COVID-19 Update - This is to inform you that the Government of India has announced a complete lockdown in India 22nd March 2020 to 14th April 2020. As a result, our offices will now be closed till 14th April 2020 and all our employees will be working from home. Office telephones will not be answered, and therefore you are requested to direct all your queries related to manuscript submission, review process, publication etc. at below mentioned details. editor@innovativepublication.com, rakesh.its@gmail.com, Mob. 8826373757, 8826859373, 9910947804


Print ISSN:-2395-1443

Online ISSN:-2395-1451

CODEN : IJCEKF

Current Issue

Year 2020

Volume: 6 , Issue: 1

  • Article highlights
  • Article tables
  • Article images

Article view: 163

Article download: 111


Belenje and Patil: Prospective study to evaluate the effectivity and acceptance of optical low vision AIDS


Introduction

Visual impairment & the need for its rehabilitation are becoming more important because of the increase in life expectancy & better standard of living.1,2 The challenges faced by patients of different age groups are different in their daily life.3 Pediatric patients have to adapt fast to the constantly developing world around them, midleaged adults have to work to lead an independent life, whereas elderly patients want to lead a quality life by engaging with their favorite hobbies.4,5 Hence it is very important to tackle the problems of each of these sectors of patients carefully. In a developing country like India in spite of a rise in irreparable ocular problems like age related macular degeneration, chronic diabetic macular oedema and many other causes, not many people are using low vision aid devices.3,6,4 It may be due to social stigma, financial aspect, cumbersomeness or any other factor. Through this study we want to find when we offer these patients with Low vision aids what made them to accept and what made them not to accept.

Materials and Methods

This was a prospective study conducted in ophthalmology department, SDM college of/Medical Sciences and Hospital Dharwad, Karnataka state, from November 2016 to April 2018. 50 Patients with low vision were included in the study after taking informed consent. Ethical clearance was taken [Letter No: SDMIEC: 0863/2016, dated 28.10.2016]. The study was conducted in accordance with the Declaration of Helsinki.

Inclusion criteria

  1. Any patient with age more than 4 years.

  2. Best corrected visual acuity (BCVA) better than Log MAR 1.3 but worse than Log MAR 0.3, near vision better than or equal to N36 in the better Seeing Eye.

Exclusion criteria

  1. Age less than 4years.

  2. BCVA worse than Log MAR1.3 or better than Log MAR 0.3, near vision worse than N36 in the better Seeing Eye.

The patient’s visual acuity for distance was assessed by early treatment diabeticr etinopathy study (ETDRS) Log MAR chart, near vision by Jaeger chart and contrast sensitivity by Pelli-Robson contrast sensitivity chart. The ocular condition was clinically diagnosed and the patients were given necessary optical low vision aids. The patients were divided into 3 groups, less than 20 years (group 1), 20 to 60 years (group 2) and more than 60 years (group 3). All 50 patients were counselled and trained to use the devices, and were followed up for 6 months to know the effectivity and acceptance of these devices at the end of 6 months. Reason for non acceptance in each of the group was noted. Chi-square test was used for correlation between variables. SPSS software version 17.0 was used. P value <0.05 was considered statistically significant.

Results

In our study we had 50 low vision aid users and majority of low vision aid users were elderly retired males (Table 1). The most common ocular diagnosis under 20 years was macular dystrophy, 20 to 60 year group was chronic diabetic macular edema and more than 60 years of age was age related macular degeneration (Table 2). Younger patients less than 20 years of age (group1) have good acceptance for both near vision aids & distance vision aids when compared to elder patients more than 60 years of age (group 3) who had good acceptance for near vision aids and poor acceptance for distance vision aids at the end of 6 months of follow up with p value of 0.001 (Table 3). Taking initial best corrected visual acuity in to account including all 3 groups it was seen that patients with visual acuity falling under Economic blindness group as defined by national program for control of blindness7 (distance vision between Log MAR 1.3 to Log MAR 1.0 and near vision between N18 – N36) had better acceptance than patient having vision better than economic blindness group (better vision than Log MAR 1.0 for distance and N18 for near) with p value 0.042 (Table 4). Patients with better contrast sensitivity greater than or equal to 0.3 had better acceptance with p value 0.023 (Table 5 ). Among LVA users less than 20 years of age (group 1) co morbidities like nystagmus, hearing loss, mental retardation, attention deficit hyperactive disorder and epilepsy was the most common reason for non acceptance, whereas cumbersomeness was the commonest reason for non acceptance among group 2 and 3 (Table 6).

Table 1
Age in years Frequency Percentage
<20 9 18.0
20 - 60 20 40.0
>60 21 42.0
Total Males Females 50 38 12 100.0 76 24

Age and gender distribution

Table 2
Age group Clinical diagnosis Number of cases
Below 20 years Macular dystrophy Retinitis pigmentosa Chorioretinal atrophy 5 2 2
20 to 60 years Chronic macular edema Retinitis pigmentosa Disc pallor Chorioretinal atrophy Corneal dystrophy / opacity 8 4 4 2 2
Above 60 years Age related macular degeneration Disc pallor Chronic macular edema 14 5 2

Clinical diagnosis of ocular diseases

Table 3
Age Less than 20 years (Group1) More than 60 years (Group 3)
Number of patients 9 21
Telescope users 6 1
Near vision aid users 6 15

Pattern of LVA users between group 1 and group 3 at end of 6 months of training

[i] Note: Younger patients less than 20 years of age had better acceptance for distance vision aids when compared with elderly patients more than 60 years of age (P 0.001)

Table 4
Visual acuity Vision better than economic blindness group Economic blindness group
LVA users 16 34
Acceptance 8 28

Acceptance based on initial best corrected visual acuity including all 3 groups

[i] Note: patients with vision under economic blindness group had better acceptance with p value 0.042

