Stelmack Joan A, Tang X Charlene, Wei Yongliang, Massof Robert W
Blind Rehabilitation Center, Department of Veterans Affairs, Edward E. Hines Jr Veterans Affairs Hospital, Blind Center, 5000 S Fifth Ave, Hines, IL 60141-3030, USA.
Arch Ophthalmol. 2012 Sep;130(9):1162-8. doi: 10.1001/archophthalmol.2012.1820.
To evaluate the effectiveness of low-vision rehabilitation in 2 cohorts derived from the Veterans Affairs Low-Vision Intervention Trial.
In a prospective study, we observed 44 participants randomly assigned to outpatient low-vision rehabilitation who did not receive additional treatment after the trial ended at 4-month follow-up and 56 participants randomly assigned to the waiting-list control group and thereafter to standard therapy. The outcome measures included visual ability domains (reading, mobility, visual information processing, and visual motor skills) and overall visual ability estimated from difficulty ratings using the 48-item Veterans Affairs Low-Vision Visual Functioning Questionnaire. Mean visual ability scores for the treatment and control groups were compared at baseline, 4 months, and 1 year. A mixed-effects model was used to test treatment effects between groups over time. Differences in visual ability mean scores from baseline to 1 year were compared between the 2 groups. Within-group changes in visual ability were compared from baseline to 1 year, from baseline to 4 months, and from 4 months to 1 year.
At baseline, there were no significant differences in mean visual ability scores between groups. From baseline to 4 months, the treatment effects for all visual ability domains and overall visual ability increased to a maximum in the treatment group (P< .001), whereas the mean scores (except visual motor skills) decreased in the control group (P< .01). From 4 months to 1 year, the differences became smaller. There was a loss of visual ability in reading and visual information processing (but not in visual motor skills, mobility, or overall visual ability) in the treatment group and a gain in all visual ability measures in the control group. Interactions of treatment and follow-up time in the mixed models showed the trend of treatment effects significantly changed over time from baseline to 1 year (P< .001) for all visual ability domains and overall visual ability. Both groups demonstrated improvement in visual ability from baseline to 1 year (P< .001) (except for mobility in the control group). Overall visual ability (but not other visual ability domains) improved more in the treatment group than in the control group (P= .01).
Visual ability improved significantly in both groups from baseline to 1 year. The Low-Vision Intervention Trial treatment effect is robust and well maintained for patients with macular diseases.
评估源自退伍军人事务部低视力干预试验的两个队列中低视力康复的效果。
在一项前瞻性研究中，我们观察了44名被随机分配到门诊低视力康复组的参与者，他们在试验于4个月随访结束后未接受额外治疗；以及56名被随机分配到等待名单对照组，随后接受标准治疗的参与者。结局指标包括视觉能力领域（阅读、移动性、视觉信息处理和视觉运动技能）以及使用48项退伍军人事务部低视力视觉功能问卷从难度评级估计的总体视觉能力。在基线、4个月和1年时比较治疗组和对照组的平均视觉能力得分。使用混合效应模型来测试随时间推移两组之间的治疗效果。比较两组从基线到1年视觉能力平均得分的差异。比较两组从基线到1年、从基线到4个月以及从4个月到1年视觉能力的组内变化。
在基线时，两组之间的平均视觉能力得分无显著差异。从基线到4个月，治疗组所有视觉能力领域和总体视觉能力的治疗效果均增加至最大值（P<0.001），而对照组的平均得分（视觉运动技能除外）下降（P<0.01）。从4个月到1年，差异变小。治疗组在阅读和视觉信息处理方面出现视觉能力丧失（但视觉运动技能、移动性或总体视觉能力未出现），而对照组所有视觉能力指标均有所提高。混合模型中治疗与随访时间的交互作用表明，对于所有视觉能力领域和总体视觉能力，从基线到1年，治疗效果的趋势随时间显著变化（P<0.001）。两组从基线到1年均显示出视觉能力的改善（P<0.001）（对照组的移动性除外）。治疗组总体视觉能力（但不是其他视觉能力领域）的改善比对照组更多（P = 0.01）。
两组从基线到1年视觉能力均有显著改善。低视力干预试验的治疗效果对于黄斑疾病患者而言是强劲且维持良好的。
