The Effect of an Educational Program for Persons with Macular Degeneration: A Pilot Study

By Smith, Theresa Marie; Thomas, Kimberly et al. | Journal of Visual Impairment & Blindness, April 2009 | Go to article overview

The Effect of an Educational Program for Persons with Macular Degeneration: A Pilot Study


Smith, Theresa Marie, Thomas, Kimberly, Dow, Katherine, Journal of Visual Impairment & Blindness


One in eight Americans aged 65 and older has an eye disease resulting in low vision (National Eye Institute, NEI, 2006). Macular degeneration is the leading cause of vision loss in the United States for persons aged 60 and older (NEI, 2007). Compared to individuals without disabilities, individuals with low vision demonstrate a 15% to 30% higher dependence on others to perform activities of daily living (Burmedi, Becker, Heyl, Wahl, & Himmelsbach, 2002). In addition, low vision can adversely affect a person's quality of life (Brown, 1999; Lamoureux et al., 2007; Scott, Smiddy, Schiffman, Feuer, & Pappas, 1999; Stelmack, 2001; Wolffsohn & Cochrane, 2000).

Vision rehabilitation has been shown to improve the performance of everyday activities and to increase the quality of life of people with low vision (Lamoureux, Hassell, & Keeffe, 2004; Lamoureux et al., 2007; Teitelman & Copolillo, 2005). However, a standard of care has not been established for low vision rehabilitation, and most outcome studies have focused on individual, rather than on group, rehabilitation (LaGrow, 2004; Lamoureux et al., 2007; McCabe, Nason, Turco, Friedman, & Seddon, 2000; Pankow, Luchins, Studebaker, & Chettleburgh, 2004; Scanlan & Cuddeford, 2004).

The purpose of the pilot study reported here was threefold. First, we sought to pilot-test a new instrument that measures independence in activities of daily living, the Smith's Activity of Daily Living Independence Survey (hereafter Smith's), which is in the early stages of development and is being designed specifically for use with people with low vision. Second, we sought to pilot-test an educational program that has been developed specifically for a low vision population to determine if it needs to be altered to be more effective when used with people with low vision. Third, we wanted to determine if the methodology that we used in the study needed to be revised so that the effects of an educational program on the independence of persons with macular degeneration in everyday activities can be more effectively determined by identifying factors that may affect the strength of any treatment effect.

The research hypothesis was this: Individuals with low vision who receive the educational program will demonstrate higher change scores in independence in their activities of daily living than will individuals with low vision who do not receive the educational program. To obtain additional information about the educational program if the research hypothesis was confirmed, the following research question was posed: Which of the six sections of the Smith's was responsible for the overall score of the Smith's being statistically significant?

METHOD

Design and participants

The pilot study used a quasi-experimental pretest-posttest research design with a nonequivalent comparison group. Participants, both men and women aged 55 and older, were recruited from the Lighthouse of Houston. All had been diagnosed with macular degeneration and had a moderate to severe level of visual impairment and a score of at least 23 on a modified Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975). The institutional review board of the university with which we are affiliated approved the study. All the participants were read the consent form and then gave written informed consent before taking part in the study.

Although 20 persons were recruited from the Lighthouse of Houston, because of attrition there were 16 participants, 8 in the treatment group and 8 in the comparison group. Members of the comparison group chose to be in that group because although they indicated they were interested in attending the educational program, they would not commit six weeks to the study.

Procedures

After the participants gave informed consent, they completed a modified Mini Mental State Examination (MMSE, Folstein et al. …

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