Stroupe ST, et al. - Experts explored the costs and consequences of low-vision (LV) rehabilitation or basic LV services for veterans with macular diseases. They noted an association of low-vision rehabilitation with improvement in several dimensions of visual function, with similar direct health care costs as for basic LV services. Nonetheless, a greater time commitment and costs to patients and caregivers could be involved with LV rehabilitation. The Low Vision Intervention Trial (LOVIT) and LOVIT II programs could provide a useful model for expanding outpatient LV services, as the veterans affairs (VA) had committed additional resources to outpatient blind rehabilitation.

Methods

• Authors conducted the US Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) II from September 27, 2010, to July 31, 2014, at 9 VA facilities and included 323 veterans with macular diseases and a best-corrected distance visual acuity of 20/50 to 20/200.
• They randomized veterans to receive basic LV services that provided LV devices without therapy, or LV rehabilitation that added a therapist to LV services who provided instruction and homework on using LV devices, eccentric viewing, and environmental modification.
• Costs and consequences between these groups were compared.
• Experts used low-vision devices without therapy and LV devices with therapy.
• They evaluated the costs of providing basic LV services or LV rehabilitation.
• Consequences were measured as changes in functional visual ability from baseline to follow-up 4 months after randomization using the VA Low Vision Visual Functioning Questionnaire.
• In dimensionless log odds units (logits), visual ability was measured.

Results

• As per the data, in 323 randomized patients, the mean (SD) age was 80 (10.5) years, 314 (97.2%) were men, and 292 (90.4%) were white.
• They noted that 160 (49.5%) received basic LV services and 163 (50.1%) received LV rehabilitation.
• Findings suggested the mean (SD) total direct health care costs per patient to be similar between patients who were randomized to receive basic LV services ($1662 [$671]) or LV rehabilitation ($1788 [$864]) (basic LV services, $126 lower; 95% CI, $299 lower to $35 higher; P=.15).
• Nonetheless, less time was required by basic LV services and had lower transportation costs.
• Results demonstrated greater improvements in overall visual ability, reading ability, visual information processing, and visual motor skill scores of patients receiving LV rehabilitation.