Characterizing functional complaints in patients seeking outpatient low-vision services in the United States.
OBJECTIVE
To characterize functional complaints of new low-vision rehabilitation patients.


METHODS
Prospective observational study.


METHODS
The Low Vision Rehabilitation Outcomes Study recruited 819 patients between 2008 and 2011 from 28 clinical centers in the United States.


METHODS
New patients referred for low-vision rehabilitation were asked, "What are your chief complaints about your vision?" before their appointment. Full patient statements were transcribed as free text. Two methods assessed whether statements indicated difficulty in each of 13 functional categories: (1) assessment by 2 masked clinicians reading the statement, and (2) a computerized search of the text for specific words or word fragments. Logistic regression models were used to predict the influence of age, gender, and visual acuity on the likelihood of reporting a complaint in each functional category.


METHODS
Prevalence and risk factors for patient concerns within various functional categories.


RESULTS
Reading was the most common functional complaint (66.4% of patients). Other functional difficulties expressed by at least 10% of patients included driving (27.8%), using visual assistive equipment (17.5%), mobility (16.3%), performing in-home activities (15.1%), lighting and glare (11.7%), and facial recognition and social interactions (10.3%). Good agreement was noted between the masked clinician graders and the computerized algorithm for categorization of functional complaints (median κ of 0.84 across the 13 categories). Multivariate logistic regression models demonstrated that the likelihood of reading difficulties increased mildly with age (odds ratio, 1.4 per 10-year increment in age; 95% confidence interval, 1.3-1.6), but did not differ with visual acuity (P = 0.09). Additionally, men were more likely to report driving difficulties and difficulties related to lighting, whereas women were more likely to report difficulty with either in-home activities or facial recognition or social interaction (P<0.05 for all). Mobility concerns, defined as walking difficulty and out-of-home activities, showed no relationship to gender, age, or visual acuity.


CONCLUSIONS
Reading was the most commonly reported difficulty, regardless of the patient's diagnosis. Neither visual acuity nor gender were predictive of reading concerns, although, age showed a small effect. Addressing reading rehabilitation should be a cornerstone of low-vision therapy.
Wilmer Eye Institute, The Johns Hopkins Medical Institute, Baltimore, Maryland.
Jamie C
JC
Brown
The Lions Vision Research and Rehabilitation Center, The Johns Hopkins Medical Institute, Baltimore, Maryland. Electronic address: jgolds28@jhmi.edu.
Judith E
JE
Goldstein
The Lions Vision Research and Rehabilitation Center, The Johns Hopkins Medical Institute, Baltimore, Maryland.
Tiffany L
TL
Chan
The Lions Vision Research and Rehabilitation Center, The Johns Hopkins Medical Institute, Baltimore, Maryland.
Robert
R
Massof
Wilmer Eye Institute, The Johns Hopkins Medical Institute, Baltimore, Maryland.
Pradeep
P
Ramulu
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001334:Automobile Driving; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011932:Reading; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States; D015354:Vision, Low / Q000503:physiopathology* / Q000534:rehabilitation; D014785:Vision, Ocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology*; D019987:Persons with Visual Disabilities / Q000534:rehabilitation; D055815:Young Adult