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Zhou J, Hou J, Li S, Zhang J. The effect of duration between sessions on microperimetric biofeedback training in patients with maculopathies. Sci Rep 2024; 14:12524. [PMID: 38822030 PMCID: PMC11143284 DOI: 10.1038/s41598-024-63327-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Abstract
Aim of this study was to explore the optimal training interval and times of microperimetric biofeedback training (MBFT) in maculopathies. Twenty-nine patients with maculopathies were divided into two groups: daily training (Group A) or alternate daily training (Group B). Both groups underwent 15 MBFT sessions. We compared the BCVA, reading speed, and fixation stability at baseline, after 5, 10, 15 sessions. After 15 sessions of MBFT, all visual parameters in both groups improved. There was a significant increase in BCVA after 5 sessions in both groups (P=0.016, and P<0.001 respectively), but Group A showed further improvement after 10 sessions (P<0.001). Regarding reading speed, Group A showed significant improvement from baseline after 15 sessions(P=0.020), Group B improved significantly after 5 sessions (P=0.047) and continued to improve after 10 sessions (P=0.030). Additionally, P1 and LgBCEA of Group A significantly improved after 10 sessions (P=0.001, and P=0.001 respectively), while Group B significantly improved after 5 sessions (P=0.002, and P<0.001 respectively). There was no significant difference in visual outcomes between the two groups (P>0.05) except LgBCEA (P=0.046) after 15 sessions. We concluded that the both MBFT frequencies are effective at improving vision and quality of life in patients with maculopathies. The alternate daily training group showed less time-dependent of improvement in all parameters and a greater benefit in fixation stability. Ten sessions are the optimal number of treatment sessions for alternate daily training.
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Affiliation(s)
- Jie Zhou
- Aier School of Ophthalmology, Central South University, Changsha, 410000, Hunan, China
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, 510040, Guangdong, China
| | - Jintong Hou
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, 410000, Hunan, China
- Sichuan Eye Hospital, Aier Eye Hospital Group, Chengdu, 610047, Sichuan, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, 410000, Hunan, China.
- Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, 510040, Guangdong, China.
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Rubin GS, Crossland MD, Dunbar HM, Brown GM, Petriti B, Roche H, Sirrell SV, Broom KT, Hamilton RD. Eccentric Viewing Training for Age-Related Macular Disease: Results of a Randomized Controlled Trial (the EFFECT Study). OPHTHALMOLOGY SCIENCE 2024; 4:100422. [PMID: 38187128 PMCID: PMC10767206 DOI: 10.1016/j.xops.2023.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024]
Abstract
Purpose Eccentric viewing training for macular disease has been performed for > 40 years, but no large studies including control groups have assessed the benefits of this training. The EFFECT (Eccentric Fixation From Enhanced Clinical Training) study is a large randomized controlled trial of 2 types of eccentric viewing training. Design Randomized controlled trial. Participants Two hundred adults with age-related macular disease. Methods Participants were randomized to either of the following: (1) a control group; (2) a group receiving supervised reading support; (3) a group receiving 3 sessions of training to optimize the use of their own preferred retinal locus; or (4) a group receiving 3 sessions of biofeedback training of a theoretically optimal trained retinal locus. All participants received standard low-vision rehabilitation. Main Outcome Measures The primary outcome was patient-reported visual task ability measured on the Activity Inventory instrument at goal level. Secondary outcomes included reading performance and fixation stability. Results There was no difference between groups on change in task ability (F(3,174) = 1.48, P = 0.22) or on any of the secondary outcome measures. Visual acuity and contrast sensitivity fell in all groups, suggesting that disease progression outweighed any benefit of training. Conclusions Eccentric viewing training did not systematically improve task ability, reading performance, or fixation stability in this study. Our results do not support the routine use of eccentric viewing training for people with progressing age-related macular disease, although this training may help people with end-stage disease. Rehabilitation of an inherently progressive condition is challenging. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Gary S. Rubin
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Michael D. Crossland
