PURPOSE: An image-enhanced educational and motivational video was developed for patients with low vision and their caretakers. Impact on knowledge, self-efficacy, and attitudes was assessed.

METHODS: The video incorporated cognitive restructuring to change emotional response; a "virtual home"; a veridical simulation of vision with age-related macular degeneration and contrast enhancement of the video. Subjects (median age 77.5) were randomized into control (n=79) and intervention (n=75) groups. Telephone interviews were at baseline, 2 weeks and 3 months. Main outcome measures were: knowledge (eight questions), self-efficacy score (seven questions), adaptive behaviors (10 questions), willingness to use devices, and emotional response (4-point scales).

RESULTS: The intervention group showed a statistically significant improvement in knowledge, (difference of 1.1 out of eight questions, p<0.001). Change in use of books-on-tape was more for the intervention group than for controls (p=0.005). The intervention group increased use of books-on-tape from 28 to 51% whereas the control group did not (34% at both times). However, there was no significant change in the use of other assistive devices, including magnifiers. Both groups increased adaptive behaviors. There was no significant difference in change of self-efficacy score or in emotional affect between the two groups.

CONCLUSIONS: The video had a small, but statistically significant impact on knowledge and willingness to use assistive devices. There was little impact on adaptive behaviors and emotional affect. The minimal changes in outcome were disappointing, but this does not minimize the importance of patient education; it just emphasizes how hard it is to effect change.