Abstract
Biofeedback training has been used to improve fixation stability in subjects with central vision loss, but the psychophysiological mechanisms underlying the functional improvements resulted was not reported. The aim of this study was to investigate the effects of microperimetric biofeedback training on different visual functions and self-reported quality of vision in subjects with age-related macular degeneration. This case-control study included six subjects (72.0 ± 6.1 years of age) diagnosed with age-related macular degeneration (wet or dry) with low vision (best corrected visual acuity ranging from 0.5 to 0.1 in the study eye) and five healthy volunteers (64.2 ± 3.7 years of age). Ophthalmological and functional examinations were obtained from all subjects twice with an approximately 3-month interval. Subjects with central vision loss performed 12 sessions (10 min each) of biofeedback training between the two examinations. Functional evaluation included: microperimetry, spatial luminance contrast sensitivities, color vision thresholds, visual acuity, and reading speed. Visual performance during daily activities was also assessed using a standardized questionnaire. The ratio (2nd/1st examination) of the spatial luminance contrast sensitivity at lower spatial frequencies were much higher for the training subjects compared with the controls. In addition, self-reported quality of vision improved after the training. The significant improvement of the visual function such as spatial luminance contrast sensitivity may explain the better self-reported quality of vision. Possible structural and physiological mechanisms underlying this neuromodulation are discussed.
Similar content being viewed by others
References
Ambati, J., & Fowler, B. J. (2012). Mechanisms of age-related macular degeneration. Neuron, 75(1), 26–39.
Amore, F. M., Paliotta, S., Silvestri, V., Piscopo, P., Turco, S., & Reibaldi, A. (2013). Biofeedback stimulation in patients with age-related macular degeneration: Comparison between 2 different methods. Canadian Journal of Ophthalmology, 48, 431–437.
Bausz, M., & Németh, J. (2006). Change in the quality of life after cataract surgery [Hun]. In S. L. Biró Zs (Ed.), The newest results of cataract and refractive surgery [Hun]. Congress of the SHIOL 2005 (pp. 53–64). Pécs: Hungarian-Artificial Lens Implantation and Refractive Surgery Society.
Brown, P. K., & Wald, G. (1964). Visual pigments in single rods and cones of human retina—direct measurements revels mechanisms of human night and color vision. Science, 144, 45–47.
Cheung, S., & Legge, G. E. (2005). Functional and cortical adaptations to central vision loss. Visual Neuroscience, 22, 187–201.
Chuang, E. L. (1987). Management of the ageing macula. Eye, 1, 311–317.
Crossland, M. D., Culham, L. E., Kabanarou, S. A., & Rubin, G. S. (2005). Preferred retinal locus development in patients with macular disease. Ophthalmology, 112, 1579–1585.
Crossland, M. D., Engel, S. A., & Legge, G. E. (2011). Preferred retinal locus in macular disease. Toward a consensus definition. Retina, 31, 2109–2114.
Fletcher, D. C., & Schuchard, R. A. (1997). Preferred retinal loci relationship to macular scotomas in a low-vision population. Ophthalmology, 104, 632–638.
González, E. G., Tarita-Nistor, L., Markowitz, S. N., & Stainbach, M. J. (2007). Computer-based test to measure optimal visual acuity in age-related macular degeneration. Investigative Ophthalmology & Visual Science, 48, 4838–4845.
Guez, J. E., Le Gargasson, J. F., Rigaudiere, F., & O’Regan, J. K. (1993). Is there a systematic location for the pseudo-fovea in patients with central scotoma? Vision Research, 33, 1271–1279.
Harris, M. J., Robins, D., Dieter, J. M. Jr., Fine, S. L., & Guyton, D. L. (1985). Eccentric visual acuity in patients with macular disease. Ophthalmology, 92, 1550–1553.
Landa, G., Su, E., Garcia, P. M., Seiple, W. H., & Rosen, R. B. (2011). Inner segment–outer segment junctional layer integrity and corresponding retinal sensitivity in dry and wet forms of agerelated macular degeneration. Retina, 31, 364–370.
Liu, R., & Kwon, M. Y. (2016). Integrating oculomotor and perceptual training to induce a pseudofovea: A model system for studying central vision loss. Journal of Vision, 16, 10.
Martins Rosa, A., Silva, M. F., Ferreira, S., Murta, J., & Castelo-Branco, M. (2013). Plasticity in the human visual cortex: An ophthalmology-based perspective. BioMed Research International, 2013, 568354.
Mandelcorn, M. S., Podbielski, D. W., & Mandelcorn, E. D. (2013). Fixation stability as a goal in the treatment of macular disease. Canadian Journal of Ophthalmology, 48, 364–367.