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Hannah M.P. Dunbar
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Graham M. Brown
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Bledi Petriti
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Hannah Roche
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | - Sarah V. Sirrell
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
| | | | - Robin D. Hamilton
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, London, UK
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Silvestri V, De Rossi F, Piscopo P, Perna F, Mastropasqua L, Turco S, Rizzo S, Mariotti SP, Amore F. The Effect of Varied Microperimetric Biofeedback Training in Central Vision Loss: A Randomized Trial. Optom Vis Sci 2023; 100:737-744. [PMID: 37747894 DOI: 10.1097/opx.0000000000002073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
SIGNIFICANCE This investigation reports for the first time the effects of different microperimetric biofeedback strategies in visually impaired subjects with central field loss. PURPOSE This study aimed to evaluate the effects of two MP-3 microperimeter biofeedback strategies on the visual performance of subjects with central vision loss. Moreover, changes between the groups were compared to provide indications of practice with biofeedback stimulation in subjects with central vision loss. METHODS Using simple randomization, 19 participants were trained according to two different biofeedback stimulation approaches using the MP-3 microperimeter. Patients were assigned to two different groups: subjects trained for 2 days a week (group A) and 3 days a week (group B). The patients in each group were randomized to perform a total of 10 or 15 sessions. RESULTS Fixation stability increased from 4.5 ± 2.8 to 2.3 ± 2.2° 2 and from 8.2 ± 6.9 to 1.4 ± 1° 2 after 2 and 3 weekly biofeedback training sessions, respectively ( P < .05). Biofeedback training induced a significant improvement of 40.7 and 29.4% in reading speed for groups A and B, respectively ( P < .05). A comparison of two weekly biofeedback training sessions with three weekly biofeedback sessions demonstrated greater fixation stability in group B ( P < .05). CONCLUSIONS This study concludes that a biofeedback intervention is effective in enhancing oculomotor control in patients with central vision loss. In our study, a more intensive biofeedback strategy seemed to produce significantly better results in terms of functional vision parameters.
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Affiliation(s)
| | | | | | | | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Silvio Paolo Mariotti
- Department of Chronic Diseases and Health Promotion, World Health Organization, Geneva, Switzerland
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Horie S, Corradetti G, Esmaeilkhanian H, Sadda SR, Cheung CMG, Ham Y, Chang A, Takahashi T, Ohno-Matsui K. Microperimetry in Retinal Diseases. Asia Pac J Ophthalmol (Phila) 2023; 12:211-227. [PMID: 36971707 DOI: 10.1097/apo.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 03/29/2023] Open
Abstract
Retinal microperimetry (MP) is a procedure that assesses the retinal sensitivity while the fundus is directly observed, and an eye tracker system is active to compensate for involuntary eye movements during testing. With this system, the sensitivity of a small locus can be accurately determined, and it has become an established ophthalmic test for retinal specialists. Macular diseases are characterized by chorioretinal changes; therefore, the condition of the retina and choroid requires careful and detailed evaluations to perform effective therapy. Age-related macular degeneration is a representative retinal disease in which the macular function has been evaluated by the visual acuity throughout the course of the disease process. However, the visual acuity represents the physiological function of only the central fovea, and the function of the surrounding macular area has not been sufficiently evaluated throughout the different stages of the macula disease process. The new technique of MP can compensate for such limitations by being able to test the same sites of the macular area repeatedly. This is especially useful in the recent management of age-related macular degeneration or diabetic macular edema during anti-vascular endothelial growth factor treatments because MP can assess the effectiveness of the treatment. MP examinations are also valuable in diagnosing Stargardt disease as they can detect visual impairments before any abnormalities are found in the retinal images. The visual function needs to be carefully assessed along with morphologic observations by optical coherence tomography. In addition, the assessment of retinal sensitivity is useful in the presurgical or postsurgical evaluations.
