Evidence for your practice: Improving Reading Performance in Older Adults with Low Vision

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Article: Smallfield, S., Kaldenberg, J. (2020). Occupational therapy interventions to improve reading performance of older adults with low vision: A systematic review. The American Journal of Occupational Therapy, 74(1), 7401185030p1- 7401185030p18. 

Rationale: Experiencing low vision can impact many aspects of a person’s day-to-day life, including reading, a skill required for participation in numerous occupations. This study sought to determine the effectiveness of occupational therapy interventions targeting improvement of reading abilities required for older adults with low vision to participate in their occupations. 

Method: Researchers conducted a systematic review of sixteen articles addressing occupational therapy interventions targeting reading performance. Evidence for the interventions presented in this article was labeled either as strong (consistent results from high-quality studies, usually RCTs); moderate (sufficient evidence, some limitations present); or low (evidence from low-level studies and is insufficient for conclusively assessing impact on health and occupational outcomes).

Results: Three intervention themes were identified from the reviewed literature: 

(1) Technology – There is moderate evidence supporting the use of stand-based electronic magnification (e.g. closed circuit television [CCTV]) to enhance reading abilities compared to other low vision devices. Participants using CCTV experienced increase reading speed and acuity and decreased reading errors.

There is low evidence supporting the use of low vision devices (e.g. handheld magnifiers, high-add spectacles, etc.), vision-specific assistive technology (e.g. OrCam), and mainstream technology (e.g. reading on a tablet or e-reader). 

(2) Visual Skills Training – There is moderate evidence for the use of eccentric viewing training with controlled eye movements for clients with central visual field impairments. This intervention was found to result in increased reading speed, duration, and comprehension.

There is low evidence for the effectiveness of visual skills training in improving reading performance in older adults with hemianopsia.

(3) Multicomponent Interventions – There is strong evidence supporting interprofessional low vision programs that include occupational therapy. Occupational therapists can run groups; support problem-solving; modify environments; educate clients about their condition, adjustment to vision loss, available resources, and adaptive strategies; and train clients to use low vision devices and perform daily occupations.

There is strong evidence supporting multicomponent interventions including vision therapy, environmental modification, low vision device prescription and training, and homework to improve reading required for occupational performance in older adults with low vision.

Conclusion & Implications for OT: 

- Low vision that affects reading abilities can limit participation in a wide variety of occupations. Reading skills should be addressed by occupational therapists who are working with older adults with low vision in order to support occupational participation.

- Evidence-based OT interventions to support reading for older adults with low vision include comprehensive low vision rehabilitation, stand-based electronic magnification, eccentric viewing training using the steady eye technique, and multicomponent low vision interventions. The evidence behind other interventions targeting this goal and population varies, and should be considered prior to use. 

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