Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study

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Abstract

Background

Age-related macular degeneration (AMD) is the leading cause of blindness in the western world. As a consequence of AMD, patients develop structural damage that comprises the fovea and subsequently present loss of central vision, low visual acuity and unstable fixation. Contrary to what happens with anti-angiogenic treatment in neovascular AMD, there is currently no definitive treatment to reverse geographic atrophy progression. The aim of this study was to determine the effectiveness of the visual rehabilitation treatment via microperimetry in patients with geographic atrophy.

Methods

Longitudinal and prospective study, 18 patients with areas of geographic atrophy in their eye of better visual acuity were included. Macular integrity assessment (Maia) microperimeter (CentreVue, Padova, Italy) was used to diagnose retinal fixation and sensitivity in these patients. Based on these data and using the training module available in the equipment, the patients underwent visual rehabilitation sessions intended to allow the patient to establish the best possible fixation in the best area of retinal sensitivity. To determine the training effectiveness, the following variables were compared before and after: visual acuity in LogMAR scale with ETDRS charts, reading speed with Minnesota Low-Vision Reading Test (MN Read), average sensitivity threshold in microperimetry; P1 and 95% Bivariate Contour Ellipse Area (BCEA) values were used for fixation stability measurement.

Results

Mean age was 77 years old (65–92). Visual acuity of the trained eye was on average 0.7 versus 0.6 LogMAR ( p = 0.006) before and one week after training. Reading speed, using both eyes, was 47 words per minute (wpm) before training and 69 wpm after training ( p = 0.04). Average retinal sensitivity was 14.1 versus 14.6 db ( p = 0.4). Fixation stability improved with P1 values of 45% versus 51% ( p = 0.05) and 95% BCEA values of 43 versus 25 ( p = 0.02) before and after training, respectively.

Conclusions

Visual training via microperimetry in patients with age-related macular degeneration is effective in improving fixation stability, reading speed, and visual acuity, measured one week after training is completed.

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Most cited references 20

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Causes and prevalence of visual impairment among adults in the United States.

Nathan Congdon, Benita J O'Colmain, Caroline C. W. Klaver … (2004)

To estimate the cause-specific prevalence and distribution of blindness and low vision in the United States by age, race/ethnicity, and gender, and to estimate the change in these prevalence figures over the next 20 years. Summary prevalence estimates of blindness (both according to the US definition of < or =6/60 [< or =20/200] best-corrected visual acuity in the better-seeing eye and the World Health Organization standard of < 6/120 [< 20/400]) and low vision (< 6/12 [< 20/40] best-corrected vision in the better-seeing eye) were prepared separately for black, Hispanic, and white persons in 5-year age intervals starting at 40 years. The estimated prevalences were based on recent population-based studies in the United States, Australia, and Europe. These estimates were applied to 2000 US Census data, and to projected US population figures for 2020, to estimate the number of Americans with visual impairment. Cause-specific prevalences of blindness and low vision were also estimated for the different racial/ethnic groups. Based on demographics from the 2000 US Census, an estimated 937 000 (0.78%) Americans older than 40 years were blind (US definition). An additional 2.4 million Americans (1.98%) had low vision. The leading cause of blindness among white persons was age-related macular degeneration (54.4% of the cases), while among black persons, cataract and glaucoma accounted for more than 60% of blindness. Cataract was the leading cause of low vision, responsible for approximately 50% of bilateral vision worse than 6/12 (20/40) among white, black, and Hispanic persons. The number of blind persons in the US is projected to increase by 70% to 1.6 million by 2020, with a similar rise projected for low vision. Blindness or low vision affects approximately 1 in 28 Americans older than 40 years. The specific causes of visual impairment, and especially blindness, vary greatly by race/ethnicity. The prevalence of visual disabilities will increase markedly during the next 20 years, owing largely to the aging of the US population.

