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Design and evaluation of a customized reading rehabilitation program for patients with age-related macular
María B Coco-Martín1, Rubén Cuadrado-Asensio, Alberto López-Miguel
1Institute of Applied Ophthalmobiology IOBA, University of Valladolid, Valladolid, Spain. bego@ioba.med.uva.es
Purpose:
To evaluate the efficacy of a reading rehabilitation program (RRP) specifically designed for patients with impaired central vision from age-related macular degeneration (AMD) and the impact of the program on the quality of life (QoL) and to determine any predictable reading performance improvements between visits.
Design:
Prospective case series.
Participants:
Forty-one patients with AMD who attended to the Institute of Applied Ophthalmobiology Eye Institute.
Methods:
An ad hoc-created RRP comprising 4 customized in-office training and in-home training visits over 6 weeks was undertaken by AMD patients. The RRP was based on the principle of stepwise progressive goal achievement: the difficulty of training tasks increased depending on the success obtained when performing previous easier ones. Reading performance was evaluated during each in-office training visit, and the individual's perception of his or her QoL was assessed before and after the RRP. Reading performance parameters were assessed to evaluate RRP effectiveness.
Main Outcome Measures:
Best-corrected visual acuity (BCVA), reading speed, reading duration, near visual acuity (VA), font size, and the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire scores. The effect sizes (mean differences and standard deviations) also were calculated.
Results:
The mean distance BCVA was 0.81±0.29 logarithm of the minimum angle of resolution units. The mean near VA with the appropriate low-vision aid was 0.91±0.18 (M notation) at baseline. The mean near magnification was 4.32±1.15 at the last in-office visit. The mean reading speed, reading duration, and font size improvement after the reading rehabilitation program were 48.31±22.06 words per minute (P<0.001), 35.46±15.68 minutes (P<0.001), and -4.08±2.19 font points (P<0.001), respectively. The effect sizes of reading speed, reading duration, and font size after the last visit were 2.19, 2.26, and -1.86, respectively. The final score of each WHOQOL-BREF domain improved significantly (P≤0.004) after the RRP. The increased ability to read a smaller font size was correlated with improvement in the physical health domain score of the WHOQOL-BREF (r=0.35; P=0.04).
Conclusions:
This customized RRP significantly enhanced reading performance and perceived QoL in patients with AMD. The improvement between visits seemed to be consistent.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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