Translation of Eye Movement Reading Training to Clinical Practice

October 23, 2019 updated by: VA Office of Research and Development

Age-related macular degeneration (AMD) is the most common visual impairment in persons over 50 years of age. It has been estimated that 1 in 3 individuals over 75 years of age and 1 in 30 individuals over 52 years of age are affected by AMD. The deficits in visual function as a result of this disease affecting the central retina are debilitating, as individuals lose their ability to carry out many of their daily activities that require resolving fine spatial details. The investigator's previous studies have shown that training with oculomotor control exercises significantly increases reading speeds in patients with AMD. In the proposed study, the investigators will examine whether these training exercises are effective when practiced at home.

In Phase 1, the investigators will develop a standardized user-friendly, Web-based platform that will allow patients to easily self-administer training exercises. The software platform will be designed to automatically choose the appropriate exercises based on a patient's previous performance, run the training exercise, and collect performance data into a universal patient data file. In Phase 2, the platform will be tested in two settings: in standard clinical rehabilitation practice and in the patient's home. Reading outcomes in the two settings will be compared. The investigators will recruit 60 patients per year for each of the three years for Phase 2 of the study. Half of these patients will be assigned to the Clinic Training Group, while the other half will be assigned to At-home Training Group. For all patients, three assessments will be taken: at baseline, after 1 month, and after 2 months of training.

The investigators will compare reading outcomes to assess the roles of feedback versus the role of frequent available practice. Because of the extensive cost and clinical resources required for vision rehabilitation, it is critical to determine whether the training program can be made less expensive, but as effective, when it is self-trained. If the investigators demonstrate the utility of at-home practice, clinical facilities and therapists' time can be made available for those activities requiring face-to-face contact

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

In the proposed study, the investigators will examine whether these training exercises are effective when practiced at home. There are two specific aims in this project:

Aim #1 (Year 1): to develop a web-based meta program that will administer the training exercises. For convenience, in this proposal, the investigators will refer to this platform as PAECT (Platform for Administering Eye movement Control Training). The PAECT meta program will incorporate all of the exercises that the investigators have developed and validated over the course of our previous Merit Review grants (Seiple, Szlyk et al., 2005, 2011). The PAECT platform will be designed to allow patients to easily run the training exercises in their homes and to practice at their convenience. The PAECT will employ an executive component that will keep track of the exercises that are practiced and record performance. Each time a subject opens the platform, it will choose the exercise for that subject based upon previous training and performance. The development of the software and the design of the hardware interface for administering the system will take place during the first year of the project. This will be done through a series of software/hardware iterations based upon feedback derived from direct patient testing of the system. The investigators will recruit ten patients with AMD to test and comment on the system during this phase of the project.

Aim #2 (Years 2-4). To compare the effects of PAECT training on reading outcomes in two training situations: (1). training done in the clinic with feedback on performance provided by a trained low-vision therapist, and (2) training done at-home with expanded opportunity for practicing the exercises, but with no therapist feedback. Patients will be assigned to one of two groups: Patients in Group 1 ("Clinical") will undergo weekly two-hour training sessions for three months using the software/hardware system. This training will be conducted in the low-vision clinic using the PAECT, with feedback on performance provided by a trained low-vision therapist. Patients in Group 2 ("At-home") will practice all of the exercises at home using the PAECT system over a three-month period. The subjects will be encouraged to use the system as often as possible, but no less than two hours per week. Sixty patients (30 in the clinical setting and 30 at home) will be tested for each of three years.

Study Type

Interventional

Enrollment (Actual)

33

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Illinois
      • Chicago, Illinois, United States, 60612
        • Jesse Brown VA Medical Center, Chicago, IL

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

55 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Patients with a diagnosis of retinal disease affecting the central visual field (e.g., non-exudative "dry" AMD)
  • with a central scotoma
  • and with visual acuity of less than or equal to 20/70 and greater than or equal to 20/400 (in the test eye), will be included in the study.
  • The presence of a central scotoma and eccentric viewing will be confirmed using an OPKO OCT/SLO microperimetry.
  • The investigator's intent is to include subjects based upon the patient's functional characteristics (e.g., eccentric viewing).

Exclusion Criteria:

  • Patients with other major ophthalmologic or neurologic disease
  • choroidal neovascularization ("wet" AMD)
  • moderate to severe media opacities
  • and cognitive impairment will be excluded.
  • Patients' disease status will be monitored throughout the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: Laboratory training
Patients will be trained in the laboratory with feedback by a rehabilitation therapist
Behavioral: Platform for Administering Eye-movement Control Training
The Platform for Administering Eye-movement Control Training (PAECT) meta program will incorporate all of the exercises that the investigators have developed and validated over the course of our previous Merit Review grants (Seiple, Szlyk et al., 2005, 2011). The PAECT platform will be designed to allow patients to easily run the training exercises in their homes and to practice at their convenience. The PAECT will employ an executive component that will keep track of the exercises that are practiced and record performance. Each time a subject opens the platform, it will choose the exercise for that subject based upon previous training and performance.
Other: Home-based training
Patients will self instruct using the computer-based training with remote intervention by a therapist
Behavioral: Platform for Administering Eye-movement Control Training
The Platform for Administering Eye-movement Control Training (PAECT) meta program will incorporate all of the exercises that the investigators have developed and validated over the course of our previous Merit Review grants (Seiple, Szlyk et al., 2005, 2011). The PAECT platform will be designed to allow patients to easily run the training exercises in their homes and to practice at their convenience. The PAECT will employ an executive component that will keep track of the exercises that are practiced and record performance. Each time a subject opens the platform, it will choose the exercise for that subject based upon previous training and performance.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Reading Performance and Accuracy Using MNREAD.
Time Frame: Participants will be assessed at baseline, 1 month and 2 months but change between baseline and final (2 months) will be reported
Participants will be trained to use eccentric viewing for reading. They will then be assessed on the following outcome measures; reading, speed and accuracy using the MNRead test, binocular visual acuity and contrast sensitivity.
Participants will be assessed at baseline, 1 month and 2 months but change between baseline and final (2 months) will be reported

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

VA Office of Research and Development

Investigators

  • Principal Investigator: Janet P Szlyk, PhD, Jesse Brown VA Medical Center, Chicago, IL

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2014

Primary Completion (Actual)

June 30, 2017

Study Completion (Actual)

June 30, 2017

Study Registration Dates

First Submitted

May 2, 2013

First Submitted That Met QC Criteria

May 10, 2013

First Posted (Estimate)

May 15, 2013

Study Record Updates

Last Update Posted (Actual)

November 13, 2019

Last Update Submitted That Met QC Criteria

October 23, 2019

Last Verified

October 1, 2019

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • C0849-R

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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