Abstract
BackgroundAge-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.MethodsLongitudinal 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.ResultsMean 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.ConclusionsVisual 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.
Highlights
Age-related macular degeneration (AMD) is the leading cause of blindness in the western world
The results presented demonstrate that the extrafoveal fixation capacity can be improved by training; in our patients, there was a significant improvement in visual acuity and reading speed
The results of our work are comparable with studies of visual rehabilitation with MP-1 microperimeter, where patients with AMD, myopic macular degeneration and other macular diseases showed improvements in visual acuity and fixation stability [5, 10, 11]
Summary
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. As a Contrary to what happens with anti-angiogenic treatment in wet macular degeneration, there is currently. Patients with eccentric fixation and low vision use extrafoveal areas of the retina to compensate loss of central fixation; these areas of the retina are known as Preferred Retinal Loci (PRL). Microperimetry systems with biofeedback training have been used for visual rehabilitation and for improving fixation stability in patients with eccentric vision [6]
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