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Melnik N, Pollmann S. Saccadic re-referencing training with gaze-contingent FRL-'fixation': Effects of scotoma type and size adaptation. Vision Res 2024; 214:108340. [PMID: 38041888 DOI: 10.1016/j.visres.2023.108340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/19/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
Foveal vision loss makes the fovea as saccadic reference point maladaptive. Training programs have been proposed that shift the saccadic reference point from the fovea to an extrafoveal location, just outside the area of vision loss. We used a visual search task to train normal-sighted participants to fixate target items with a predetermined 'forced retinal location' (FRL) adjacent to a simulated central scotoma. We found that training was comparatively successful for scotomata that had either a sharp or blurry demarcation from the background. Completing the task with sharp-edged scotoma resulted in overall higher training gains. Training with blurry-edged scotoma, however, yielded overall better results when scotoma size was increased after training and participants needed to adapt to a more eccentric FRL, as may be necessary in patients with progressive degenerative eye diseases.
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Affiliation(s)
- Natalia Melnik
- Department of Psychology, Otto-von-Guericke University, Magdeburg, Germany.
| | - Stefan Pollmann
- Department of Psychology, Otto-von-Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences, Otto-von-Guericke University, Magdeburg, Germany
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Lee JH, Ahn J, Shin JY. Sequential structural and functional change in geographic atrophy on multimodal imaging in non-exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:2199-2207. [PMID: 36877299 DOI: 10.1007/s00417-023-06022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/06/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
PURPOSE To investigate the temporal order of photoreceptor atrophy, retinal pigment epithelium (RPE) atrophy and visual acuity loss in patients with center-involving geographic atrophy (GA) in non-exudative age-related macular degeneration (neAMD). METHODS Forty eyes of 25 consecutive patients who eventually developed center-involving GA were investigated. Fundus autofluorescence (FAF) and infrared image coupled optical coherence tomography (OCT) were acquired at each visit. Development of RPE atrophy and photoreceptor atrophy was defined as abnormal hyper/hypo-fluorescence on FAF and photoreceptor loss on OCT over 50% of the vertical or horizontal diameters of the center 1 mm circle, respectively. Visual acuity loss was defined as worsening of more than 0.2 logMAR compared to baseline. Kaplan-Meier analyses was performed to compare the sequential order of these three events. RESULTS Mean age was 72.72 ± 8.63 years, and follow-up duration was 27.36 ± 17.22 months, with an average number of visits of 3.04 ± 1.54 during follow-up. GA progressed from photoreceptor atrophy on OCT, RPE atrophy on FAF, and then to vision loss (p < 0.001). The median survival time of photoreceptors preceded that of visual acuity by 16.3 months, and the median survival time of RPE preceded that of visual acuity by 7.0 months. At baseline, majority of eyes showed drusen only (57.5%), while the most common feature was incomplete RPE and outer retinal atrophy at 3-year follow-up (40.4%). CONCLUSION In the progression of center-involving GA, photoreceptor atrophy on OCT and RPE atrophy on FAF precedes visual decline, and can act as biomarkers predicting future visual decline within the following years.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea.
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Gopalakrishnan S, Majumder PD, Sudharshan S, Raman R. Role of eccentric viewing training with microperimeter for low vision rehabilitation in multifocal choroiditis: Case report. Saudi J Ophthalmol 2023; 37:167-169. [PMID: 37492216 PMCID: PMC10365252 DOI: 10.4103/sjopt.sjopt_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/06/2023] [Indexed: 07/27/2023] Open
Abstract
A 21-year-old student with healed multifocal choroiditis involving the macula presented with difficulty in seeing distance and reading her college books. Based on microperimetr'y, the location of her preferred retinal locus and the position of new trained retinal locus (TRL) were identified. With multiple sessions of biofeedback training, her mean retinal sensitivity improved from 4.8 to 8.8 dl, distance vision from 3/60 to 6/36, and near vision from N32 to N8 in the right eye. At 6-month follow-up, her TRL position and visual acuity were found to be stable. This case report highlights that eccentric viewing training using microperimeter can significantly improve the efficiency of functional vision in patients with choroiditis.
