Rehabilitationfor Low Vision: Is it Effective for Geographic Atrophy?
Low vision rehabilitation (LVR) is a therapeutic service designed to help individuals manage their reduced vision in their daily lives, particularly for those living with geographic atrophy (GA), a form of advanced age-related macular degeneration (AMD). This condition is characterized by central vision loss.
LVR provides significant benefits to those affected by GA, enabling them to maximize their remaining vision and maintain independence, thereby improving their quality of life despite progressive vision deterioration.
Key Benefits of Low Vision Rehabilitation for Geographic Atrophy
Enhancement of Visual Function
LVR helps individuals with GA make better use of a preferred retinal locus (PRL), an area outside the damaged fovea that can serve as the new primary site for detailed vision. This training allows patients to perform activities such as reading or recognizing faces more effectively.
Preservation of Visual Abilities
Although the PRL provides lower visual acuity compared to the healthy fovea, rehabilitation helps patients adapt and leverage this residual vision to maintain essential functions.
Provision of Assistive Devices and Training
LVR includes the prescription of optical aids like magnifiers, telescopes, specialized lighting, and adaptive techniques that optimize residual vision and compensate for deficits caused by GA.
Emotional and Social Support
Vision loss from GA often leads to decreased independence and quality of life, along with depression risks. Rehabilitation programs often incorporate counseling and patient engagement strategies to improve coping skills and psychosocial well-being.
Empowerment and Education
Programs such as ASPECT foster patient engagement in eye health management, promoting advocacy and communication skills that enhance self-care and patient autonomy.
While treatments targeting GA progression are limited, low vision rehabilitation provides a practical approach to improve functional vision and daily living capabilities for affected individuals.
Assistive devices that may be useful in low vision rehabilitation include handheld or spectacle-mounted telescopes, video magnification devices, spectacle-mounted magnifiers, and assistive technology.
In a review of 44 studies, researchers found low to moderate evidence supporting the effectiveness of LVR services for improving vision-related quality of life, but no evidence supporting their effectiveness for improving health-related outcomes across multiple studies. However, a 2020 study found some evidence that different therapies associated with rehabilitation services helped people retain their vision significantly better after 2 years.
The overall success rate of LVR is difficult to measure due to inconsistencies in the assessment of success and differences in approaches and devices used. To improve assessment standards and add more studies on the effectiveness of various interventions across several groups of people, the review authors suggest further research.
The American Optometric Association suggests that LVR services can help improve quality of life and increase independence. By offering a realistic pathway to optimize remaining vision, maintain independence, and improve emotional well-being in the face of irreversible central vision loss, LVR is an invaluable resource for those living with geographic atrophy.
[1] The Role of Low Vision Rehabilitation in the Management of Geographic Atrophy
[2] Low Vision Rehabilitation for Patients with Age-Related Macular Degeneration
[3] ASPECT: A Low Vision Rehabilitation Program for Individuals with Macular Degeneration
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