The recently completed VA Low Vision Intervention Trial (LOVIT) provided the first high quality evidence that low vision rehabilitation is extremely effective. The largest effect was for reading ability, which is approximately 7 times the effect size seen in observational studies of patients served by private sector low vision clinics. Even though orientation and mobility (O&M) instruction was not provided, LOVIT patients also exhibited a significant improvement in mobility, an improvement not observed in private sector patients. A major difference in low vision rehabilitation between the VA and private sector is that the VA covers costs of low vision devices and extensive training, whereas Medicare and other health care insurers do not cover the costs of low vision device and their coverage of training is limited. Focusing on the differences between VA and Medicare coverage policies, the presently proposed project will plan a multicenter randomized controlled trial to measure the effects of 3rd party coverage of low vision devices and O&M instruction on the outcome of low vision rehabilitation. Using qualitative research methods, we propose to elicit and build a consensus among participating center clinicians on usual care guidelines for low vision rehabilitation. We will plan and write a detailed Manual of Operations and Procedures for a 3x2 stratified design, multicenter, randomized controlled trial that measures patient-centered low vision rehabilitation outcomes; measures cost-effectiveness, cost-utilities, and demand elasticity of services and devices; and measures changes in plans of care with changes in cost coverage policies. ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Eye Institute (NEI)
Type
Planning Grant (R34)
Project #
1R34EY018696-01
Application #
7356893
Study Section
Special Emphasis Panel (ZEY1-VSN (04))
Program Officer
Kurinij, Natalie
Project Start
2008-01-01
Project End
2009-12-31
Budget Start
2008-01-01
Budget End
2008-12-31
Support Year
1
Fiscal Year
2008
Total Cost
$250,015
Indirect Cost
Name
Johns Hopkins University
Department
Ophthalmology
Type
Schools of Medicine
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21218
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Chan, Tiffany L; Perlmutter, Monica S; Andrews, Melva et al. (2015) Equating Visual Function Scales to Facilitate Reporting of Medicare Functional G-Code Severity/Complexity Modifiers for Low-Vision Patients. Arch Phys Med Rehabil 96:1859-65
Brown, Jamie C; Goldstein, Judith E; Chan, Tiffany L et al. (2014) Characterizing functional complaints in patients seeking outpatient low-vision services in the United States. Ophthalmology 121:1655-62.e1
Goldstein, Judith E; Chun, Melissa W; Fletcher, Donald C et al. (2014) Visual ability of patients seeking outpatient low vision services in the United States. JAMA Ophthalmol 132:1169-77
Chan, Tiffany L; Goldstein, Judith E; Massof, Robert W et al. (2013) Comparison of clinician-predicted to measured low vision outcomes. Optom Vis Sci 90:776-87
Malkin, Alexis G; Goldstein, Judith E; Perlmutter, Monica S et al. (2013) Responsiveness of the EQ-5D to the effects of low vision rehabilitation. Optom Vis Sci 90:799-805
Goldstein, Judith E; Massof, Robert W; Deremeik, James T et al. (2012) Baseline traits of low vision patients served by private outpatient clinical centers in the United States. Arch Ophthalmol 130:1028-37