This pilot study demonstrated feasibility and acceptability of telerehabilitation between a provider in-office and a low vision patient at home as an approach to provide follow-up care to improve reading ability with magnification devices and that would help overcome barriers related to transportation and paucity of providers.
A recent systematic review found no publications with results on the topic of telerehabilitation for low vision. Our goal was to perform the initial steps to develop, administer, refine, and evaluate components required to deliver follow-up low vision telerehabilitation services.
Three low vision providers (ophthalmic technician or optometrist) conducted telerehabilitation sessions from their office with 10 visually impaired older adults in their homes, who recently received a handheld magnification device for reading and self-reported difficulty with returning for follow-up training at their provider's office. All except one participant had never used videoconferencing before our study, and three had never used the Internet. Participants and providers rated the use of loaner hardware devices (i.e., tablets, MiFi mobile hotspot) and Health Insurance Portability and Accountability Act–compliant, secure videoconference services during telerehabilitation sessions at which participants read MNREAD cards and received feedback on magnifier use.
Providers reported little to no difficulty with evaluating participants' reading speed, reading accuracy, and working distance with their magnifier. Both providers and participants rated video quality as excellent to good. Audio quality ratings were variable, generally related to signal strength or technical issues during some sessions. All participants agreed that they were satisfied and comfortable receiving telerehabilitation and evaluation via videoconferencing. Eight of 10 reported that their magnifier use improved after telerehabilitation. All except one reported that they were very interested in receiving telerehabilitation services again if their visual needs change.
Positive feedback from both participants and providers in this pilot study supports the feasibility, acceptability, and potential value of low vision telerehabilitation.
1College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida
2Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California
3Alphapointe, Kansas City, Missouri
4Department of Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska
5Envision Research Institute, Wichita, Kansas
6Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, California
7New England College of Optometry, Boston, Massachusetts
* abittne1@jhmi.edu
Submitted: December 22, 2017
Accepted: May 7, 2018
Funding/Support: Envision Research Institute (to AKB).
Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest in connection with the work.
Author Contributions and Acknowledgments: Conceptualization: AKB, PY, AB, JDS, TS; Data Curation: AKB, PY, AB, NCR; Formal Analysis: AKB; Funding Acquisition: AKB; Investigation: AKB, PY, AB, NCR; Methodology: AKB; Project Administration: AKB, NCR; Resources: AKB, JDS, TS; Software: AKB; Supervision: AKB; Validation: AKB; Visualization: AKB; Writing – Original Draft: AKB, NCR; Writing – Review & Editing: PY, AB, JDS, TS, NCR. The authors thank Alisha Trivedi, Marsha Zaman, and Megan Rouse, who were student research assistants at the College of Optometry, Nova Southeastern University, and assisted with the administration of surveys to the patient participants. They also thank their wireless technology consultant, Andrew Jacobson, for his assistance with the selection of the hardware devices to conduct the telerehabilitation sessions, as well as Dr. Amy Nau for the initial idea and encouragement to study telerehabilitation for low vision.
