Scotoma Awareness Training for Low Vision (SPOT Trial)
Palo Alto (17 mi)Age: 18+
Sex: Any
Travel: May be covered
Time Reimbursement: Varies
Trial Phase: N/A
Recruiting
Sponsor: University of Alabama at Birmingham
No Placebo Group
Approved in 1 jurisdiction
Trial Summary
What is the purpose of this trial?This trial tests a new training method for older adults with Macular Degeneration, a condition causing central vision loss. The training uses a simulated blind spot to help patients become aware of their vision loss and develop new ways to see better. By making patients aware of their blind spot, the training aims to improve their vision and daily functioning. Eccentric viewing training has been shown to improve near visual acuity, reading speed, and daily functioning in people with central vision loss.
Is Scotoma Perimetry Oculomotor Training a promising treatment for low vision?Yes, Scotoma Perimetry Oculomotor Training is promising because it helps people with central vision loss improve their reading ability by training them to use a different part of their eye for seeing. This training can make reading faster and easier, and the benefits last over time.234710
What safety data exists for Scotoma Awareness Training for Low Vision?The provided research does not directly address safety data for Scotoma Awareness Training or its related methods. However, the studies suggest that training methods like establishing a preferred retinal locus (PRL) and using microperimetry biofeedback can improve visual function without mentioning adverse effects. The absence of reported safety concerns in these studies may imply a favorable safety profile, but specific safety data is not detailed.126911
What data supports the idea that Scotoma Awareness Training for Low Vision is an effective treatment?The available research shows that Scotoma Awareness Training for Low Vision can help people with central vision loss improve their reading and visual search abilities. For example, one study found that after training, five out of six patients used a new part of their eye for reading, which increased their reading speed to 71 words per minute. Another study showed that training helped participants make faster and more accurate eye movements when searching for visual targets, and some retained these skills months later. These results suggest that the training can effectively improve how people with vision loss use their eyes, making everyday tasks easier.245810
Do I have to stop taking my current medications for this trial?The trial protocol does not specify whether you need to stop taking your current medications.
Eligibility Criteria
This trial is for adults with severe vision impairment (20/100 or worse) due to Macular Degeneration. Participants must have had this level of vision loss for at least two years and show specific light sensitivity differences between their macula and peripheral retina. Those who can't remain still during eye tracking or have very large retinal blind spots are excluded.Inclusion Criteria
My central vision is significantly worse than my peripheral vision.
My condition has been severe for at least 2 years.
I have been diagnosed with Macular Degeneration.
Exclusion Criteria
I can't stay still for long periods during eye tracking tests.
I have large blind spots in both of my eyes.
Treatment Details
'Scotoma awareness' Training, which aims to improve understanding and adaptation to blind spots in central vision, is being tested against a control training program. The study seeks to enhance low vision therapies based on how the brain adapts after central vision loss.
2Treatment groups
Experimental Treatment
Group I: Condition 2 - Control TrainingExperimental Treatment1 Intervention
In the control condition, participants will perform the same task as the scotoma awareness training, without the artificial visible scotoma.
Group II: Condition 1 - 'Scotoma awareness' TrainingExperimental Treatment1 Intervention
Participants will be asked to report the emotion of an emoji face ('happy' vs 'sad') that could appear anywhere on screen. For the entire duration of the training, an explicit, sharp outlined occluder surrounding the participant's true retinal scotoma will be rendered on screen. This occluder will be generated through a gaze-contingent display. The size and the contrast of the target will change adaptively in response to the patient's performance.
Find a clinic near you
Research locations nearbySelect from list below to view details:
UABBirmingham, AL
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Who is running the clinical trial?
University of Alabama at BirminghamLead Sponsor
University of California, RiversideCollaborator
References
Automated visual field examination in children aged 5-8 years. Part I: Experimental validation of a testing procedure. [2022]In 106 children aged 5-8 years, we determined how much training was needed to stabilize the response strategy prior to actual visual field assessment and we evaluated the reliability and acceptable duration of automated static perimetry (Octopus 2000R). A specially designed familiarization procedure was used to train the children to: (1) gaze at the center of the visual field while paying attention to light stimuli projected onto the periphery and (2) press the buzzer only when light stimuli were perceived. The subsequent examination phase consisted of 15 successive identical blocks of 27 trials (12 stimulus trials, 12 false-positive catch-trials, and three false-negative catch-trials), and was stopped before the end if signs of fatigue appeared. Age had a marked influence both on endurance (the number of blocks performed increased significantly) and on response reliability (false-positive responses decreased between 5- and 6-year-olds). The increase in false-negative responses toward the end indicates that examination is no longer reliable, and should be stopped. We concluded that most children as young as five can undergo examination by automated static perimetry. Changes regarding learning, stimulus intensity and testing procedure are suggested in order to adapt the examination to age, level of vigilance and health condition of the children.
