Vision Rehabilitation Training With Multimodal Feedback in Central Vision Loss

Central vision loss from macular degeneration creates blind spots that impair reading, face recognition, and navigation. Individuals must learn to use peripheral vision, requiring retraining of eye movements. Our preliminary research using high-speed eye tracking demonstrated that people with larger scotomas have impaired eye movement control, and that single-session visual feedback training showed limited immediate benefit, though combining feedback types showed promise.

This study will evaluate whether extended binocular training (5 weekly sessions) with multimodal feedback improves eye movement control in 8-15 participants with bilateral central vision loss. Unlike conventional monocular rehabilitation systems, our approach trains both eyes simultaneously using real-time visual and auditory feedback during saccadic and smooth pursuit tasks. Participants will receive gaze-contingent scotoma awareness feedback, preferred retinal locus feedback, and auditory cues while performing eye tracking exercises.

Primary outcomes include saccadic accuracy (latency, landing error, amplitude) and smooth pursuit parameters (gain, tracking accuracy). Secondary outcomes include contrast sensitivity and self-reported visual function. Success could establish an evidence base for accessible home-based training using virtual reality technology, potentially benefiting millions with macular degeneration.

Study Overview

• Status: Recruiting
• Conditions: Macular Degeneration; Low Vision; Central Visual Impairment
• Intervention / Treatment: Behavioral: eccentric viewing training with biofeedback

• Study Type: Interventional
• Enrollment (Estimated): 12
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nicole C Ross, OD; Phone Number: 6175875626; Email: rossn@neco.edu
• Study Contact Backup: Name: Cecilia Idman-Rait, MPH; Email: idmanraitc@neco.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Recruiting
      • New England College of Optometry
      • Contact: Nicole C Ross, OD, MSc.; Phone Number: 617-587-5626; Email: rossn@neco.edu
      • Contact: Cecilia Idman-Rait, MPH; Email: idmanraitc@neco.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Bilateral central scotomas confirmed via computerized tangent screen Visual acuity between 20/60 and 20/200 (0.5 - 1.00 logMAR) in either eye Stable central vision loss (no change in visual acuity >0.2 logMAR in past 6 months) Age 14 years or older, with diagnosis of macular disease Normal cognitive function (Mini-Mental State Examination score ≥24) Ability to provide informed consent and complete study visits No major hearing loss Fluent in English

Exclusion Criteria:

Unstable ocular disease (e.g., ongoing treatments and/or injections) Peripheral vision loss of less than 40 degrees Conditions affecting oculomotor control independent of CVL

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Feedback Training; All participants will receive binocular oculomotor training with multimodal feedback. Participants will complete 5 weekly training sessions (approximately 60 minutes each) performing saccadic and smooth pursuit eye movement exercises. Training incorporates three types of feedback presented systematically across sessions: (1) scotoma awareness feedback via gaze-contingent black circle overlay representing the blind spot, (2) preferred retinal locus (PRL) feedback via dynamic gaze-contingent ring showing real-time fixation location, and (3) auditory feedback with tone modulation indicating fixation stability, PRL accuracy, and target acquisition. Eye movements are recorded using binocular eye tracking at 2000Hz. Contrast sensitivity is assessed intermittently during training using adaptive Gabor presentations. Outcomes are measured at baseline (Week 0) and post-training (Week 6).

Behavioral: eccentric viewing training with biofeedback; Participants will complete 5 weekly training sessions (approximately 60 minutes each) performing eye movement exercises while receiving real-time multimodal feedback. Training includes: Saccadic Training: Visually-guided saccades to targets appearing at randomized locations with instructions to use peripheral (inferior) retinal locus. Targets shift horizontally, vertically, and obliquely to train all saccadic directions. Smooth Pursuit Training: Circular pursuit of moving targets at 2.6°/s in randomized directions with instructions to maintain peripheral gaze above the target. Feedback Modalities (systematically varied across sessions):Scotoma Awareness: Gaze-contingent black circle overlay representing participant's blind spot; Preferred Retinal Locus (PRL) Feedback: Dynamic gaze-contingent ring showing real-time fixation location; Auditory Feedback: Tone modulation indicating fixation stability, PRL accuracy, and target acquisition success; Combined multimodal feedback

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Saccadic Accuracy (Landing Error)	Mean distance in degrees between saccade landing position and target location, measured using binocular eye tracking during visually-guided saccade tasks. Lower values indicate better accuracy.	At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Saccadic Latency	Time in milliseconds from target appearance to saccade initiation, measured using binocular eye tracking. Faster latencies indicate improved oculomotor response.	At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Smooth Pursuit Gain	Ratio of eye velocity to target velocity during smooth pursuit tasks (optimal gain = 1.0). Higher gain values indicate better pursuit tracking accuracy.	At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Number of Catch-up Saccades During Pursuit	Mean number of corrective saccades per trial during smooth pursuit tasks. Fewer catch-up saccades indicate smoother, more accurate pursuit performance.	At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Contrast Sensitivity Function	Area under the log contrast sensitivity function (AULCSF) measured using adaptive Gabor presentations during eye movement tasks. Higher values indicate better contrast sensitivity.	Baseline, Post-training (Week 6)
Change in Fixation Stability	Area of the bivariate contour ellipse at 95% confidence interval of fixation positions during stationary target fixation tasks, measured in square degrees. Smaller ellipse area indicates more stable fixation.	Baseline, Post-training (Week 6)
Change in Vision Related Quality of Life	Baseline, Post-training (Week 6)	At First study visit - Baseline, at last training session - week 5, and post training (week 11 )

Collaborators and Investigators

• Sponsor: New England College of Optometry
• Collaborators: H. Eric Cushing Foundation; Northeastern University, Department of Psychology

Publications and helpful links

Helpful Links

• Lab wesbite

Study record dates

Study Major Dates

• Study Start (Actual): January 31, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: January 30, 2026
• First Submitted That Met QC Criteria: May 5, 2026
• First Posted (Actual): May 11, 2026

Study Record Updates

• Last Update Posted (Actual): May 11, 2026
• Last Update Submitted That Met QC Criteria: May 5, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Eye Diseases; Vision Disorders; Sensation Disorders; Retinal Diseases; Blindness; Retinal Degeneration; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Vision, Low; Macular Degeneration; Blindness, Cortical; Therapeutics; Mind-Body Therapies; Complementary Therapies; Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities; Feedback, Psychological; Biofeedback, Psychology
• Other Study ID Numbers: Saccades 2.0

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No