June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
First results from the EFFECT Trial, an RCT of eccentric viewing training for patients with AMD
Author Affiliations & Notes
  • Gary Rubin
    Visual Neuroscience, University College London, London, ENGLAND, United Kingdom
    Biomedical Research Centre for Ophthalmology, NIHR, London, United Kingdom
  • Footnotes
    Commercial Relationships   Gary Rubin, None
  • Footnotes
    Support  Fight for Sight Programme Award
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4766. doi:
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      Gary Rubin; First results from the EFFECT Trial, an RCT of eccentric viewing training for patients with AMD. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4766.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Eccentric Viewing Training (EVT) aims to teach people who have lost their central vision from conditions such as AMD to use their peripheral vision to perform daily tasks like reading and recognizing faces. EVT is widely practiced in some European countries, especially Sweden, and at some low vision centers in the US and elsewhere. EVT is not generally available through the NHS in the UK. One reason it is not offered is the lack of evidence that EVT is effective. In 2011 we initiated the EFFECT Trial to help close the gap in the evidence

Methods : EFFECT is a four parallel arm RCT. 50 patients were recruited into each of four groups. Group 1 is the control group that receives standard care (no EVT). Group 2 received the same amount of contact time as Group 1 but no EVT. Group 3 received 3 sessions of EVT at their self selected preferred retinal location (PRL) and Group 4 is given 3 sessions of EVT at a location chosen by the trainer that is meant to be optimal for daily tasks. All participants’ better eye had acuity worse than logMAR 0.3 and a dense central scotoma. EVT was administered by optometrists trained and certified by an experienced low vision trainer. The primary outcome was self –reported difficulty with daily activities measured with the Massof Activity Inventory,(MAI).

Results : 200 patients were recruited to the study. 178 participants completed the 6-month follow up and 168 12 months . After controlling for baseline MAI score and other covariates, MAI scores at the 6-month follow-up were highest for group 2 (equal contact time, no EVT) and lowest for group 3 (training at the PRL), but the difference, 0.23 logits was not statistically significant (p>0.1) or clinically meaningful. The results were the same at the 12-month follow-up.

Conclusions : We were not able to demonstrate a measurable benefit of EVT. There are several reasons why this may be so. We may have offered too little EVT, or used the wrong traing methods. We may have selected the wrong patients or used the wrong outcome measure. But baseds on our prior work we believe the most likely eplanation is that most people who develop a central scotoma from AMD discover eccentric viewing on their own; without any formal training. EVT may help the AMD patient discover eccentric viewing more quilckly or adopt a better ecentric viewing strategy, but these must remain open questions for future studies to address.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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