Impacto do uso de lentes filtrantes em pacientes com baixa visão
Data
2024-10-15
Autores
Silva, André Leite da 
Orientadores
Ferraz, Nívea Nunes
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Pacientes com baixa visão podem ser favorecidos por programas de habilitação e reabilitação visual para potencialização e melhor uso da visão residual por meio da adaptação de recursos de tecnologia assistiva. Dentre estes recursos estão as lentes filtrantes, que visam promover a atenuação das radiações luminosas que atingem os olhos, proporcionando conforto, proteção e melhora da visão funcional, principalmente quando há queixa de fotofobia e ofuscamento. Desta forma, este estudo teve por objetivo investigar a melhora do conforto visual e o impacto nas funções visuais com o uso de lentes filtrantes em pacientes com baixa visão.
Métodos: Foram incluídos participantes que obedeciam aos seguintes critérios de inclusão: idade maior ou igual a 10 anos; acuidade visual (AV) para longe no melhor olho com a melhor correção óptica entre 0,6 logMAR e 1,3 logMAR; queixa de fotofobia e sintomas associados; assinatura do termo de consentimento livre e esclarecido para participação em pesquisa. Foi elaborado e aplicado em entrevistas individuais um Questionário de Impacto Visual Funcional por Fotofobia e Ofuscamento (QIVFFO), que incluiu 28 questões sobre a presença e a intensidade de sintomas na exposição à claridade/luminosidade e dificuldade para a realização de tarefas diárias. As questões foram agrupadas em dois principais domínios, sintomatologia (questões 1 a 4 e 15 a 18) e funcionamento visual (questões 5 a 14 e 19 a 28), com cinco possibilidades de resposta em escala Likert, para as quais foi atribuída pontuação zero, 25, 50, 75 ou 100. A partir da média aritmética da pontuação, foram calculados os escores dos domínios e o escore global de impacto visual funcional por fotofobia e ofuscamento, sendo que quanto menor a pontuação, pior a visão funcional. Os participantes foram submetidos a exame oftalmológico completo, avaliação das funções visuais (AV, sensibilidade ao contraste e visão de cores) e teste com lentes filtrantes. As funções visuais foram avaliadas com a lente filtrante prescrita, e três meses após a prescrição, o participante foi contatado por telefone para reaplicação do questionário, em caso de aquisição das lentes. Os resultados do QIVFFO foram comparados antes e após a prescrição da lente filtrante e foi avaliada a associação entre a melhora do escore do escore global e: causa principal da baixa visão, presença de opacidade de meios, cor da íris, funções visuais. Os resultados foram analisados utilizando-se o aplicativo Stata Data Analysis and Statistical Software versão 14. O nível de significância estatística foi considerado como p < 0,05.
Resultados: Foram incluídos 33 participantes (60,6% do sexo masculino), com idade variando de 10 a 78 anos (média = 35 ± 20 anos). Das lentes filtrantes prescritas, a maioria (57,6%) era de pigmento resultante cinza, seguido por marrom (24,2%), âmbar (6,1%), azul (6,1%), amarelo (3,0%) e vermelho (3,0%). Os resultados de AV e sensibilidade ao contraste foram comparáveis sem e com o filtro. A visão de cores foi estatisticamente pior com a lente filtrante (p < 0,005). Antes da prescrição do filtro, o escore global de impacto visual funcional por fotofobia e ofuscamento medido pelo QIVFFO foi em média 61 ± 15, e os escores dos domínios sintomatologia e funcionamento visual, 69 ± 13 e 57 ± 17, respectivamente. Dezessete dos 33 participantes (51,5%) fizeram a aquisição da lente prescrita, houve melhora estatisticamente significante do escore global (em média 23 pontos) e também dos domínios. A melhora do escore foi significantemente associada (p = 0,038) à presença opacidades de meios oculares, sem relação com causa da baixa visão, cor da íris, AV, sensibilidade ao contraste e visão de cores.
Conclusões: As lentes filtrantes promoveram melhora do conforto visual neste grupo de participantes com baixa visão, porém sem impacto positivo nas funções visuais.
