Disparities in Knowledge and Use of Low Vision

Disparities in Knowledge and Use of Low Vision Rehabilitation Annick Mwilambwe, MD 1, Walter Wittich, MSc 2, 3, Ellen E. Freeman, Ph. D 3270 1, 4 1 Department of Ophthalmology, University of Montreal, 2 Department of Neurology & Neurosurgery, Mc. Gill University, 3 Lady Davis Institute for Medical Research, Montreal, 4 Research Center, Maisonneuve-Rosemont Hospital; Montreal, Quebec, Canada Purpose Results Describe the demographic, visual, health, and psychological variables associated with knowledge and use of low vision rehabilitation services in Montreal, Quebec Table 1: Relationships with Knowledge of LVR OR 95% CI Acuity in Better Eye 20/70 -200+ 20/200 -20/400+ 20/400 or worse Cause of Low Vision Patient Knows Patient Does Not Know Race White Black Other English First Language French First Language Brief Cope Active Coping Introduction • Low vision rehabilitation services are covered by universal health insurance for persons in Quebec who have visual acuity worse than 20/70 in the better eye. • It is important that visually impaired patients who qualify are informed about the option of low vision rehabilitation. • Low vision rehabilitation (LVR) consists of learning ways to optimize the use of residual vision, utilizing low vision aids such as magnifiers and computer equipment, and making adaptations to the environment. Methods Study Population • Data come from the Montreal Barriers Study (PI: Olga Overbury, OD, Ph. D) • 448 patients with best-corrected visual acuity worse than 20/70 in the better eye were recruited from ophthalmology clinics from 3 university-affiliated hospitals (SMBD Jewish General Hospital, Montreal General Hospital, Royal Victoria Hospital, Hôpital Notre Dame) in Montreal, Quebec (Canada) from January 15, 2007 until July 25, 2008. • 617 patients were eligible to participate and 448 agreed to participate giving a response rate of 73% Statistical Analysis • Pearson’s chi-square tests and t-tests were done as preliminary analyses • Multiple logistic regression was used to identify independent relationships 1. 00 2. 12 1. 00 4. 05 2. 08 1. 00 1. 83 1. 00 0. 37, 1. 11 0. 17, 0. 63 1. 15, 3. 91 1. 44, 11. 38 0. 86, 5. 00 1. 02, 3. 26 0. 87, 1. 15 Brief Cope Emotional Support 0. 94 0. 82, 1. 07 Brief Cope Acceptance 0. 82 Variables that were associated with knowledge of LVR in preliminary analyses were race, first language, visual acuity, primary diagnosis, knowledge of the cause of low vision, and the active coping, emotional support, and acceptance subscales of the Brief Cope (p<0. 05). However, in a logistic regression model of previously significant variables, only those with worse acuity, blacks, those whose first language was French, and those with higher acceptance scores were more likely to know about LVR after adjustment (Table 1). 0. 70, 0. 97 Other: Asian, Middle Eastern, Latino, Native American, and other Table 2: Relationships With Participation in LVR in Those Who Knew About It Participation in LVR OR 95% CI Data Collection • Patients were asked “Have you ever been told about or referred to a low vision clinic in the hospital or outside the hospital like CNIB, L'Institut Nazareth et Louis-Braille, or Montreal Association for the Blind? ” • If the answer was yes, the patient was considered to have knowledge of low vision rehabilitation • If the patients had heard of low vision services, they were then asked if they had participated • Interviewer-administered questionnaires were given including a depression questionnaire (10 -item CES-D) and a questionnaire about coping strategies (Brief Cope). The Brief Cope has 14 subscales—one for each coping mechanism. Higher scores indicate a greater use. Outcomes: 1) Knowledge of low vision rehabilitation; 2) Participation in low vision rehabilitation 1. 00 0. 64 0. 33 A majority of patients in the sample (71%, n=318) had knowledge of low vision rehabilitation (LVR). 130 people or 29% had no knowledge of LVR. Of those who had knowledge, 81% (n=257) reported participating in low vision rehabilitation. Acuity in Better Eye 20/70 -200+ 20/200 -20/400+ 20/400 or worse Brief Cope Self. Distraction Brief Cope Substance Abuse Brief Cope Behavioral Disengagement 1. 00 0. 47 0. 29 0. 84 0. 23, 0. 97 0. 12, 0. 66 0. 70, 1. 01 3. 03 However, in a logistic regression model of previously significant variables, only those with worse visual acuity were more likely to participate in LVR after adjustment (Table 2). The coping variables were no longer statistically significant. 0. 61, 15. 02 1. 20 Among those who had knowledge of LVR, variables that were associated with participation in LVR in preliminary analyses were acuity and the self-distraction, substance abuse, and behavioral disengagement subscales of the Brief Cope (p<0. 05). 0. 86, 1. 69 Conclusions • • We recommend that eye care professionals pay particular attention to informing all patients with acuity worse than 20/70 of the availability of low vision services, regardless of their opinion about the patient’s interest or need. Future research should examine the awareness and use of low vision rehabilitation in other regions and attempt to confirm and explain the racial and language disparities. Funding: This study was supported by the Reseau de la recherche en santé de la vision of the Fonds de la recherche en santé du Québec; CR : none; Contact information: ellen. e. freeman@umontreal. ca