Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies

Abstract

Purpose Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient's PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes. Methods Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient's spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed. Results Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B. Conclusions This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.

Efficacy of biofeedback rehabilitation based on visual evoked potentials analysis in patients with advanced age-related macular degeneration

“…The MAIA microperimeter has also be used for biofeedback rehabilitation. A recent study confirmed its utility in healthy retinal area training of 77 consecutive AMD patients with bilateral central vision loss 17 . Daibert-Nido et al 26 , in a retrospective review of 30 cases, also reported improvements for visual acuity, however with a negative trend for fixation stability, confirming the utility of the same tool in AMD patients.…”

Characteristics of Preferred Retinal Locus in Eyes with Central Vision Loss Secondary to Different Macular Lesions

“…Importantly, considerable research has verified that fixation stability can be improved by eccentric fixation training. 11,[45][46][47][48][49][50][51][52][53][54] Therefore, training programs for different macular lesions should be individualized. For small and sharp scotomas, a natural PRL may be optimal for patients.…”

Evidence-Based Practice and Trends in Visual Rehabilitation for Patients with Age-Related Macular Degeneration

“…Similarly, Morales et al discuss improving the fixation stability in the PRL through biofeedback fixation training (BFT), which consist of slightly moving the gaze towards the training locus during different sessions [75]. Another training paradigm integrating oculomotor control and pattern recognition has also been evaluated, demonstrating that these strategies combined are capable of inducing a PRL over a short period of time in eight subjects with normal vision and a simulated central scotoma [76].…”