Neurovisual rehabilitation of patients with geographic atrophy secondary to age-related macular degeneration with AvDesk system

Abstract

Purpose

The aim of this study is to evaluate the efficacy of neurovisual rehabilitation using the AvDesk training system (Linari Medical, Pisa, Italy) in patients with geographic atrophy (GA) due to age-related macular degeneration (AMD) in their eye with better visual acuity.

Methods

This study employed a prospective, observational, single-centre case series design. All patients underwent neurovisual rehabilitation using an AvDesk device. The protocol included sessions twice a week for a duration of 3 consecutive weeks. Before and at the end of the protocol, all patients underwent a standardized ophthalmic examination. MAIA microperimeter was used to assess fixation parameters, using bivariate contour ellipse area (BCEA) at both 63% and 95% confidence intervals, and macular sensitivity (MS). Additionally, the NEI-VFQ 25 questionnaire was administered to evaluate the clinical response.

Results

17 eyes from 17 patients were included in the study. The mean (SD) best-corrected visual acuity (BCVA) at baseline was 0.55 (0.28), improving to 0.39 (0.26) LogMAR (p = 0.0002), after completing the training. The mean (SD) MS did not change, ranging from 8.81 (6.08) dß to 8.60 (5.99) dß (p = 0.30). Following training, both BCEA 63% and 95% values exhibited a modest reduction, although these changes did not reach statistical significance (p > 0.05). Absolute scotomas remained stable (24.41 before treatment vs. 24.65 after treatment; p = 0.83). The NEI-VFQ 25 overall score improved from 55.05 to 62.18 post-treatment (p < 0.01).

Conclusions

The AvDesk training system is an effective tool for neurovisual rehabilitation in AMD patients with GA, yielding improvements in BCVA, fixation stability and quality of life.

Keywords

RETINA SOCIOECONOMICS AND EDUCATION IN MEDICINE/OPHTHALMOLOGY age-Related macular degeneration < RETINA OPTICS / REFRACTION / INSTRUMENTS retinal pathology / research < RETINA

Get full access to this article

View all access options for this article.

References

Wong

, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. Lancet Glob Health 2014; 2: e106–e116. doi:https://doi.org/10.1016/S2214-109X(13)70145-1

Kawasaki

Yasuda

Song

, et al. The prevalence of age-related macular degeneration in Asians. Ophthalmology 2010; 117: 921–927. doi:https://doi.org/10.1016/j.ophtha.2009.10.007

Ferris

Wilkinson

Bird

, et al. Clinical classification of age-related macular degeneration. Ophthalmology 2013; 120: 844–851. doi:https://doi.org/10.1016/j.ophtha.2012.10.036

Schmitz-Valckenberg

Fleckenstein

Göbel

, et al. Optical coherence tomography and autofluorescence findings in areas with geographic atrophy due to age-related macular degeneration. Invest Opthalmology Visual Sci2011; 52: 1. doi:https://doi.org/10.1167/iovs.10-5619

Elliott

Trukolo-Ilic

Strong

, et al. Demographic characteristics of the vision-disabled elderly. Invest Ophthalmol Vis Sci 1997; 38: 2566–2575.

Kleen

Levoy

. Low vision care: correlation of patient age, visual goals, and aids prescribed. Am J Optom Physiol Opt 1981; 58: 200–205.

Heier

Lad

Holz

, et al. Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials. Lancet 2023; 402: 1434–1448. doi:https://doi.org/10.1016/S0140-6736(23)01520-9

Khanani

Patel

Staurenghi

, et al. Efficacy and safety of avacincaptad pegol in patients with geographic atrophy (GATHER2): 12-month results from a randomised, double-masked, phase 3 trial. Lancet 2023; 402: 1449–1458. doi:https://doi.org/10.1016/S0140-6736(23)01583-0

Palmer

Logan

Nabili

, et al. 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. doi:https://doi.org/10.1136/bjo.2008.152231

10.

Parodi

Toto

Mastropasqua

, et al. Prismatic correction in patients affected by age-related macular degeneration. Clin Rehabil 2004; 18: 828–832. doi:https://doi.org/10.1191/0269215504cr801oa

11.

Vukicevic

Fitzmaurice

. Rehabilitation strategies used to ameliorate the impact of centre field loss. Vis Impair Res 2005; 7: 79–84. doi:https://doi.org/10.1080/133882350500377762

12.

Goodrich

Mehr

. Eccentric viewing training and low vision aids: current practice and implications of peripheral retinal research. Am J Optom Physiol Opt 1986; 63: 119–126.

13.

Zigiotto

Damora

Albini

, et al. Multisensory stimulation for the rehabilitation of unilateral spatial neglect. Neuropsychol Rehabil 2021; 31: 1410–1443. doi:https://doi.org/10.1080/09602011.2020.1779754

14.

Làdavas

Tosatto

Bertini

. Behavioural and functional changes in neglect after multisensory stimulation. Neuropsychol Rehabil 2022; 32: 662–689. doi:https://doi.org/10.1080/09602011.2020.1786411

15.

Tinelli

Cioni

Purpura

. Development and implementation of a new telerehabilitation system for audiovisual stimulation training in hemianopia. Front Neurol 2017; 8: 621. doi:https://doi.org/10.3389/fneur.2017.00621

16.

Timberlake

Peli

Essock

, et al. Reading with a macular scotoma. II. Retinal locus for scanning text. Invest Ophthalmol Vis Sci 1987; 28: 1268–1274.

