As part of the Saturday symposium “Reading Rehabilitation for Individuals With Low Vision” (Sym03), Ava Katherine Bittner, OD, PhD, gave a presentation titled “Evaluating Reading With Telerehabilitation,” in which she discussed techniques, devices, and training available to assist low vision patients with their reading challenges.
Why telerehabilitation? The main reason that patients with visual impairment have a low vision evaluation is because of difficulty with reading, said Dr. Bittner. Training with magnifiers can help patients overcome this challenge. The use of telerehabilitation for magnifier training has several benefits: low vision patients need not travel, and training takes place in their home environments with their own devices. The patient simply turns on their phone and angles it so that the low vision provider can evaluate their reading activity and then teach them how to improve their use of magnifiers for reading.
Telerehabilitation trial protocols. In this multicenter (five private practices and four academic centers) randomized controlled trial, a total of 62 patients were randomized to a remote telerehabilitation group (n = 39) or an in-office training control group (n = 23). Ultimately, 27 of the remote patients and 18 of the in-office patients completed the trial. Training was provided by an OD or an occupational therapist, and telerehabilitation patients were set up with:
- a loaner smartphone along with a stand allowing the phone to be angled appropriately for the trainer to observe the patient’s behavior
- Rescue Assist software enabling the trainer to remotely access the patient’s phone
- Zoom videoconferencing platform
- Lighthouse continuous text card and MNread acuity chart
- a prescribed magnifier (as were in-office controls after initial assessment).
Patient demographics:
- 76% of patients used a handheld magnifier, 11% an optical magnifier on a stand, and 13% an electronic magnifier
- Mean age was 65 years, with a broad age range of 20 to 93 years
- 69% of patients were female
- 23% were members of ethnic or racial minorities
- 59 was the mean general health score (range, 20-90) on the SF-36 questionnaire (scale, 0-100)
Reading outcomes were assessed at baseline, one month, and four months if additional training was needed. Patients took between one and four sessions to achieve proficiency with their magnifiers.
Telerehabilitation provided improvements similar to in-office rehabilitation. After the first telerehabilitation session, 35% of patients were proficient in the use of the magnifiers; 48% attained proficiency after two sessions. Those aged 70 and older were more likely to need more than one session as were those without college education.
No significant difference was seen in the magnitude of improvement between the at-home group and the in-office group of patients, and both had high comprehension scores. However, although the groups had similar results in this trial, higher-powered studies are needed, and Dr. Bittner plans to include at least 120 patients in the next study.
Conclusion. Telerehabilitation with prescribed magnifiers can enhance reading ability and efficiency as an alternative option to in-office vision rehabilitation. —Kathleen Erickson
Financial disclosures: Dr. Bittner: Biovisics: C; jCyte, Inc.: C; Pixium Vision: C.
Disclosure key: C = Consultant/Advisor; E = Employee; EE = Employee, executive role; EO = Owner of company; I = Independent contractor; L = Lecture fees/Speakers bureau; P = Patents/Royalty; PS = Equity/Stock holder, private corporation; S = Grant support; SO = Stock options, public or private corporation; US = Equity/Stock holder, public corporation. For definitions of each category, see aao.org/eyenet/disclosures.
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