According to a study, low-vision (LV) rehabilitation is associated with improvement in several dimensions of visual function, which is published online April 12 in JAMA Ophthalmology

Chronic visual impairments (low vision [LV] and blindness) are among the ten most prevalent causes of disability in the United States, with an estimated 240?000 new cases of visual impairment annually. Visual impairments often limit functional ability, hindering the performance of common tasks, such as reading, social interaction, and recreation. The estimated financial burden of visual problems in the United States was more than $139 billion annually in 2013. 

The leading causes of LV are diseases most prevalent in older patients, such as patients typically treated at US Department of Veterans Affairs (VA) healthcare facilities, including age-related macular degeneration, glaucoma, diabetic retinopathy, and optic neuropathies. More than 1 million US veterans age 45 years and older have visual impairments: 157?000 with legal blindness and 1?026?000 with LV not severe enough to be classified as legally blind.

Kevin T. Stroupe, Ph.D., from the Edward Hines Jr. Veterans Affairs (VA) Hospital in Hines, Ill., and colleagues conducted the Low Vision Intervention Trial (LOVIT) II from Sept. 27, 2010, to July 31, 2014, at nine VA facilities. The study included 323 veterans with macular diseases and a best-corrected distance visual acuity of 20/50 to 20/200. Veterans were randomized to receive basic LV services that provided LV devices (160 participants) or LV rehabilitation (LV services + a therapist; 163 participants).

The researchers found that the mean total direct health care costs per patient were similar for the two groups ($1,662 for basic LV services versus $1,788 for LV rehabilitation; P = 0.15), although basic LV services required less time and had lower transportation costs. There were greater improvements in overall visual ability, reading ability, visual information processing, and visual motor skill scores for patients receiving LV rehabilitation.

Although the cost-consequences analysis cannot be compared with treatments for other conditions, it indicates to policymakers the costs associated with improving the functional visual ability of veterans with LV with macular diseases. Moreover, the costs included were those directly related to the intervention. The interventions’ downstream effect on health care costs was not considered. Consequently, the results may understate the economic benefits of the intervention.

"Low-vision rehabilitation was associated with improvement in several dimensions of visual function, with similar direct health care costs as for basic LV services," the authors write. "As the VA has committed additional resources to outpatient blind rehabilitation, the LOVIT and LOVIT II programs may provide a useful model for expanding outpatient LV services."