17.

Bronstad

Albu

Bowers

, et al. Driving with central visual field loss II: how scotomas above or below the preferred retinal locus (PRL) affect hazard detection in a driving simulator. PLoS One 2015; 10: e0136517. doi:https://doi.org/10.1371/journal.pone.0136517

18.

Jaffe

Schmitz-Valckenberg

Boyer

, et al. Randomized trial to evaluate tandospirone in geographic atrophy secondary to age-related macular degeneration: the GATE study. Am J Ophthalmol 2015; 160: 1226–1234. doi:https://doi.org/10.1016/j.ajo.2015.08.024

19.

Mangione

. Psychometric properties of the national eye institute visual function questionnaire (NEI-VFQ). Arch Ophthalmol 1998; 116: 1496. doi:https://doi.org/10.1001/archopht.116.11.1496

20.

Mangione

. Development of the 25-list-item national eye institute visual function questionnaire. Arch Ophthalmol 2001; 119: 1050. doi:https://doi.org/10.1001/archopht.119.7.1050

21.

Yuzawa

Fujita

Tanaka

, et al. Assessing quality of life in the treatment of patients with age-related macular degeneration: clinical research findings and recommendations for clinical practice. Clin Ophthalmol Published online July 2013: 1325. doi:https://doi.org/10.2147/OPTH.S45248

22.

Sørensen

Andersen

Henningsen

, et al. Danish version of visual function questionnaire-25 and its use in age-related macular degeneration. Dan Med Bull 2011; 58: A4290.

23.

Kovac

Vukosavljevic

Djokic Kovac

, et al. Validation and cross-cultural adaptation of the national eye institute visual function questionnaire (NEI VFQ-25) in Serbian patients. Health Qual Life Outcomes 2015; 13: 142. doi:https://doi.org/10.1186/s12955-015-0330-5

24.

Parodi

Triolo

Morales

, et al. MP1 And MAIA fundus perimetry in healthy subjects and patients affected by retinal dystrophies. Retina 2015; 35: 1662–1669. doi:https://doi.org/10.1097/IAE.0000000000000504

25.

Calabrèse

Bernard

Hoffart

, et al. Wet versus dry age-related macular degeneration in patients with central field loss: different effects on Maximum Reading speed. Invest Opthalmology Visual Sci 2011; 52: 2417. doi:https://doi.org/10.1167/iovs.09-5056

26.

Crossland

Engel

Legge

. The preferred retinal locus in macular disease. Retina 2011; 31: 2109–2114. doi:https://doi.org/10.1097/IAE.0b013e31820d3fba

27.

Crossland

Culham

Kabanarou

, et al. Preferred retinal locus development in patients with macular disease. Ophthalmology 2005; 112: 1579–1585. doi:https://doi.org/10.1016/j.ophtha.2005.03.027

28.

Tarita-Nistor

González

Markowitz

, et al. Plasticity of fixation in patients with central vision loss. Vis Neurosci 2009; 26: 487–494. doi:https://doi.org/10.1017/S0952523809990265

29.

Crossland

Culham

Rubin

. Fixation stability and reading speed in patients with newly developed macular disease*. Ophthalmic Physiological Optics 2004; 24: 327–333. doi:https://doi.org/10.1111/j.1475-1313.2004.00213.x

30.

Chung

STL

. Cortical reorganization after long-term adaptation to retinal lesions in humans. J Neurosci 2013; 33: 18080–18086. doi:https://doi.org/10.1523/JNEUROSCI.2764-13.2013

31.

Giacomelli

Virgili

Giansanti

, et al. Clinical and microperimetric predictors of Reading speed in low vision patients: a structural equation modeling approach. Invest Opthalmology Visual Sci 2013; 54: 4403. doi:https://doi.org/10.1167/iovs.12-10734

32.

Vingolo

Salvatore

Cavarretta

. 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. doi:https://doi.org/10.1007/s10484-009-9083-4

33.

Pacella

Mazzeo

, et al. Effectiveness of vision rehabilitation treatment through MP-1 microperimeter in patients with visual loss due to macular disease. Clin Ter 2012; 163: e423–e428.

34.

Verdina

Giacomelli

Sodi

, et al. Biofeedback rehabilitation of eccentric fixation in patients with stargardt disease. Eur J Ophthalmol 2013; 23: 723–731. doi:https://doi.org/10.5301/ejo.5000291

35.

Ramírez Estudillo

León Higuera

Rojas Juárez

, et al. Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study. Int J Retina Vitreous 2017; 3: 21. doi:https://doi.org/10.1186/s40942-017-0071-1

36.

Ratra

Gopalakrishnan

Dalan

, et al. Visual rehabilitation using microperimetric acoustic biofeedback training in individuals with central scotoma. Clin Exp Optom 2019; 102: 172–179. doi:https://doi.org/10.1111/cxo.12834

37.

Sivaprasad

Tschosik

Kapre

, et al. Reliability and construct validity of the NEI VFQ-25 in a subset of patients with geographic atrophy from the Phase 2 Mahalo Study. Am J Ophthalmol 2018; 190: 1–8. doi:https://doi.org/10.1016/j.ajo.2018.03.006

38.

Künzel

Möller

Lindner

, et al. Determinants of quality of life in geographic atrophy secondary to age-related macular degeneration. Invest Opthalmology Visual Sci 2020; 61: 63. doi:https://doi.org/10.1167/iovs.61.5.63

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB