Table 2.
Evidence Table for Reading Performance for Older Adults With Low Vision
| Author/Year | Level of Evidence/Study Design/Participants/Inclusion Criteria | Intervention and Control | Outcome Measures | Results |
| Technology | ||||
| Burggraaff et al. (2012) | Level I Multicenter masked RCT N = 122 randomized, N = 114 in intention-to-treat analysis (59.6% female) Intervention group, n = 59 (M age = 75.4; 61.0% female) Control group, n = 55 (M age = 78.6; 58.2% female) Inclusion Criteria Age ≥18, prescribed a stand-mounted CCTV, fluent in Dutch, no indication of cognitive deficits |
Intervention Delivery instructions from the CCTV supplier combined with outpatient standardized training from low vision therapists, 60-min sessions 1×/wk (M = 2 sessions) Control Delivery instructions only |
• Dutch version of the RRC for reading acuity • Reading speed in wpm • Reading errors • Column-tracking time • Technical reading |
No significant differences were found between groups. Reading acuity, speed, and accuracy improved in both groups with the CCTV. |
| Gill et al. (2013) | Level II 3-group, within-subjects N = 27 (M age = 78.9; sex not reported) Inclusion Criteria Stable wet AMD in one or both eyes, would benefit from a low vision aid as indicated by ocular assessment by a retinal specialist |
Intervention No intervention; reading speed assessed on an iPad, e-reader, and paper with varying text sizes Control No control |
• Reading speed in wpm for paper, iPad, and e-reader • Mean change in wpm for changes in text size and device |
Participants read significantly faster using an iPad with larger text sizes compared with paper. Participants read significantly faster on paper compared with the e-reader. |
| Kaldenberg & Smallfield (2017) | Level III 1-group pretest–posttest with follow-up N = 4 (M age = 74.25; 100% female) Inclusion Criteria Age ≥65, English-speaking, willing to explore new technology options for living with vision loss, not currently using tablet technology, no significant cognitive impairment as identified by the Brief Screen for Cognitive Impairment, functional vision loss as indicated by the Visual Function Risk Assessment, access to a tablet and wireless Internet, able to travel to the intervention site |
Intervention Group training in tablet use, 10 weekly sessions Control No control |
• COPM • Daily tablet use |
Daily tablet use increased from 15 min at pretest to 3.0 hr at posttest and 4.5 hr at follow-up. COPM Performance scores showed a mean increase of 3.45 and COPM Satisfaction scores a mean increase of 3.65. Improvement of >2 points is considered meaningful clinical change. This study did not directly target the outcome of reading but used the COPM and an iPad to improve performance of and satisfaction with daily activities. |
| Moisseiev & Manis (2016) | Level III Prospective pilot study N = 12 (M age = 62; 50% female) Inclusion Criteria Age >18, legally blind with best-corrected visual acuity of 20/200 or worse in better-seeing eye |
Intervention Training at enrollment on use of the portable artificial vision device (OrCam) by an experienced instructor, single 90- to 120-min session; after completing a 10-item test, participants were given the device to use in their regular settings for ≥1 hr/day over 1 wk Control No control |
10-item functional test designed to include daily activities that are difficult for a person with low vision | Mean scores on the functional test improved significantly from baseline to after the first week of portable artificial vision device use. For 7 participants who also used their own low vision aids, the portable artificial vision device improved their mean test scores significantly compared with use of only their low vision aids and use of no low vision aids. |
| Visual Skills Training | ||||
| Aimola et al. (2014) | Level I Parallel-group RCT N = 70 (38.6% female), N = 52 at completion Intervention group, n = 28 (M age = 61.43) Control group, n = 24 (M age = 63.96) Inclusion Criteria Age ≥18, HVFDs confirmed using monocular automatic perimetry, macular sparing |
Intervention Reading and exploration training with difficulty adjusted on the basis of previous reading speed and accuracy, 35 hr total Control Visual attention tasks but no exploration or large horizontal eye movements, 35 hr total |
