Telerehabilitation Training to Facilitate Improved Reading Ability with New Magnification Devices for Low Vision

Abstract

Significance: This pilot study provides some insight about the potential benefits of telerehabilitation training to improve the reading ability of adults with low vision using magnifiers, to spur future work with larger groups. Telerehabilitation services can be implemented clinically to facilitate access to follow-up care for low vision.

Purpose: A recent Cochrane systematic review revealed that there are no published visual function outcomes for telerehabilitation with handheld magnification devices for low vision; thus, this study aimed to provide evidence for its preliminary efficacy.

Methods: One to 4 months after receiving a new magnification device (i.e., handheld or stand optical magnifier or portable electronic magnifier), 14 adult low vision patients (with any visual acuity level or ocular diagnosis) received two training sessions at home via telerehabilitation with their vision rehabilitation provider located remotely in-office. Telerehabilitation included a loaner smartphone for Zoom videoconferencing with remote control access software. The Minnesota Low-Vision Reading Test was administered during each of the telerehabilitation sessions to assess near reading (acuity and speed) with the new magnifier.

Results: Mean reading acuity with the magnifier was 0.17 logMAR across subjects before training at telerehabilitation session 1, which significantly improved to 0.09 on average a few weeks later at telerehabilitation session 2 (95%confidence interval, -0.001 to -0.16; P = .047). Logarithm reading speed with the magnifier for the reading acuity level at session 1 improved significantly by 0.18 log words per minute on average for the same text size at session 2 (95% confidence interval, 0.06 to 0.29; P = .002). With the magnifier at session 2, 71% of participants gained at least 0.1 log unit in reading acuity, and half improved by >0.01 in log reading speed; all participants with increased reading speed also improved in reading acuity ( P = .02).

Conclusions: These preliminary data support that telerehabilitation can enhance reading ability and efficiency with newly prescribed magnifiers as an alternative option to in-office vision rehabilitation.

Trial registration: ClinicalTrials.gov NCT04066075.

Figure 1.

Box plot of the mean SF-36 scores for general health in relation to whether participants improved in their reading acuity (≥0.1 logMAR) with the magnifier from telerehabilitation session 1 to session 2. In the box plot, the bottom and top of the box are the 25th and 75th percentile (i.e. the upper and lower quartiles, respectively) and the band near the middle of the box is the 50th percentile (i.e. the median). The ends of the whiskers represent the lowest datum within 1.5 times the interquartile range of the lower quartile, and the highest datum still within 1.5 times the interquartile range of the upper quartile. Outliers are represented as dots located outside of the whiskers.

Figure 2.

Scatterplot of the between-session change (second – first telerehabilitation session) in log reading speed in words per minute (WPM) (black markers; y-axis on left side) and percent (%) change in the log reading speed (green markers; y-axis on right side) versus the baseline log reading speed with the magnifier at the first session, for participants with (w/)(open circles) or without (w/o)(filled circles) improved (Imp.) reading acuity (RA) with the magnifier at the second session. The regression lines are fit through all data points for log WPM (black) or percent change (green).