Perspective on Vision Science-Informed Interventions for Central Vision Loss

Abstract

Pathologies affecting central vision, and macular degeneration (MD) in particular, represent a growing health concern worldwide, and the leading cause of blindness in the Western World. To cope with the loss of central vision, MD patients often develop compensatory strategies, such as the adoption of a Preferred Retinal Locus (PRL), which they use as a substitute fovea. However, visual acuity and fixation stability in the visual periphery are poorer, leaving many MD patients struggling with tasks such as reading and recognizing faces. Current non-invasive rehabilitative interventions are usually of two types: oculomotor, aiming at training eye movements or teaching patients to use or develop a PRL, or perceptual, with the goal of improving visual abilities in the PRL. These training protocols are usually tested over a series of outcome assessments mainly measuring low-level visual abilities (visual acuity, contrast sensitivity) and reading. However, extant approaches lead to mixed success, and in general have exhibited large individual differences. Recent breakthroughs in vision science have shown that loss of central vision affects not only low-level visual abilities and oculomotor mechanisms, but also higher-level attentional and cognitive processes. We suggest that effective interventions for rehabilitation after central vision loss should then not only integrate low-level vision and oculomotor training, but also take into account higher level attentional and cognitive mechanisms.

Enabling identification of component processes in perceptual learning with nonparametric hierarchical Bayesian modeling

“…It can significantly enhance human performance ( Ball & Sekuler, 1982 ; Dosher & Lu, 1998 ; Fiorentini & Berardi, 1980 ; Huang, Zhou, & Lu, 2008 ; Karni & Sagi, 1991 ; Petrov, Van Horn, & Ratcliff, 2011 ; Poggio, Fahle, & Edelman, 1992 ) and has been shown to persist for years ( Zhou et al., 2006 ). The study of perceptual learning not only reveals the functions and mechanisms underlying these phenomena but also enhances our understanding of brain plasticity and the development of training procedures for perceptual expertise ( Hoffman et al., 2013 ) or rehabilitation of clinical conditions ( Huxlin, 2009 ; Levi, 2020 ; Maniglia, Visscher, & Seitz, 2021 ; Yu, Cheung, Legge, & Chung, 2010 ).…”

The effect of duration between sessions on microperimetric biofeedback training in patients with maculopathies

“…However, the foveal region is vulnerable to degeneration due to changes in blood flow, oxygen and nutrient delivery caused by many macular diseases 1 . Macular diseases, such as age-related macular degeneration (AMD), myopic macular degeneration (MMD), and Stargardt's disease (STGD), are characterized by impairments of the photoreceptors in the macula, which in turn lead to disorders in daily work tasks, such as driving, reading, and facial recognition, seriously affecting the quality of life of patients 2 . MMD and AMD have been the leading causes of irreversible low vision and blindness in recent years due to an aging population and increasing prevalence of myopia 3,4 .…”

“…However, the brain is able to work around this. To compensate for the lack of central fixation, the brain automatically chooses an area of the retina outside the central macular to form eccentric fixation, known as the preferred retinal locus (PRL) 2,8 . This common adaptive strategy is a sign of neural plasticity, consistent with the hypothesis of partial cortical reorganization 9 .…”

Topical Review: Impact of Central Vision Loss on Navigation and Obstacle Avoidance while Walking

“…There are numerous literature reviews on central vision loss and age-related macular degeneration, and most of them focus on epidemiology, 31 treatment, 32 quality of life, 4 and rehabilitation including assistive devices. 33 There are several reviews that focus on the effects of central vision loss on mobility while driving. For example, Owsley and McGwin 34 focused exclusively on driving and central vision loss due to age-related macular degeneration.…”