title: A low-vision rehabilitation program for patients with mild cognitive deficits.
abstract: OBJECTIVE
  We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment.
  
  
  OBJECTIVE
  To design and pilot-test an LVR program for patients with macular disease and cognitive deficits.
  
  
  METHODS
  The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program.
  
  
  METHODS
  Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011.
  
  
  METHODS
  Twelve patients completed the intervention, and 11 companions attended at least 1 training session.
  
  
  METHODS
  Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member).
  
  
  METHODS
  Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales.
  
  
  RESULTS
  Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals.
  
  
  CONCLUSIONS
  This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC 27710, USA. heather.whitson@duke.edu
authors.forename: Heather E
authors.initials: HE
authors.lastname: Whitson
authors.forename: Diane
authors.initials: D
authors.lastname: Whitaker
authors.forename: Guy
authors.initials: G
authors.lastname: Potter
authors.forename: Eleanor
authors.initials: E
authors.lastname: McConnell
authors.forename: Fay
authors.initials: F
authors.lastname: Tripp
authors.forename: Linda L
authors.initials: LL
authors.lastname: Sanders
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Muir
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
authors.forename: Scott W
authors.initials: SW
authors.lastname: Cousins
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000534:rehabilitation*; D060329:Education of Persons with Visual Disabilities / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D010865:Pilot Projects; D015397:Program Evaluation; D012164:Retinal Diseases / Q000534:rehabilitation; D018434:Sickness Impact Profile; D015354:Vision, Low / Q000534:rehabilitation*; D019987:Persons with Visual Disabilities / Q000534:rehabilitation*