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Digital Physiotherapeutic Vision-Specific Training System for Patients with Diabetic Retinopathy: A Propensity
Lisha Ni1, Qiuju Zhou1, Minghua Fan1
1Department of Ophthalmology, Lishui Hospital of Wenzhou Medical University, The First Affiliated Hospital of Lishui University, Lishui People's Hospital, Lishui, China.
Introduction:
Diabetic retinopathy (DR) often causes vision loss and functional impairment. Standard low vision rehabilitation improves visual function but many patients cannot access it because of cost, travel, and limited specialist availability. We aimed to compare a home-based digital vision rehabilitation program to standard in-clinic rehabilitation in patients with DR.
Methods:
We conducted a retrospective matched cohort study at a tertiary eye center in China. Adults with moderate to severe visual impairment from DR were included. A total of 380 patients were analyzed after 1:1 propensity score matching (190 per group). One group underwent a 12-week home-based digital physiotherapeutic vision training program delivered via a mobile app with daily exercises and weekly telehealth supervision, while the other group received standard in-person low vision rehabilitation over 12 weeks. The primary outcome was change in visual functional status measured by the Veterans Affairs Low-Vision Visual Functioning Questionnaire-48 (VA LV VFQ-48). Secondary outcomes included visual acuity, vision-related quality of life, depressive symptoms, mobility, metabolic control, and cost. Outcomes were assessed at baseline, 12, 24, and 48 weeks.
Results:
Both the home-based digital training and standard in-clinic rehabilitation groups achieved substantial improvements in vision-specific functional status over 48 weeks. VFQ-48 scores increased by 22-26 points in each group, indicating clinically meaningful gains, and the digital program's improvement was comparable to standard care (demonstrating non-inferiority for the primary outcome). All secondary outcomes improved comparably in both groups, with no significant between-group differences. The digital intervention cost 7791 Chinese yuan (CNY) per patient over 48 weeks compared to 10,305 CNY with standard care, providing a net savings of 2514 CNY per patient. Both approaches were well tolerated, with no major safety concerns.
Conclusions:
Home-based digital rehabilitation was non-inferior to standard in-clinic rehabilitation in improving functional vision, while substantially reducing costs and maintaining safety. These findings support implementing home-based or hybrid telerehabilitation models to broaden access to vision rehabilitation services.
Level Of Evidence:
Level III retrospective cohort study.
