Head-mounted Visual Assistive Technology-related Quality of Life Changes after Telerehabilitation.

SIGNIFICANCE: Head-mounted low vision devices have become a viable alternative to enhance residual vision. This study supports the use of a head-mounted display to improve aspects of functional vision and quality of life. Much is still unknown regarding the required frequency, duration, or potential effectiveness of this telerehabilitation training protocol or what characteristics best identify optimal users. PURPOSE: A randomized study explored the effect of telerehabilitation on quality of life and functional vision in individuals with low vision using a head-mounted display. METHODS: We recruited 57 participants (age, 21 to 82 years; mean, 54.5 years) among new prospective eSight Eyewear users, randomized 1:1 into two parallel groups; the experimental group received the telerehabilitation training provided by a low vision therapist, whereas the control group received the self-training standard offered by the device manufacturer and without involvement of a low vision therapist. The primary outcome measures were the impact of telerehabilitation on validated measures of assistive technology-related quality of life: the Psychosocial Impact of Assistive Devices Scale and the Quebec User Evaluation of Satisfaction with Assistive Technology scale. Exploratory outcomes were the assessment of self-reported functional vision using the Veterans Affairs Low Vision Visual Functioning Questionnaire-48 and cybersickness associated with head-mounted display use with the Simulator Sickness Questionnaire. RESULTS: Assistive technology-related quality of life was improved when measured by the satisfaction scale but not the psychosocial scale within the first 3 months, independently of training type. Overall, functional vision improvement was observed within the first 2 weeks of device use and maintained during the 6-month study, independently of group type. Cybersickness outcomes were similar between training groups and did not change significantly for 6 months. CONCLUSIONS: eSight Eyewear, either with telerehabilitation or with the manufacturer self-training comparison, improved functional vision and increased users' quality of life within the initial 3 months of device training and practice.

Personalized Telerehabilitation for a Head-mounted Low Vision Aid: A Randomized Feasibility Study.

SIGNIFICANCE: A recent trend in low vision rehabilitation has been the use of portable head-mounted displays to enhance residual vision. Our study confirms the feasibility of telerehabilitation and informs the development of evidence-based recommendations to improve telerehabilitation interventions to reduce device abandonment. PURPOSE: To develop evidence-based recommendations for telerehabilitation, we conducted a feasibility study in preparation for a future randomized trial on the use of head-mounted displays. METHODS: We recruited novice eSight Eyewear users, randomized 1:1: the experimental group received telerehabilitation by a low vision therapist using video conferencing; the control group completed at home self-training provided by the device manufacturer. The primary feasibility outcomes were whether the recruitment goal of 60 participants (30/group) was attainable within 1 year and how participants judged the accessibility and acceptability of the telerehabilitation. An exploratory outcome was the impact of telerehabilitation on eSight Eyewear use behavior. RESULTS: Among 333 eSight users, 57 participants were enrolled, of which 35% withdrew from the study, whereas the remainder completed the 6-month follow-up. The withdrawal rate was higher in the control group but did not differ significantly from the experimental group. High accessibility (93% of participants accessed the platform) and global acceptability (100% overall satisfaction) were reported among those who completed the telerehabilitation protocol. The therapist had no difficulty judging the participants' reading performances qualitatively while participants used their device to read their eSkills and VisExc guides. Most participants improved their daily activities, based on qualitative reports of the attained goals. Seventy-nine percent of individuals declined to participate, whereas 16% of participants decided not to use eSight Eyewear anymore. CONCLUSIONS: The data demonstrated the feasibility of a randomized controlled telerehabilitation study for people with low vision using a head-mounted display. Positive feedback from the participants and the therapist suggests the potential value of this modality for low vision services.

Factors related to the use of a head-mounted display for individuals with low vision.

