What was the aim of this review?
The goal of this review was to evaluate the benefits of providing vision rehabilitation services remotely (via telerehabilitation) for people with low vision. In telerehabilitation a vision rehabilitation provider uses an internet-based approach rather than usual care in an office to train people with low vision to improve their use of remaining visual function. Our primary interest was changes in vision-related quality of life achieved by each type of training as measured by questionnaires. We were also interested in visual function, such as reading ability, as well as compliance with scheduled training sessions and satisfaction ratings.
Given the growing interest in telemedicine as a way to help address some of the many barriers to in-office care for people with low vision, the two ongoing studies, once completed, may help us understand whether telerehabilitation can be used to provide services to people with low vision, and whether the effects of telerehabilitation are similar to in-office care.
What was studied in the review?
Low vision is a reduction in visual functioning that cannot be fixed by eyeglasses, contact lenses, or other medical and surgical treatments. People with low vision typically find it difficult to perform daily activities, such as reading and driving. About 300 million people have low vision worldwide. Vision rehabilitation is one way to help improve quality of life of people with low vision, by evaluating visual functioning, prescribing appropriate visual assistive aids or devices, offering support services, and providing training to use magnification devices and strategies to make the most of their remaining vision. Office-based rehabilitation training for low vision has been shown to be effective; however, there are many challenges that can prevent patients from attending visits at the doctor's office. When additional training is provided, there is an increased effectiveness of magnification devices and skills to use remaining vision. Technology has made it possible to provide some healthcare services through the internet, including telerehabilitation, which also offers the convenience of rehabilitation sessions at home in the individual's usual environment. However, it is currently unknown whether this approach for remote services works for vision rehabilitation.
What are the main results of the review?
We found two ongoing studies of telerehabilitation for low vision, and one completed trial that indirectly addressed the research question. The completed trial showed similar effects for telerehabilitation with a therapist versus an active control intervention involving a self-administered training guide to learn to use a new wearable electronic device for low vision.
How up-to-date is this review?
The evidence is current to 14 September 2021 for completed trials and 16 March 2022 for ongoing trials.
The included trial found similar efficacy between telerehabilitation with a therapist and an active control intervention of self-guided training in mostly younger to middle-aged adults with low vision who received a new wearable electronic aid. Given the disease burden and the growing interest in telemedicine, the two ongoing studies, when completed, may provide further evidence of the potential for telerehabilitation as a platform for providing services to people with low vision.
Low vision affects over 300 million people worldwide and can compromise both activities of daily living and quality of life. Rehabilitative training and vision assistive equipment (VAE) may help, but some visually impaired people have limited resources to attend in-person visits to rehabilitation clinics to be trained to learn to use VAE. These people may be able to overcome barriers to care through access to remote, internet-based consultation (telerehabilitation).
To compare the effects of telerehabilitation with face-to-face (e.g. in-office or inpatient) vision rehabilitation services for improving vision-related quality of life and near reading ability in people with visual function loss due to any ocular condition. Secondary objectives were to evaluate compliance with scheduled rehabilitation sessions, abandonment rates for VAE devices, and patient satisfaction ratings.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Eyes and Vision Trials Register) (2021, Issue 9); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any language restriction or study design filter in the electronic searches; however, we restricted the searches from 1980 onwards because the internet was not introduced to the public until 1982. We last searched CENTRAL, MEDLINE Ovid, Embase, and PubMed on 14 September 2021, and the trial registries on 16 March 2022.
We included randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in which participants diagnosed with low vision had received vision rehabilitation services remotely from a human provider using internet, web-based technology compared with an approach involving in-person consultations.
Two review authors independently screened titles and abstracts retrieved by the searches of the electronic databases and then full-text articles for eligible studies. Two review authors independently abstracted data from the included studies. Any discrepancies were resolved by discussion.
We identified one RCT/CCT that indirectly met our inclusion criteria, and two ongoing trials that met our inclusion criteria. The included trial had an overall high risk of bias. We did not conduct a quantitative analysis since multiple controlled trials were not identified.
The single included trial of 57 participants utilized a parallel-group design. It compared 30 hours of either personalized low vision training through telerehabilitation with a low vision therapist (the experimental group) with the self-training standard provided by eSight using the eSkills User Guide that was self-administered by the participants at home for one hour per day for 30 days (the comparison group). The trial investigators found a similar direction of effects for both groups for vision-related quality of life and satisfaction at two weeks, three months, and six months. A greater proportion of participants in the comparison group had abandoned or discontinued use of the eSight Eyewear at two weeks than those in the telerehabilitation group, but discontinuance rates were similar between groups at one month and three months. We rated the certainty of the evidence for all outcomes as very low due to high risk of bias in randomization processes and missing outcome data and imprecision.