Vision restoration miracles using rehabilitative tools and techniques, among urban poor patients

INTRODUCTION

Low vision (LV) is defined as visual impairment despite treatment, surgery, or standard refractive correction, but with the potential to use the residual vision.

The World Health Organization describes a person with LV as the one who has an impairment of visual function, even after treatment and/or standard refractive correction, and has a visual acuity (VA) of <6/18 to perception of light, or a visual field of <10° from the point of fixation, but who uses or is potentially able to use vision for the planning and/or execution of a task for which vision is essential.¹

LV is characterized by irreversible visual loss, decreased visual field, glare, contrast, and decreased ability to perform daily activities such as reading or writing, and some people who suffer from this condition may be socially withdrawn.

The prevalence of LV in a population-based cross-sectional study in India was reported to be 1.05% in the year 2000, with a burden of 10.6 million people requiring LV services.² The magnitude of LV is estimated to be 54.5 million in India.

The study aimed to explore the clinical profile of patients requiring low vision aids (LVA) and assess the effectiveness of common everyday household artifacts to improve the quality of life of patients with LV.³ As opposed to optical devices such as tele-lenses and other more expensive LVA, an attempt was made to explore the availability and experiment with the use of household artifacts, readily available or modifiable in a patient’s household, to improve the quality of life among patients with LV.

MATERIAL AND METHODS

The aim of the study was to explore the clinical profile of patients requiring LVA and assess the effectiveness of common everyday household artifacts to improve the quality of life of patients with LV. As opposed to optical devices such as tele-lenses and other more expensive LV aids, an attempt was made to explore the availability and experiment with the use of household artifacts, readily available or modifiable in a patient’s household, to improve the quality of life among patients with LV.

A cross-sectional analysis of LV patients attending a LV Clinic in Patna between November 2021 and February 2022 was undertaken with a telephone prospective follow-up after a few weeks. A total of 138 patients who were referred to the LV Clinic were screened with Snellen’s chart. The Snellen chart was used to assess VA for distance and near vision. For all cases, BCVA was determined after refraction. Color vision, contrast sensitivity, and visual field were done, wherever possible.

A semi-structured interview was undertaken to understand their abilities and disabilities around their day-to-day activities and tasks (modified Activity of Daily Living tool). A general interaction helped determine the condition of their residences and living spaces, the availability of household artifacts in the places of their residence, and their ability to modify them for their use. Oral informed consent was obtained from the patients, who were explained about their condition and supported to use LVAs. The study adhered to all ethical protocols.

Household modifications and artifacts were categorised according to place and need to use to improve the quality of life in LV patients. This was combined with simple techniques, user training, and counselling to improve motivation and confidence. These were as follows:

• Kitchen and cooking: change of wall color along with source and direction of light. Special or modified user-friendly utensils for safety and techniques for pouring hot and cold beverages differently.

• Outdoor and indoor activity: walking cane, foldable walking cane with alarm.

• Common household activities and finer work: needle threader, torch light, colored chocolate beads, and mobiles with the use of voice commands.

• Writing and reading: Signature guide

• Money-related: Cardboard notes for counting money.

Patients were followed up physically or on the phone to assess their improvement and overall satisfaction on a five-point scale, with the highest point being for the most satisfied.

RESULTS

Of the 140 patients who attended the LV Clinic, 110 (79%) were male and 30 (21%) were female. Of the patients, 23% were young (first 2 decades), 55% were middle-aged (3rd to 5th decades), 20% were senior citizens (6th and 7th decades), and 2% were elderly (8^th decade or older).

On screening with Snellen’s chart after BCVA, 18% had perception of light in RE and 14% in LE, 14% and 22% had hand movement in RE and LE; acuity between and including 6/60 and 6/36 was 55% in RE and 41% in LE and VA between and including 6/18 and 6/6 was 13% in RE and 23% in LE.

On enquiry of activities of daily living, difficulties were faced in viewing and using mobile phones (45%), viewing TV (21%), undertaking outdoor tasks (20%), undertaking household work (12%), undertaking finer work like writing and reading (10%), undertaking kitchen work (14%) and transport, work or occupation related (25%). (Multiple responses were allowed, so the percentages will not add to 100%)

During follow-up, 138 patients responded, and 2 were lost to follow-up; their responses related to living space modifications and household artifacts were as follows (multiple responses): 81% benefitted from the counselling, 8% reported improvement through modifications in household lighting, and 8% through changes in kitchen ambience and utensil modifications. Among artifacts, 10% benefited from using torch light, 25% benefited from money-counting notes, 9% benefited from the use of a walking stick or cane, and 36% benefited from a non-specific mix of household modifications, artifacts, and counselling.

Patient satisfaction with the set of interventions was overall very high, with 65% rating 5/5, 32% rating 4/5, and 3% rating 3/5, and they reported a general improvement in overall quality of life and ease in doing day-to-day tasks.

DISCUSSION

Patients with LV suffer from a complex set of problems ranging from loss of confidence, hesitancy, fear, and overall visual and physical inabilities and challenges to live their day-to-day lives. While they can be from any age range, most difficulties are faced during the productive years of their lives, and in general, men access LVA clinics more than women. A holistic approach to therapy using a mix of counselling, modification of household ambience, and use of household artifacts has a combined result in improving overall patient satisfaction and quality of life.^4,5

CONCLUSION

The humble counselling, individual training, and the use of simple household artefacts, based on specific needs and opportunities, can do miracles in low-vision patients who had no hope of living a normal and productive life. The holistic intervention encompasses the patient’s home and work spheres of life, and intervenes across a wide range of daily tasks and accomplishments, bringing an overall improvement in the quality of daily living.