Macular disease is one of the main causes of visual impairment. We studied the efficacy of low-vision rehabilitation by means of MP-1 biofeedback examination in patients with different macular disease. Five patients were enrolled (3 female and 2 male, mean age 53.8 years) and a total of 9 eyes was examined: 2 eyes with vitelliform dystrophy, 1 with a post-traumatic macular scar, 2 with Stargardt disease, 2 with myopic macular degeneration, 2 with cone dystrophy. All the patients underwent the following tests: visual acuity, reading speed, fixation test, MP-1 microperimetry. Low-vision rehabilitation, which lasted 10 weeks, consisted of 10 training sessions of 10 min for each eye, performed once a week using the MP-1 biofeedback examination. Statistical analysis was performed using Student's t-test. p values less than 0.05 were considered statistically significant. After training all patients displayed an improvement in visual acuity, fixation behaviour, retinal sensitivity and reading speed. Fixation behaviour within the 2 degrees diameter circle improved and was statistically significant for reading speed (p = 0.01). Reading speed improved from a mean value of 64.3 to 92 words/min. Our results show that audio feedback can, by increasing attentional modulation, help the brain to fix the final preferred retinal locus. Audio feedback facilitates stimuli transmission between intraretinal neurons as well as between the retina and brain, which is where the highest level of stimuli processing occurs, thereby probably supporting a "remapping phenomenon".

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Purpose The aim of this study was to determine a sequence of structural changes in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) using optical coherence tomography-Angiography (OCT-A) and comparing with other imaging modalities. Methods Patients with a new diagnosis of acute onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT) and OCT-A. All non-invasive imaging was repeated during follow-up. Results Ten eyes of 5 patients were included in the study, 3 males and 2 females, with a mean age of 26.2 years (range: 21-32) and a mean follow-up of 6.4 months (range: 2.6-13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease. Conclusions Multimodal imaging in patients with APMPPE in acute and long term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect pre-clinical changes and chart resolution at the level of the choriocapillaris.

In this study we evaluated the efficacy of visual rehabilitation by means of two different types of biofeedback techniques in patients with age related macular degeneration (AMD). Thirty patients, bilaterally affected by AMD, were randomly divided in two groups: one group was treated with an acoustic biofeedback (AB group), the other was treated with luminous biofeedback of a black and white checkerboard flickering during the examination (LB group). All patients underwent a complete ophthalmological examination. Rehabilitation consisted of 12 training sessions of 10 min for each eye performed once a week for both groups. Both groups showed better visual performance after rehabilitation and luminous flickering biofeedback stimulus showed a statistically significant improvement in training the patients to modify their preferred retinal locus in comparison to acoustic biofeedback. This suggests that it might be possible in the damaged retina to override dead photoreceptor and outer retinal layers and involve residual surviving cells, as well as amplify and integrate retinal and brain cortex plasticity by using other spared channels towards associative pathways.