Abstract
Pathologies affecting central vision, and macular degeneration (MD) in particular, represent a growing health concern worldwide, and the leading cause of blindness in the Western World. To cope with the loss of central vision, MD patients often develop compensatory strategies, such as the adoption of a Preferred Retinal Locus (PRL), which they use as a substitute fovea. However, visual acuity and fixation stability in the visual periphery are poorer, leaving many MD patients struggling with tasks such as reading and recognizing faces. Current non-invasive rehabilitative interventions are usually of two types: oculomotor, aiming at training eye movements or teaching patients to use or develop a PRL, or perceptual, with the goal of improving visual abilities in the PRL. These training protocols are usually tested over a series of outcome assessments mainly measuring low-level visual abilities (visual acuity, contrast sensitivity) and reading. However, extant approaches lead to mixed success, and in general have exhibited large individual differences. Recent breakthroughs in vision science have shown that loss of central vision affects not only low-level visual abilities and oculomotor mechanisms, but also higher-level attentional and cognitive processes. We suggest that effective interventions for rehabilitation after central vision loss should then not only integrate low-level vision and oculomotor training, but also take into account higher level attentional and cognitive mechanisms.
Highlights
With the growing elderly population in the United States and worldwide, age-related diseases are becoming a serious health issue that demands increasingly high healthcare expenditures
Barraza-Bernal et al (2017), in another training study using simulated scotoma, showed that locations in the peripheral visual field with high attentional capabilities are likely candidates for Preferred Retinal Locus (PRL) development. Following these studies that focused on oculomotor behavior, others showed that visual training in conditions of simulated central vision loss leads to improvement in both oculomotor and perceptual functions, such as fixation stability, saccadic re-referencing toward the PRL (Maniglia et al, 2020a) peripheral visual acuity (Maniglia et al, 2020a) and reading (Liu and Kwon, 2016)
We report early results from two studies, one conducted with healthy participants trained with simulated scotoma and the other with macular degeneration (MD) patients. 19 healthy participants for the simulated scotoma study (20.4 ± 1.8 years, 12 females) and 11 MD patients (62.6 ± 15.8 years, 6 females) were randomly assigned between coordinated attentional training (CAT) (10 healthy participants and 6 MD patients, see Figure 3) or a standard perceptual learning (SPL) approach (9 healthy participants and 5 MD patients)
Summary
With the growing elderly population in the United States and worldwide, age-related diseases are becoming a serious health issue that demands increasingly high healthcare expenditures (agingstats.gov). Barraza-Bernal et al (2017), in another training study using simulated scotoma, showed that locations in the peripheral visual field with high attentional capabilities are likely candidates for PRL development Following these studies that focused on oculomotor behavior, others showed that visual training in conditions of simulated central vision loss leads to improvement in both oculomotor and perceptual functions, such as fixation stability, saccadic re-referencing toward the PRL (Maniglia et al, 2020a) peripheral visual acuity Some reports suggest that years of experience may be required certain changes in the visual system (Castaldi et al, 2016), as well as to understand how training may be differently effective as a function of age or disease etiology
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