Aging of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. Girdler and colleagues conducted a two-armed randomized controlled trial of older adults (n=77) with ARVL comparing 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care + self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains. The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of self-management was also successful in significantly reducing depression, increasing physical and mental health, generalized and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks' follow-up.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study offered hope to older patients with vision problems. It is hoped that the authors can conduct studies like this, but with a longer follow-up of subjects. As it is, however, the results are still encouraging.

SJ Girdler et al. Vision self-management for older adults: a randomized controlled trial. British Journal of Ophtalmology, 2010;94:223-238.