Public health and the eye Interventions to improve functioning, participation, and quality of life in children with visual impairment: a systematic review Ellen B.M. Elsman, MSc a, *, Mo Al Baaj, MSc a , Gerardus H.M.B. van Rens, MD, PhD, Prof a,b , Wencke Sijbrandi, MSc c , Ellen G.C. van den Broek, MSc d , Hilde P.A. van der Aa, PhD a , Wouter Schakel, MSc a , Martijn W. Heymans, PhD e , Ralph de Vries, MSc f , Mathijs P.J. Vervloed, PhD g , Bert Steenbergen, PhD, Prof g , Ruth M.A. van Nispen, PhD a a Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Ophthalmology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands b Department of Ophthalmology, Elkerliek Hospital, Helmond, The Netherlands c Bartime ´us, Zeist, The Netherlands d Royal Dutch Visio, Huizen, The Netherlands e Amerdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands f Medical Library, Vrije Universiteit, Amsterdam, The Netherlands g Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands article info Article history: Received 21 June 2018 Received in revised form 10 January 2019 Accepted 17 January 2019 Available online 28 January 2019 Donald Fong and Johanna Seddon, Editors Keywords: visual impairment children rehabilitation review functioning participation abstract Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children’s well-being, children should be entitled to the most effective rehabilitation programs. We review evi- dence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology. * Corresponding author: Ellen B.M. Elsman, MSc, Amsterdam University Medical Centers, Location VU University Medical Center, PK4X191, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Tel: þ31-20-4444795; Fax: þ31-20-4444745. E-mail address: e.elsman@vumc.nl (E.B.M. Elsman). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/survophthal 0039-6257/$ e see front matter ª 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). https://doi.org/10.1016/j.survophthal.2019.01.010 survey of ophthalmology 64 (2019) 512 e557