Short-Term Clinical Results of Preferred Retinal Locus Training

Ayşe Bozkurt Oflaz, Banu Turgut Öztürk, Şaban Gönül, Berker Bakbak, Şansal Gedik, Süleyman Okudan, Ayşe Bozkurt Oflaz, Banu Turgut Öztürk, Şaban Gönül, Berker Bakbak, Şansal Gedik, Süleyman Okudan

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.

Keywords: Low vision rehabilitation; microperimetry; preferred retinal locus training.

Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
The change in the fixation area used by the patient after training sessions. According to the MAIA (CenterVue®, Padova, Italy) normative studies, the decibel scale is color-coded where green represents normal values, yellow suspect, red abnormal, and black absolute scotomas. (a) The sensitivity map before training demonstrates difficulty in fixation. (b) In the new sensitivity map (after treatment), assessment of the same area demonstrates convergence of the blue fixation points, indicating more stable fixation behavior
Figure 2
Figure 2
P1 and P2 values were significantly increased in full-threshold 4-2 tests conducted after preferred retinal locus training compared to before training. Despite favorable changes in BCEA 63%, BCEA 95%, and average threshold, they were not statistically significant BCEA: Bivariate contour ellipse area
Figure 3
Figure 3
P1 and P2 values recorded over 8 sessions show a significant increase after session 5, while no significant changes were observed in BCEA 63% and BCEA 95% values BCEA: Bivariate contour ellipse area

