Exploring the Role of Telemedicine in Low Vision Rehabilitation in Patients with Heredomacular Degeneration – A Novel Concept

Background Teleophthalmology is widely used for screening and diagnosis of many eye disorders. But its role in low vision rehabilitation is unexplored. The purpose of this study was to explore the feasibility of teleophthalmology for visual rehabilitation. Methods We prospectively enrolled 15 patients (age range 12-30 years, mean 16±3.2 years) with heredomacular degeneration with reduced central vision but healthy paracentral retina. We used visual stimulation and biofeedback with video game play. After the baseline investigations, the patients were given a compact disc with the video game and were trained to play the game. Subsequently, they did 40 hours of the visual training at home which was monitored using teleophthalmology by us at our tertiary institute. We used video chat and screen sharing software to guide the patients and monitor compliance. The primary outcome was feasibility of monitoring visual training remotely and secondary outcome was improvement in visual function. Results Seven patients returned for follow up after completing the training. The visual acuity improved from 0.74±0.29 to 0.66±0.32 logMAR (p=0.043). There was significant improvement in contrast sensitivity (p=0.023) and fixation stability (p=0.018). The vision related quality of life questionnaire showed improved scores. The ease of communication, patient comfort were high. The office visits were limited to two. Conclusions Our study showed preliminary evidence of benefit of teleophthalmology in visual rehabilitation and monitoring. The reduced visits would likely promote compliance and reduce economic burden of the rehabilitatory training.