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Affiliation(s)
- Sarika Gopalakrishnan
- Low Vision Care Clinic, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Parthopratim D. Majumder
- Senior Ophthalmologist, Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sridharan Sudharshan
- Senior Ophthalmologist, Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Vitreo Retinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
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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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Ro-Mase T, Ishiko S, Yoshida A. Effect of Background Brightness on Preferred Retinal Loci in Patients With Macular Disease. Transl Vis Sci Technol 2020; 9:32. [PMID: 33173611 PMCID: PMC7594603 DOI: 10.1167/tvst.9.11.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the effect of background brightness on the preferred retinal locus (PRL) in patients with macular disease. Methods The study included 27 eyes (27 patients) with macular disease. Microperimetry (MP) was performed to evaluate the PRL and retinal sensitivity (RS) at 10 cd/m2. A prototypical device was used to evaluate the PRL at 650 cd/m2. Patients were divided into two groups: central fixation (CF) and eccentric fixation (EF). Results The PRLs under different brightness levels differed significantly (P < 0.001) in 15 of 27 eyes (two of 13 eyes in the CF group and 13 of 14 eyes in the EF group). The best-corrected visual acuities (BCVAs) in eyes with different PRLs were significantly worse (P = 0.019) than in eyes with one PRL, although the foveal RS did not differ significantly. In patients with BCVAs over 0.1, the PRLs differed in four of 13 eyes in the CF group and in three of four eyes in the EF group (P > 0.05); in patients with BCVAs of 0.1 or lower, the PRLs differed in one of four eyes and 10 of 10 eyes, respectively (P = 0.011). Conclusions In patients with macular disease, PRLs can change depending on the surrounding brightness. It may be beneficial to evaluate PRLs under brighter background conditions (e.g., in ambient light) when performing visual rehabilitation for these patients. Translational Relevance This study provides important information for visual rehabilitation of patients with macular disease.
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Affiliation(s)
- Tomoko Ro-Mase
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Satoshi Ishiko
- Department of Medicine and Engineering Combined Research Institute, Asahikawa Medical University, Asahikawa, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
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Prahalad KS, Coates DR. Asymmetries of reading eye movements in simulated central vision loss. Vision Res 2020; 171:1-10. [PMID: 32276109 DOI: 10.1016/j.visres.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/31/2020] [Accepted: 03/13/2020] [Indexed: 11/18/2022]
Abstract
Patients with central vision loss are forced to use an eccentric retinal location as a substitute for the fovea, called a preferred retinal locus, or PRL. Clinical studies have shown that patients habitually choose a PRL located either to the left, and/or below the scotoma in the visual field. The position to the right of the scotoma is almost never chosen, even though this would be theoretically more suitable for reading, since the scotoma no longer blocks the upcoming text. In the current study, we tested whether this asymmetry may have an oculomotor basis. Six normally sighted subjects viewed page-like text with a simulated scotoma, identifying embedded numbers in "words" comprising random letters. Subjects trained and tested with three different artificial PRL ("pseudo-PRL," or pPRL) locations: inferior, to the right, or to the left of the scotoma. After several training blocks for each pPRL position, subjects were found to produce reliable oculomotor control. Both reading speed and eye movement characteristics reproduced observations from traditional paradigms such as page-mode reading and RSVP for an advantage for an inferior pPRL. While left and right positions resulted in similar reading speeds, we observed that a right pPRL caused excessively large saccades and more direction switches, exhibiting a zig-zag pattern that developed spontaneously. Thus, we propose that patients' typical avoidance of pPRL positions to the right of their scotoma could have an oculomotor component: the erratic eye motion might potentially negate the perceptual benefit that this pPRL would offer.