AIM: The decision-making process around the (non-)use of assistive technologies is multifactorial. The goal of the present study was to identify which factors predict or correlate with the use of a head-mounted magnification device for low vision (LV) (eSight Eyewear), by applying this multifactorial paradigm in order to tailor LV rehabilitation interventions to reduce device abandonment. METHODS: Using a cross-sectional design, participants were recruited from 567 eSight Eyewear owners to complete a 45-min survey online including questions from standardized questionnaires classified into four families: personal, device-related, environmental, and interventional. Using current device use/nonuse as a binary outcome, logistic regression analyses were performed to identify the variables that predicted the highest percentage of variance in eSight use. RESULTS: The 109 (19.2%) respondents with complete data had a mean age of 47.7 years (SD = 25.4, range: 9-96), 51% self-reported a central visual impairment. The final regression model alternatives accounted for 84.7%, 68.7%, 83.7%, and 64.7% (Nagelkerke's pseudo R2) of the variance in eSight use. The most consistently predictive variables of sustained device use across models were: higher scores on the Psychological Impact of Assistive Devices Scale (PIADS) and the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) scale, and participants' lack of experiencing headaches while using the device. CONCLUSIONS: None of the traditional clinical variables (demographics, ocular, or general health), or LV rehabilitation experience was predictive of sustained use of a head-mounted LV display. However, the administration of standardized device-impact questionnaires may be able to identify device users that could benefit from individualized attention during LV rehabilitation provision to reduce the probability of device abandonment.Implications for rehabilitationInvestigating the factors predicting (non-)use of head-mounted magnification devices for low vision (LV) is important to identify patients with a higher risk of device nonuse and to provide evidence for interventions designed to improve use.The optimal combinations of our statistical analysis models highlighted the importance of individualized attention focusing on the user during LV rehabilitation provision of, and training with, head-mounted devices.Standardized device-related quality of life measures were robust predictors of device use and may be able to identify individuals that could benefit from individualized attention during LV rehabilitation.The absence of headaches while using a head-mounted magnification device was a robust predictor of continued use.User follow-up service satisfaction strongly predicted continued devices use, indicating that manufacturers and rehabilitation service organizations need to maintain a high level of service.

Factors related to the use of magnifying low vision aids: a scoping review.

Background: The decision process around the (non-)use of assistive technologies is multifactorial. Its determinants have previously been classified into personal, device-related, environmental and interventional categories. Whether these categories specifically apply to the use of magnifying low vision aids was explored here, using this classification.Methods: A scoping review (Embase, MedLine, Cochrane, ERIC ProQuest, CINAHL, NICE Evidence, Trip Database) was conducted to summarize the extent, range, and nature of research regarding the categories that are associated with low vision aid (non-)usage. A combination of key words and MeSH terms was used based upon the identified core concepts of the research question: low vision, assistive technology and adherence. Inter-rater reliability for the selection process was considered acceptable (kappa = 0.87). A combination of numerical and qualitative description of 21 studies was performed.Results: Studies report high variability rates of people possessing devices but not using them (range: 2.3-50%, M = 25%, SD = 14%). We were able to replicate the conceptual structure of the four categories that had previsouly been identified with other devices. Age, diagnosis and visual acuity demonstrated contradictory influence on optical low vision aid usage. Change in vision, appropriate environment, consistent training, patient's motivation and awareness of low vision services, emerged as contributor factors of use.Conclusion: This review provides evidence that clinicians should not rely on traditionally available clinical factors to predict device use behavior. Worsening vision and low motivation appear as predictors of device nonuse and should be considered from the clinician's point of view. Education about potential facilitating factors and promotion of innovative care are strongly encouraged.Implications for rehabilitationInvestigation of the factors predicting (non-)use of magnifying low vision aids is important. These findings can help clinicians to identify patients with a higher risk of non-use of low vision aids as well as provide evidence for interventions designed to improve use.Knowledge of low vision services and types of magnifying low vision aids available to patients appears as fundamental in the process of device use and needs to be supported by more educational programs.Psychological factors predicting (non-)use of low vision aids need to be considered in the choice of rehabilitation and follow-up strategies by a multidisciplinary team, focusing more on mechanisms of adaptation and patient's motivation.Training intensity should play a central role in the development of innovative intervention programs to reduce device abandonment.

Measuring changes in device use of a head-mounted low vision aid after personalised telerehabilitation: protocol for a feasibility study.

