June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Scotoma Awareness and Eye Movement Training in Age-Related Macular Degeneration
Author Affiliations & Notes
  • Preeti Verghese
    Smith-Kettlewell Eye Res Inst, San Francisco, CA
  • Christian P Janssen
    Smith-Kettlewell Eye Res Inst, San Francisco, CA
    Utrecht University, Utrecht, Netherlands
  • Footnotes
    Commercial Relationships Preeti Verghese, None; Christian Janssen, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2620. doi:
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      Preeti Verghese, Christian P Janssen; Scotoma Awareness and Eye Movement Training in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2620.

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

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Abstract
 
Purpose
 

As most individuals with age related macular degeneration are unaware of their scotoma, we seek to: 1. Develop a paradigm to increase scotoma awareness and 2. Train the preferred retinal locus (PRL) to move towards the scotoma to reveal information obscured by the scotoma.

 
Methods
 

We first estimated the extent of monocular scotoma and the loci of fixation using a scanning laser ophthalmoscope. We also estimated the location of the binocular scotoma using a custom program that projected stimuli on a large screen. Our goal was to train individuals to direct their PRL toward the scotoma, to uncover missing information. The training paradigm involved comparing two stimuli located on opposite sides of the PRL to determine if they were the same or different. One stimulus was hidden behind the individual’s binocular scotoma and the other was clearly visible in the location opposite the scotoma. As the task required knowing the identity of both stimuli, moving the PRL towards the scotoma was the best way to reveal the obscured stimulus. Observers were trained in multiple blocks over two practice sessions.

 
Results
 

At the start of training, patients initially looked at the visible stimulus (away from the scotoma), but with practice they began to direct their PRL toward the scotoma. The attached figure shows how well participants were able to direct their saccades towards the target, after training and at a 2-month follow-up viist. At the end of training, 4 out of 7 individuals made saccades more than half way toward the hidden target. At the 2-month retention assessment, all observers consistently made saccades toward the the target hidden in the scotoma. Self-reports suggest increased subjective awareness of scotoma location for some, which could explain the high proportion of saccades towards the scotoma.

 
Conclusions
 

A visual search task designed to direct eye movements toward the scotoma improves both scotoma awareness and eye movement efficiency.  

 
The box plots show the distribution of saccade length relative to the target distance from fixation, for each of 7 participants. (Saccades that reach the center of target are denoted by 1, saccades that do not move toward the target by 0.) The upper and lower panels show data at the end of training and at a 2-month retention assessment, respectively.
 
The box plots show the distribution of saccade length relative to the target distance from fixation, for each of 7 participants. (Saccades that reach the center of target are denoted by 1, saccades that do not move toward the target by 0.) The upper and lower panels show data at the end of training and at a 2-month retention assessment, respectively.

 
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