• Perimetry using the Oculus Twinfield 2 perimeter and the Esterman preset program • Visual search using a find-the-number technique • Reading speed in wpm • Driving hazard perception • Obstacle avoidance • Visuomotor search • Test of Everyday Attention • Sustained Attention to Response Task • NEI VFQ–25 • Impact of Vision Impairment questionnaire |
The intervention group showed significantly greater improvements in visual searching and reading and greater subjective improvement compared with the control group. |
| Chung (2011) | Level III Pretest–posttest N = 6 (4 with AMD, 2 with Stargardt disease; M age = 73.8; 50% female) Inclusion Criteria Long-standing central vision loss |
Intervention Training in RSVP reading, 6 weekly sessions with 300 sentences per session Control No control |
• Monocular visual acuities using the Bailey Lovie high-contrast letter acuity chart • RSVP reading speeds in wpm for six print sizes • Location of the fPRL • Fixation stability |
RSVP reading speeds improved 34%–70% (M = 53%). Reading speed improved significantly for all participants. No improvements were found in visual acuity, critical print size measurements, location of the fPRL, and fixation stability. |
| de Haan et al. (2015) | Level I RCT with wait-list control N = 54 at randomization, N = 49 at analysis (M age = 56; 34.7% female) Intervention group, n = 26 (M age = 55; 30.8% female) Control group, n = 23 (M age = 57; 39.1% female) Inclusion Criteria HVFD; at least a quadrantopia, restricted to one-half of the visual field, from acquired postchiasmic brain injury; time since onset >5 mo; binocular visual acuity of Snellen ≥0.5 (6/12 or 20/40, LogMAR 0.3); stable neurological and ophthalmological condition; stable eye and head motility; able to walk ≥50 m; MMSE score ≥24/30 |
Intervention InSight-Hemianopia Compensatory Scanning Training emphasizing systematic horizontal scanning rhythm, provided by occupational therapists, 15 60- to 90-min sessions over 10 wk totaling 18.5 hr Control Wait list; no intervention |
• ETDRS 2000 Letter Chart for monocular visual acuity • Gecko Test for contrast sensitivity • RRC in wpm • Reading speed and correct answers with a 400-word paragraph • Scanning test with dot patterns • Hazard perception test • Tracking test • Percentage preferred walking speed • NEI VFQ–25 • Independent Mobility Questionnaire • Cerebral Visual Disorders questionnaire |
No improvements were found in nonmobility visual skills, including reading, visual counting, and visual search. Participants reported greater success in avoiding obstacles by detecting peripheral stimuli while walking. |
| Hayes et al. (2012) | Level III 1-group pretest–posttest N = 13, N = 10 at completion (M age = 65.4; 50% female) Inclusion Criteria Acquired brain injury 2 wk to 6 mo before assessment, left or right homonymous hemianopia, MMSE score ≥25, corrected vision of ≥6/18, age ≥18, able to give informed consent |
Intervention Standardized NVT visual scanning therapy program consisting of static scanning and mobility training provided by orientation and mobility instructors, occupational therapists, and low vision therapists, 1-hr sessions 3×/wk for 7 wk Control No control |
• NEI VFQ–25 • LV VFQ–48 • Pepper Visual Skills Reading Test for speed and accuracy |
Significant improvements were found in quality of life (NEI VFQ–25 and LV VFQ–48) at 3 mo postintervention. NVT training did not improve performance on reading tasks. Results of the Pepper test were not reported. |
| Jacquin-Courtois et al. (2013) | Level II Pretest–posttest with healthy control N = 13 Intervention group, n = 7 (M age = 58.9; 42.9% female) Control group, n = 6 (M age and sex not reported) Inclusion Criteria Unilateral visual field defect, chronic phase postinjury with normal or corrected-to-normal binocular visual acuity, macular sparing |
Intervention Computer-based compensatory eye movement training using a ramp-step search paradigm, 8-min search tasks, 100 trials of each, in a single training session Control Same intervention for participants with no visual field defect |
• Visual search task • Rapid scanning task • Reading task |
The intervention group improved significantly on the visual search tasks but not on the rapid scanning or reading tasks. The control group showed no significant difference from pretest to posttest on any task. |
| Keller & Lefin-Rank (2010) | Level I RCT N = 20 (40% female) Intervention group, n = 10 (M age = 54.7; 40% female) Control group, n = 10 (M age = 63.6; 40% female) Inclusion Criteria Left- or right-sided visual field deficit |
