Occupational Therapy for Age-Related Macular Degeneration

Overseen By Michelle Dowling, OTD

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: MCPHS University

Disqualifiers: Other age related eye diseases

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 1 day

50 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

The goal of this clinical trial is to learn if education about additional task lighting, enhanced contrast, enlarged print instructions, smart apps and organizational strategies will improve medication management skills. The main questions it aims to answer are: Does additional task lighting, enhanced contrast, enlarged print instructions, smart apps and organizational strategies improve medication management skills, reduce errors and improve functional use of remaining vision for this task? Participants will: Oftentimes, the client is unaware of these strategies which may improve occupational performance during a valued activity. Clients with AMD, DR or Glaucoma who choose to receive the one hour OT service will be provided with 1:1 education regarding the devices and strategies that may improve their ability to perform medication management skills.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems to focus on improving how you manage your medications rather than changing them.

Is occupational therapy for low vision safe for humans?

The research does not specifically address safety concerns, but occupational therapy for low vision is generally considered safe as it focuses on teaching skills and using devices to help people with vision loss manage daily activities. ^{1 2 3 4 5}

How is occupational therapy for age-related macular degeneration different from other treatments?

Occupational therapy for age-related macular degeneration focuses on improving daily living skills and independence through the use of vision-enhancing devices and adaptive equipment, rather than directly treating the eye condition itself. This approach is unique because it combines practical tools and patient education to help individuals adapt to vision loss, enhancing their quality of life. ^{1 2 6 7 8}

What data supports the effectiveness of the treatment Occupational Therapy Interventions for Low Vision Care for Age-Related Macular Degeneration?

Research shows that occupational therapy interventions, especially those using a multicomponent approach, are effective in helping older adults with low vision improve their ability to perform daily activities at home. Additionally, combining behavioral activation with low vision rehabilitation has been found to improve visual function in patients with age-related macular degeneration. ^{2 3 9 10 11}

Who Is on the Research Team?

Michelle Dowling, OTD

Principal Investigator

MCPHS University

Are You a Good Fit for This Trial?

This trial is for individuals with Age-Related Macular Degeneration (AMD) who are receiving eye care services at the MCPHS School of Optometry in Worcester. Participants will allow their anonymous data to be used for research and are interested in learning how certain strategies might improve their medication management.

Inclusion Criteria

I have AMD and am getting eye care at MCPHS Worcester.

I agree to let my anonymous data be used for research.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive a one-hour occupational therapy session focusing on education about task lighting, enhanced contrast, enlarged print instructions, smart apps, and organizational strategies to improve medication management skills.

1 day

1 visit (in-person)

Follow-up

Participants are reassessed for the effectiveness of interventions provided, using the MediCog and R-SRAFVP assessment tools.

4 weeks

1 visit (phone or in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Occupational Therapy Interventions for Low Vision Care

Trial Overview The study tests if occupational therapy interventions like additional lighting, enhanced contrast, enlarged print instructions, smart apps, and organizational strategies can help people with AMD manage medications better and make more effective use of their vision.

How Is the Trial Designed?

Group I: Receiving OT interventions Experimental Treatment 1 Intervention

All participants will receive all OT interventions

Occupational Therapy Interventions for Low Vision Care is already approved in United States, Canada, European Union for the following indications:

Approved in United States as Occupational Therapy for:

• Improvement of medication management skills in individuals with visual impairments such as AMD

Approved in Canada as Occupational Therapy for:

• Enhancement of daily living activities including medication management for visually impaired individuals

Approved in European Union as Occupational Therapy for:

• Support for individuals with visual impairments to manage medications effectively

Who Is Running the Clinical Trial?

MCPHS University

Lead Sponsor

Trials

1

Recruited

50+

Published Research Related to This Trial

In a study of 100 older adults (ages ≥55) in subacute rehabilitation, worse vision, specifically poor contrast sensitivity, was linked to less time spent in occupational therapy, suggesting that vision impairment can limit therapy utilization.

Additionally, lower visual acuity was associated with greater functional dependency at discharge, indicating that vision issues may reduce the effectiveness of occupational therapy in improving patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of vision impairment on intensity of occupational therapy utilization and outcomes in subacute rehabilitation. Cimarolli, VR., Morse, AR., Horowitz, A., et al.[2019]

In a study of 188 patients with age-related macular degeneration, combining behavioral activation with low vision rehabilitation led to greater improvements in functional vision compared to supportive therapy alone, particularly in reading and daily tasks.

Patients receiving the combined treatment showed the most significant benefits when their visual acuity was better than 20/70, suggesting that this approach is especially effective for those with mild visual impairment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration. Deemer, AD., Massof, RW., Rovner, BW., et al.[2018]

The Revised Low Vision Independence Measure (LVIM-R) effectively detects improvements in visual ability after occupational therapy, showing significant increases in scores for both visual field and visual acuity in a study of 44 participants with an average age of 80.2 years.