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Ophthalmologic examinations for cataract, glaucoma, diabetic retinopathy, macular degeneration and visual acuity were performed on 2631 of the 3977 members of the Framingham (Massachusetts) Heart Study population still living in 1973-1975. The subjects ranged in age from 52 to 85 years. This monograph presents the detailed protocols and record forms for screening and diagnostic examinations, definitions of the specific abnormalities and characteristics used to screen for each disease, criteria for suspicion and diagnosis of diseases, detailed tables of the basic data from the study, evaluation of quality of the data, and discussion of selected findings. The tables provide data on the number and proportion of persons and of eyes with each type of abnormality and each disease, by age and sex. Where appropriate, the data are further classified by location of abnormality, severity, bilaterality and associated visual acuity limitation. The study was sponsored by the National Eye Institute.

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Psychophysics of reading. VIII. The Minnesota Low-Vision Reading Test.

A Luebker, Matthew C Ross, David G Legge … (1989)

This is the eighth in a series of papers dealing with the role of vision in reading. In previous papers, we have evaluated the effects of stimulus and subject variables on reading rate using a drifting-text procedure. In this paper, we describe a new test of reading rate that uses static text, called the Minnesota Low-Vision Reading Test (MNread). It is microcomputer-based, and more easily set up and administered than the drifting-text procedure. It is of potential value as a standardized psychophysical test of reading and should be useful in research, clinical, and educational applications. Some types of low-vision aids rely on drifting text and others on static text. Is reading performance different for these two modes of text presentation? We measured reading rate as a function of angular character size for normal and low-vision subjects with drifting and static text. Although reading rates were highly correlated for the two modes of text presentation, normal subjects usually read static text more rapidly. The reverse was true for low-vision subjects; their reading rates for drifting text were slightly higher (average 15%) than for static text.

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Author and article information

Contributors

Juan Abel Ramírez Estudillo: ramirezestudillo@gmail.com

Mario Isaías León Higuera: marioleonhiguera@hotmail.com

Sergio Rojas Juárez: srojas11@yahoo.com

Maria de Lourdes Ordaz Vera:

ORCID: http://orcid.org/0000-0002-0556-0328

lourdesordazv@hotmail.com

Yessica Pablo Santana: yessicapablo2003@hotmail.com

Benito Celis Suazo: celisbenito@yahoo.com

Journal

Journal ID (nlm-ta): Int J Retina Vitreous

Journal ID (iso-abbrev): Int J Retina Vitreous

Title: International Journal of Retina and Vitreous

Publisher: BioMed Central (London )

ISSN (Electronic): 2056-9920

Publication date (Electronic): 22 May 2017

Publication date PMC-release: 22 May 2017

Publication date Collection: 2017

Volume: 3

Electronic Location Identifier: 21

Affiliations

[1 ]Retina Department, Fundación Hospital Nuestra Señora de la Luz, Ezequiel Montes 135, Cuauhtemoc, Tabacalera, 06030 Ciudad de México, México

[2 ]Retina and Vitreous Research Fellow, Fundación Hospital Nuestra Señora de la Luz, Ezequiel Montes 135, Cuauhtemoc, Tabacalera, 06030 Ciudad de México, México

[3 ]Low Vision Department, Fundación Hospital Nuestra Señora de la Luz, Ezequiel Montes 135, Cuauhtemoc, Tabacalera, 06030 Ciudad de México, México

Author information

Maria de Lourdes Ordaz Vera http://orcid.org/0000-0002-0556-0328

Article

Publisher ID: 71

DOI: 10.1186/s40942-017-0071-1

PMC ID: 5439132

PubMed ID: 28536656

SO-VID: b4d01866-d13c-469f-84e6-8281865988a3

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 December 2016

Date accepted : 13 March 2017

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Keywords: age-related macular degeneration,geographic atrophy,visual rehabilitation,microperimetry,fixation stability

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Keywords: age-related macular degeneration, geographic atrophy, visual rehabilitation, microperimetry, fixation stability

Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study

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Karger: Ophthalmology

Most cited references 20

Causes and prevalence of visual impairment among adults in the United States.

The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975.

Psychophysics of reading. VIII. The Minnesota Low-Vision Reading Test.

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