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A selection of some of the most commonly prescribed low-vision aids. (a) Coil Max auto-touch hand magnifiers are useful at home and when out and about. The grip-operated on/off switch is particularly useful for those who find switching on low-vision aids with their thumb difficult. (b) An Eschenbach Mobilent folding magnifier can be worn around the neck on a string. (c) Bright field magnifiers have light-gathering properties and are popular with children. (d) Illuminated stand magnifiers are useful for prolonged reading tasks. (e) Low-powered telescopic spectacles are sometimes prescribed to help people see the television when moving closer is not an option. (f) Tinted overshields reduce light from above and the sides and this can help reduce glare. (g) Portable electronic magnifiers enhance contrast and are very popular with patients of all ages. (h) PL fluorescent lamps can be useful with a range of tasks and do not become hot. (i) Clipboards are often issued to low-vision patients as they keep the reading material flat.
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Context 1
... types of low-vision aid dispensed are identified in Figure 3. Together, hand, folding pocket and illuminated hand magnifiers were the most commonly dispensed. The 20 most commonly prescribed low-vision aids are shown in Table 3 and a proportion are illustrated in Figure 4. Has the WLVS made any difference? ...
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... Other studies have characterized patterns and longitudinal trends in prescribing rehabilitative devices from the 1970s to the early 2000s, but information about potential shifts in practice patterns in recent years is lacking. [24][25][26][27] Here, we used a retrospective study design to characterize trends over the past decade in the topics discussed during low-vision patient case histories and the types of rehabilitative devices assessed in low-vision examinations at two clinics. independent ethical review board and conforms with the principles and applicable guidelines for the protection of human subjects in biomedical research. ...
... Prior work also suggested that younger patients are more likely to be prescribed rehabilitative devices but did not indicate with which types of devices this trend was associated. 26 Unlike these optical technologies, emerging wearable electronic vision enhancement systems are not necessarily designed to be used by people while they are in motion (e.g., IrisVision, Pleasanton, CA; Jordy, Enhanced Vision, Huntington Beach, CA), highlighting the continued importance of optics for distance tasks. In some cases, a smartphone camera with digital magnification may replace the role of a handheld telescope on the go. ...
Significance:
Understanding longitudinal changes in why individuals frequent low vision clinics is crucial for ensuring that patient care keeps current with changing technology and changing lifestyles. Among other findings, our results suggest that reading remains a prevailing patient complaint, with shifting priorities towards technology-related topics.
Purpose:
To understand changes in patient priorities and patient care in low vision over the past decade.
Methods:
We conducted a retrospective study of exam records (2009-2019, 3470 exams) from two United States low vision clinics. Automated word searches summarized two properties of the records: topics discussed during the case history and types of rehabilitative devices assessed. Logistic regression was used to model effects of exam year, patient age, patient gender, and level of visual impairment.
Results:
Collapsing across all years, the most common topic discussed was reading (78%), followed by light-related topics (71%) and technology (59%). While the odds of discussing reading trended downward over the decade (odds ratio = 0.57; p = 0.026), technology, social interaction, mobility, and driving trended upward (odds ratios = 4.53, 3.31, 2.71, 1.95; all ps < 0.001). The most frequently assessed devices were tinted lenses (95%). Over time, video magnifier and spectacle assessments trended downward (odds ratios = 0.64, 0.72; p = 0.004, 0.035), while assessments of other optical aids increased. The data indicate several consistent differences amongst patient demographics.
Conclusions:
Reading is likely to remain a prevailing patient complaint, but an increase in technology-related topics suggests shifting priorities, particularly in younger demographics. "Low tech" optical aids have remained prominent in low vision care even as "high tech" assistive devices in the marketplace continue to advance.
... In Wales, approximately one-third of all optometrists are accredited as part of the Low Vision Service Wales and supply optical LVAs within the NHS from their community practices. 3 For the past few years, it has been possible for them to supply one specified p-EVES device, with anecdotal reports from patients and practitioners suggesting that these devices are popular and successful. However more research was required to evaluate whether this new technology offers real benefits in comparison to current optical LVAs, and to establish the exact role that p-EVES devices could play within low vision service provision. ...
Purpose:
To compare the performance of near vision activities using additional portable electronic vision enhancement systems (p-EVES), to using optical magnifiers alone, by individuals with visual impairment.
Methods:
A total of 100 experienced optical aid users were recruited from low vision clinics at Manchester Royal Eye Hospital, Manchester, UK, to a prospective two-arm cross-over randomised controlled trial. Reading, performance of near vision activities, and device usage were evaluated at baseline; and at the end of each study arm (Intervention A: existing optical aids plus p-EVES; Intervention B: optical aids only) which was after 2 and 4 months.