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Affiliation(s)
| | - Daniel R Coates
- College of Optometry, University of Houston, 4901 Calhoun Road, Houston, TX 77204, USA.
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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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Visual Acuity Is Not the Best at the Preferred Retinal Locus in People with Macular Disease. Optom Vis Sci 2019; 95:829-836. [PMID: 29877902 DOI: 10.1097/opx.0000000000001229] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Little is known about how the preferred retinal locus (PRL) develops in patients with macular disease. We found that acuity is worse at the PRL than at other retinal locations around the scotoma, suggesting that the selection of the PRL location is unlikely to be based on optimizing acuity. PURPOSE Following the onset of bilateral macular disease, most patients adopt a retinal location outside the central scotoma, the PRL, as their new retinal location for visual tasks. Very little information is known about how the location of a PRL is chosen. In this study, we tested the hypothesis that the selection of the location for a PRL is based on optimizing visual acuity, which predicts that acuity is the best at the PRL, compared with other retinal locations. METHODS Using a scanning laser ophthalmoscope that allowed us to position visual targets at precise retinal locations, we measured acuity psychophysically using a four-orientation Tumbling-E presented at the PRL and at multiple (ranged between 23 and 36 across observers) locations around the scotoma for five observers with bilateral macular disease. RESULTS For all five observers, the acuity at the PRL was never the best among all testing locations. Instead, acuities were better at 15 to 86% of the testing locations other than the PRL, with the best acuity being 17 to 58% better than that at the PRL. The locations with better acuities did not cluster around the PRL and did not necessarily lie at the same distance from the fovea or the PRL. CONCLUSIONS Our finding that acuity is worse at the PRL than at other locations around the scotoma implies that the selection of the PRL location is unlikely to be based on optimizing acuity.
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Abstract
PURPOSE In this experiment, we tested whether perceptually delineating the scotoma location and border with a gaze contingent polygon overlay improves reading speed and reading eye movements in patients with bilateral central scotomas. METHODS Eight patients with age-related macular degeneration and bilateral central scotomas read aloud MNRead style sentences with their preferred eye. Eye movement signals from an EyeLink II eyetracker were used to create a gaze contingent display in which a polygon overlay delineating the area of the patient's scotoma was superimposed on the text during 18 of the 42 trials. Blocks of six trials with the superimposed polygon were alternated with blocks of six trials without the polygon. Reading speed and reading eye movements were assessed before and after the subjects practiced reading with the polygon overlay. RESULTS All of the subjects but one showed an increase in reading speed. A paired-samples t-test for the group as a whole revealed a statistically significant increase in reading speed of 0.075 ± 0.060 (SD) log wpm after reading with the superimposed polygon. Individual subjects demonstrated significant changes in reading eye movements, with the greatest number of subjects demonstrating a shift in the average vertical fixation locus. Across subjects, there was no significant difference between the initial and final reading eye movements in terms of saccades per second, average fixation duration, average amplitude of saccades, or proportion of non-horizontal saccades. CONCLUSIONS The improvement in reading speed (0.075 log wpm or 19%) over the short experimental session for the majority of subjects indicates that making the scotoma location more visible is potentially beneficial for improving reading speed in patients with bilateral central scotomas. Additional research to examine the efficacy of more extended training with this paradigm is warranted.
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Roberts PS, Rizzo JR, Hreha K, Wertheimer J, Kaldenberg J, Hironaka D, Riggs R, Colenbrander A. A conceptual model for vision rehabilitation. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2016; 53:693-704. [PMID: 27997671 PMCID: PMC5444332 DOI: 10.1682/jrrd.2015.06.0113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/15/2015] [Indexed: 01/15/2023]
Abstract
Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.
