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Posted: May 20, 2008

Elderly with Vision Diseases Aided by Aggressive Low-Vision Therapy

A study of elderly veterans with macular degeneration indicates that an aggressive, low-vision therapy program can substantially improve elderly vision.

Researchers from the University of Illinois at Chicago College of Medicine reached their conclusion after testing of a therapy regimen that included a home visit, counseling, assistive devices such as magnifiers, and assignments to the elderly to practice using the devices.

Low vision not only affects daily function, but also increases the risk of depression, injury and an overall decline in health. Most diseases that cause low vision are not curable. In the Illinois testing, the concentration was on diseases of the macula - the area of the retina with the sharpest vision.

"In most cases, impaired vision cannot be corrected and rehabilitation is the only option for regaining lost function for the patient with low vision. Low-vision rehabilitation aims to restore functional ability, the ability to perform tasks modulated by visual impairment," the UI researchers said.

For the study, Joan A. Stelmack, O.D., M.P.H., of the Edward E. Hines Jr. VA Hospital in Hines, Illinois, and the UI at Chicago College of Medicine, and colleagues examined 126 patients with low vision and diseases affecting the macula who were eligible for Veterans Affairs services.

Participants were randomly assigned to one of two groups. In one group, patients received a vision therapy program incorporating a low-vision examination, counseling, assistive devices such as magnifiers, and five weekly sessions provided by a low-vision therapist to teach use of the assistive devices and other adaptive strategies. Participants were also assigned homework to ensure they used the devices outside of therapy.

In the second group, participants were placed on a waiting list for the therapy program and received no treatment for four months, an amount of time veterans might normally wait to receive such services.

After four months, the 64 patients in the treatment group received an average of 10.46 hours of face-to-face vision therapy, and researchers found that they experienced a significant improvement in all aspects of visual function, including their reading ability.

They also found that among the 62 patients in the group that did not receive therapy, vision and functional ability declined over the four-month follow-up.

"Significant improvements in functional ability for mobility, visual information processing, visual motor skills and overall ability also were seen in the treatment group; small losses in these functions were observed in the control group," the authors reported in the journal Archives of Ophthalmology.

"At least 10 hours of low-vision therapy, including a home visit and assigned homework to encourage practice, is justified for patients with moderate and severe vision loss from macular diseases," they concluded.

They also took note of the status of the VA study participants and normally long lead time to treatment, adding: "Because the waiting-list control patients demonstrated a decline in functional ability, low-vision services should be offered as early as possible."

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