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Affiliation(s)
- Shintaro Horie
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - Houri Esmaeilkhanian
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, CA, US
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, US
| | | | - Yeji Ham
- Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Andrew Chang
- Sydney Eye Hospital, The University of Sydney, Sydney Retina Clinic and Day Surgery, Sydney, Australia
| | - Tomonari Takahashi
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
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Newman NJ, Yu-Wai-Man P, Subramanian PS, Moster ML, Wang AG, Donahue SP, Leroy BP, Carelli V, Biousse V, Vignal-Clermont C, Sergott RC, Sadun AA, Fernández GR, Chwalisz BK, Banik R, Bazin F, Roux M, Cox ED, Taiel M, Sahel JA. Randomized trial of bilateral gene therapy injection for m.11778G > A MT-ND4 Leber optic neuropathy. Brain 2022; 146:1328-1341. [PMID: 36350566 PMCID: PMC10115230 DOI: 10.1093/brain/awac421] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/20/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022] Open
Abstract
Leber hereditary optic neuropathy (LHON) is an important example of mitochondrial blindness with the m.11778G > A mutation in the MT-ND4 gene being the most common disease-causing mitochondrial DNA (mtDNA) variant worldwide. The REFLECT phase 3 pivotal study is a randomized, double-masked, placebo-controlled trial investigating the efficacy and safety of bilateral intravitreal injection of lenadogene nolparvovec in patients with a confirmed m.11778G > A mutation, using a recombinant adeno-associated virus vector 2, serotype 2 (rAAV2/2-ND4). The first-affected eye received gene therapy; the fellow (affected/not-yet-affected) eye was randomly injected with gene therapy or placebo. The primary endpoint was the difference in change from baseline of best-corrected visual acuity (BCVA) in second-affected/not-yet-affected eyes treated with lenadogene nolparvovec versus placebo at 1.5 years post-treatment, expressed in logarithm of the minimal angle of resolution (LogMAR). Forty-eight patients were treated bilaterally and 50 unilaterally. At 1.5 years, the change from baseline in BCVA was not statistically different between second-affected/not-yet-affected eyes receiving lenadogene nolparvovec and placebo (primary endpoint). A statistically significant improvement in BCVA was reported from baseline to 1.5 years in lenadogene nolparvovec-treated eyes: -0.23 LogMAR for the first-affected eyes of bilaterally treated patients (p < 0.01); and -0.15 LogMAR for second-affected/not-yet-affected eyes of bilaterally treated patients and the first-affected eyes of unilaterally treated patients (p < 0.05). The mean improvement in BCVA from nadir to 1.5 years was -0.38 (0.052) LogMAR and -0.33 (0.052) LogMAR in first-affected and second-affected/not-yet-affected eyes treated with lenadogene nolparvovec, respectively (bilateral treatment group). A mean improvement of -0.33 (0.051) LogMAR and -0.26 (0.051) LogMAR was observed in first-affected lenadogene nolparvovec-treated eyes and second-affected/not-yet-affected placebo-treated eyes, respectively (unilateral treatment group). The proportion of patients with one or both eyes on-chart at 1.5 years was 85.4% and 72.0% for bilaterally and unilaterally treated patients, respectively. The gene therapy was well tolerated, with no systemic issues. Intraocular inflammation, which was mostly mild and well controlled with topical corticosteroids, occurred in 70.7% of lenadogene nolparvovec-treated eyes versus 10.2% of placebo-treated eyes. Among eyes treated with lenadogene nolparvovec, there was no difference in the incidence of intraocular inflammation between bilaterally and unilaterally treated patients. Overall, the REFLECT trial demonstrated an improvement of BCVA in LHON eyes carrying the m.11778G > A mtDNA mutation treated with lenadogene nolparvovec or placebo to a degree not reported in natural history studies and supports an improved benefit/risk profile for bilateral injections of lenadogene nolparvovec relative to unilateral injections.