Location and stability of a newly established eccentric retinal locus suitable for reading, achieved through training of patients with a dense central scotoma. [2022]Six patients, median age 71 years, with a dense central scotoma in one eye and a median visual acuity of 0.06 (20/330) in the same eye, were all (100%) shown by means of fundus photography including a fixation target to preferably use an unfavorable retinal locus for fixation, i.e., within the lesion (scotoma). None of the patients was able to read novel text with the affected eye. A computer and video display system were used to determine the most suitable area above or below the visual field scotoma (below or above the retinal lesion) for reading and the magnification needed at this eccentricity. The same setup was also used for an introductory training in reading single words as well as scrolled text with the aim of establishing a preferred retinal locus (PRL) at a favorable, eccentric position, the trained retinal locus (TRL). Thereafter, the patients were provided with strong positive lenses (median power, 40 D) for reading printed text at a very short reading distance (median, 2.5 cm), first single words, above and below which help lines were printed to facilitate eccentric fixation, and finally, novel text. The total training time was 4 to 5 h. Thereafter, fundus photography showed that five of the patients (83%) used their TRL as their PRL. Reading speed was 71 words per minute (median). Our results seem to indicate that an eccentric PRL favorable for effective reading can be established through training and that a fairly low number of training sessions is required.
Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope. [2022]Twenty patients with age-related macular degeneration, an absolute central scotoma and a mean visual acuity of 0.04 (20/475) were studied. A scanning laser ophthalmoscope (SLO) was used for microperimetry and determination of preferred retinal locus, often located to the left of the retinal lesion (corresponding to a location to the left of the visual field scotoma), which is considered unfavorable for reading. All 20 patients were trained to use a new and more favorable retinal locus for reading, above (or occasionally below) the retinal lesion (corresponding to a location below or above the visual field scotoma), first by reading scrolled text under simultaneous fixation monitoring and instruction in the SLO and then by reading printed text, using high magnification (mean 14.3x). For the 18 patients who learned to use eccentric viewing, reading speed with adequate magnification prior to training was 9.0+/-5.8 words/min. With training (mean 5.2 hours), it increased significantly (p
A technique to train new oculomotor behavior in patients with central macular scotomas during reading related tasks using scanning laser ophthalmoscopy: immediate functional benefits and gains retention. [2018]Reading with a central scotoma involves the use of preferred retinal loci (PRLs) that enable both letter resolution and global viewing of word. Spontaneously developed PRLs however often privilege spatial resolution and, as a result, visual span is commonly limited by the position of the scotoma. In this study we designed and performed the pilot trial of a training procedure aimed at modifying oculomotor behavior in subjects with central field loss. We use an additional fixation point which, when combined with the initial PRL, allows the fulfillment of both letter resolution and global viewing of words.
Adaptation to a simulated central scotoma during visual search training. [2014]Patients with a central scotoma usually use a preferred retinal locus (PRL) consistently in daily activities. The selection process and time course of the PRL development are not well understood. We used a gaze-contingent display to simulate an isotropic central scotoma in normal subjects while they were practicing a difficult visual search task. As compared to foveal search, initial exposure to the simulated scotoma resulted in prolonged search reaction time, many more fixations and unorganized eye movements during search. By the end of a 1782-trial training with the simulated scotoma, the search performance improved to within 25% of normal foveal search. Accompanying the performance improvement, there were also fewer fixations, fewer repeated fixations in the same area of the search stimulus and a clear tendency of using one area near the border of the scotoma to identify the search target. The results were discussed in relation to natural development of PRL in central scotoma patients and potential visual training protocols to facilitate PRL development.
Microperimetry biofeedback training in a patient with bilateral myopic macular degeneration with central scotoma. [2018]Microperimetry-1 (MP-1) evaluation and MP-1 biofeedback training were done in a case of bilateral myopic macular degeneration with a central scotoma. Fixation behavior, location and stability of preferred retinal locus, eye movement speed, and mean sensitivity were assessed. The mean retinal sensitivities before, after and at 1-year after training in the right eye were 2.9 dB, 2.9 dB and 3.7 dB and in the left eye were 3.5 dB, 3.7 dB and 1.8 dB. The fixation point in the 2° gravitation circle, improved from 40% to 50% in the right eye and from 43% to 67% in the left eye. The average eye speed before, after and at 1-year after training in right eye were 0.19°/s, 0.26°/s and 0.25°/s and in left eye were 0.36°/s, 0.25°/s and 0.27°/s. Thus, biofeedback training using MP-1 can improve the visual function in patients with macular diseases and central scotoma.
