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The Effectiveness of Low-Vision Rehabilitation on Participation in Daily Living and Quality of Life

¹From the Department of Ophthalmology, Centre for Eye Research Australia, The University of Melbourne, East Melbourne, Victoria, Australia; ²Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia; the ³NH&MRC (National Health and Medical Research Council) Centre for Clinical Eye Research, Flinders University and Flinders Medical Centre, Bedford Park, SA, Australia; and ⁴Vision CRC, Sydney, NSW, Australia.

PURPOSE. To evaluate the effectiveness of a multidisciplinary low-vision rehabilitation program on quality of life evaluated by the Impact of Vision Impairment (IVI) instrument.

METHODS. First-time referrals to low-vision clinics were assessed before and after rehabilitation (3–6 months). Rasch analysis was used to estimate the three IVI subscale and overall values on an interval scale. A mixed between–within subjects ANOVA was used to identify whether presenting visual acuity had an interaction effect with rehabilitation change. Cohen d values were used to estimate the magnitude of the change and the standardized response mean (SRM) procedure was selected to determine the clinical significance of the rehabilitation-induced changes.

RESULTS. One hundred twenty-four women and 68 men (mean age, 80.3 years) completed the rehabilitation. Most had age-related macular degeneration (62%, 119) and were moderately to severely vision impaired (<6/18; 78%, 149). After rehabilitation, significant improvements were recorded for the overall IVI score (P = 0.006) and two subscales: reading and accessing information and emotional well-being (P = 0.007 and 0.009, respectively). No significant improvement was found on the mobility and independence subscale (P = 0.07). The magnitude of the postintervention improvement was found to be relatively moderate (Cohen d = 0.17–0.30) and clinically modest (SRM = 0.22–0.42).

CONCLUSIONS. Significant improvements in overall quality of life and two specific areas of daily living in people with low vision were found, although the magnitude and clinical significance of the rehabilitation-induced gains were modest. Further investigation in other models of low-vision rehabilitation is needed to optimize quality of life gains in people with low vision.

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