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Affiliation(s)
- Nancy J Newman
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Prem S Subramanian
- Sue Anschutz-Rodgers University of Colorado Eye Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mark L Moster
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sean P Donahue
- Department of Ophthalmology, Neurology, and Pediatrics, Vanderbilt University, and Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bart P Leroy
- Department of Ophthalmology and Center for Medical Genetics, Ghent University Hospital, and Department of Head & Skin, Ghent University, Ghent, Belgium
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogenetica, Bologna, Italy
- Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Valerie Biousse
- Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Catherine Vignal-Clermont
- Department of Neuro Ophthalmology and Emergencies, Rothschild Foundation Hospital, Paris, France
- Centre Hospitalier National D'Ophtalmologie des Quinze Vingts, Paris, France
| | - Robert C Sergott
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, PA, USA
| | - Alfredo A Sadun
- Doheny Eye Institute, UCLA School of Medicine, Los Angeles, CA, USA
| | | | - Bart K Chwalisz
- Department of Ophthalmology, Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA
| | - Rudrani Banik
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - José-Alain Sahel
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France
- Fondation Ophtalmologique A. de Rothschild, Paris, France
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- CHNO des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC, Paris, France
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Bozkurt Oflaz A, Turgut Öztürk B, Gönül Ş, Bakbak B, Gedik Ş, Okudan S. Short-Term Clinical Results of Preferred Retinal Locus Training. Turk J Ophthalmol 2022; 52:14-22. [PMID: 35196835 PMCID: PMC8876780 DOI: 10.4274/tjo.galenos.2021.73368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives This study evaluated acoustic biofeedback training using microperimetry in patients with foveal scars and an eligible retinal locus for better fixation. Materials and Methods A total of 29 eligible patients were enrolled in the study. The acoustic biofeedback training module in the MAIA (Macular Integrity Assessment, CenterVue®, Italy) microperimeter was used for training. To determine the treatment efficacy, the following variables were compared before and after testing: best corrected visual acuity (BCVA); MAIA microperimeter full threshold 4-2 test parameters of average threshold value, fixation parameters P1 and P2, and bivariate contour ellipse area (BCEA) for 63% and 95% of fixation points; contrast sensitivity (CSV 1000E Contrast Sensitivity Test); reading speed using the Minnesota Low-Vision Reading Test (MNREAD reading chart); and quality of life (NEI-VFQ-25). In addition, fixation stability parameters were recorded during each session. Results The study group consisted of 29 patients with a mean age of 68.72±8.34 years. Median BCVA was initially 0.8 (0.2-1.6) logMAR and was 0.8 (0.1-1.6) logMAR after 8 weeks of preferred retinal locus training (p=0.003). The fixation stability parameter P1 improved from a mean of 21.28±3.08% to 32.69±3.69% (p=0.001) while mean P2 improved from 52.79±4.53% to 68.31±3.89% (p=0.001). Mean BCEA 63% decreased from 16.11±2.27°2 to 13.34±2.26°2 (p=0.127) and mean BCEA 95% decreased from 45.87±6.72°2 to 40.01±6.78°2 (p=0.247) after training. Binocular reading speed was 38.28±6.25 words per minute (wpm) before training and 45.34±7.35 wpm after training (p<0.001). Statistically significant improvement was observed in contrast sensitivity and quality of life questionnaire scores after training. Conclusion Beginning with the fifth session, biofeedback training for a new trained retinal locus improved average sensitivity, fixation stability, reading speed, contrast sensitivity, and quality of life in patients with macular scarring.
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Affiliation(s)
- Ayşe Bozkurt Oflaz
- University of Health Sciences Turkey, Adana City Training and Research Hospital, Clinic of Ophthalmology, Adana, Turkey
| | - Banu Turgut Öztürk
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Şaban Gönül
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Berker Bakbak
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Şansal Gedik
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Süleyman Okudan
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
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Tonti E, Budini M, Vingolo EM. Visuo-Acoustic Stimulation's Role in Synaptic Plasticity: A Review of the Literature. Int J Mol Sci 2021; 22:ijms221910783. [PMID: 34639122 PMCID: PMC8509608 DOI: 10.3390/ijms221910783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022] Open
Abstract
Brain plasticity is the capacity of cerebral neurons to change, structurally and functionally, in response to experiences. This is an essential property underlying the maturation of sensory functions, learning and memory processes, and brain repair in response to the occurrence of diseases and trauma. In this field, the visual system emerges as a paradigmatic research model, both for basic research studies and for translational investigations. The auditory system remains capable of reorganizing itself in response to different auditory stimulations or sensory organ modification. Acoustic biofeedback training can be an effective way to train patients with the central scotoma, who have poor fixation stability and poor visual acuity, in order to bring fixation on an eccentrical and healthy area of the retina: a pseudofovea. This review article is focused on the cellular and molecular mechanisms underlying retinal sensitivity changes and visual and auditory system plasticity.