Table 5
Contrast sensitivity More than 0.3 Less than 0.3
LVA users 32 18
Acceptance 27 9

Pelli-Robson contrast sensitivity including all 3 groups

[i] Note : Patients with pelli-robson contrast sensitivity more than 0.3 had better acceptance p value 0.023

Table 6
Age group Cause for non acceptance Number of cases
Less than 20 years Co morbidity 3(100%)
20 to 60 years Cumbersome Social Co morbidity 3(50%) 2(33%) 1(17%)
More than 60 years Cumbersome Social 3(60%) 2(40%)

Reason for non acceptance in all 3 groups

Discussion

In our study majority of the patients were elderly retired males with reading hobby and age related macular degeneration was the most common ocular disease in these patients (Table 1,Table 2), which is similar to other studies.3,6,4 Elderly patients had good acceptance for near vision devices but poor acceptance for distance vision aids when compared with younger patients who had better acceptance for both near & distance vision aids (Table 3). Since younger patients had wide range of activities like reading books, seeing black board at school, playing in park, seeing video games in electronic gadgets, they needed the support of both telescopes and near vision aids to perform their tasks. Whereas older patients were more confined to the near vision activities and felt telescopes were cumbersome to operate, especially when they had problems like tremors and cervical spondylosis. The main reason for non acceptance of optical low vision aids among younger patients was associated co morbidity like nystagmus, hearing difficulties, mental retardation, attention deficit hyperactive kids, epilepsy (Table 6). Some of these problems can be treated or kept under control before giving a low vision aid trial, and this might help in better acceptance. Other studies8,9,10,11 also showed that, additional disabilities like (hearing disability, Mental retardation, cerebral palsy, syndrome child) had poor low vision aid acceptance. The profile from these studies showed that a typical LVA user is an older child (12-15 yrs), with no additional disability. This is comparable with our study which showed co morbidity as a main reason for non acceptance in patients less than 20 years of age.

Economic blindness group more readily accepted the low vision aid devices when compared to patients with better initial BCVA (Table 4) because they had a constant drive to improve in their academic and professional career, hence targeting this group had very good acceptance. Main reason for non acceptance in 20 to 60 year age group and above 60 year age group in our study was cumbersome more than social stigma (Table 6). Causes of failure of usage in other studies9,10,11,12 was expectation of patient more than Cumbersomeness and Social stigma. Since we have counseled all our patients prior to low vision aid prescription that low vision aid is the only solution to their problem, we did not have failures due to expectation. Hence tackling the expectation of patients prior to LVA trial is key for success.

Patient with good contrast sensitivity more than or equal to 0.3 on Pelli-Robson contrast sensitivity chart had better acceptance (Table 5). Contrast sensitivity is a direct indicator of visual and retinal function13,14 hence patients with better contrast more readily accepted the devices.

Conclusion

Prescription of low vision aids, adequate training and addressing the co morbidities can improve the acceptance level. Similarly economic blindness group more readily accepted the low vision aids since it helped their academic and professional development. Patients with better contrast sensitivity had better acceptance. Addressing the expectation by proper counselling before prescription of low vision aids is a must.

Source of Funding

None.

Conflict of Interest

None.

References

1 

Wahl Hans-Werner The psychological challenge of late-life vision impairment: concepts, findings, and practical implicationsJ Ophthalmol20132013278135278135

2 

Ji L H Peng X Xue Age Differences in the Experience of Daily Life Events: A Study Based on the Social Goals PerspectiveFront Psychol2017816231623

3 

S R Kulkarni S R Aghashe R B Khandekar M D Deshpande Prevalence and determinants of age-related macular degeneration in the 50 years and older population: a hospital based study in Maharashtra, IndiaIndian J Ophthalmol2013615196201

4 

N Hamade W G Hodge M Rakibuz-Zaman M S Malvankar-Mehta The Effects of Low-Vision Rehabilitation on Reading Speed and Depression in Age Related Macular Degeneration: A Meta-AnalysisPLoS One2016117e0159254

5 

P Rishi E Rishi A Maitray A Agarwal S Nair S Gopalakrishnan Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care: A prospective study in a tertiary eye-care settingIndian J Ophthalmol2017651112031208

6 

S Srinivasan G Swaminathan V Kulothungan R Raman T Sharma Prevalence and the risk factors for visual impairment in age-related macular degenerationEye (Lond)2017316846855

7 

P Vashist S S Senjam V Gupta N Gupta A Kumar Definition of blindness under National Programme for Control of Blindness: Do we need to revise it?Indian J Ophthalmol20176529296

8 

K M De Carvalho N Minguini D C Moreira Filho Kara-José N Characteristics of a pediatric low-vision populationJ Pediatr Ophthalmol Strabismus1998353162165

9 

J Stelmack Quality of life of low vision patients and outcomes of low vision rehabilitationOptom Vis Sci2001785353342

10 

G C Brown Vision and quality of life. Trans Am Ophthalmologic Society Trans Am Ophthalmologic Society199997473511

11 

S Leat Fryer A N J Runmey Outcome of low vision aid provision: the effectiveness of a low vision clinicOpto Vis Sci1994713199206

12 

R C Humphry G M Thompson Low vision aids - evaluation in a general eye departmentTrans Ophthalmol Soc UK1986105296303

13 

Niemeyer E James Michael A Paradiso Contrast sensitivity, V1 neural activity, and natural visionJ Neurophysiol20171172492508

14 

S T Chung G E Legge Comparing the Shape of Contrast Sensitivity Functions for Normal and Low VisionInvest Ophthalmol Vis Sci201657119820710.1167/iovs.15-18084



jats-html.xsl

© 2019 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (creativecommons.org)