Young Glaucoma Patients Can Benefit From Vision Rehab

Glaucoma patients who receive vision rehabilitation services are mostly functionally monocular, not legally blind. Referring these patients, especially younger glaucoma patients, for such services might help them live with changes to their vision, according to a study published in Ophthalmology Glaucoma.

The cross-sectional study examined the demographic and clinical characteristics of people with glaucoma who attended a hospital-based vision rehabilitation center. Investigators reviewed the charts of 191 patients with an age range of 9 to 103 years old. Data collected from these charts included: demographics, referring physician, past ocular history, glaucoma diagnosis, past ocular surgery, intraocular pressure, optic nerve findings, results of a functional intake assessing activities of daily living (ADLs), depression, visual hallucinations, best-corrected visual acuity (BCVA), mean deviation (MD) scores on visual field testing, and log contrast sensitivity (CS). 

The main outcome measurements in the study were participant demographic information, ocular history, self-reported difficulty with ADLs, depression, visual hallucinations, BCVA, visual field, and CS.

Investigators found that 90% of patients received their referral to vision rehabilitation from an ophthalmologist, and 55% were functionally monocular. There was a median 9 line difference in BCVA between all eyes. The median BCVA was 20/50; the median MD score was -13.95 dB; the median CS was 1.05. 

“Patients reported having the greatest difficulty with reading (88%), writing (72%), and mobility (67%). Seventy-eight percent of patients stopped driving and 12% reported difficulty driving,” they report. “Among those experiencing depression, there was a 4:1 ratio of depressed patients having difficulty with mobility. One-third of patients experienced visual hallucinations.”

The study also advocates for having discussions with patients about lighting and glare to help improve their daily living and maintain independence. “It is encouraging that glaucoma patients are being referred to vision rehabilitation before the point of legal blindness, and from this data, we may be able to develop guidelines that improve our evaluation and management of this patient group,” according to investigators. 

The study’s limitations include its small sample size, including in the functional intake categories. Nine patients, (5%) didn’t have a functional intake assessment, but since the study is retrospective, researchers don’t know why it wasn’t always performed, but there didn’t seem to be any difference for age, visual acuity, or visual field. Also, visual field data weren’t available for all patients for a variety of reasons. Finally, the study was conducted at only a single vision rehabilitation center — so its results might not apply to all.

Reference

Kaleem MA, Rajjoub R, Schiefer C, et al. Characteristics of glaucoma patients attending a vision rehabilitation service. Ophthalmol Glaucoma. Published online March 12, 2021. doi:10.1016/j.ogla.2021.03.005