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Papageorgiou E, Lazari K, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1970533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, New Jersey, USA
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Li S, Deng X, Zhang J. An Overview of Preferred Retinal Locus and Its Application in Biofeedback Training for Low-Vision Rehabilitation. Semin Ophthalmol 2021; 37:142-152. [PMID: 34436959 DOI: 10.1080/08820538.2021.1931355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Central vision loss (CVL) caused by macular damage generally disables common daily tasks, which cannot be reversed by present treatments. Fortunately, it has been found that biofeedback training by inducing or reinforcing preferred retinal locus (PRL) as an eccentric fixation reference contributes to the improvement of visual performance in patients with CVL. However, the clinical application is still under controversy due to poor knowledge of its fundamental and inconsistent practical standards. This article aims to summarize the possible rationale for the development, location, re-location and evaluating indicators of PRL, and the general apparatus, protocol, and outcome of biofeedback PRL training.
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Affiliation(s)
- Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Guangzhou Aier Eye Hospital, Guangzhou, Guangdong China
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10
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Newman NJ, Yu-Wai-Man P, Carelli V, Moster ML, Biousse V, Vignal-Clermont C, Sergott RC, Klopstock T, Sadun AA, Barboni P, DeBusk AA, Girmens JF, Rudolph G, Karanjia R, Taiel M, Blouin L, Smits G, Katz B, Sahel JA. Efficacy and Safety of Intravitreal Gene Therapy for Leber Hereditary Optic Neuropathy Treated within 6 Months of Disease Onset. Ophthalmology 2021; 128:649-660. [PMID: 33451738 DOI: 10.1016/j.ophtha.2020.12.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a single intravitreal injection of rAAV2/2-ND4 in subjects with visual loss from Leber hereditary optic neuropathy (LHON). DESIGN RESCUE is a multicenter, randomized, double-masked, sham-controlled, phase 3 clinical trial. PARTICIPANTS Subjects with the m.11778G>A mitochondrial DNA mutation and vision loss ≤6 months from onset in 1 or both eyes were included. METHODS Each subject's right eye was randomly assigned (1:1) to treatment with rAAV2/2-ND4 (single injection of 9 × 1010 viral genomes in 90 μl) or to sham injection. The left eye received the treatment not allocated to the right eye. MAIN OUTCOME MEASURES The primary end point was the difference of the change from baseline in best-corrected visual acuity (BCVA) between rAAV2/2-ND4-treated and sham-treated eyes at week 48. Other outcome measures included contrast sensitivity, Humphrey visual field perimetry, retinal anatomic measures, and quality of life. Follow-up extended to week 96. RESULTS Efficacy analysis included 38 subjects. Mean age was 36.8 years, and 82% were male. Mean duration of vision loss at time of treatment was 3.6 months and 3.9 months in the rAAV2/2-ND4-treated eyes and sham-treated eyes, respectively. Mean baseline logarithm of the minimum angle of resolution (logMAR) BCVA (standard deviation) was 1.31 (0.52) in rAAV2/2-ND4-treated eyes and 1.26 (0.62) in sham-treated eyes, with a range from -0.20 to 2.51. At week 48, the difference of the change in BCVA from baseline between rAAV2/2-ND4-treated and sham-treated eyes was -0.01 logMAR (P = 0.89); the primary end point of a -0.3 logMAR (15-letter) difference was not met. The mean BCVA for both groups deteriorated over the initial weeks, reaching the worst levels at week 24, followed by a plateau phase until week 48, and then an improvement of +10 and +9 Early Treatment Diabetic Retinopathy Study letters equivalent from the plateau level in the rAAV2/2-ND4-treated and sham-treated eyes, respectively. CONCLUSIONS At 96 weeks after unilateral injection of rAAV2/2-ND4, LHON subjects carrying the m.11778G>A mutation treated within 6 months after vision loss achieved comparable visual outcomes in the injected and uninjected eyes.