Purpose: Patients with low vision can benefit from visual habilitation and rehabilitation programs to enhance and better use residual vision by adapting assistive technology resources. Among the devices used are filtering lenses, which aim to promote the attenuation of light radiation that reaches the eyes, providing comfort, protection, and improved functional vision, especially when there are complaints of photophobia and glare. Therefore, this study aimed to investigate the improvement in visual comfort and the impact on visual functions using filtering lenses in patients with low vision. Methods: Participants who met the following inclusion criteria were included: age greater than or equal to 10 years; distance visual acuity (VA) in the betterseeing eye with the best optical correction between 0.6 logMAR and 1.3 logMAR; complaint of photophobia and associated symptoms; signing the free and informed consent form for research participation. A Functional Visual Impact Questionnaire due to Photophobia and Glare (QIVFFO) was developed and applied in individual interviews, which included 28 questions about the presence and intensity of symptoms when exposed to light and difficulty in carrying out daily tasks. The questions were grouped into two main domains, symptoms (questions 1 to 4 and 15 to 18) and visual functioning (questions 5 to 14 and 19 to 28), with five possible responses on a Likert scale, for which a score was assigned zero, 25, 50, 75 or 100. From the arithmetic mean of the score, the domain scores and the overall functional visual impact score due to photophobia and glare were calculated, with the lower the score, the worse the functional vision. Participants underwent a complete ophthalmological examination, assessment of visual functions (VA, contrast sensitivity, and color vision), and testing with filtering lenses. Visual functions were assessed with the prescribed filtering lens, and three months after prescription, the participant was contacted by telephone to readminister the questionnaire, in case of purchasing the lenses. The QIVFFO results were compared before and after the prescription of the filtering lens and the association between the improvement in the global score and: the main cause of low vision, presence of media opacity, iris color, and visual functions was evaluated. The results were analyzed using the Stata Data Analysis and Statistical Software version 14 application. The level of statistical significance was considered as p < 0.05. Results: Thirtythree participants were included (60.6% male), with ages ranging from 10 to 78 years (mean = 35 ± 20 years). Of the filtering lenses prescribed, the majority (57.6%) had a gray pigment, followed by brown (24.2%), amber (6.1%), blue (6.1%), yellow (3.0%) and red (3.0%). AV and contrast sensitivity results were comparable without and with the filter. Color vision was statistically worse with the filtering lens (p < 0.005). Before filter prescription, the global score of functional visual impact due to photophobia and glare measured by QIVFFO was on average 61 ± 15, and the scores for the symptomatology and visual functioning domains were 69 ± 13 and 57 ± 17, respectively. Seventeen of the 33 participants (51.5%) purchased the prescribed lens, there was a statistically significant improvement in the global score (on average 23 points) and also in the domains. The improvement in the score was significantly associated (p = 0.038) with the presence of ocular media opacities, unrelated to the cause of low vision, iris color, VA, contrast sensitivity and color vision. Conclusions: Filtering lenses improved visual comfort in this group of participants with low vision, but without positively impacting visual functions.
Purpose: Patients with low vision can benefit from visual habilitation and rehabilitation programs to enhance and better use residual vision by adapting assistive technology resources. Among the devices used are filtering lenses, which aim to promote the attenuation of light radiation that reaches the eyes, providing comfort, protection, and improved functional vision, especially when there are complaints of photophobia and glare. Therefore, this study aimed to investigate the improvement in visual comfort and the impact on visual functions using filtering lenses in patients with low vision. Methods: Participants who met the following inclusion criteria were included: age greater than or equal to 10 years; distance visual acuity (VA) in the betterseeing eye with the best optical correction between 0.6 logMAR and 1.3 logMAR; complaint of photophobia and associated symptoms; signing the free and informed consent form for research participation. A Functional Visual Impact Questionnaire due to Photophobia and Glare (QIVFFO) was developed and applied in individual interviews, which included 28 questions about the presence and intensity of symptoms when exposed to light and difficulty in carrying out daily tasks. The questions were grouped into two main domains, symptoms (questions 1 to 4 and 15 to 18) and visual functioning (questions 5 to 14 and 19 to 28), with five possible responses on a Likert scale, for which a score was assigned zero, 25, 50, 75 or 100. From the arithmetic mean of the score, the domain scores and the overall functional visual impact score due to photophobia and glare were calculated, with the lower the score, the worse the functional vision. Participants underwent a complete ophthalmological examination, assessment of visual functions (VA, contrast sensitivity, and color vision), and testing with filtering lenses. Visual functions were assessed with the prescribed filtering lens, and three months after prescription, the participant was contacted by telephone to readminister the questionnaire, in case of purchasing the lenses. The QIVFFO results were compared before and after the prescription of the filtering lens and the association between the improvement in the global score and: the main cause of low vision, presence of media opacity, iris color, and visual functions was evaluated. The results were analyzed using the Stata Data Analysis and Statistical Software version 14 application. The level of statistical significance was considered as p < 0.05. Results: Thirtythree participants were included (60.6% male), with ages ranging from 10 to 78 years (mean = 35 ± 20 years). Of the filtering lenses prescribed, the majority (57.6%) had a gray pigment, followed by brown (24.2%), amber (6.1%), blue (6.1%), yellow (3.0%) and red (3.0%). AV and contrast sensitivity results were comparable without and with the filter. Color vision was statistically worse with the filtering lens (p < 0.005). Before filter prescription, the global score of functional visual impact due to photophobia and glare measured by QIVFFO was on average 61 ± 15, and the scores for the symptomatology and visual functioning domains were 69 ± 13 and 57 ± 17, respectively. Seventeen of the 33 participants (51.5%) purchased the prescribed lens, there was a statistically significant improvement in the global score (on average 23 points) and also in the domains. The improvement in the score was significantly associated (p = 0.038) with the presence of ocular media opacities, unrelated to the cause of low vision, iris color, VA, contrast sensitivity and color vision. Conclusions: Filtering lenses improved visual comfort in this group of participants with low vision, but without positively impacting visual functions.
Descrição
Citação
SILVA, André da. Impacto do uso de lentes filtrantes em pacientes com baixa visão. 2024. 109 f. Dissertação (Mestrado Profissional em Tecnologia, Gestão e Saúde Ocular) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.