. Furthermore, earlier studies were mainly conducted in countries with no systematic national provision or financial coverage of LVS and/or with a low income, such as the United States [ 25 , 28 , 32 ], Australia [ 30 , 31 ], Canada [ 23 ], India [ 29 , 33 ], Colombia [ 34 ] and Ghana [ 35 ]. As a consequence, insights to referral barriers and facilitators are particularly lacking from high-income countries in general with different types of healthcare and coverage systems.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

Stolwijk

Nispen

Ham

et al. 2023

BMC Health Serv Res

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Background Underutilization of and lack of access to low vision services (LVS) has been reported internationally. The purpose of this study was to identify barriers and facilitators in LVS referral procedures and service delivery from both the perspective of people with visual impairment and professionals from different eye care providers in the Netherlands. Methods A qualitative study in the Netherlands was conducted. Barriers and facilitators were explored through semi structured interviews with older adults with macular degeneration, diabetic retinopathy and/or glaucoma (n = 14), and healthcare professionals including ophthalmologists and LVS professionals (n = 16). Framework analysis was used for analyzing the interviews with Atlas.ti software. Results According to both patients and professionals, facilitators in LVS access and utilization are having motivation, self-advocacy, high participation needs and social support, as well as being negatively impacted by the impairment. Both samples found having good communication skills and informing patients about LVS as a healthcare provider to facilitate access. A long patient-provider relationship and the Dutch healthcare system were also mentioned as facilitators. Professionals additionally found long disease duration and the presence of low vision optometric services in the ophthalmic practice to promote access. Barriers that were reported by patients and professionals are lack of motivation, self-advocacy and acceptance of the impairment in patients. In addition, having low participation needs as a patient, lack of information provision by providers and time constraints in the ophthalmic practice were mentioned as barriers. Professionals also reported lack of social support, short disease duration of patients, a short patient-provider relationship and lack of coordination of care in the ophthalmic practice to hinder access. Conclusions Findings suggest that providers’ lack of information provision about LVS, especially to patients who are less assertive, hamper referral to LVS. Providers should have attention for patients’ LVS needs and actively inform them and their social network about LVS to facilitate access. Educating and training providers about how and when to address LVS may help to reduce barriers in the referral pathways. In addition, referral procedures may benefit from tools that make providers more aware of LVS.

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Intersectionality and access to visual rehabilitation services: Experiences of people with low vision, a qualitative study

Cited by 5 publications

References 26 publications

Recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento, la rehabilitación y el seguimiento de personas mayores de 7 años con baja visión

Recomendaciones basadas en la evidencia para el diagnóstico, el tratamiento, la rehabilitación y el seguimiento de personas mayores de 7 años con baja visión

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

Barriers and facilitators in the referral pathways to low vision services from the perspective of patients and professionals: a qualitative study

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