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Affiliation(s)
- Nancy J Newman
- Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom; Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy; Unit of Neurology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Mark L Moster
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Valerie Biousse
- Departments of Ophthalmology, Neurology, and Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Catherine Vignal-Clermont
- Department of Neuro-Ophthalmology and Emergencies, Rothschild Foundation Hospital, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France
| | - Robert C Sergott
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; German Center for Neurodegenerative Diseases, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Alfredo A Sadun
- Doheny Eye Institute/UCLA School of Medicine, Los Angeles, California
| | - Piero Barboni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Adam A DeBusk
- Departments of Neurology and Ophthalmology, Wills Eye Hospital and Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Günther Rudolph
- Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany
| | - Rustum Karanjia
- Doheny Eye Institute/UCLA School of Medicine, Los Angeles, California; Department of Ophthalmology, University of Ottawa Eye, Ottawa, Ontario, Canada
| | | | | | | | | | - José-Alain Sahel
- Centre Hospitalier National d'Ophtalmologie des Quinze Vingts, Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; Fondation Ophtalmologique A. de Rothschild, Paris, France; Department of Ophthalmology, The University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; CHNO des Quinze-Vingts, Institut Hospitalo-Universitaire FOReSIGHT, INSERM-DGOS CIC, Paris, France
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11
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Das K, Gopalakrishnan S, Dalan D, Velu S, Ratra V, Ratra D. Factors influencing the choice of low‐vision devices for visual rehabilitation in Stargardt disease. Clin Exp Optom 2021; 102:426-433. [DOI: 10.1111/cxo.12867] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
- Kalpita Das
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Sarika Gopalakrishnan
- Department of Optometry, Shanmugha Arts, Science, Technology and Research Academy, Thanjavur, India,
- Department of Low Vision Care, Sankara Nethralaya, Chennai, India,
| | - Daleena Dalan
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Saranya Velu
- Department of Low Vision Care, Sankara Nethralaya, Chennai, India,
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
| | - Dhanashree Ratra
- Department of Vitreoretinal Diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India,
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12
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Li S, Deng X, Chen Q, Lin H, Zhang J. Characteristics of Preferred Retinal Locus in Eyes with Central Vision Loss Secondary to Different Macular Lesions. Semin Ophthalmol 2021; 36:734-741. [PMID: 33764273 DOI: 10.1080/08820538.2021.1900289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Preferred retinal locus (PRL) training has been applied to low-vision rehabilitation for patients with central vision loss (CVL). This study aimed to explore the characteristics of a natural PRL in eyes with different macular lesions. The data may be useful in customizing training programs. METHODS A total of 72 eyes with CVL were included and assigned into two groups. In group A, 29 eyes diagnosed with macular holes featured relatively sharp borders and small areas of lesions. In group B, 44 eyes showed lesions characterized by irregular borders and large areas. The PRL location relative to a scotoma in the retina, fixation stability, and the average threshold surrounding the PRL were determined and compared between the two groups. RESULTS In group A, the PRL was located above in 48.28%, below in 27.59%, left in 62.07%, right in 31.03%, and inside in 3.45% of the eyes. In group B, the PRL was located above in 39.53%, below in 4.65%, left in 44.19%, right in 6.98%, and inside in 27.91% of eyes. The amount of retinal displacement occurring within 1° from an initial reference point (P< .05) and the 95% bivariate contour ellipse area (P< .05) in group A were respectively higher and lower than those in group B. However, the average thresholds around the PRLs in the two groups showed no significant difference (P > .05). CONCLUSIONS A PRL to the left of or above a scotoma tends to develop to avoid the right and inferior field defect, regardless of the scale and boundary of lesions. Although light sensitivity around a PRL shows no relation to lesion features, fixation stability is worse in irregular and large lesions.