Integrating oculomotor and perceptual training to induce a pseudofovea: A model system for studying central vision loss. [2018]People with a central scotoma often adopt an eccentric retinal location (Preferred Retinal Locus, PRL) for fixation. Here, we proposed a novel training paradigm as a model system to study the nature of the PRL formation and its impacts on visual function. The training paradigm was designed to effectively induce a PRL at any intended retinal location by integrating oculomotor control and pattern recognition. Using a gaze-contingent display, a simulated central scotoma was induced in eight normally sighted subjects. A subject's entire peripheral visual field was blurred, except for a small circular aperture with location randomly assigned to each subject (to the left, right, above, or below the scotoma). Under this viewing condition, subjects performed a demanding oculomotor and visual recognition task. Various visual functions were tested before and after training at both PRL and nonPRL locations. After 6-10 hr of the training, all subjects formed their PRL within the clear window. Both oculomotor control and visual recognition performance significantly improved. Moreover, there was considerable improvement at PRL location in high-level function, such as trigram letter-recognition, reading, and spatial attention, but not in low-level function, such as acuity and contrast sensitivity. Our results demonstrated that within a relatively short time, a PRL could be induced at any intended retinal location in normally-sighted subjects with a simulated scotoma. Our training paradigm might not only hold promise as a model system to study the dynamic nature of the PRL formation, but also serve as a rehabilitation regimen for individuals with central vision loss.
Training eye movements for visual search in individuals with macular degeneration. [2019]We report a method to train individuals with central field loss due to macular degeneration to improve the efficiency of visual search. Our method requires participants to make a same/different judgment on two simple silhouettes. One silhouette is presented in an area that falls within the binocular scotoma while they are fixating the center of the screen with their preferred retinal locus (PRL); the other silhouette is presented diametrically opposite within the intact visual field. Over the course of 480 trials (approximately 6 hr), we gradually reduced the amount of time that participants have to make a saccade and judge the similarity of stimuli. This requires that they direct their PRL first toward the stimulus that is initially hidden behind the scotoma. Results from nine participants show that all participants could complete the task faster with training without sacrificing accuracy on the same/different judgment task. Although a majority of participants were able to direct their PRL toward the initially hidden stimulus, the ability to do so varied between participants. Specifically, six of nine participants made faster saccades with training. A smaller set (four of nine) made accurate saccades inside or close to the target area and retained this strategy 2 to 3 months after training. Subjective reports suggest that training increased awareness of the scotoma location for some individuals. However, training did not transfer to a different visual search task. Nevertheless, our study suggests that increasing scotoma awareness and training participants to look toward their scotoma may help them acquire missing information.
Scotoma Visibility and Reading Rate with Bilateral Central Scotomas. [2018]In this experiment, we tested whether perceptually delineating the scotoma location and border with a gaze contingent polygon overlay improves reading speed and reading eye movements in patients with bilateral central scotomas.
Peripheral oculomotor training in individuals with healthy visual systems: Effects of training and training transfer. [2020]Individuals with pathological or simulated central visual field loss can be trained to use a preferred retinal locus (PRL) as a substitute for their non-functioning fovea. The functional benefits of a stable PRL are well documented, but little is known about oculomotor adaptations during PRL acquisition or transfer of training to another location in response to real or simulated disease progression. In this study, eight normally-sighted observers were trained to use a pseudo-PRL (pPRL) at one of two locations by guiding an eccentrically placed, gaze-contingent ring over a fixation target. The pPRL location was 6.4 degrees in either inferior or right visual field, balanced across observers. Training was completed in two sessions of 200 hundred trials separated by a week. Between sessions, the pPRL position was switched. Task performance was quantified both in terms of gaze stability around the fixation target and gaze accuracy in terms of distance between the target and ring centers. The latter was used to provide feedback by covarying the diameter of the ring to make the task easier or harder on the basis of subject performance. Accuracy and stability significantly increased with training and was comparable at each trained location. Performance gains were retained over a week and transferred from the first to the second pPRL location. Thus, pPRL training with feedback can provide sustained, generalizable improvements in oculomotor control following simulated foveal vision loss. These results suggest that low vision rehabilitation specialists may prioritize PRL training locations based on sensory function alone, since oculomotor gains are relatively uniform; and that training early in the disease process may benefit later adaptations should eye disease progress.
Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma. [2021]To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma.