User:JaeHyung Choi/Vision Rehabilitation

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Vision Rehabilitation (often called vision rehab) is a term for a medical rehabilitation in order to improve vision or low vision. The rehabilitation is the process of restoring functional ability, quality of life, and independence in an individual who has lost function through illness or injury. In the case of vision rehabilitation, most rehabilitation services are focused on low vision. Low vision is a visual impairment that cannot be corrected by regular eyeglasses, contact lenses, medication, or surgery, and it interferes with the ability to perform everyday activities.[1] The visual impairment is caused by various reasons including brain damage, vision loss, and etc.[2]

Basic Background[edit]

  • Rehabilitation
The rehabilitation does not undo or reverse the cause of damage, but seeks to promote function and independence through adaptation. Individuals can seek rehabilitation in a number of different domains, such as motor rehabilitation after a stroke or physical rehabilitation after a car accident.
  • Low Vision
The total of approximately 14 million Americans is suffering from low vision. The low vision is a condition where a level of vision is 20/70 or worse and it cannot be fully recovered with medical treatment, surgery, or conventional glasses. The low vision is clearly different from blindness since people with low vision have some useful sight. However, those people often have hard time accomplishing daily tasks as their vision deteriorates such as reading, cooking, driving, recognizing people's faces, and discerning color.The table below explains about the basic definitions of low vision and blindness.[3]
Definition Visual Activity Visual Field
Moderate Visual Impairment <20/60 to 20/160 Not Considered
Severe Visual Impairment ≤20/200 to 20/400 Visual Field ≤20 degrees
Profound Visual Impairment <20/400 to 20/1000 Visual Field ≤10 degrees
Near-total Vision Loss ≤20/1250
Total Blindness No perception of light

Causation[edit]

The low vision is not caused by a single disease. Multiple of diseases come together and impact to cause low vision or blindness. Despite the fact that the low vision mainly influences the elderly, it still can appear at any stage in life. Most people develop low vision as a result of eye conditions and diseases, including macular degeneration, diabetic retinopathy, glaucoma, cataracts, retinitis pigmentosa, and stroke.
Some causes of low vision, such as cataracts, are treatable and good vision can be restored. When diagnosed early, other conditions that lead to low vision, such as wet macular degeneration and glaucoma, can be halted or slowed - although vision lost is irreversible.[4] The impact of each of these eye diseases on functional vision is summarized in table below.[3]

Disease Clinical Presentation Associated Disabilities
Age-related Macular Degeneration Reduced visual acuity and Loss of central vision (central scotoma) Difficulty reading, inability to recognize faces, distortion or disappearance of central vision, reduced color vision, reduced contrast perception, mobility difficulties related to loss of depth and contrast cues.
Diabetic retinopathy Reduced visual acuity, Scattered central scotoma, Peripheral and mid-peripheral scotoma, and Macula edema Difficulty with tasks requiring fine-detail vision such as reading, distorted central vision, fluctuating vision, loss of color perception, mobility problems due to loss of depth and contrast cues. In severe cases, total blindness can occur.
Glaucoma Degeneration of the optic disc and Loss of peripheral vision (constricted visual field) Mobility and reading problems due to restricted visual fields, people suddenly appearing in the visual field. In severe cases, total blindness can occur.
Cataract Reduced visual acuity, Light scatter, Sensitivity to glare, and Image distortion Remedied by lens extraction in 90% of cases. If not, difficulty with detail vision, difficulty with bright and changing light levels, reduced color vision, decreased contrast perception, mobility difficulties related to loss of depth and contrast cues.
Macular Degeneration
Diabetic Retinopathy
Glaucoma
Cataract

Treatments[edit]

Neurological Approach[edit]

Chemical Treatments[edit]

Gene Therapy[edit]

Occupational Therapy[edit]

Mechanical Approach[edit]

Mobility Training[edit]

Home Skills Training[edit]

Current Research[edit]

Useful Tips [5][edit]

  1. Identify yourself when you enter the room. Tell the person with visual impairment who else is accompanying you.
  2. Keep the environment organized and free of obstacles. Do not rearrange a person with visual impairment’s belongings without describing their new location.
  3. Ask the person what type of lighting allows for optimum use of vision. Use good contrast to assist the person in daily activities (i.e. pour dark coffee into a white cup, write very large with a bold black marker).
  4. When eating, describe the location of food items and utensils using a clock format. (i.e. “you have potato at 4:00, peas at 7:00 and meat at 12:00”).
  5. Use raised markers, high contrast tape, nail polish or “puffy” fabric paint to mark dials on appliances, thermostat, salt and pepper shakers, etc.
  6. Mobility: Have the person with visual impairment lightly hold your bent elbow. Walk smoothly, and both verbally and physically indicate steps or obstacles. Be sure to inquire as to which side is more comfortable for the person.
  7. Be creative! Rely on input from the person with visual impairment to assist him or her in being as independent as possible!