Intervention AVT, 20 30-min sessions over 3 wk Control VT, 20 30-min sessions over 3 wk |
• Visual exploration tests for reading and object search • Impairment in ADLs questionnaire • Electro-oculography |
The intervention group showed significant improvements compared with the control group on all outcomes. |
| Mödden et al. (2012) | Level I RCT, single-blind, single-center treatment study N = 45 (42.2% female) RT group, n = 15 (M age = 58.3; 33.3% female) CT group, n = 15 (M age = 57.1; 40.0% female) Control group, n = 15 (M age = 59.0; 53.3% female) Inclusion Criteria Inpatient rehabilitation patients with homonymous hemianopia and posterior cerebral artery stroke |
Intervention RT group: Computer-based stimulation of border areas of their visual field defects through perception of visual target within the visual field border, 15 30-min sessions over 3 wk CT group: Training in visual search strategies through identification of critical targeted icon, 15 30-min sessions over 3 wk Control Standard OT, including training focused on systematic eye movements toward lost visual field during ADLs, 15 30-min sessions over 3 wk |
Primary RT group • Visual field expansion • Reading performance CT group • Visual search performance • Reading performance Secondary • Test Battery of Attentional Performance • Behavioral Inattention Test for visual exploration • Wechsler Memory Test for reading ability • German Extended Barthel Index |
Compared with the control group, the CT group showed better visual search performance, but the RT group did not experience a larger expansion of the visual field. No significant differences were found between groups in reading speed. Intragroup pre–post comparisons demonstrated that the CT group improved on all outcomes and the RT group on several, whereas the control group improved on only one. |
| Palmer et al. (2010) | Level III Retrospective 1-group pretest–posttest N = 300, N = 242 at completion (M age = 75.4; 68.2% female) Inclusion Criteria Diagnosis of AMD |
Intervention Eccentric viewing training, on individual basis with a tutor, consisting of preferred eye identification, preferred retinal locus identification, magnification and refraction correction using low vision aids, optimal lighting identification, and visual fixation strategies (steady eye), 1.5 hr 1×/wk for 3–4 sessions, followed by individualized homework tasks Control No control |
• Reading speed • Font size using the Keeler N Series Near Vision Vocational Test Chart • Maximal duration of comfortable reading • Percentage of comprehension |
Reading speed improved significantly from 48.0 to 71.9 wpm. 82.6% of participants improved, 6.5% did not improve, and 10.5% had decreased reading speed. Mean font size improved significantly from N14.3 to N11.5. Before the training, 3% of participants could read font size N10 or smaller; after the training, 36% could read N10 or smaller. Reading duration improved significantly from 1.7 min to 15.8 min. 95% of participants could read for a longer period after training. Percentage of comprehension improved significantly from 73.7% to 92.7%. |
| Schuett et al. (2012) | Level III Single-subject baseline and crossover design N = 36 (16.7% female) Group A, n = 18 (M age = 64.0; 16.7% female) Group B, n = 18 (M age = 63.7; 16.7% female) Inclusion Criteria Homonymous visual field loss, brain injury diagnosis by cranial computed tomography scan and/or magnetic resonance imaging scan, macular sparing |
Intervention Group A: Computer-based VET (M = 12.3 sessions) followed by reading training (M = 11.6 sessions) Group B: Reading training (M = 12.6 sessions) followed by VET (M = 11.5 sessions) Control No control |
• Reading speed in wpm • Visual exploration time • Number of errors |
Improvements in reading and visual exploration were significant for both groups, with no significant difference between groups. Specific training led to improvements in related functional tasks (e.g., reading training improved reading speed). |
| Seiple et al. (2011) | Level I RCT, repeated-measures, counterbalanced, crossover N = 36 Intervention group, n = 30 (median age = 79; 50% female) Control group, n = 6 (M age = 78.4, sex not reported) Inclusion Criteria Diagnosis of dry nonexudative AMD, visual acuity >20/400 in the better-seeing eye |
Intervention Three vision rehabilitation training approaches: Module 1, visual awareness and eccentric viewing; Module 2, control of reading eye movements (steady eye); and Module 3, reading practice with sequential presentation of lexical information; 6 weekly 2-hr sessions for each approach Control No intervention; training delayed for 18 wk |
