title: Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration.
abstract: To compare the efficacy of behavioral activation (BA) plus low vision rehabilitation with an occupational therapist (OT-LVR) with supportive therapy (ST) on visual function in patients with age-related macular degeneration (AMD).
  
  
  
  Single-masked, attention-controlled, randomized clinical trial with AMD patients with subsyndromal depressive symptoms (n = 188). All subjects had two outpatient low vision rehabilitation optometry visits, then were randomized to in-home BA + OT-LVR or ST. Behavioral activation is a structured behavioral treatment aiming to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment that provides emotional support and controls for attention. Functional vision was assessed with the activity inventory (AI) in which participants rate the difficulty level of goals and corresponding tasks. Participants were assessed at baseline and 4 months.
  
  
  
  Improvements in functional vision measures were seen in both the BA + OT-LVR and ST groups at the goal level (d = 0.71; d = 0.56 respectively). At the task level, BA + OT-LVR patients showed more improvement in reading, inside-the-home tasks and outside-the-home tasks, when compared to ST patients. The greatest effects were seen in the BA + OT-LVR group in subjects with a visual acuity ≥20/70 (d = 0.360 reading; d = 0.500 inside the home; d = 0.468 outside the home).
  
  
  
  Based on the trends of the AI data, we suggest that BA + OT-LVR services, provided by an OT in the patient's home following conventional low vision optometry services, are more effective than conventional optometric low vision services alone for those with mild visual impairment. (ClinicalTrials.gov number, NCT00769015.).
authors.affiliation: Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Deemer
authors.affiliation: Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Massof
authors.affiliation: Departments of Psychiatry, Neurology, and Ophthalmology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Barry W
authors.initials: BW
authors.lastname: Rovner
authors.affiliation: Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Casten
authors.affiliation: Department of Occupational Therapy, Jefferson Elder Care, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
authors.forename: Catherine V
authors.initials: CV
authors.lastname: Piersol
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000628:therapy; D008297:Male; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015354:Vision, Low / Q000150:complications* / Q000523:psychology / Q000628:therapy; D014792:Visual Acuity; D019987:Persons with Visual Disabilities / Q000534:rehabilitation*