Eccentric viewing training provided in VA
blind rehabilitation centers and VICTORS
Joan Stelmack, OD
1,4,5 and Robert W. Massof, Ph.D,
2 Thomas R. Stelmack, OD 3,4,5
1Edward
Hines VA Hospital, 2Johns Hopkins Wilmer Eye Institute, Chicago Health
Care System, West Side Division, 3Dept. of Ophthalmology and Visual Science UIC,
4Illinois College of Optometry 5
Objectives: VA clinicians train low vision
patients with blur or blind spots in their central vision to compensate
for their visual performance difficulties by eccentric viewing, aligning
images into a healthy area of retina outside of the damaged foveal/macular
region. As there is considerable controversy in the low vision field regarding
patient selection and effectiveness of this training, our research program
will develop and validate methods and tools to evaluate eccentric viewing
training procedures and outcomes. The purpose of this initial study is
to determine the current standard of practice for eccentric viewing training
in the VA.
Methods: The administrative directors of
all 10 VA blind rehabilitation programs and the 3 VICTORS programs were
mailed a letter requesting that the optometrists and visual skills instructors
complete a survey on eccentric viewing training. The visual skills instructors
were asked to rate both frequency of use and preference for EV evaluation
and training techniques. The optometrists were asked to rate evaluation
techniques and EV training prescription criteria.
Results: Responses were received from instructors
and optometrists representing 80% of BRCs and 67% of VICTORS. All programs
report that they provide EV training. Sixteen of 24 instructors believe
that EV training is always useful for patients who have difficulty with
EV. Six of 24 instructors report routinely training patients to use their
presenting preferred retinal locus while seven of 24 indicate that they
routinely train patients to use a new retinal locus for EV. Thirteen respondents
believe it is always important to train patients to move their eyes instead
of their heads, 10 believe it is sometimes important, and one believes
that it is never important. The average number of minutes of training
per patient varied from 20 minutes to nearly 24 hours with instructors
within a single center varying by as much as two orders or magnitude.
Eighty two per cent of optometrists prescribe EV training routinely, yet
there was not a consensus among these practitioners as to the criteria
for selecting the best EV area.
Conclusions: The results of this survey,
particularly with regard to EV training time per patient, reveal an inconsistent
standard of practice across VA centers and demonstrate the need for prospective
studies of the efficacy and effectiveness of different EV training regimens.
The protocol being developed in our study, "Methods and Tools to
Evaluate Eccentric Viewing Training," will enable researchers to
design clinical trials to further evaluate the benefits of different training
techniques. Results of these studies will contribute to development of
practice guidelines needed for low vision training and result in both
improved service delivery and more cost-effective use of resources throughout
the VA system.
Funding acknowledgment: This study is funded
by VA Rehabilitation Research and Development Service, project #C2707I.
Illinois College of Optometry Faculty Research Fund and Illinois Society
for Prevention of Blindness provided pilot project funding.