Telerehabilitation Training to Facilitate Improved Reading Ability with New Magnification Devices for Low Vision.

SIGNIFICANCE: This pilot study provides some insight about the potential benefits of telerehabilitation training to improve the reading ability of adults with low vision using magnifiers, to spur future work with larger groups. Telerehabilitation services can be implemented clinically to facilitate access to follow-up care for low vision. PURPOSE: A recent Cochrane systematic review revealed that there are no published visual function outcomes for telerehabilitation with handheld magnification devices for low vision; thus, this study aimed to provide evidence for its preliminary efficacy. METHODS: One to 4 months after receiving a new magnification device (i.e., handheld or stand optical magnifier or portable electronic magnifier), 14 adult low vision patients (with any visual acuity level or ocular diagnosis) received two training sessions at home via telerehabilitation with their vision rehabilitation provider located remotely in-office. Telerehabilitation included a loaner smartphone for Zoom videoconferencing with remote control access software. The Minnesota Low-Vision Reading Test was administered during each of the telerehabilitation sessions to assess near reading (acuity and speed) with the new magnifier. RESULTS: Mean reading acuity with the magnifier was 0.17 logMAR across subjects before training at telerehabilitation session 1, which significantly improved to 0.09 on average a few weeks later at telerehabilitation session 2 (95%confidence interval, -0.001 to -0.16; P = .047). Logarithm reading speed with the magnifier for the reading acuity level at session 1 improved significantly by 0.18 log words per minute on average for the same text size at session 2 (95% confidence interval, 0.06 to 0.29; P = .002). With the magnifier at session 2, 71% of participants gained at least 0.1 log unit in reading acuity, and half improved by >0.01 in log reading speed; all participants with increased reading speed also improved in reading acuity ( P = .02). CONCLUSIONS: These preliminary data support that telerehabilitation can enhance reading ability and efficiency with newly prescribed magnifiers as an alternative option to in-office vision rehabilitation.

Subjective and Objective Measures of Daytime Activity and Sleep Disturbance in Retinitis Pigmentosa.

SIGNIFICANCE: Objectively measured limitations in daytime activity levels appear to be inextricably linked with sleep disturbances in retinitis pigmentosa (RP) patients, as well as associated with unemployment status and central vision loss. Innovative interventional strategies should be developed to help improve these issues and overall quality of life for RP patients. PURPOSE: Novel sensor devices are emerging as valuable tools to objectively assess behavior. We used validated measures of wrist accelerometry to determine relationships between sleep, vision, and physical activity in RP subjects. METHODS: For one week, 33 RP adults wore a wrist Actiwatch to detect movement during the day (average total activity counts) and disturbed sleep at night. They completed Early Treatment Diabetic Retinopathy Study visual acuity testing, Pelli-Robson contrast sensitivity, Goldmann V4e visual fields, and sleep diaries and validated questionnaires to assess their sleep and general health. RESULTS: Greater wake after sleep onset time measured with actigraphy (i.e., sleep disruption) (P = .01), loss of visual acuity (P = .009), and nonemployment/student status (P = .002) were all significant predictors of reduced daytime average total activity counts in a multiple linear regression model, after adjusting for contrast sensitivity as a cooperative suppressor variable (P = .01) (R = 0.54). Fragmentation measured with actigraphy (i.e., restlessness during sleep) (P = .07) and decreased sleep quality ratings reported upon awakening by the participants in a sleep diary (P = .06) were each marginally associated with reduced daytime average total activity counts, whereas nonemployment/student status, reduced visual acuity, and contrast sensitivity were still significant predictors. Objective and subjective measures of sleep or daytime activity were not statistically significantly correlated (P > .05). CONCLUSIONS: We find nonemployment/student status and sleep disturbances appear to be related to reduced daytime activity levels in adults with central vision loss due to RP. These findings underscore the importance of developing and evaluating interventions to help RP patients maintain engagement in productive activities and improve their disturbed sleep.

Feasibility of Using Bluetooth Low Energy Beacon Sensors to Detect Magnifier Usage by Low Vision Patients.