• Sentence reading performance calculated by reading speed in wpm • LV VFQ–48 |
Reading speed decreased by 8.4 ± 7.2 wpm after Module 1, increased by 27.3 ± 6.8 wpm after Module 2, and decreased by 9.8 ± 7.2 wpm after Module 3. Reading speeds improved significantly after Module 2 compared with Modules 1 and 3 (decrease in wpm). The control group experienced little change in reading speed but improved over the 18 wk by an average of 0.96 wpm. |
| Multicomponent Interventions | ||||
| Rovner et al. (2013) | Level I Single-masked RCT with attention control N = 241 (63.5% female) Intervention group, n = 121 (M age = 82.7; 67.8% female) Control group, n = 120 (M age = 82.8; 59.2% female) Inclusion Criteria Age ≥65, bilateral AMD, visual acuity between 20/70 and 20/400 in the better-seeing eye, moderate difficulty performing a vision-functional activity (e.g., reading mail, attending social activities) |
Intervention Problem-solving therapy consisting of determination of functional problems caused by vision loss and creation of goals and solutions to address the problems Control Nondirective supportive therapy consisting of empathy, respect, and optimism, with no focus on vision rehabilitation |
• TVF • NEI VFQ–25 • Activities Inventory • Vision-related quality of life |
No significant differences were found between groups in TVF scores at 3 and 6 mo. No significant changes were found in NEI VFQ–25 scores. Vision-related quality of life improved more for the intervention group than the control group. The intervention group also exhibited more coping strategies. |
| Stelmack et al. (2012) | Level I RCT N = 100 (2% female) Intervention group, n = 44 (M age = 78.9; 0% female) Control group, n = 56 (M age = 79.9; 3.6% female) Inclusion Criteria Diagnosis of macular disease, visual acuity in the better-seeing eye worse than 20/100 and better than 20/500 |
Intervention Low vision intervention protocol consisting of 5 weekly 2-hr low vision therapy sessions, a home visit from a vision therapist, 5 hr/wk of homework, and low vision devices prescribed when appropriate and provided at no charge, over 2 mo Control Wait list; intervention was provided after trial concluded at 4 mo but before 1-yr follow-up |
• LV VFQ–48 for reading ability, mobility, visual information processing, visual–motor skills, and overall visual ability | The intervention group improved significantly in all aspects of visual function (reading, mobility, visual information processing, and motor skills) compared with the control group from baseline to 4-mo follow-up. The control group improved significantly in all aspects of visual function except mobility from baseline to 1 yr. Overall, visual ability of the intervention group improved significantly more than that of the control group. |
Note. ADLs = activities of daily living; AMD = age-related macular degeneration; AVT = audiovisual stimulation training; CCTV = closed-circuit television; COPM = Canadian Occupational Performance Measure; CT = compensatory therapy; fPRL = preferred retinal locus for fixation; HVFDs = homonymous visual field defects; LV VFQ–48 = Veterans Affairs Low Vision Functioning Questionnaire; M = mean; MMSE = Mini-Mental State Examination; NEI VFQ–25 = National Eye Institute Vision Function Questionnaire–25 plus supplement; NVT = Neuro Vision Technology; OT = occupational therapy; RCT = randomized controlled trial; RRC = Radner Reading Charts; RSVP = Rapid Serial Visual Presentation; RT = restitution therapy; TVF = targeted vision function; VET = visual exploration training; VT = visual stimulation training; wpm = words per minute.
This table is a product of AOTA’s Evidence-Based Practice Project and the American Journal of Occupational Therapy. Copyright © 2020 by the American Occupational Therapy Association. It may be freely reproduced for personal use in clinical or educational settings as long as the source is cited. All other uses require written permission from the American Occupational Therapy Association. To apply, visit www.copyright.com.
Suggested citation: Smallfield, S., & Kaldenberg, J. (2020). Occupational therapy interventions to improve reading performance of older adults with low vision: A systematic review (Table 2). American Journal of Occupational Therapy, 74, 7401185030. https://doi.org/10.5014/ajot.2019.038380