Reading with low vision: the impact of research on clinical management*

Lovie‐Kitchin, Jan E.

doi:10.1111/j.1444-0938.2010.00565.x

Cited by 27 publications

(36 citation statements)

References 76 publications

(167 reference statements)

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“…The ability of a participant to read N8 print over a short period of time does not necessarily mean that he or she will be capable of reading newsprint in comfort for a reasonable period of time. It is estimated that in order to read print comfortably an acuity 'reserve' is required; 128 for example, for someone to read N8 print comfortably for a reasonable period of time, they would usually need have a NVA of N4.…”

Section: Near Acuitymentioning

confidence: 99%

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

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BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Near Acuitymentioning

confidence: 99%

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

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“…Yakın ve uzak için ihtiyaç duyulan büyütme gücü ve cihaz tipi hastanın günlük hayatta karşılaştığı problemlerin çözümüne göre değişiklik gösterebilmektedir. 23,24,25,26,27,28 Çalışmamızın sonucuna göre yakın görme rehabilitasyonu amacı ile 136 hastaya (%75,1), uzak görme rehabilitasyonu amacı ile 127 hastaya (%70,1) cihaz önerilmiştir. Retinitis pigmentosa grubunda diğer hasta gruplarına göre görme düzeyinin daha kötü olduğu tespit edilmiştir.…”

Section: Discussionunclassified

“…Filtrenin en önemli etkisinin fotofobiyi azaltarak hasta konforunu arttırdığı ifade edilmiştir. 27 Bizim çalışmamızda fotofobi ve kamaşma şikayetleri olan 79 hastaya (%43,6) 527-600 nm dalga boyundaki ışığı filtreleme özelliği gösteren gözlükler önerilmiştir. Retrospektif bir çalışma olduğu için dosyalarda kayıtlı oran bu şekildedir.…”

Section: Discussionunclassified

Low Vision Rehabilitation in Patients with Hereditary Retinal Dystrophy

Petriçli¹,

Merdoğan²,

Tunay³

et al. 2015

tjo

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Amaç: Herediter retina distrofisi tanısı ile izlenen olgularda az görme rehabilitasyonu yöntemlerini değerlendirmek. Ge reç ve Yön tem: Bu çalışma Ankara Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Az Görenler Rehabilitasyon ve Araştırma Birimi'nde Ocak 2005-Mayıs 2013 tarihleri arasında yapılmıştır. Bu birime başvuran 1841 hastanın 181'inin (%9,8) tanısının herediter retina distrofisi (HRD) olduğu saptanmıştır. Hastalar, uzak ve yakın görme keskinlikleri tespit edildikten sonra ICD-10 sınıflamasının görme bozukluğu kategorilerine göre gruplandırıldı. Hastaların demografik verileri, önerilen uzak ve yakın optik-teleskopik cihaz tipleri kaydedildi. Veriler ortalama ± standart sapma (SD), sayı veya yüzde (%) olarak verildi. Bulgular: Toplam 181 hastanın 73'ü kadın, 108'i erkekti. Hastaların ortalama ilk muayene yaşı 27,1±17,3'tü. Hastaların %39,2'si 18 yaş altı pediatrik yaş grubundaydı. HRD'ler içinde, sırasıyla retinitis pigmentosa %35,7, kon-rod distrofileri %22,0, Stargardt hastalığı %19,6, kon distrofileri %17,1, akromatopsi %4,4, konjenital durağan gece körlüğü %0,4 ve Leber'in konjenital amarozisi %0,4 oranında tespit edildi. ICD 10 sınıflamasına göre 10 hasta hafif derecede görme bozukluğu, 126 hasta az görme, 44 hasta ise körlük kategorisinde idi. Uzak görme rehabilitasyonu amacı ile 127 (%70,1) hastaya teleskop önerildi. Çalışmamızda hastaların ortalama yakın görme keskinlikleri 1,2±0,3 LogMAR idi. Yakın görme rehabilitasyonu amacı ile 136 (%75,1) hastaya optik sistem reçete edildi. Fotofobi için hastaların %43,6'sına filtre gözlük önerildi. Sonuç: HRD hastaları, hastalığın ilerleyici olması ve etkin tedavisinin bulunmaması nedeniyle tanı konulduğu andan itibaren az görme rehabilitasyonu için adaydırlar. Bu çalışmada HRD hastalarının yaklaşık 2/3'üne az görme rehabilitasyonu için cihaz önerilmiştir. Bu olguların az görme rehabilitasyonu ile uğraşan kliniklere yönlendirilmeleri, optik ve optik olmayan sistemlerden fayda görmeleri için önemlidir. (