The LVIM-R can be reliably used in both home health and outpatient settings to assess the effectiveness of low vision rehabilitation, making it a valuable tool for occupational therapists working with elderly patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Responsiveness of the Revised Low Vision Independence Measure (LVIM-R). Smith, TM., Hong, I., Reistetter, TA.[2022]

Multicomponent interventions that teach older adults with low vision essential skills and knowledge are highly effective in helping them maintain independence in daily activities at home, based on a systematic review of 17 studies.

Personalized multidisciplinary interventions that focus on individual goals lead to better outcomes compared to non-personalized approaches, highlighting the importance of tailored support for older adults with vision loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occupational therapy interventions to improve performance of daily activities at home for older adults with low vision: a systematic review. Liu, CJ., Brost, MA., Horton, VE., et al.[2019]

Occupational therapists frequently adjusted their interventions for clients with low vision to account for additional chronic conditions, implementing strategies like increased treatment sessions and referrals to other professionals.

Older adults with low vision perceived their vision loss as having a greater impact on their daily independence than their comorbid conditions, highlighting the need for targeted interventions that prioritize vision-related challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention. Barstow, BA., Warren, M., Thaker, S., et al.[2015]

The AOTA Evidence-Based Practice Project has created a comprehensive table that summarizes research opportunities for occupational therapy interventions aimed at older adults with low vision, highlighting the current state of evidence.

This resource is designed to assist researchers, students, and clinicians in developing innovative studies to address key questions in occupational therapy, promoting evidence-based practices in the field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Research opportunities in the area of older adults with low vision. [2013]

The systematic review on occupational therapy for older adults with low vision highlights effective interventions that can improve functional independence in this population, particularly for those with age-related macular degeneration.

The Evidence Connection articles demonstrate how research findings can be applied to real clinical cases, helping occupational therapists make informed decisions based on the latest evidence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occupational Therapy Interventions for Older Adults With Low Vision. Smallfield, S., Kaldenberg, J.[2020]

Occupational therapy practitioners (N = 34) in low vision rehabilitation reported using a mix of self-designed and standardized assessments, indicating a flexible approach to evaluating clients' needs.

The majority of services are provided to older adults, with practitioners emphasizing the importance of continuing education and collaboration with other low vision professionals for effective intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Results from a survey of occupational therapy practitioners in low vision rehabilitation. Copolillo, A., Warren, M., Teitelman, JL.[2013]

In a study of 131 older adults with age-related macular degeneration (AMD), those in a health promotion program used low vision assistive devices (AD) more effectively alongside daily living devices compared to those in an individual program.

Despite increased use of non-optical AD and ADL devices, there was no significant link between the number of low vision AD used and changes in dependence levels over 28 months, suggesting that simply using more devices does not guarantee improved daily living performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Low vision, ADL and hearing assistive device use among older persons with visual impairments. Eklund, K., Dahlin-Ivanoff, S.[2019]

Low vision is a prevalent issue among the elderly, significantly impacting their independence and health, ranking just behind arthritis and heart disease as a cause of functional impairment in individuals over 70.

While laser therapy can help postpone vision loss from macular degeneration, the best approach for managing low vision includes using vision-enhancing devices, adaptive equipment, and education, often leading to improved quality of life through tailored rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of age-related visual impairment on functional independence in the elderly. Swagerty, DL.[2007]

Age-related macular degeneration (ARMD) is becoming more common in the aging U.S. population, leading to significant vision loss that can affect independence and quality of life.

Low vision rehabilitation techniques, focusing on magnification, contrast, and illumination, are essential for improving visual function and helping individuals regain independence despite ARMD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vision rehabilitation of persons with age related macular degeneration. Siemsen, DW., Brown, WL.[2019]

Citations

1. United States pubmed.ncbi.nlm.nih.gov

Impact of vision impairment on intensity of occupational therapy utilization and outcomes in subacute rehabilitation. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Functional Outcomes of the Low Vision Depression Prevention Trial in Age-Related Macular Degeneration. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Responsiveness of the Revised Low Vision Independence Measure (LVIM-R). [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Occupational therapy interventions to improve performance of daily activities at home for older adults with low vision: a systematic review. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Client and therapist perspectives on the influence of low vision and chronic conditions on performance and occupational therapy intervention. [2015]

6. United States pubmed.ncbi.nlm.nih.gov

Research opportunities in the area of older adults with low vision. [2013]

7. United States pubmed.ncbi.nlm.nih.gov

Occupational Therapy Interventions for Older Adults With Low Vision. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Results from a survey of occupational therapy practitioners in low vision rehabilitation. [2013]

9. England pubmed.ncbi.nlm.nih.gov

Low vision, ADL and hearing assistive device use among older persons with visual impairments. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

The impact of age-related visual impairment on functional independence in the elderly. [2007]

11. England pubmed.ncbi.nlm.nih.gov

Vision rehabilitation of persons with age related macular degeneration. [2019]