Low Vision Rehabilitation Recommended for Patients With ARMD

Low vision rehabilitation programs and low vision aids are recommended for patients who have age-related macular degeneration (ARMD) and ARMD-related geographic atrophy, according to a study published in the Journal of Ophthalmology.

An estimated 300 million people in the United States will have ARMD by 2040. Geographic atrophy “is an advanced form of ARMD characterized by irreversible atrophy of the retinal pigment epithelium, photoreceptors, and choriocapillaris.” Low vision rehabilitation is aimed at getting patients at peace with themselves through contributions to the functional use of their current vision. Quality-of-life questionnaires are used to determine the effectiveness of this rehab. This study aimed to “evaluate the low-vision rehabilitation methods in patients with ARMD-related geographic atrophy and to evaluate the effect of visual rehabilitation on the quality of life in these patients.”

Patients were included in this study if they accepted participation, had not received low vision rehabilitation services, and did not have a history of using low vision aid devices . Patients were excluded if they had other ocular pathologies that weren’t ARMD that could reduce their vision, if they could not comply with examinations or tests, and had eye surgery during the study period.

Participants had a detailed ophthalmological examination, including the measurement of best-corrected visual acuity (BCVA). Early Treatment Diabetic Retinopathy Study charts were used to measure distance visual acuity. Short-wavelength fundus autofluorescence images were used to evaluate the size and localization of the atrophy. The National Eye Institute visual functioning questionnaire was used to evaluate quality of life; this encompasses 25 main questions and 13 additional questions that asked about general health, general vision, ocular pain, near and distant activities, visual functioning, mental health, driving, color vision, and peripheral vision. Low vision aid device trials were also performed for all patients.

There were 78 patients who were included in this study who had low vision due to AMD-related geographic atrophy, of which 62.8% were male. The control group comprised patients who did not apply the rehabilitation methods. The mean (SD) age of all patients was 75.72 (9.44) years, and there were no statistically significant age or gender differences.

The better-seeing eye at distance and near had a significantly better mean BCVA in the rehabilitation group compared with the control group: 0.72 (0.26) vs 0.85 (0.22) logMAR (3.22 [2.97] vs 4.30 [2.89] M, respectively). In addition, the control group had a greater mean area of atrophy compared with the rehabilitation group: 7.78 (4.70) mm² vs 15.46 (9.37) mm². Atrophy localization was not significantly different between the groups.

The mean score of the quality of life questionnaire was 46.85 (11.58) in the overall group. Overall composite score and age, duration of complaints, and BCVA for near had significant negative correlations. Further, the overall composite score (45.59 vs 55.88), general vision (40.00 vs 45.00), near activities (25.00 vs 37.50), distance activities (29.17 vs 41.67), and vision-specific variables increased in the rehabilitation group after their treatment compared with baseline.

All participants were recommended a low vision aid, of which 17 were recommended more than 1 low vision aid for near vision. The rehabilitation group had 98.25% of patients who used hyperocular glasses; 45.61% of patients preferred glasses with 450 nm filters in addition to the low vision aid devices.

Some limitations of this study are that the population may not be generalizable and there was not a real control group.

The researchers concluded that low vision rehabilitation should be a treatment protocol for patients with ARMD.

Reference

Acar DE, Batioglu F, Idil A, Sahli E, Goksuluk D. Rehabilitation methods for patients with geographic atrophy due to age-related macular degeneration and effects of rehabilitation on quality of life. J Ophthalmol. Published online July 8, 2023. doi:10.1155/2023/3389750