Citation information: Macnaughton J, Latham K & Vianya-Estopa M. Rehabilitation needs and activity limitations of adults with a visual impairment entering a low vision rehabilitation service in England. AbstractPurpose: To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. Methods: Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. Results: Sixty people (mean age AE S.D. = 75.8 AE 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 AE 2.91), mobility outdoors (6.55 AE 3.92), mobility indoors within an unfamiliar environment (5.52 AE 3.93) and writing (5.27 AE 3.02). Greater rehabilitative need was associated with younger age (b = À0.46, p < 0.001), and with higher depressive symptomatology (b = 0.35, p < 0.01; model R 2 34%). Goals with greatest difficulty were mending clothing (À1.95 AE 0.35 logits) and hobbies and crafts (À1.32 AE 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (b = 0.39, p < 0.001), lower visual acuity (b = 0.42, p < 0.001) and lower adjustment of visual loss (b = 0.31, p < 0.01; model R 2 53%). Conclusions: Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need.

Purpose:The purpose of this study was to determine what a person with vision loss considers a 'comfortable' print size to read, and examine whether this reflects any of three currently used parameters for identifying print size required for sustained reading tasks: minimum size to achieve maximum reading speed (the critical print size (CPS)); minimum size for functional reading at 80 wpm and/or a size that is double the reading acuity (representing an acuity reserve of 2:1).Methods: Forty-seven participants entering low vision rehabilitation (mean age 77 years, 24 with macular degeneration) were assessed using MNREAD charts to determine reading acuity, maximum reading speed, CPS and the minimum size allowing functional (80 wpm) reading. Comfortable print size was assessed by asking participants to identify 'the smallest print size that you would find comfortable using' on the MNREAD chart.Results: There was little difference between comfortable print size and CPS (mean difference 0.05 logMAR (SD 0.18); p = 0.08, limits of agreement ±0.35 logMAR), and no trend for the difference between values to differ across the functional range.Size for functional reading could only be assessed for 41 participants, and the difference between this and comfortable print size varied across the functional range. Comfortable print size was consistently smaller than twice the reading acuity size (mean difference 0.11 logMAR (SD 0.17); p < 0.001), with an average acuity reserve of 1.74:1. Conclusions:Asking people with visual impairment to identify a print size that is comfortable to read provides a print size similar to the CPS. This can be used as a guide in selecting magnification for sustained reading without having to undertake further analyses. Identification of perceived comfortable print size may offer a time-efficient clinical method of estimating magnification requirements, and be relevant for undertaking effective remote consultations.

Introduction: Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment in the United Kingdom. It has a wideranging detrimental impact on daily living, including impairment of functional ability and quality of life. Assistive technology designed to overcome this impairment includes wearable electronic vision enhancement systems (wEVES). This scoping review assesses the usefulness of these systems for people with AMD. Methods: Four databases (Cumulative Index to Nursing and Allied Health Literature, PubMed, Web of Science and Cochrane CENTRAL) were searched to identify papers that investigated image enhancement with a head-mounted electronic device on a sample population that included people with AMD. Results: Thirty-two papers were included: 18 studied the clinical and functional benefits of wEVES, 11 investigated use and usability and 3 discussed sickness and adverse effects. Conclusions: Wearable electronic vision enhancement systems provide handsfree magnification and image enhancement producing significant improvements in acuity, contrast sensitivity and aspects of laboratory-simulated daily activity. Adverse effects were infrequent, minor and spontaneously resolved with the removal of the device. However, when symptoms arose, they sometimes persisted with continued device usage. There are multi-factorial influences and a diversity of user opinions on promotors to successful device use. These factors are not exclusively driven by visual improvement and incorporate other issues including device weight, ease of use and inconspicuous design. There is insufficient evidence of any cost-benefit analysis for wEVES. However, it has been shown that a user's decision to make a purchase evolves over time, with their estimates of cost falling below the retail price of the devices. Additional research is needed to understand the specific and distinct benefits of wEVES for people with AMD. Further patient-centred research should assess the benefits of wEVES in user-led activities when directly compared with alternative coping strategies, allowing professionals and users to make better prescribing and purchasing decisions. K E Y W O R D Sage-related macular degeneration, head-mounted display, image enhancement, low-vision aid, visually impaired persons, wearable devices, wearable electronic vision enhancement systems

Longitudinal changes in priority rehabilitation needs, vision-related activity limitation and importance of visual goals were evaluated in a sample of people with a visual impairment over a year following entry to low vision rehabilitation services in England. Methods: Participants were adults with newly registered visual impairment within Leicestershire. Priority scores, indicating the level of rehabilitative need, were determined from the importance and difficulty scores of the 48 goals of the Participation and Activity Inventory (PAI). Rasch analysis of the difficulty and importance scores examined activity limitation and importance separately. PAI outcome measures were assessed on entry to rehabilitation services and at 4 and 12 months thereafter.Results: Forty-eight participants (mean age 74.2, SD 14.1 years) completed three visits. Overall, there was a statistically significant reduction in the perceived need for rehabilitation over time (p < 0.001, η p 2 = 0.29), driven by reduced perceived difficulty (p < 0.001, η p 2 = 0.32) but stable importance (p = 0.73) of goals, with most change occurring between baseline and 4 months. PAI goals with greatest rehabilitative need at study entry were reading, mobility and writing, and these remained of highest priority over time. The greatest priority score decrease was for the goal 'Hobbies and crafts'. The largest decrease in importance was for 'Mobility outdoors', whereas 'Relationship with loved ones' increased most.Conclusions: Despite a decline in the perceived need for rehabilitation over the study period, there remains a need for continued support and intervention at 12 months following registration with rehabilitation services, particularly for the key goals of reading, writing and mobility. Early identification and support for individuals' important but difficult goals could prevent such goals being relinquished.Goals concerning relationships and communication became more important over time, indicating that re-evaluation of needs at follow-up is necessary to inform ongoing service provision.