Academic journal article Journal of Visual Impairment & Blindness

The Psychosocial Impact of Closed-Circuit Televisions on Persons with Age-Related Macular Degeneration

Academic journal article Journal of Visual Impairment & Blindness

The Psychosocial Impact of Closed-Circuit Televisions on Persons with Age-Related Macular Degeneration

Article excerpt

Abstract: Closed-circuit televisions (CCTVs) are used by many elderly people who have age-related macular degeneration (AMD). The functional vision of 68 participants, which was measured immediately after they adopted CCTVs, suggested successful outcomes, but the psychosocial impact of the use of CCTVs did not peak until a month later. The findings help identify circumstances in which CCTV-assisted rehabilitation may be enhanced for better long-term outcomes.

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Age-related macular degeneration (AMD) is the leading cause of blindness in the industrial world (Resnikoff et al., 2004). The associated loss of central vision interferes with many seeing activities, but reading difficulty is the most problematic result of this condition for many people (Massof, 2002; Scilley, DeCarlo, Wells, & Owsley, 2004). Assistive devices such as closed-circuit televisions (CCTVs) are useful tools for restoring diminished reading abilities, which leads to increased participation in physical and social activities (Pape, Kim, & Weiner, 2002).

Although CCTV assessments are often included in the low vision services provided by large institutions, they are performed much less frequently by private practitioners (Dickinson, 1998; McLinden, Douglas, McCall, & Arter, 2002; Overbury & Collin, 2000; Porter, 2002; Romfo, 1988, cited in Lund& Watson, 1997; Seidman & Hood, 1996). One possible reason may be the paucity of evidence-based information on the systematic applicability of CCTV systems. There have been only a few reports on longitudinal studies of low vision devices (Boerner, Reinhardt, & Horowitz, 2006; Hinds et al., 2003; Lamoureux et al., 2007; Russell et al., 2001). In general, the results have suggested that low vision rehabilitation results in significant improvement in function. However, the magnitude of the rehabilitation-induced gains needs to be further investigated (Lamoureux et al., 2007). We are aware of only one published longitudinal study that focused specifically on AMD patients and the outcomes of their use of CCTVs (Strong, Jutai, Bevers, Hartley, & Plotkin, 2003). Hence, it is not known what levels of functional independence may be achieved, what areas of daily living may be improved, and what is the stability of the impact of CCTV usage over time. Without this information, one cannot make specific recommendations to practitioners about CCTV-assisted rehabilitation with confidence.

Clinicians and researchers have adopted the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) as a benchmark instrument for assessing functional vision status. NEI VFQ-25 is designed to measure the influence of visual symptoms and visual impairments on generic health domains, such as emotional well-being and social functioning, in addition to task-oriented domains that are related to daily visual functioning (Mangione et al., 2001). This 25-item survey covers areas of general health, general vision, ocular pain, and vision-specific tasks. The subscales are transformed into 0-100 scales, where 100 represents the best possible score and 0 represents the worst. The subscale scores are generated as independent, function-specific items. The requisite computations convert these measures into 12 subscale items: general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, color vision, and peripheral vision.

Psychosocial impact is meant to describe factors within a person and factors that are attributable to the environment that affect the psychological adjustment of an individual (Day & Jutai, 1996; Jutai & Day, 2002). The Psychosocial Impact of Assistive Devices Scale (PIADS) is used to measure the impact of an assistive device on functional independence, well-being, and quality of life (Day & Jutai, 1996; Jutai & Day, 2002). It is based on the assumptions that the subjective quality of life is a complex and multidimensional construct and that an assistive technology device promotes a good quality of life to the extent that the user feels competent, confident, and inclined (or motivated) to exploit life's possibilities (Jutai, 1999). …

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