Clinical Studies[edit]

Since vision rehabilitation is focusing on low vision mainly, there are many clinical studies focused on low vision. However, there are still many mobility training and assisting devices for people with low vision.

Study Title Interventions Conditions
Reading Performance with a Video Magnifier[6] Behavioral: Video camera magnifier Macular Degeneration
VA Low Vision Intervention Trials[7] Low Vision Intervention Low Vision
Clinical Trial of Peripheral Prism Glasses for Hemianopia[8] Device: High power peripheral prism glasses, Device: Low power peripheral prism glasses Homonymous Hemianopia
Project Magnify - A Comparison of Two Strategies to Improve Reading Ability[9] Device: Optical Aids Low Vision
Predictors of Driving Performance and Successful Mobility - Rehabilitation in Patients with Medical Eye Condition[10] Procedure: Low Vision Low Vision
The Use of Transcranial Direct Current Stimulation (TDCS) to Enhance the Rehabilitative Effect of Vision Restoration Therapy[11] Behavioral: Vision Restoration Therapy (VRT); Device: Transcranial direct current stimulation (tDCS) Hemianopia; Quadrantanopia; Scotoma; Visual Field Loss
Low Vision Study Comparing EV Training vs. CCTV for AMD Rehabilitation [12] Behavioral: Eccentric Viewing (EV) Training; Device: Closed Circuit Television (CCTV) AMD
The Impact of Rehabilitation on Quality of Life in Visually Impaired [13] Procedure: Blindness Blindness
Wayfinding Information Access System for People with Vision Loss [14] Device: RFID device Blindness
Emergency Egress and Information System for Persons with Vision Loss [15] Device: Electronic Badge Blindness
Virtually Reality Mobility Training System for Veterans with Vision Loss[16] Device: Virtual Sound System Blindness
Evaluation of Eye Movement Tracking Systems for Visual Rehabilitation [17] Procedure: Visual Blindness
Vision Restoration Therapy (VRT) to Treat Non-Arteritic Anterior Ischemic Optic Neuropathy [18] Device: Vision Restoration Therapy (NOVAVISION) Non-Arteritic Anterior Ischemic Optic Neuropathy
Safety and Efficacy of ATG003 in Patients with Wet Age-Related Macular Degeneration (AMD) [19] Drug: Mecamylamine; Drug: Placebo Macular Degeneration
Low Vision Intervention Trail II (LOVIT II) [20] Other: Interdisciplinary Low Vision Service; Other: Basic Low Vision Service Central Vision Loss From Macular Diseases
Functional Vision in TBI [21] Other: Vision Restoration Therapy; Behavioral: NVT Eye Scanning Therapy; Behavioral: Eccentric Viewing Training; Behavioral: Sham Visually Impaired Persons; Brain Injuries
Low Vision Depression Prevention Trial for Age Related Macular Degeneration (VITAL) [22] Behavioral: BA-LVR; Behavioral: ST-LVR AMD; Depression
Restricted Useful Field View as a Risk Factor in Older Adults [23] Procedure: Prevention of Falls Visual Impairment
Improving Vision and Quality of Life in the Nursing Home [24] Device: Spectacles; Procedure: Cataract Surgery Refractive Error; Cataract
The Effect of Somatosensory Cue on Postural Stability in Blinded Persons [25] Other: Observational Visual Impairment
Use of "Smart Wheelchairs" to Provide Independent Mobility to Visual and Mobility Impairments [26] Device: Smart Power Assistance Module (SPAM); Device: Smart Wheelchair Component System (SWCS) Blindness; Wheelchair Users
Living Successfully with Chronic Eye Diseases [27] Behavioral: Low Vision Self-Management Program Chronic Diseases; Low Vision; Diabetic Retinopathy; Glaucoma; AMD
Yoga for Persons with Severe Visual Impairment (RPY) [28] Behavioral: Yoga Intervention Sleep Disturbance; Stress; Anxiety; Depression; Balance Impairment

