Low Vision Rehabilitation for Persons with Macular Degeneration and Mild Cognitive Deficits

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A new study, published “online first” in the April 2013 issue of JAMA Ophthalmology (formerly Archives of Ophthalmology), demonstrates the feasibility and benefits of a low vision rehabilitation program for patients with macular disease who also have mild cognitive deficits.

JAMA Ophthalmology is an international peer-reviewed journal published monthly by the American Medical Association (AMA), and is part of the JAMA Network of journals.

About the Research

The study, entitled A Low-Vision Rehabilitation Program for Patients with Mild Cognitive Deficits, was authored by Heather E. Whitson, MD, MHS; Diane Whitaker, OD; Guy Potter, PhD; Eleanor McConnell, RN, PhD; Fay Tripp, OT; Linda L. Sanders, MPH; Kelly W. Muir, MD, MHS; Harvey J. Cohen, MD; and Scott W. Cousins, MD. Lead author Heather E. Whitson is assistant professor of medicine in the Division of Geriatrics and Ophthalmology at Duke University Medical Center in Durham, North Carolina.

The objective of the study was to design and pilot-test The Memory or Reasoning Enhanced Low Vision Rehabilitation Program (MORE-LVR), a proposed low vision rehabilitation intervention for patients with macular disease and cognitive deficits.

More about the Study

From the article abstract:

Importance: We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment.

Design: The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program.

Setting: Eligible patients were recruited from a low vision rehabilitation (LVR) clinic from October 1, 2010, through March 31, 2011.

Participants: Twelve patients completed the intervention, and 11 companions attended at least one training session.

Intervention: Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a six-week period, (2) simplified training experience addressing no more than three individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member).

Results: Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean scores on the National Eye Institute’s Visual Function Questionnaire (VFQ – 25) composite score and near-activities score; timed performance measures (writing a grocery list, filling in a crossword puzzle answer); a score indicating satisfaction with independence; and logical memory. All patients and companions reported progress toward at least one individualized goal; more than 70% reported progress toward all three goals.

Conclusions and Relevance: This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.

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