Results:
A total of 82 participants completed the study. Overall, maximum reading speed for high contrast sentences was not statistically significantly different for optical aids and p-EVES, although the critical print size and threshold print size which could be accessed with p-EVES were statistically significantly smaller (p < 0.001 in both cases). The optical aids were used for a larger number of tasks (p < 0.001), and used more frequently (p < 0.001). However p-EVES were preferred for leisure reading by 70% of participants, and allowed longer duration of reading (p < 0.001). During the study arm when they had a p-EVES device, participants were able to carry out more tasks independently (p < 0.001), and reported less difficulty with a range of near vision activities (p < 0.001).
Conclusions:
The study provides evidence that p-EVES devices can play a useful role in supplementing the range of low vision aids used to reduce activity limitation for near vision tasks.
... The additional benefits of p-EVES systems over traditional optical magnifiers include binocular viewing, habitual working distance, variable magnification, adjustable contrast settings and freeze frame facility (Taylor et al. 2014). In the Welsh NHS low vision service, p-EVES devices are now provided to eligible patients and anecdotal evidence suggests that they are both popular and successful (Charlton et al. 2011). However, at present p-EVES devices are not routinely provided by NHS low vision services throughout the rest of the UK. ...
Purpose:
To determine the incremental cost-effectiveness of portable electronic vision enhancement system (p-EVES) devices compared with optical low vision aids (LVAs), for improving near vision visual function, quality of life and well-being of people with a visual impairment.
Methods:
An AB/BA randomized crossover trial design was used. Eighty-two participants completed the study. Participants were current users of optical LVAs who had not tried a p-EVES device before and had a stable visual impairment. The trial intervention was the addition of a p-EVES device to the participant's existing optical LVA(s) for 2 months, and the control intervention was optical LVA use only, for 2 months. Cost-effectiveness and cost-utility analyses were conducted from a societal perspective.
Results:
The mean cost of the p-EVES intervention was £448. Carer costs were £30 (4.46 hr) less for the p-EVES intervention compared with the LVA only control. The mean difference in total costs was £417. Bootstrapping gave an incremental cost-effectiveness ratio (ICER) of £736 (95% CI £481 to £1525) for a 7% improvement in near vision visual function. Cost per quality-adjusted life year (QALY) ranged from £56 991 (lower 95% CI = £19 801) to £66 490 (lower 95% CI = £23 055). Sensitivity analysis varying the commercial price of the p-EVES device reduced ICERs by up to 75%, with cost per QALYs falling below £30 000.
Conclusion:
Portable electronic vision enhancement system (p-EVES) devices are likely to be a cost-effective use of healthcare resources for improving near vision visual function, but this does not translate into cost-effective improvements in quality of life, capability or well-being.
... Anecdotal reports from patients and practitioners suggest that these devices are popular and successful, and research suggests that the p-EVES device is among the most popular devices supplied through the scheme. 13 ...
PurposeTo describe the study design and methodology for the p-EVES study, a trial designed to determine the effectiveness, cost-effectiveness and acceptability of portable Electronic Vision Enhancement System (p-EVES) devices and conventional optical low vision aids (LVAs) for near tasks in people with low vision.Methods
The p-EVES study is a prospective two-arm randomised cross-over trial to test the hypothesis that, in comparison to optical LVAs, p-EVES can be: used for longer duration; used for a wider range of tasks than a single optical LVA and/or enable users to do tasks that they were not able to do with optical LVAs; allow faster performance of instrumental activities of daily living; and allow faster reading. A total of 100 adult participants with visual impairment are currently being recruited from Manchester Royal Eye Hospital and randomised into either Group 1 (receiving the two interventions A and B in the order AB), or Group 2 (receiving the two interventions in the order BA). Intervention A is a 2-month period with conventional optical LVAs and a p-EVES device, and intervention B is a 2-month period with conventional optical LVAs only.ResultsThe study adopts a mixed methods approach encompassing a broad range of outcome measures. The results will be obtained from the following primary outcome measures: Manchester Low Vision Questionnaire, capturing device ‘usage’ data (which devices are used, number of times, for what purposes, and for how long) and the MNRead test, measuring threshold print size, critical print size, and acuity reserve in addition to reading speed at high (≈90%) contrast. Results will also be obtained from a series of secondary outcome measures which include: assessment of timed instrumental activities of daily living and a ‘near vision’ visual functioning questionnaire. A companion qualitative study will permit comparison of results on how, where, and under what circumstances, p-EVES devices and LVAs are used in daily life. A health economic evaluation will provide results on: the incremental cost-effectiveness of p-EVES compared to optical magnifiers; cost-effectiveness; and cost-utility.Conclusions
The evidence base in low vision rehabilitation is modest and further high quality clinical trials are required to inform decisions on healthcare provision. The p-EVES study findings are anticipated to contribute to this broader evidence requirement, with the methodological issues evident here being relevant to other trials within the field.
