Characterizing functional complaints in patients seeking outpatient low-vision services in the United States

Abstract

Purpose: To characterize functional complaints of new low-vision rehabilitation patients.

Design: Prospective observational study.

Participants: 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.

Main outcome measures: 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.

Figure 1.

Bar graph showing the number of functional complaints per individual in a national sample of patients seeking low-vision treatment. Data taken from 819 new low-vision patients seeking treatment at 1 of 28 clinical centers.

Figure 2.

Bar graph showing the frequency of various functional complaints among a national sample of patients seeking low-vision treatment. Data taken from 819 new low-vision patients seeking treatment at 1 of 28 clinical centers.

Figure 3.

Bar graph showing the frequency of functional complaints by ocular disease diagnosis in a national sample of patients seeking low-vision treatment. Diagnosis defined by International Classification of Disease, Ninth Edition, coding. AMD = age-related macular degeneration.