Partnership Between Private And Public Institutions To Deliver Comprehensive Low Vision Care: First-Year Experience In Verona, Italy
Gianfrancesco M. Villani, Silvia Pellegrini, Fabio Di Cerbo and Yuri Nalini Ophthalmology, C. Riabilitazione Ipovedenti e Microperimetria, Castel d’ Azzano, Italy
Purpose: To evaluate the efficacy of the rehabilitative intervention at the Low Vision Center of Verona (CRIM) from Dec 2012 to Nov 2013
Methods:Efficacy of treatment was evaluated in terms of achievement of independent performance for the desired (visual) task (e.g., main outcome measure for reading was independent reading of IreST text). Cost-effectiveness of the intervention was measured by the number of low vision rehabilitation sessions (LVR-S) per patient. Patients’s satisfaction was investigated by a structured phone survey
Results:59 patients were referred. Age median (range) was 76 (12-97) years. ETDRS BCVA median
(range) was 20/200 (32-NLP). 44 patients (74.6%) had “low vision” according to the VA ranges in ICD-9-CM. Among patients’s goals, reading was stated by all but two patients (96.6%), followed by
glare control (40.7%), and face recognition (20%). LVR-S were 155 overall, with a median (range) of 2 (1-8) per patient. 29 patients (49.2%) successfully completed a LVR pathway, consisting of evaluation, training, and prescription of a device (group “y”). 11 patients (18.6%) were not prescribed any device, and were not expected to benefit from further intervention in a reasonable period of time (group “n”).
19 patients (32.2%) were considered to be still in the process (group “ny”). LVR-S total, median (range), and average for each group are as follows: 93, 2 (1-8), 3.2 [group y]; 20, 2 (1-4), 1.8 [group n]; 42, 2 (1-8), 2.21 [group ny]. In terms of LVR-S, a significant difference was found between group y and n (p<0.01), and a weaker difference between group y and ny (p=0.08). The phone survey was answered by 34 patients, as the others were out of reach. Among them, 30 (88%) patients declared to be satisfied with the intervention received
Conclusions: Applied low vision care struggles between the ambition to meet patients’s needs thoroughly and the shortage of resources. The median of two LVR-S per patient advocates the elaboration of an algorithm that allows a comprehensive, effective, and standardized intervention to be carried out in this limited number of sessions. A more extensive workup will be provided to selected patients (as testified by LVR-S ranging up to 8 in groups y and ny) according to their assessed areas of likely improvement and overall potential.