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Tommaso Verdina, Giovanni Giacomelli, Andrea Sodi, Monica Pennino, Vittoria Murro, Ugo Menchini; Biofeedback rehabilitation of eccentric fixation in patients with Stargardt Disease using the MP-1 Microperimeter. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4369.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of biofeedback microperimetric training of eccentric fixation in a series of patients with Stargardt disease (STGD).
Eighteen patients with STGD with known ABCA4 mutations, unstable or relatively unstable fixation located in the superior retina with Bivariate Contour Ellipse Area (BCEA) 68.2% > 2,0°2 and best corrected visual acuity (BCVA) between 20/320 (1.2 logMar) and 20/100 (0.7 logMar) in the better eye were recruited. Fundus photography, microperimetry (10-2 program, 4-2 procedure with a 2° red cross) and fixation analysis (40sec. with a 2° red cross) with the Nidek MP-1 were performed. Patients were divided into two groups with similar ages and characteristics of the Preferred Retinal Location (PRL). Twelve patients (Group A) underwent eight consecutive biofeedback PRL training sessions of 10 min each, performed once a week in the better eye. Six patients (Group B) did not have the training. BCVA, reading speed (RS), contrast sensibility (CS), BCEA and total field retinal sensitivity (TS) were evaluated in the better eye in both groups and compared at baseline and after 10 weeks.
The PRL for the 18 eyes was located from 5° to 12° (mean value 7.68°) superior to the fovea. For all 12 eyes in Group A we found significantly improved (p<0.01) stabilization of fixation at the end of the training period (mean BCEA 68.2% from 6.39 +/- 6.05°2 to 1.58 +/- 0.94°2). In addition there was improvement in mean BCVA from 34.00 +/- 5.44 to 37.67 +/- 5.57 letters at ETDRS chart; in mean RS (p<0.01) from 66.67 +/- 19.30 to 84.00 +/- 24.23 W/m; CS from 16.33 +/- 7.01 to 18.75 +/- 7.14 letters at 2 meters and in 45% text contrast with the REX test (3rd sentence) in 4 patients. TS was also significantly improved (p<0.01) in all patients from 10.68 +/- 3.64 dB to 12.29 +/- 3.80 dB. For the Group B eyes (control group) we did not find a significant change in fixation at 10 weeks (BCEA 68.2% from 4.67 +/- 2.04°2 to 4.92 +/- 1.92°2) and all the other parameters also remained almost unchanged: BCVA and RS decreased respectively from 40.17 +/- 6.11 to 37.00 +/- 6.51 letters and from 67.50 +/- 24.59 to 58.00 +/- 21.21 W/m, CS from 20.00 +/- 7.69 to 18.33 +/- 8.14 letters, 45% text contrast (3rd sentence) did not improve at all, TS changed from 12.45 +/- 4.99 to 12.68 +/- 4.72 dB.
Biofeedback rehabilitation training with MP-1 shows good results in STGD patients with unstable or relatively unstable fixation leading to a stabilization of the PRL and a consequent improvement in aspects of patients’ visual function and reading performance.
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