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Affiliation(s)
- Pamela S. Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - John-Ross Rizzo
- Rehabilitation Medicine, New York University Langone Medical Center, New York, NY
| | - Kimberly Hreha
- Kessler Institute for Rehabilitation and Kessler Foundation, West Orange, NJ, and Teachers College, Columbia University, New York, NY
| | - Jeffrey Wertheimer
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Jennifer Kaldenberg
- College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Dawn Hironaka
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
| | - Richard Riggs
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Health System, Los Angeles, CA
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Gaffney AJ, Margrain TH, Bunce CV, Binns AM. How effective is eccentric viewing training? A systematic literature review. Ophthalmic Physiol Opt 2014; 34:427-37. [PMID: 24735182 DOI: 10.1111/opo.12132] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/18/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The global prevalence of age-related macular degeneration and associated central vision loss is rising. Central vision loss hinders the performance of many activities of daily living. Adaptive strategies such as eccentric viewing and steady eye strategy may be used to compensate for central vision loss. In order to establish the potential of these rehabilitation strategies, this systematic review evaluates current literature regarding the effectiveness of eccentric viewing and steady eye strategy training in people with central vision loss. RESULTS The search strategies identified 2605 publications, 36 of which met the inclusion criteria for the review, but only three of which were randomised controlled trials. This literature shows that eccentric viewing and steady eye strategy training can improve near visual acuity, reading speed, and performance of activities of daily living in people with central vision loss. However, there was insufficient literature to establish a relationship between training and distance visual acuity or quality of life. There is no conclusive evidence to show that a particular model of eccentric viewing training is superior to another, little clear evidence of a relationship between participant characteristics and training outcomes and no data regarding the cost effectiveness of training. CONCLUSION This report highlights the need for further robust research to establish the true potential and cost effectiveness of eccentric viewing and steady eye strategy training as a rehabilitation strategy for individuals with central vision loss.
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Affiliation(s)
- Allannah J Gaffney
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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Walsh DV, Liu L. Adaptation to a simulated central scotoma during visual search training. Vision Res 2014; 96:75-86. [DOI: 10.1016/j.visres.2014.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
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Abstract
PURPOSE This study describes the binocular eccentric gaze direction (EGD) of 434 patients with binocular central field loss and presents a comparison with other studies on eccentric gaze behavior. METHODS We reviewed the records of 434 patients with bilateral central scotomas. Eligible patients had not received eccentric viewing training and demonstrated a spontaneously developed eccentric gaze behavior. Data were collected on monocular and binocular EGD, visual acuity, and underlying ocular pathology. Findings concerning the EGD were compared with other studies that evaluated gaze behavior in patients with central field loss. RESULTS In the group of 434 patients, age-related macular disease was the most frequent pathology (77%). The majority of these patients demonstrated a binocular EGD (bEGD) to the right (50%). In 25% of the patients, a superior bEGD was found. Less often, a bEGD to the left (14%) and to inferior (11%) were encountered. Review of the literature indicates that the majority of patients developed a monocular EGD in the superior direction. CONCLUSIONS This is a study on bEGD behavior in a large population of patients with bilateral central scotomas. The bEGD was guided by the gaze of the better-seeing eye. The preference for a bEGD to the right differs from findings of previous studies. Review of the literature suggests that not only the ocular pathology but also the method of investigation is most likely to influence the observed EGD. Most studies evaluated the location of the preferred retinal locus using a monocular technique; this may not reflect an individual's actual binocular behavior as it relates to activities of daily living.