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Affiliation(s)
- Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Qianyin Chen
- Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Huimin Lin
- Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China.,Guangzhou Aier Eye Hospital, Guangzhou, Guangdong, China
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13
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Silvestri V, Turco S, Piscopo P, Guidobaldi M, Perna F, Sulfaro M, Amore F. Biofeedback stimulation in the visually impaired: a systematic review of literature. Ophthalmic Physiol Opt 2021; 41:342-364. [PMID: 33733527 DOI: 10.1111/opo.12787] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is estimated that approximately 1.3 billion people live with some form of distance or near visual impairment. Numerous studies have been carried out to evaluate the effects of biofeedback (BF) and establish if it could be a useful tool in vision rehabilitation for various eye diseases. OBJECTIVE This systematic review aimed: 1) to examine the current evidence of BF efficacy for the rehabilitation of the visually impaired and 2) to describe methodological variations used in previous BF studies to provide recommendations for vision rehabilitation interventions. METHODS A systematic review was conducted in the Medline, PubMed, Cochrane Library and Web of Science databases to collect documents published between January 2000 and May 2020. Of the 1,960 studies identified, 43 met the criteria for inclusion. The following information was collected from each study: sample size, control group, any eye disease, apparatus used, frequency and number of sessions of BF, main outcomes of training and whether a follow-up was conducted. The first group included studies published as scientific articles in peer-reviewed journals. The second group included abstracts of studies presented at peer-reviewed conferences. Publications were also grouped according to the eye disease treated. RESULTS 25 articles and 18 peer-reviewed conference abstracts (PRCAs) were included in this review. BF stimulation is a commonly used technique for the treatment of visual impairment caused by macular disease. Most BF studies evaluate the effect of training on the preferred retinal locus (PRL), particularly with regard to fixation location and stability. Across these studies, participants who received BF intervention improved fixation stability and reading speed. High variability in the number of sessions and the duration of BF training was found. Most studies did not use a control group. CONCLUSIONS The findings of this review present evidence for biofeedback treatment in vision rehabilitation, with improved oculomotor abilities. Currently, it is not possible to formulate evidence-based recommendations for a standard training procedure due to the poor quality of existing randomised controlled trials. High-quality studies are needed to develop standard protocols for a range of eye diseases.
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Affiliation(s)
- Valeria Silvestri
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Simona Turco
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Paola Piscopo
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Margherita Guidobaldi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Fabiana Perna
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Sulfaro
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Filippo Amore
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, World Health Organization Collaborating Centre, International Agency for Prevention of Blindness- Italia Onlus, Rome, Italy.,Fondazione Policlinico Universitario "Agostino Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
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14
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Sahli E, Altinbay D, Bingol Kiziltunc P, Idil A. Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma. Curr Eye Res 2020; 46:731-738. [PMID: 33073619 DOI: 10.1080/02713683.2020.1833348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. MATERIALS AND METHODS 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. RESULTS The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). CONCLUSION Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.
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Affiliation(s)
- Esra Sahli
- Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey
| | - Deniz Altinbay
- Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey.,Department of ophthalmology, Niv Eye Center, Adana, Turkey
| | | | - Aysun Idil
- Department of Ophthalmology, School of Medicine, Ankara University, Ankara, Turkey
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15
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Caputo R, Febbrini Del Magro E, Amoaku WM, Bacci GM, Marziali E, Morales MU. The efficacy of biofeedback visual rehabilitation therapy in patients with infantile nystagmus syndrome: A retrospective study. Eur J Ophthalmol 2020; 31:2101-2106. [PMID: 32627590 DOI: 10.1177/1120672120940981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report fixation stability changes in patients with different forms of infantile nystagmus syndrome (INS), who have undergone a visual rehabilitation through biofeedback fixation training (BFT) with microperimetry (MP). DESIGN Retrospective study. METHODS Patients 6 to 12 years-old with INS who performed BFT with MP. Initially 10 once-weekly followed by eight twice-weekly sessions of BFT during a minimum of 6 months period were performed. Visual acuity (VA) and MP fixation stability indices were analyzed, including displacement from fixation point (P1, P2) and percentage of retinal loci used during fixation attempt (BCEA 63% and 95%). Statistical analysis was conducted at baseline (BL), 10 weeks (W10) and 6 months (M6). RESULTS Twelve patients (mean age 8.9 years.) with INS completed the whole training session. All patients showed significant improvement in the mean BCEA fixation area (deg2): For BCEA@95% BL was 78.0, 46.1 at W10, and 27.4 at M6 (p-value = 0.004). For BCEA@63% BL was 27.3, 15.4 in W10, and 9.17 at M6 (p = 0.01). The ANOVA test for the FS indices of P1 and P2, as well as for BCVA showed no significant difference when compared at the same intervals. CONCLUSION Fixation stability (FS) indices of BCEAs (63% and 95%) improved at W10 and M6, while P1 and P2 showed significant improvement at W10 but not at M6, probably because BCEA involves a much larger area than P1 and P2. VA did not show significant improvement at any time point.
