• Outcomes of the Veterans Affairs LOVIT II Trial

    By Lynda Seminara and selected by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, February 2017

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    The initial Veterans Affairs Low Vision Intervention Trial (LOVIT) evaluat­ed the effectiveness of an intensive rehabilitation program for legally blind veterans with macular diseases. In the subsequent trial (LOVIT II), Stelmack et al. compared outcomes for 2 types of low vision (LV) interventions among veterans with less severe visual impair­ment (best-corrected distance visual acuity [BCDVA] in the better eye of 20/50-20/200): LV optical devices provided either (1) with no LV therapy or (2) in combination with LV rehabil­itation with a therapist. Although both interventions were beneficial, the added rehab increased effectiveness only for patients with BCDVA of 20/63-20/200.

    In the LOVIT II study, 323 veterans (314 men; mean age, 80 years) were randomized to receive LV devices with or without rehab therapy from a special­ist who provided training and home­work on the use of the devices.

    In telephone interviews at baseline and 4 months, participants responded to questionnaires including the VA Low Vision Visual Functioning Question­naire, Short Form-36, EuroQoL-5D, and MNREAD; and the researchers evaluated changes in visual ability and quality of life. Visual ability was mea­sured in dimensionless log odds units (logits), with a 0.14-logit change corre­sponding to the ability change expected from a 1-line change in visual acuity.

    The authors found that both basic LV services and basic LV plus rehabili­tation therapy improved visual ability and mobility in veterans with mac­ular disease and better-eye BCDVA of 20/50-20/200. In the preplanned stratified analyses, individuals with BCDVA of 20/63-20/200 experienced greater improvement with LV rehab than with basic LV services. Among patients whose better-eye BCDVA was 20/50-20/63, there were no significant differences in outcomes between the 2 programs.

    On the basis of their findings, the authors concluded that basic LV ser­vices alone may be adequate for most patients with mild visual impairment.

    The original article can be found here.