Individualized low vision therapy improves acuity in children, adults
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Key takeaways:
- Children had better near and distance visual acuity than adults before receiving visual aids.
- Optical aids were more commonly prescribed to children, and adults more often received electronic aids.
Researchers observed significant improvement in visual acuity among children and adults with low vision after being individually fitted with optical or electronic aids, according to a study published in Journal of Personalized Medicine.
“The aim was to assess both the current situation of the patients as well as the current treatment standards of low vision therapy,” Madeleine A. Perrault, of the department of pediatrics and neonatology at Saarland University Medical Center, and colleagues wrote. “A special focus was the identification of differences in the etiology of visual impairment and the provision of aids for children and adolescents compared to adult patients.”
Perrault and colleagues analyzed records from 502 patients (51.6% female; median age, 71 years; range, 4-99 years) with low vision who visited the department of ophthalmology at Saarland University Medical Center in Germany between Jan. 1, 2016, and April 30, 2020. The researchers examined patients’ diagnoses and compared visual acuity before and after the prescription of magnifying visual aids.
The study included 355 patients (70.7%) aged 18 years and older and 147 patients (29.3%) aged 4 to 17 years. The most common diagnoses were age-related macular degeneration (37.3% of total; 52.7% of adults) and albinism (21.5% of total; 61.9% of children).
At baseline, the median visual acuity among all patients was 1.0 logMAR (mean, 0.88; standard deviation [SD], ±0.9), and binocular near visual acuity was 0.8 logMAR (mean, 0.7; SD, ± 0.76). Children had better near visual acuity than adults (median, 0.54 logMAR vs. 0.9 logMAR; P < .001), as well as distance visual acuity (median, 0.88 logMAR vs. 1 logMAR; P = .001).
Overall, 999 low vision aids were prescribed, with 382 patients receiving more than one device. Nearly all patients (97.6%) received suitable visual aids, the researchers wrote.
Optical visual aids were more commonly prescribed than electronic aids among all patients (68.5% vs. 43.8%), although adults were more frequently prescribed electronic and acoustic aids and children were more frequently prescribed optical aids (P < .001).
After receiving visual aids, visual acuity improved significantly from baseline to an average of 0.3 logMAR (SD ± 0.76) for near visual acuity and 0.6 logMAR (SD ± .07) for distance visual acuity (P < .001).
The researchers did not find a statistically significant difference between optical and electronic visual aids for near visual acuity, with monoculars demonstrating the greatest possible improvement in distance visual acuity.
“Ultimately, this study showed that near and distance visual acuity could be improved through visual aids, perhaps merely through optical aids such as magnifying glasses alone,” the researchers wrote. “It should be acknowledged that the fitting of low vision aids remains a personalized fitting method and should be a source of help and improvement in an individual’s daily life and integration into society.”
Perspective
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This study underscores important insights for optometric clinicians, emphasizing the impactful role of individually fitted low vision aids in enhancing visual acuity and reading ability across diverse age groups. The findings emphasize that beyond measurable improvements in acuity, patient satisfaction and acceptance with fitted low vision aids are high, highlighting the importance of incorporating these aids into clinical practice. The study suggests that despite the availability of electronic aids, optical options — particularly magnifying glasses — remain both practical and socially accepted, addressing the economic constraints faced by patients.
However, some limitations should be considered. The study’s bias toward a larger adult population and potential underrepresentation of children may affect generalizability. While acknowledging the benefits of optical aids, the study highlights the need for further exploration into the potential advantages of electronic aids, particularly for adults with severe visual impairments.
Optometric clinicians can leverage these findings by adopting a personalized, patient-centered approach, considering age, social dynamics and specific vision-related challenges, to optimize the fitting and recommendation of low vision aids in their practice.
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