Low Vision Devices and Rehabilitation Services

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DESCRIPTION (provided by applicant): The recently completed VA Low Vision Intervention Trial (LOVIT) provided the first high quality evidence that low vision rehabilitation is extremely effective. The largest effect was for reading ability, which is approximately 7 times the effect size seen in observational studies of patients served by private sector low vision clinics. Even though orientation and mobility (O&M) instruction was not provided, LOVIT patients also exhibited a significant improvement in mobility, an improvement not observed in private sector patients. A major difference in low vision rehabilitation between the VA and private sector is that the VA covers costs of low vision devices and extensive training, whereas Medicare and other health care insurers do not cover the costs of low vision device and their coverage of training is limited. Focusing on the differences between VA and Medicare coverage policies, the presently proposed project will plan a multicenter randomized controlled trial to measure the effects of 3rd party coverage of low vision devices and O&M instruction on the outcome of low vision rehabilitation. Using qualitative research methods, we propose to elicit and build a consensus among participating center clinicians on usual care guidelines for low vision rehabilitation. We will plan and write a detailed Manual of Operations and Procedures for a 3x2 stratified design, multicenter, randomized controlled trial that measures patient-centered low vision rehabilitation outcomes; measures cost-effectiveness, cost-utilities, and demand elasticity of services and devices; and measures changes in plans of care with changes in cost coverage policies.