SIGNIFICANCE: We demonstrated proof of concept for the potential for Bluetooth low energy beacons to reliably collect data to serve as an indicator that low vision patients are using handheld magnifiers for reading, which might be used in the future to prevent the abandonment of magnification or other assistive devices. PURPOSE: Bluetooth low energy beacons are an emerging novel technology involving tiny sensors that collect real-time, continuous, objective data, which might help to ascertain the abandonment of low vision devices in a timely manner, thus prompting a follow-up evaluation to attempt to resolve issues. We evaluated whether Bluetooth beacon data could indicate when low vision patients used handheld optical magnifiers for reading. METHODS: We recorded temperature and/or relative humidity data from Estimote sticker and BlueMaestro Tempo Disc beacons attached to handles of optical magnifiers used for reading by low vision patients in clinic (n = 16) and at home (n = 3). RESULTS: In the clinic, patients whose hand/fingers made direct versus indirect contact with Estimote beacons had greater temperature increases on average from baseline after 30 seconds (0.73°C vs. 0.28°C), 60 seconds (1.04°C vs. 0.40°C), 90 seconds (1.39°C vs. 0.60°C), 105 to 120 seconds (1.59°C vs. 0.62°C), and 135 to 150 seconds (2.07°C vs. 0.97°C). During magnifier usage at home, BlueMaestro beacons measured rapidly increased temperature (5.6°C per minute on average; range 2.7 to 7.3°C) and relative humidity (19.4% per minute on average; range 8.7 to 34%). Humidity tended to reach its maximum increase and return back to baseline significantly more quickly than temperature (P = .007). All increases during magnifier usage were much greater than the maximum room fluctuations without use (clinic, 0.2°C over 120 seconds; home, 0.6°C and 2.4% over 1 minute). The beacons were nonintrusive and acceptable by patients. CONCLUSIONS: Estimote and BlueMaestro beacons can reliably detect temperature and/or humidity increases when held by low vision patients while reading with a magnifier.

Feasibility of Telerehabilitation for Low Vision: Satisfaction Ratings by Providers and Patients.

SIGNIFICANCE: This pilot study demonstrated feasibility and acceptability of telerehabilitation between a provider in-office and a low vision patient at home as an approach to provide follow-up care to improve reading ability with magnification devices and that would help overcome barriers related to transportation and paucity of providers. PURPOSE: A recent systematic review found no publications with results on the topic of telerehabilitation for low vision. Our goal was to perform the initial steps to develop, administer, refine, and evaluate components required to deliver follow-up low vision telerehabilitation services. METHODS: Three low vision providers (ophthalmic technician or optometrist) conducted telerehabilitation sessions from their office with 10 visually impaired older adults in their homes, who recently received a handheld magnification device for reading and self-reported difficulty with returning for follow-up training at their provider's office. All except one participant had never used videoconferencing before our study, and three had never used the Internet. Participants and providers rated the use of loaner hardware devices (i.e., tablets, MiFi mobile hotspot) and Health Insurance Portability and Accountability Act-compliant, secure videoconference services during telerehabilitation sessions at which participants read MNREAD cards and received feedback on magnifier use. RESULTS: Providers reported little to no difficulty with evaluating participants' reading speed, reading accuracy, and working distance with their magnifier. Both providers and participants rated video quality as excellent to good. Audio quality ratings were variable, generally related to signal strength or technical issues during some sessions. All participants agreed that they were satisfied and comfortable receiving telerehabilitation and evaluation via videoconferencing. Eight of 10 reported that their magnifier use improved after telerehabilitation. All except one reported that they were very interested in receiving telerehabilitation services again if their visual needs change. CONCLUSIONS: Positive feedback from both participants and providers in this pilot study supports the feasibility, acceptability, and potential value of low vision telerehabilitation.

Worse-than-usual visual fields measured in retinitis pigmentosa related to episodically decreased general health.

BACKGROUND/AIMS: We examined whether retinitis pigmentosa (RP) subjects' worse-than-usual vision measures were related to episodic changes in psychosocial factors and/or general health. METHODS: In a prospective, cohort study, 37 RP subjects self-administered personal computer (PC)-based visual acuity (VA), contrast sensitivity (CS) and visual field (VF) tests at home twice a week, for 16 sessions in 2-3 months. Subjects rated their general health prior to each vision test session, and completed the Perceived Stress Scale, Positive and Negative Affect Schedules, and Epworth and Stanford Sleepiness Scales immediately after each session. RESULTS: Nine subjects with reduced mean VA >0.5 log minimal angle of resolution (logMAR) on average had statistically significant 26% more sessions with measured deviations ≥0.1 logMAR from their mean (95% CI 20% to 32%; p<0.001), which were not significantly related to changes in psychosocial factors or general health. Measured deviations ≥0.1 logCS from mean CS were not statistically significantly related to any measured factors. We found a statistically significant increased frequency of sessions with ≥20% VF reduction from the mean (p<0.001) as mean log VF area was reduced. Subjects reporting reduced general health during a session had a statistically significant over twofold greater odds of having a VF reduction from the mean beyond 1 SD (95% CI 1.26 to 5.00; p=0.009). CONCLUSIONS: Measured episodic VF reductions were more common in advanced RP and related to decreased general health at a session, which should be considered during clinical examinations and trials when determining true changes in vision. We did not find evidence that fluctuations in psychosocial factors were significantly correlated with vision reductions across subjects.