Worldwide Argus II implantation: recommendations to optimize patient outcomes.

BACKGROUND: A position paper based on the collective experiences of Argus II Retinal Prosthesis System investigators to review strategies to optimize outcomes in patients with retinitis pigmentosa undergoing retinal prosthesis implantation. METHODS: Retinal surgeons, device programmers, and rehabilitation specialists from Europe, Canada, Middle East, and the United States were convened to the first international Argus II Investigator Meeting held in Ann Arbor, MI in March 2015. The recommendations from the collective experiences were collected. Factors associated with successful outcomes were determined. RESULTS: Factors leading to successful outcomes begin with appropriate patient selection, expectation counseling, and preoperative retinal assessment. Challenges to surgical implantation include presence of staphyloma and inadequate Tenon's capsule or conjunctiva. Modified surgical technique may reduce risks of complications such as hypotony and conjunctival erosion. Rehabilitation efforts and correlation with validated outcome measures following implantation are critical. CONCLUSIONS: Bringing together Argus II investigators allowed the identification of strategies to optimize patient outcomes. Establishing an on-line collaborative network will foster coordinated research efforts to advance outcome assessment and rehabilitation strategies.

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

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.