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Jeong JH, Moon NJ. A study of eccentric viewing training for low vision rehabilitation. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:409-16. [PMID: 22131778 PMCID: PMC3223708 DOI: 10.3341/kjo.2011.25.6.409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 02/22/2011] [Indexed: 11/23/2022] Open
Abstract
Purpose The definition of eccentric viewing (EV) is using non-foveal preferred retinal loci (PRL) for viewing. The purpose of the present study was to investigate the clinical effect of EV training for low vision rehabilitation in patients with central scotomas. Methods The direction of EV was monitored in 30 low vision patients with central scotomas by moving the patient's view. The PRL was found by using a direct ophthalmoscope and retinal camera; the preserved visual field was identified using a kinetic visual field analyzer. The relationships between EV, PRL, and visual field were evaluated. The patients and their guardians were educated regarding EV. After 2 weeks of self-training, maintenance of EV was checked and changes in best-corrected visual acuity (BCVA), reading speed, and satisfaction questionnaire were evaluated. Results A relationship between EV, PRL, and visual field was in accordance in half of the patients. There were no significant differences in demographics and basic visual characteristics in patients where the relationship was not in accordance. EV was maintained in two-thirds of the patients, but there were no significant differences in demographics and basic visual characteristics in patients who discontinued EV. There were no significant improvements in BCVA; however, reading speed and the satisfaction scores increased significantly with EV. Conclusions The direction of EV was effectively detected by convenient access using an inexpensive method. Functional vision and satisfaction significantly improved following EV training. EV training can be used as an effective method for low vision rehabilitation in patients with central scotomas.
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Affiliation(s)
- Jae Hoon Jeong
- Department of Ophthalmology, Chung-Ang University College of Medicine, Seoul, Korea
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Cideciyan AV. Leber congenital amaurosis due to RPE65 mutations and its treatment with gene therapy. Prog Retin Eye Res 2010; 29:398-427. [PMID: 20399883 DOI: 10.1016/j.preteyeres.2010.04.002] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Leber congenital amaurosis (LCA) is a rare hereditary retinal degeneration caused by mutations in more than a dozen genes. RPE65, one of these mutated genes, is highly expressed in the retinal pigment epithelium where it encodes the retinoid isomerase enzyme essential for the production of chromophore which forms the visual pigment in rod and cone photoreceptors of the retina. Congenital loss of chromophore production due to RPE65-deficiency together with progressive photoreceptor degeneration cause severe and progressive loss of vision. RPE65-associated LCA recently gained recognition outside of specialty ophthalmic circles due to early success achieved by three clinical trials of gene therapy using recombinant adeno-associated virus (AAV) vectors. The trials were built on multitude of basic, pre-clinical and clinical research defining the pathophysiology of the disease in human subjects and animal models, and demonstrating the proof-of-concept of gene (augmentation) therapy. Substantial gains in visual function of clinical trial participants provided evidence for physiologically relevant biological activity resulting from a newly introduced gene. This article reviews the current knowledge on retinal degeneration and visual dysfunction in animal models and human patients with RPE65 disease, and examines the consequences of gene therapy in terms of improvement of vision reported.
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Affiliation(s)
- Artur V Cideciyan
- Scheie Eye Institute, University of Pennsylvania, 51 North 39th St, Philadelphia, PA 19104, USA.
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Rohrschneider K, Bültmann S, Springer C. Use of fundus perimetry (microperimetry) to quantify macular sensitivity. Prog Retin Eye Res 2008; 27:536-48. [DOI: 10.1016/j.preteyeres.2008.07.003] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Sullivan B, Jovancevic-Misic J, Hayhoe M, Sterns G. Use of multiple preferred retinal loci in Stargardt's disease during natural tasks: a case study. Ophthalmic Physiol Opt 2008; 28:168-77. [PMID: 18339049 DOI: 10.1111/j.1475-1313.2008.00546.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with central visual field loss often use a preferred retinal locus (PRL) to compensate for their deficit. We present a case study examining the eye movements of a subject with Stargardt's disease causing bilateral central scotomas, while performing a set of natural tasks including: making a sandwich; building a model; reaching and grasping; and catching a ball. In general, the subject preferred to use PRLs in the lower left visual field. However, there was considerable variation in the location and extent of the PRLs used. Our results demonstrate that a well-defined PRL is not necessary to adequately perform this set of tasks and that many sites in the peripheral retina may be viable for PRLs, contingent on task and stimulus constraints.
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Affiliation(s)
- Brian Sullivan
- Center for Perceptual Systems, University of Texas at Austin, Austin, TX 78712, USA.
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