INTRODUCTION: A recent trend in low vision (LV) has been towards the use of portable head-mounted displays (HMDs) to enhance residual vision. The decision process around the (non-)use of such devices have been identified as multifactorial. Among important barriers identified in the context of magnifying LV aids were transportation issues and insufficient training. In recent years, telerehabilitation has become of growing interest in healthcare because it allows individuals to remain at home while receiving rehabilitation services. A recent pilot study indicated encouraging outcomes; however, very few applications of telerehabilitation for LV have been tested systematically. METHODS AND ANALYSIS: To help guide evidence-based practice recommendations for this modality, we will carry out a feasibility study to assess the recruitment, retention, accessibility and acceptability of an eventual fully randomised trial of telerehabilitation for people with LV using HMDs. We will recruit 60 participants aged 18+ years among prospective eSight Eyewear owners, randomised 1:1 into two parallel groups. The active intervention will be the telerehabilitation operated by a LV therapist; the control arm will be the current self-training standard provided by the device vendor. The primary feasibility outcome measures will be: time to recruit participants, loss to follow-up, accessibility and acceptability of the telerehabilitation (satisfaction of the users and LV therapist). Exploratory outcomes will be the impact of telerehabilitation on eSight Eyewear use behaviour (discontinuance rate), and validated measures of assistive-technology-related quality of life. ETHICS AND DISSEMINATION: The study was approved by the Ethics Review Board of the Centre de Recherche Interdisciplinaire en Réadaptation de Montréal métropolitain (CRIR# 1286-1217). Dissemination is planned via local, national and international healthcare conferences and peer-reviewed journal publications.

The Effect of a Head-mounted Low Vision Device on Visual Function.

SIGNIFICANCE: Head-mounted low vision devices have received considerable attention in recent years owing to rapidly developing technology, facilitating ease of use and functionality. Systematic clinical evaluations of such devices remain rare but are needed to steer future device development. PURPOSE: The purpose of this study was to investigate, in a multicenter prospective trial, the short- and medium-term effects of a head-worn vision enhancement device (eSight Eyewear). METHODS: Participants aged 13 to 75 years with stable vision (distance acuity, 20/60 to 20/400; visual field diameter >20°) were recruited across six sites. Data were collected at baseline (no device), at fitting (with device), and after 3 months of everyday use. Outcome measures were visual ability measured by the Veterans Affairs Low Vision Visual Functioning Questionnaire 48, distance acuity (Early Treatment Diabetic Retinopathy Study), reading performance (MNREAD chart), contrast sensitivity (MARS chart), face recognition, and a modified version of the Melbourne Low Vision Activities of Daily Living (ADL) Index. RESULTS: Among the 51 participants, eSight introduction immediately improved distance acuity (0.74 ± 0.28 logMAR), contrast sensitivity (0.57 ± 0.53 log units), and critical print size (0.52 ± 0.43 logMAR), all P < .001, without any further change after 3 months; reading acuity improved at fitting (0.56 ± 0.35 logMAR) and by one additional line after 3 months, whereas reading speed only slightly increased across all three time points. The Melbourne ADL score and face recognition improved at fitting (P < .01) with trends toward further improvement at 3 months. After 3 months of use, Veterans Affairs Low Vision Visual Functioning Questionnaire 48 person measures (in logits) improved: overall, 0.84, P < .001; reading, 2.75, P < .001; mobility, 0.04, not statistically significant; visual information, 1.08, P < .001; and visual motor, 0.48, P = .02. CONCLUSIONS: eSight introduction yields immediate improvements in visual ability, with face recognition and ADLs showing a tentative benefit of further use. Overall, visual ability, reading, and visual information showed greatest benefit with device use. Further studies need to examine benefits of practice and training and possible differential effects of underlying pathology or baseline vision.

Orthoptic and video-oculographic analyses in oculopharyngeal muscular dystrophy.

INTRODUCTION: Mild ophthalmoparesis can be seen in oculopharyngeal muscular dystrophy (OPMD). METHODS: Orthoptic analysis included assessment of phoria/tropia, eye excursion, saccades, pursuit, stereoacuity, and Hess-Lancaster screen test. Video-oculography included fixation, horizontal and vertical saccades, and pursuit. RESULTS: Orthoptic abnormalities were: tropia (4 of 6); abnormal eye excursion (4 of 6, 78% involved lateral or superior rectus muscles); abnormal horizontal or vertical saccades (2 of 6); abnormal pursuit (0 of 6); abnormal stereoacuity (2 of 6); and pathological Hess-Lancaster screen (4 of 6). Video-oculographic abnormalities were present for: fixation (1 of 6); saccade latency (1 of 6); horizontal pursuit (3 of 6); and vertical pursuit (0 of 6). For horizontal saccades, mean velocity, peak velocity, and gain were pathological in 5 of 6, 5 of 6 (61% of pathological mean and peak velocities involved abducting eye movements), and 3 of 6, respectively. For vertical saccades, mean velocity, peak velocity, and gain were pathological in 4 of 6, 4 of 6 (53% involved upward movements), and 3 of 6, respectively. CONCLUSION: The data indicate preferential involvement of lateral and (to a lesser degree) superior rectus muscles in OPMD.