Preliminary Findings on the Optimization of Visual Performance in Patients with Age-Related Macular Degeneration Using Biofeedback Training
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Biofeedback training has been used to improve fixation stability in subjects with central vision loss, but the psychophysiological mechanisms underlying the functional improvements resulted was not reported. The aim of this study was to investigate the effects of microperimetric biofeedback training on different visual functions and self-reported quality of vision in subjects with age-related macular degeneration. This case-control study included six subjects (72.0 ± 6.1 years of age) diagnosed with age-related macular degeneration (wet or dry) with low vision (best corrected visual acuity ranging from 0.5 to 0.1 in the study eye) and five healthy volunteers (64.2 ± 3.7 years of age). Ophthalmological and functional examinations were obtained from all subjects twice with an approximately 3-month interval. Subjects with central vision loss performed 12 sessions (10 min each) of biofeedback training between the two examinations. Functional evaluation included: microperimetry, spatial luminance contrast sensitivities, color vision thresholds, visual acuity, and reading speed. Visual performance during daily activities was also assessed using a standardized questionnaire. The ratio (2nd/1st examination) of the spatial luminance contrast sensitivity at lower spatial frequencies were much higher for the training subjects compared with the controls. In addition, self-reported quality of vision improved after the training. The significant improvement of the visual function such as spatial luminance contrast sensitivity may explain the better self-reported quality of vision. Possible structural and physiological mechanisms underlying this neuromodulation are discussed.
KeywordsBiofeedback training Psychophysiology Visual system Low vision Macular degeneration
We would like to thank very much Kornél Szekeres, Miklós Maczkó, and Ágnes Urbin for their support to develop the software. We would also like to acknowledge financial support from the Sao Paulo Research Foundation - FAPESP (Grant Nos. 2016/22007-5 and 2016/04538-3), National Council for Scientific and Technological Development – CNPq (Grant Nos. 470785/2014-4 and 404239/2016-1), and the János Bolyai Scholarship of the Hungarian Academy of Sciences. We also thank the patients and the healthy volunteers for their participation in this study.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Bausz, M., & Németh, J. (2006). Change in the quality of life after cataract surgery [Hun]. In S. L. Biró Zs (Ed.), The newest results of cataract and refractive surgery [Hun]. Congress of the SHIOL 2005 (pp. 53–64). Pécs: Hungarian-Artificial Lens Implantation and Refractive Surgery Society.Google Scholar
- Martins Rosa, A., Silva, M. F., Ferreira, S., Murta, J., & Castelo-Branco, M. (2013). Plasticity in the human visual cortex: An ophthalmology-based perspective. BioMed Research International, 2013, 568354.Google Scholar
- Midena, E., Angeli, C. D., Blarzino, M. C., Valenti, M., & Segato, T. (1997). Macular function impairment in eyes with early age-related macular degeneration. Investigative Ophthalmology & Visual Science, 38, 469–477.Google Scholar
- Mollon, J. D., & Reffin, J. P. (1989). A computer-controlled colour vision test that combines the principles of Chibret and of Stilling. Proceedings of the Physyiological Society, vol. 414.Google Scholar
- Polyak, S. (1949). Retinal structure and color vision. In F. B. Fischer, A. J. Schaeffer, & A. Sorsby A (Eds.), Documenta Ophthalmologica: Advances in Ophthalmology. The Hague, Netherlands: Dr. W. Junk, vol. 3, p. 24Y46.Google Scholar
- Rodriguez-Carmona, M. L., Harlow, J. A., Walker, G., & Barbur, J. L. (2005). The variability of normal trichromatic vision and the establishment of the “normal” range. Proceedings of 10th Congress of the International Colour Association. Granada (pp. 979–982).Google Scholar
- Steinberg, E. P., Tielsch, J. M., Schein, O. D., Javitt, J. C., Sharkey, P., Cassard, S. D., Legro, M. W., Diener-West, M., Bass, E. B., Damiano, A. M., et al. (1994). The VF-14. An index of functional impairment in patients with cataract. Archives of Ophthalmology, 112, 630–638.CrossRefGoogle Scholar
- Sunness, J. S., Schuchard, R. A., Shen, N., Rubin, G. S., Dagnelie, G., & Haselwood, M. (1995). Landmark-driven fundus perimetry using the scanning laser ophthalmoscope. Investigative Ophthalmology & Visual Science, 36, 1863–1874.Google Scholar
- Zeffren, B. S., Applegate, R. A., Bradley, A., & van Heuven, W. A. J. (1990). Retinal fixation point location in the foveal avascular zone. Investigative Ophthalmology & Visual Science, 31, 2099–2105.Google Scholar