Outcomes of the Veterans Affairs LOVIT II Trial
JAMA Ophthalmology, February 2017
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.