Low vision service model evaluation project (LOVESME)

Title: Low Vision Service Model Evaluation (LOVSME) Project.

Author(s): The author list and advisory panel list is extensive for this project. Please refer to information in the documents available for download; Publisher: RNIB.

Background

This research was carried out by researchers from the universities of Cardiff, Manchester, Aston and Bangor with Moorfields, Royal Victoria Eye and Manchester Royal Eye Hospitals plus Fife Society for the Blind, on behalf of RNIB. It aimed to investigate the benefits for people with visual impairment of an integrated low vision and rehabilitation pathway, and to determine whether this integrated approach has additional benefits for users, when compared to standard low vision and rehabilitation care.

Key findings

• There is a lack of high-quality evidence to support the effectiveness of low vision service provision. The majority of studies use a relatively weak ‘before and after’ comparison design, many do not provide a full description of the intervention studied and results are not always reported in full. There has been little agreement about how best to measure outcomes and this frustrates study comparisons.
• Low vision aids improve reading ability and are valued by service users.
• Well-resourced rehabilitation programmes (e.g. Veterans Affairs programmes in USA) can produce large improvements in ‘functional ability’ but there is no evidence that they improve ‘generic health related quality-of-life’.
• There is contradictory evidence about the ability of services to improve ‘vision related quality-of-life’.
• Despite several reports of small improvements in mood following low vision rehabilitation there is no evidence that even the well-resourced Veterans Affairs programme can reduce depressive symptoms in its client group. However, other types of programmes such as “Independent Living Programmes” and “Adaptive Skills Training” may help people ‘adjust’ to vision loss.
• There is no evidence that ‘enhanced’ services are better at improving ‘vision related quality of life’ than ‘standard’ hospital-based services in the UK.
• There is no evidence that ‘multidisciplinary services’ are better at improving vision related quality of life than ‘optometric services’ in Holland, however there is evidence that a ‘group-based health education programme’ is more effective than an ‘individual intervention’.
• There is some evidence that rehabilitation outcomes peak at around 2-3 months and decline thereafter but this is not a universal finding.
• There is some evidence that rehabilitation outcomes are better following more intense rehabilitation programmes but, the optimum ‘dose’ has not yet been established.
• There is very little information about rehabilitation outcomes in children and none about outcomes in those of ‘working age’ and in minority groups.
• Only 2 studies are directly relevant to the cost of low vision rehabilitation, but it is not possible to conclude that the programmes studied were cost effective.