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“…For each factor of the SUS, participant responses to the 5-item Likert agreement scale were scored by subtracting 1 from odd numbered factors, subtracting the even numbered factors from 5 and multiplying each factor by 2.5 for a total possible score of 100 for the entire 10-item scale [54]. The total mean usability score as well as the scores for learnability (factors 4 and 10) and usability (factors 1-3 and 5-9) [55] were compared between the populations of participants who did and did not own a computer/touchscreen device using a Mann-Whitney test for nonparametric data.…”

Section: Methodsmentioning

confidence: 99%

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

Grindrod¹,

Gates²,

Dolovich³

et al. 2014

JMIR mHealth uHealth

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BackgroundIn order to take medications safely and effectively, individuals need to be able to see, read, and understand the medication labels. However, one-half of medication labels are currently misunderstood, often because of low literacy, low vision, and cognitive impairment. We sought to design a mobile tool termed ClereMed that could rapidly screen for adults who have difficulty reading or understanding their medication labels.ObjectiveThe aim of this study was to build the ClereMed prototype; to determine the usability of the prototype with adults 55 and over; to assess its accuracy for identifying adults with low-functional reading ability, poor ability on a real-life pill-sorting task, and low cognition; and to assess the acceptability of a touchscreen device with older adults with age-related changes to vision and cognition.MethodsThis pilot study enrolled adults (≥55 years) who were recruited through pharmacies, retirement residences, and a low-vision optometry clinic. ClereMed is a hypertext markup language (HTML)-5 prototype app that simulates medication taking using an iPad, and also provides information on how to improve the accessibility of prescription labels. A paper-based questionnaire included questions on participant demographics, computer literacy, and the Systems Usability Scale (SUS). Cognition was assessed using the Montreal Cognitive Assessment tool, and functional reading ability was measured using the MNRead Acuity Chart. Simulation results were compared with a real-life, medication-taking exercise using prescription vials, tablets, and pillboxes.ResultsThe 47 participants had a mean age of 76 (SD 11) years and 60% (28/47) were female. Of the participants, 32% (15/47) did not own a computer or touchscreen device. The mean SUS score was 76/100. ClereMed correctly identified 72% (5/7) of participants with functional reading difficulty, and 63% (5/8) who failed a real-life pill-sorting task, but only 21% (6/28) of participants with cognitive impairment. Participants who owned a computer or touchscreen completed ClereMed in a mean time of 26 (SD 16) seconds, compared with 52 (SD 34) seconds for those who do not own a device (P<.001). Those who had difficulty, struggled with screen glare, button activation, and the “drag and drop” function.ConclusionsClereMed was well accepted by older participants, but it was only moderately accurate for reading ability and not for mild cognitive impairment. Future versions may be most useful as part of a larger medication assessment or as a tool to help family members and caregivers identify individuals with impaired functional reading ability. Future research is needed to improve the sensitivity for measuring cognitive impairment and on the feasibility of implementing a mobile app into pharmacy workflow.

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Reading with low vision: the impact of research on clinical management*

Cited by 27 publications

References 76 publications

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives

Low Vision Rehabilitation in Patients with Hereditary Retinal Dystrophy

ClereMed: Lessons Learned From a Pilot Study of a Mobile Screening Tool to Identify and Support Adults Who Have Difficulty With Medication Labels

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