... 37 The Low Vision Service Wales (LVSW) now operates out of over 185 optometric practices that are co-ordinated centrally by an administration team. 38 Multidisciplinary working is achieved by the optometrists linking with community-based professionals in social services and voluntary organisations. The LVSW is a low dose, low-cost, rehabilitation intervention but it has dramatically improved access to services 39 and has been found to be as effective as the traditional hospital-based services 40 and effective over the longer term. ...
Over the last 50 years, the concept of a low vision service has changed considerably. It has moved away from just the optometrist or optician dispensing magnifiers, to having a large team working across the health and social/ community care sectors, with voluntary organisations often playing an important role. This paper reviews how low vision rehabilitation services have evolved and what models of low vision care are currently available. It goes on to consider the effectiveness and accessibility of low vision care. Finally it explores what the future might hold for low vision services, to be better prepared for the increase in the number of people with low vision and their evolving needs and what role(s) an optometrist might have within these anticipated developments.
... In Wales, the GOS remains unchanged. However, in 2003 the Welsh government commissioned additional enhanced optometric services nationally: the Primary Eyecare Acute Referral Scheme (PEARS) and Wales Eye Health Examination (WEHE) (Sheen et al. 2008) and the Low Vision Service Wales (LVSW) (Charlton et al. 2011). Together these Wales Eyecare Services (WECS) aimed to enable more people to be managed in the community, preserve sight through the early detection of eye disease and provide help to those who have visual impairment for which further treatment is not appropriate. ...
... In 2004, to improve waiting times and access to existing hospital low-vision services, the Welsh government chose to develop funded primary care-based low-vision services throughout Wales (Margrain et al. 2005). The LVSW now operates out of over 185 optometry practices that are coordinated centrally by an administration team (Charlton et al. 2011). Multidisciplinary working is achieved by the optometrists linking with community-based professionals in social services and voluntary organisations. ...
... In Wales, the GOS remains unchanged. However, in 2003 the Welsh government commissioned additional enhanced optometric services nationally: the Primary Eyecare Acute Referral Scheme (PEARS) and Wales Eye Health Examination (WEHE) (Sheen et al. 2008) and the Low Vision Service Wales (LVSW) (Charlton et al. 2011). Together these Wales Eyecare Services (WECS) aimed to enable more people to be managed in the community, preserve sight through the early detection of eye disease and provide help to those who have visual impairment for which further treatment is not appropriate. ...
... In 2004, to improve waiting times and access to existing hospital low-vision services, the Welsh government chose to develop funded primary care-based low-vision services throughout Wales (Margrain et al. 2005). The LVSW now operates out of over 185 optometry practices that are coordinated centrally by an administration team (Charlton et al. 2011). Multidisciplinary working is achieved by the optometrists linking with community-based professionals in social services and voluntary organisations. ...
Introduction:
Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wide-ranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD.
Methods:
Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD.
Results:
Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects.
Conclusions:
Wearable electronic vision enhancement systems provide hands-free magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions.
Aims:
To evaluate the long-term effectiveness of the community-based Low Vision Service Wales (LVSW).
Methods:
A long-term observational study of the Government-funded, community-based, low-vision rehabilitation service which operates in over 180 optometry practices in Wales. Participants were recruited from the LVSW (n=342; 246 women; median age 82 years) at baseline (before the Low Vision intervention). The primary outcome measure was change in visual disability as evaluated by the seven-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). Change was measured on the same cohort at three separate time points, and comparisons were made between these: baseline-3 months; 3-18 months; baseline-18 months. Secondary outcome measures included: use of low-vision aids (LVAs) and satisfaction with the service provided.
Results:
Questionnaires were sent to 281 participants (whose visual disability had been measured at baseline and 3 months) at 18 months postintervention. Responses were received from 190 (67.6%) people; 24 were deceased. Self-reported visual disability was significantly reduced (Wilcoxon Signed Rank (WSR) test: p<0.001) between baseline and 18 months by -0.28 logits (-1.24 to 0.52). This was less than that found between baseline and 3 months; -0.61 logits (-1.81 to 0.02). At 18 months, 79% patients used their LVAs at least once a week which was not significantly different to that found at 3 months (WSR: p=0.127).
Conclusions:
This study provides evidence that the effect of the LVSW persists over a period of 18 months; disability is reduced from baseline, and use of LVAs remains high.