References

    1. Congdon N, O’Colmain B, Klaver C, Klein R, Muñoz B, Friedman DS, Kempen J, Taylor HR, Mitchell P, Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arc Ophthalmol. 2004;122:477–485.
    1. Tarita-Nistor L, González EG, Markowitz SN, Steinbach MJ. Plasticity of fixation in patients with central vision loss. Vis Neurosci. 2009;26:487–494.
    1. Chung ST. Improving reading speed for people with central vision loss through perceptual learning. Invest Ophthalmol Vis Sci. 2011;52:1164–1170.
    1. Baker CI, Peli E, Knouf N, Kanwisher NG. Reorganization of visual processing in macular degeneration. J Neurosci. 2005;25:614–618.
    1. Baseler HA, Gouws A, Haak KV, Racey C, Crossland MD, Tufail A, Rubin GS, Cornelissen FW, Morland AB. Large-scale remapping of visual cortex is absent in adult humans with macular degeneration. Nat Neurosci. 2011;14:649–655.
    1. Shima N, Markowitz SN, Reyes SV. Concept of a functional retinal locus in age-related macular degeneration. Can J Ophthalmol. 2010;45:62–66.
    1. Morales MU, Saker S, Wilde C, Rubinstein M, Limoli P, Amoaku WM. Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies. Int Ophthalmol. 2020;40:305–312.
    1. Nilsson UL, Frennesson C, Nilsson SEG. Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope. Vision Res. 2003;43:1777–1787.
    1. Fujii GY, de Juan Jr E, Sunness J, Humayun MS, Pieramici DJ, Chang TS. Patient selection for macular translocation surgery using the scanning laser ophthalmoscope. Ophthalmology. 2002;109:1737–1744.
    1. Vingolo EM, Cavarretta S, Domanico D, Parisi F, Malagola R. Microperimetric biofeedback in AMD patients. Appl Psychophysiol Biofeedback. 2007;32:185–189.
    1. Vingolo EM, Fragiotta S, Domanico D, Limoli PG, Nebbioso M, Spadea L. Visual Recovery after Primary Retinal Detachment Surgery: Biofeedback Rehabilitative Strategy. J Ophthalmol. 2016;2016:8092396.
    1. Vingolo EM, Salvatore S, Cavarretta S. Low-vision rehabilitation by means of MP-1 biofeedback examination in patients with different macular diseases: a pilot study. Appl Psychophysiol Biofeedback. 2009;34:127–133.
    1. Buia C, Tiesinga P. Attentional modulation of firing rate and synchrony in a model cortical network. J Comput Neurosci. 2006;20:247–264.
    1. Scuderi G, Verboschi F, Domanico D, Spadea L. Fixation improvement through biofeedback rehabilitation in Stargardt disease. Case Rep Med. 2016;2016:4264829.
    1. Morales MU, Saker S, Mehta RL, Rubinstein M, Amoaku WM. Preferred retinal locus profile during prolonged fixation attempts. Can J Ophthalmol. 2013;48:368–374.
    1. Markowitz SN. Principles of modern low vision rehabilitation. Can J Ophthalmol. 2006;41:289–312.
    1. Amore FM, Paliotta S, Silvestri V, Piscopo P, Turco S, Reibaldi A. Biofeedback stimulation in patients with age-related macular degeneration: comparison between 2 different methods. Can J Ophthalmol. 2013;48:431–437.
    1. Morales MU, Saker S, Amoaku WM. Bilateral eccentric vision training on pseudovitelliform dystrophy with microperimetry biofeedback. BMJ Case Rep. 2015;2015:bcr2014207969.
    1. Morales MU, Saker S, Wilde C, Pellizzari C, Pallikaris A, Notaroberto N, Rubinstein M, Rui C, Limoli P, Smolek MK, Amoaku WM. Reference Clinical Database for Fixation Stability Metrics in Normal Subjects Measured with the MAIA Microperimeter. Transl Vis Sci Technol. 2016;5:6.
    1. Altınbay D, İdil SA. Current Approaches to Low Vision (Re)Habilitation. Turk J Ophthalmol. 2019;49:154–163.
    1. Ozdemir H, Şentürk F, Arf S, Karaçorlu M. Mikroperimetri. Turk J Ophthalmol. 2011;41:401–406.
    1. İdil AS, Çalışkan D, İdil BN. Development and validation of the Turkish version of the MNREAD visual acuity charts. Turk J Med Sci. 2011;41:565–570.
    1. Toprak AB, Eser E, Guler C, Baser FE, Mayali H. Cross-validation of the Turkish version of the 25-item national eye institute visual functioning questionnaire (NEI-VFQ 25) Ophthalmic Epidemiol. 2005;12:259–269.
    1. Bourne RR, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Keeffe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta-analysis. Lancet Glob Health. 2017;5:e888–e897.
    1. İdil A. Yaşa Bağlı Makula Dejenerasyonunda Az Görme Rehabilitasyonu. Turkiye Klinikleri J Ophthalmol. 2015;8:143–146.
    1. Maniglia M, Cottereau BR, Soler V, Trotter Y. Rehabilitation approaches in macular degeneration patients. Front Syst Neurosci. 2016;10:107.
    1. Pijnacker J, Verstraten P, van Damme W, Vandermeulen J, Steenbergen B. Rehabilitation of reading in older individuals with macular degeneration: A review of effective training programs. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2011;18:708–732.
    1. Sagi D. Perceptual learning in vision research. Vision Res. 2011;51:1552–1566.
    1. Seiple W, Szlyk JP, McMahon T, Pulido J, Fishman GA. Eye-movement training for reading in patients with age-related macular degeneration. Invest Ophthalmol Vis Sci. 2005;46:2886–2896.
    1. Palmer S, Logan D, Nabili S, Dutton GN. Effective rehabilitation of reading by training in the technique of eccentric viewing: evaluation of a 4-year programme of service delivery. Br J Ophthalmol. 2010;94:494–497.
    1. Crossland MD, Engel SA, Legge GE. The preferred retinal locus in macular disease: toward a consensus definition. Retina. 2011;31:2109–2114.
    1. Watson GR, Schuchard RA, De l’Aune WR, Watkins E. Effects of preferred retinal locus placement on text navigation and development of advantageous trained retinal locus. J Rehabil Res Dev. 2006;43:761–770.
    1. Pacella E, Pacella F, Mazzeo F, Turchetti P, Carlesimo S, Cerutti F, Lenzi T, De Paolis G, Giorgi D. Effectiveness of vision rehabilitation treatment through MP-1 microperimeter in patients with visual loss due to macular disease. Clin Ter. 2012;163:e423–428.
    1. Lang CE, Lohse KR, Birkenmeier RL. Dose and timing in neurorehabilitation: prescribing motor therapy after stroke. Curr Opin Neurol. 2015;28:549–555.
    1. Gee BM, Gerber LD, Butikofer R, Covington N, Lloyd K. Exploring the parameters of intensity, frequency, and duration within the constraint induced movement therapy published research: A content analysis. NeuroRehabilitation. 2018;42:167–172.
    1. Raman R, Damkondwar D, Neriyanuri S, Sharma T. Microperimetry biofeedback training in a patient with bilateral myopic macular degeneration with central scotoma. Indian J Ophthalmol. 2015;63:534–546.
    1. Vingolo EM, Salvatore S, Domanico D, Spadea L, Nebbioso M. Visual rehabilitation in patients with myopic maculopathy: our experience. Can J Ophthalmol. 2013;48:438–442.
    1. Ratra D, Gopalakrishnan S, Dalan D, Ratra V, Damkondwar D, Laxmi G. Visual rehabilitation using microperimetric acoustic biofeedback training in individuals with central scotoma. Clin Exp Optom. 2019;102:172–179.
    1. Ueda-Consolvo T, Otsuka M, Hayashi Y, Ishida M, Hayashi A. Microperimetric biofeedback training improved visual acuity after successful macular hole surgery. J Ophthalmol. 2015;2015:572942.
    1. Verboschi F, Domanico D, Nebbioso M, Corradetti G, Scalinci SZ, Vingolo EM. New trends in visual rehabilitation with MP-1 microperimeter biofeedback: optic neural dysfunction. Funct Neurol. 2013;28:285–291.
    1. Hamade N, Hodge WG, Rakibuz-Zaman M, Malvankar-Mehta MS. The effects of low-vision rehabilitation on reading speed and depression in age related macular degeneration: a meta-analysis. PloS One. 2016;11:e0159254.
    1. Salvatore S, Librando A, Esposito M, Vingolo EM. The Mozart effect in biofeedback visual rehabilitation: a case report. Clin Ophthalmol. 2011;5:1269–1272.
    1. Estudillo JAR, Higuera MIL, Juárez SR, de Lourdes Oraz Vera M, Santana YP, Suazo BC. Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study. Int J Retina Vitreous. 2017;3:21.
    1. Dilks DD, Baker CI, Peli E, Kanwisher N. Reorganization of visual processing in macular degeneration is not specific to the “preferred retinal locus”. J Neurosci. 2009;29:2768–2773.
    1. Bozkurt M, Ozturk B, Kerimoglu H, Ersan I, Arbag H, Bozkurt B. Association of age-related macular degeneration with age-related hearing loss. J Laryngol Otol. 2011;125:231–235.

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