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Affiliation(s)
- Roberto Caputo
- Pediatric Ophthalmology Unit, AOU Meyer Children's Hospital, Florence, Italy
| | | | - Winfried M Amoaku
- Academic Ophthalmology, Division of Clinical Neurosciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Giacomo Maria Bacci
- Pediatric Ophthalmology Unit, AOU Meyer Children's Hospital, Florence, Italy
| | - Elisa Marziali
- Pediatric Ophthalmology Unit, AOU Meyer Children's Hospital, Florence, Italy
| | - Marco U Morales
- Academic Ophthalmology, Division of Clinical Neurosciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies. Int Ophthalmol 2019; 40:305-312. [DOI: 10.1007/s10792-019-01180-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022]
Abstract
Abstract
Purpose
Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient’s PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes.
Methods
Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient’s spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed.
Results
Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B.
Conclusions
This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.
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Iuliano L, Fogliato G, Gorgoni F, Corbelli E, Bandello F, Codenotti M. Idiopathic epiretinal membrane surgery: safety, efficacy and patient related outcomes. Clin Ophthalmol 2019; 13:1253-1265. [PMID: 31409964 PMCID: PMC6643061 DOI: 10.2147/opth.s176120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022] Open
Abstract
This review aims to give to the reader an overview selectively oriented on safety and efficacy of surgery, providing concise and direct answers about crucial questions of trainees and experts. Surgery for idiopathic epiretinal membrane (ERM) is a safe and effective procedure that can achieve long-term stable postoperative visual and anatomical improvement, with an overall low recurrence and complication rate. Young patients, with a short onset of symptoms and with better initial visual acuity achieve higher levels of visual outcome. The preoperative degree of metamorphopsia is the prognostic factor for their postoperative degree. Successful results may be obtained in eyes with specific optical coherence tomography criteria, such as thin ganglion cell layers, thin internal plexiform layer, longer photoreceptors outer segment, regular ellipsoid zone and cone outer segment tips line, and without ectopic inner foveal layer. Internal limiting membrane peeling demonstrates positive anatomical and functional outcomes, but final positions about its safety remain controversial.
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Affiliation(s)
- Lorenzo Iuliano
- Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giovanni Fogliato
- Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Francesca Gorgoni
- Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Eleonora Corbelli
- Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Francesco Bandello
- Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Codenotti
- Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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18
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Ratra D, Rakshit A, Ratra V. Visual rehabilitation using video game stimulation for Stargardt disease. Ther Adv Ophthalmol 2019; 11:2515841419831158. [PMID: 30886944 PMCID: PMC6410391 DOI: 10.1177/2515841419831158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/22/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stargardt disease, a common form of heredomacular degeneration, leads to severe vision loss. Video game play can act as a positive biofeedback to reinforce visual rehabilitation and fixation training. It can potentially lead to visual improvement. This study was done to explore the possibility of visual improvement using video game stimulation for visual rehabilitation in Stargardt disease. METHODS We evaluated eight patients with Stargardt disease who had nonatrophic retina surrounding the area of degeneration at the macula. They underwent extensive baseline testing to determine their Snellen visual acuity, pattern visual evoked potentials, retinal sensitivity, and fixation analysis with microperimetry, electroretinography, fundus photography, optical coherence tomography, and autofluorescence. They were given 40 h of training with video game play and re-evaluated on all the tests. RESULTS They showed both subjective and objective evidence of improvement in visual functions and vision-related tasks. Visual acuity (from 0.77 ± 0.29 to 0.71 ± 0.32 logMAR, p = 0.027), contrast sensitivity (from 1.28 ± 0.25 to 1.46 ± 0.17, p = 0.002), and fixation stability (log of bivariate contour ellipse area from 6.67 ± 0.52 to 5.85 ± 0.84, p = 0.022) improved significantly. The retinal sensitivity improved by 0.47 ± 3.39 dB (p = 0.67). Stereopsis and pattern visual evoked potentials showed improvement. A low vision questionnaire documented subjective improvement. CONCLUSION Visual stimulation by video game play can result in improvement in visual acuity, fixation pattern, and retinal sensitivity with improvement in vision-related tasks. It can serve as a simple rehabilitatory technique for patients with central vision loss due to Stargardt disease.
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Affiliation(s)
- Dhanashree Ratra
- Department of Vitreoretinal diseases, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Archayeeta Rakshit
- Department of Psychophysics, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Vineet Ratra
- Department of Comprehensive Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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