Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
Duke-National University of Singapore Medical School, Singapore, Singapore.
Br J Ophthalmol. 2020 Nov;104(11):1585-1590. doi: 10.1136/bjophthalmol-2019-315620. Epub 2020 Feb 19.
To assess the clinical and patient-centred effectiveness of a novel residential ocular care (ROC) model in Australian individuals residing in residential care.
In this prospective, multicentred, randomised controlled trial conducted in 38 Australian aged-care facilities (2015-2017), 178 visually impaired individuals living in residential care facilities (mean age ±SD: 83.9±8.6 years; 65.7% women) were cluster randomised to ROC (n=95) or usual care (n=83) pathways. The ROC arm comprised a tailored and comprehensive within-site eye examination and care rehabilitation pathway, while usual care participants were given a referral to an external eyecare provider. Outcomes included presenting distance and near visual acuity (PNVA); Rasch-transformed Reading, Emotional and Mobility scores from the Impact of Vision Impairment questionnaire; quality of vision (QoV comprising Rasch-transformed Frequency, Severity and Bother domains) scores; Euroqol-5-Dimensions (raw scores); Cornell Scale for Depression (raw scores) and 6-month falls frequency, assessed at baseline and 6 months post intervention. Within-group and between-group comparisons were conducted using linear mixed models, adjusted for baseline differences in characteristics between the two arms.
At 6 months, intention-to-treat analyses showed significant between-group improvements in ROC residents compared with usual care for PNVA, Emotional and QoV scores (all p<0.05) These significant findings were retained in per-protocol analyses. No other between-group changes were observed.
Our ROC model was effective in improving near vision, emotional well-being and perceived burden of vision-related symptoms in residential care dwellers in Australia with vision impairment. Future studies to evaluate the cost effectiveness and implementation of ROC in Australia are warranted.
评估一种新型的眼保健（ROC）模式在澳大利亚居住在养老院的个体中的临床和以患者为中心的有效性。
在这项于 2015 年至 2017 年在澳大利亚 38 家养老院进行的前瞻性、多中心、随机对照试验中，随机分配了居住在养老院的 178 名视力受损者（平均年龄±标准差：83.9±8.6 岁；65.7%为女性）至 ROC（n=95）或常规护理（n=83）路径。ROC 组包括量身定制的全面现场眼部检查和护理康复途径，而常规护理组的参与者则被转介到外部眼科保健提供者处。结果包括远距和近距视力（PNVA）；从视觉障碍影响问卷（Impact of Vision Impairment Questionnaire）得出的经拉斯克转换的阅读、情感和移动评分；视力质量（包含经拉斯克转换的频率、严重程度和困扰域）评分；欧洲五维健康量表（EuroQol-5-Dimensions，原始分数）；康奈尔抑郁量表（原始分数）和 6 个月内跌倒频率，分别在基线和干预后 6 个月进行评估。采用线性混合模型进行组内和组间比较，调整了两组间基线特征的差异。
意向性治疗分析显示，与常规护理相比，ROC 组居民在 6 个月时在 PNVA、情感和 QoV 评分方面有显著的组间改善（均 p<0.05）。这些显著发现保留在方案分析中。未观察到其他组间变化。
我们的 ROC 模式在改善澳大利亚视力受损养老院居民的近视力、情绪健康和与视力相关症状的感知负担方面是有效的。未来有必要在澳大利亚评估 ROC 的成本效益和实施情况。
