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.