Project Summary or Abstract The successful application of magnification devices for reading and daily tasks is predicated on their correct use by individuals with low vision (LV). Barriers related to transportation, geography, and/or health-related concerns often limit LV patients’ ability to attend several in-office training sessions as part of low vision rehabilitation (LVR) to optimize visual function with magnification devices. A promising solution is real-time videoconferencing to provide telerehabilitation, involving remotely delivered LVR services by a LVR provider in-office to a patient at home. Telerehabilitation for LV appears to be feasible and acceptable by both patients and LVR providers, with preliminary evidence that its efficacy for enhancing reading ability may be similar to in-office LVR. However, it has not yet been fully demonstrated whether telerehabilitation is at least as effective as in-office usual care for LV follow-ups. This would be critical information for LV providers for reassurance that either modality is acceptable. Another key issue in LVR is the need for an effective system to continually assess how patients are functioning at home. Ideally this would involve a non-invasive, efficient method to assess when magnifier device abandonment occurs, so that a timely telerehabilitation session can be initiated. Bluetooth low energy (BLE) beacon sensors attached to the handles of magnifiers can collect longitudinal data regarding environmental changes, which might serve as a helpful indicator of magnifier use patterns by LV patients at home. Specifically, we propose to conduct a randomized non-inferiority trial of the potential for telerehabilitation to enhance visual ability by providing remotely-delivered LVR training to use magnification devices and/or visual assistive mobile apps in comparison to in-office usual care LVR. This will provide an evidence basis for whether the effects of two interventions are not clinically and statistically different from each other. This is important to determine if a novel service delivery mode (i.e., telerehabilitation), that might be safer, more resource efficient, convenient, may improve adherence and/or access to care, is at least as effective as a more established approach (i.e., in-office) with proven effectiveness. We aim to show how telehealth services can be made readily accessible to those with LV, as well as the value of annual follow-ups via telerehabilitation. We will determine whether BLE beacon sensor data are valid indicators of hand-held optical magnifier usage by LV patients at home. We anticipate that beacon sensors attached to hand-held optical magnifiers will measure increased temperature and/or humidity when motion is detected. Beacon sensor data will determine if it is feasible to remotely assess when magnifiers are used or abandoned, and if their frequency of use changes following telerehabilitation or in-office LVR. We envision that telerehabilitation can improve patient outcomes as an alternative, effective method for the provision of follow-up LV services. This is a high priority given the increasing prevalence of LV, paucity of LV providers, and barriers to care. Beacon sensors are a novel solution for monitoring LV patients beyond the clinical office visit, which could enhance patient management with timely LV services and evaluation of LV device use.

Narrative One goal of this research is to conduct a non-inferiority trial of telerehabilitation versus in-office care to provide follow-up training to individuals with low vision to enhance their quality of life by using magnification devices and/or visual assistive mobile apps for important daily activities, such as reading and/or other valued tasks. This is a high priority given the increasing prevalence of low vision, paucity of low vision rehabilitation providers, and barriers related to access to care, such as transportation and geography, which can be essentially eliminated with telerehabilitation. Another goal of this project is to determine whether significant changes in environmental data collected by Bluetooth low energy beacon sensors can be used as a solution to monitor and indicate when low vision patients’ have abandoned the use of their magnification devices, which has the potential to substantially enhance patient management by providing timely low vision rehabilitation services.