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A low-vision rehabilitation program for patients with mild cognitive deficits.

Whitson HE, Whitaker D, Potter G, McConnell E, Tripp F, Sanders LL, Muir KW, Cohen HJ, Cousins SW. A low-vision rehabilitation program for patients with mild cognitive deficits. JAMA ophthalmology. 2013 Jul 1; 131(7):912-9.

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IMPORTANCE: We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment. OBJECTIVE: To design and pilot-test an LVR program for patients with macular disease and cognitive deficits. DESIGN: The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program. SETTING: Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011. PARTICIPANTS: Twelve patients completed the intervention, and 11 companions attended at least 1 training session. INTERVENTION: Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member). MAIN OUTCOME MEASURES: Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales. RESULTS: Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals. CONCLUSIONS AND RELEVANCE: This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.

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