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Rehabilitation with biofeedback training in age-related macular degeneration for improving distance vision

Published:April 02, 2019DOI:https://doi.org/10.1016/j.jcjo.2018.10.016

      ABSTRACT

      Objectives

      Biofeedback training (BT) is a modern method for enhancing the use of preferred retinal loci (PRL) retraining for new retinal loci (TRL), hence improving far and near vision. This article attempts to clarify the optimal methodology for BT and the types of patients who can benefit most from BT.

      Methods

      This is a retrospective review of cases who received BT with the macular integrity assessment (MAIA) microperimetre. Outcome measures selected for analysis were visual acuity, PRL location, fixation stability, fixation pattern orientation, reading acuity, critical print size, and reading speed.

      Results

      Out of 30 cases who received BT, only those with age-related macular degeneration and visual acuity of logMAR 0.8 (20/126) or poorer showed a visual acuity gain (statistically significant of 12 letters) after BT. Those with other diagnoses and those with residual Early Treatment Diabetic Retinopathy Study best-corrected visual acuity of logMAR of 0.7 (20/100) or better showed only positive trends for visual acuity and a negative trend for fixation stability. All subjects showed a shift in PRL location toward the superior quadrant of the retina (p < 0.02) in those who received BT.

      Conclusion

      BT seems to offer patients a unique and efficient modality to improve distance vision outside of using optical devices.

      RÉsumÉ

      Objectif

      L'apprentissage par rétroaction biologique (ARB) est une technique moderne qui consiste à perfectionner l'utilisation d'aires de fixation préférentielles (PRL, pour preferred retinal loci) dans la rééducation de nouvelles aires de fixation, en vue d'améliorer la vision de près et de loin. Cet article vise à préciser la méthodologie optimale de l'ARB et les types de patients qui peuvent tirer le plus profit de cette technique.

      Méthodes

      Il s'agit d'une revue de synthèse rétrospective portant sur des sujets qui ont reçu un ARB au moyen d'un micropérimètre permettant l’évaluation de l'intégrité maculaire (MAIA, pour macular integrity assessment). Les paramètres de mesure retenus pour l'analyse étaient l'acuité visuelle, la localisation des PRL, la stabilité de la fixation, l'orientation du modèle de fixation, l'acuité de lecture, la taille critique des caractères ainsi que la vitesse de lecture.

      Résultats

      Sur les 30 patients qui ont fait l'objet d'un ARB, seuls ceux qui présentaient une dégénérescence maculaire liée à l’âge et dont l'acuité visuelle se chiffrait à 0,8 logMAR (20/126) ou moins ont bénéficié d'une amélioration de leur acuité visuelle (d'un nombre statistiquement significatif de 12 lettres) après l'ARB. On a observé une tendance positive en matière d'acuité visuelle et une tendance négative quant à la stabilité de la fixation chez les sujets qui présentaient d'autres diagnostics ou dont la meilleure acuité visuelle corrigée résiduelle selon l’échelle ETDRS (Early Treatment of Diabetic Retinopathy Study) était de 0,7 logMAR (20/100) ou mieux. Il s'est produit un déplacement de la localisation des PRL vers le quadrant supérieur de la rétine (p < 0,02) chez tous les sujets qui ont profité d'un ARB.

      Conclusion

      L'ARB semble être une modalité unique et efficace pour améliorer la vision de loin sans qu'il soit besoin de recourir à des aides optiques.
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