See Also[edit]

References[edit]

  1. ^ Liu, C.J., Brost, M.A., Horton, V.E, Kenyon, S.B., & Mears, K.E. (2013). "Occupational Therapy Interventions to Improve Performance of Daily Activities at Home for Older Adults with Low Vision:A Systematic Review". Journal of Occupational Therapy. 67 (3).{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Fletcher, K., & Barton, J.J.S. (2012). "Vision Rehabilitation: multidisciplinary care of the patient following brain injury". Perception. 41 (10): 1287-1288.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ a b Vision Rehabilitation for Elderly Individuals with Low Vision or Blindness. USA: Department of Health & Human Services. 2004. p. 20.
  4. ^ "Low Vision and Visual Rehabilitation". University of Michigan. Retrieved 18 November 2013.
  5. ^ Wicker, Donna. "Helpful Hints for Families of the Visually Impaired" (PDF). Low Vision Services. Retrieved 18 November 2013.
  6. ^ Reading Performance With a Video Magnifier, http://clinicaltrials.gov/show/NCT01670643
  7. ^ VA Low Vision Intervention Trial (LOVIT), http://clinicaltrials.gov/show/NCT00223756
  8. ^ Clinical Trial of Peripheral Prism Glasses for Hemianopia, http://clinicaltrials.gov/show/NCT00494676
  9. ^ Project Magnify - A Comparison of Two Strategies to Improve Reading Ability, http://clinicaltrials.gov/show/NCT00366392
  10. ^ Predictors of Driving Performance and Successful Mobility - Rehabilitation in Patients with Medical Eye Condition, http://clinicaltrials.gov/show/NCT00013377
  11. ^ The Use of Transcranial Direct Current Stimulation (TDCS) to Enhance the Rehabilitative Effect of Vision Restoration Therapy, http://clinicaltrials.gov/show/NCT00921427
  12. ^ Low Vision Study Comparing EV Training vs. CCTV for AMD Rehabilitation, http://clinicaltrials.gov/show/NCT00971464
  13. ^ The Impact of Rehabilitation on Quality of Life in Visually Impaired, http://clinicaltrials.gov/show/NCT00013403
  14. ^ Wayfinding Information Access System for People with Vision Loss, http://clinicaltrials.gov/show/NCT00829036
  15. ^ Emergency Egress and Information System for Persons with Vision Loss, http://clinicaltrials.gov/show/NCT00262509
  16. ^ Virtually Reality Mobility Training System for Veterans with Vision, http://clinicaltrials.gov/show/NCT00333879
  17. ^ Evaluation of Eye Movement Tracking Systems for Visual Rehabilitation, http://clinicaltrials.gov/show/NCT00013429
  18. ^ Vision Restoration Therapy (VRT) to Treat Non-Arteritic Anterior Ischemic Optic Neuropathy, http://clinicaltrials.gov/show/NCT00140491
  19. ^ Safety and Efficacy of ATG003 in Patients with Wet Age-Related Macular Degeneration (AMD), http://clinicaltrials.gov/show/NCT00414206
  20. ^ Low Vision Intervention Trail II (LOVIT II), http://clinicaltrials.gov/show/NCT00958360
  21. ^ Functional Vision in TBI, http://clinicaltrials.gov/show/NCT01214070
  22. ^ Low Vision Depression Prevention Trial for Age Related Macular Degeneration (VITAL), http://clinicaltrials.gov/show/NCT00769015
  23. ^ Restricted Useful Field View as a Risk Factor in Older Adults, http://clinicaltrials.gov/show/NCT00013351
  24. ^ Improving Vision and Quality of Life in the Nursing Home, http://clinicaltrials.gov/show/NCT00347620
  25. ^ The Effect of Somatosensory Cue on Postural Stability in Blinded Persons, http://clinicaltrials.gov/show/NCT00650676
  26. ^ Use of "Smart Wheelchairs" to Provide Independent Mobility to Visual and Mobility Impairments, http://clinicaltrials.gov/show/NCT00333762
  27. ^ Living Successfully with Chronic Eye Diseases, http://clinicaltrials.gov/show/NCT01879501
  28. ^ Yoga for Persons with Severe Visual Impairment (RPY), http://clinicaltrials.gov/show/NCT01366677


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