Midena, E., Angeli, C. D., Blarzino, M. C., Valenti, M., & Segato, T. (1997). Macular function impairment in eyes with early age-related macular degeneration. Investigative Ophthalmology & Visual Science, 38, 469–477.
Midena, E., Vujosevic, S., & Cavarzeran, F., for the Microperimetry Study Group (2010). Normative agerelated database for the MP1 microperimeter. Ophthalmology., 117, 1571–1576.
Mollon, J. D., & Reffin, J. P. (1989). A computer-controlled colour vision test that combines the principles of Chibret and of Stilling. Proceedings of the Physyiological Society, vol. 414.
Nathans, J., Thomas, D., & Hogness, D. S. (1986). Molecular genetics of human color vision: The genes encoding blue, green, and red pigments. Science, 232, 193–202.
Nilsson, U. L., Frennesson, C., & Nilsson, S. E. (1998). Location and stability of a newly established eccentric retinal locus suitable for reading, achieved through training of patients with a dense central scotoma. Optometry and Vision Science, 75, 873–878.
Nilsson, U. L., Frennesson, C., & Nilsson, S. E. (2003). Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope. Vision Research, 43, 1777–1787.
Owsley, C., & Sloane, M. E. (1987). Contrast sensitivity, acuity, and the perception of ‘real-world’ targets. British Journal of Ophthalmology, 71, 791–796.
Peyrin, C., Ramanoel, S., Roux-Sibilon, A., Chokron, S., & Hera, R. (2017). Scene perception in age-related macular degeneration: Effect of spatial frequencies and contrast in residual vision. Vision Research, 130, 36–47.
Polyak, S. (1949). Retinal structure and color vision. In F. B. Fischer, A. J. Schaeffer, & A. Sorsby A (Eds.), Documenta Ophthalmologica: Advances in Ophthalmology. The Hague, Netherlands: Dr. W. Junk, vol. 3, p. 24Y46.
Putnam, N. M., Hofer, H. J., Doble, N., Chen, L., Carroll, J., & Williams, D. R. (2005). The locus of fixation and foveal cone mosaic. Journal of Vision, 5, 632–639.
Rodriguez-Carmona, M. L., Harlow, J. A., Walker, G., & Barbur, J. L. (2005). The variability of normal trichromatic vision and the establishment of the “normal” range. Proceedings of 10th Congress of the International Colour Association. Granada (pp. 979–982).
Schotter, E. R., Angele, B., & Rayner, K. (2012). Parafoveal processing in reading. Attention, Perception, & Psychophysics, 74, 5–35.
Steinberg, E. P., Tielsch, J. M., Schein, O. D., Javitt, J. C., Sharkey, P., Cassard, S. D., Legro, M. W., Diener-West, M., Bass, E. B., Damiano, A. M., et al. (1994). The VF-14. An index of functional impairment in patients with cataract. Archives of Ophthalmology, 112, 630–638.
Sunness, J. S., Schuchard, R. A., Shen, N., Rubin, G. S., Dagnelie, G., & Haselwood, M. (1995). Landmark-driven fundus perimetry using the scanning laser ophthalmoscope. Investigative Ophthalmology & Visual Science, 36, 1863–1874.
Tarita-Nistor, L., González, E. G., Markowitz, S. N., & Steinbach, M. J. (2009). Plasticity of fixation in patients with central vision loss. Visual Neuroscience, 26(5–6), 487–494.
Thomson, L. C. (1946). Foveal colour sensitivity. Nature, 157, 805.
Ueda-Consolvo, T., Otsuka, M., Hayashi, Y., Ishida, M., & Havashi, A. (2015). Microperimetric biofeedback training improved visual acuity after successful macular hole surgery. Journal of Ophthalmology, 2015, 572942.
Vemala, R., Sivaprasad, S., & Barbur, J. L. (2017). Detection of early loss of color vision in age-related macular degeneration—with emphasis on drusen and reticular pseudodrusen. Investigative Ophthalmology & Visual Science, 58, 247–254.
Vingolo, E. M., Cavarretta, S., Domanico, D., Parisi, F., & Malagola, R. (2007). Microperimetric biofeedback in AMD patients. Appl Psychophysiol Biofeedback, 32, 185–189.
Vingolo, E. M., Salvatore, S., & Cavarretta, S. (2009). Low-vision rehabilitation by means of MP-1 biofeedback examination in patients with different macular diseases: A pilot study. Appl. Psychophysiol. Biofeedback, 34, 127–133.
Vingolo, E. M., Salvatore, S., & Limoli, P. G. (2013). MP-1 biofeedback: luminous pattern stimulus versus acoustic biofeedback in age related macular degeneration (AMD). Appl Psychophysiol Biofeedback, 38, 11–16.
Westheimer, G. (1965). Visual acuity. Annual Review of Psychology, 16, 359–380.
Westheimer, G. (1984). Spatial vision. Annual Review of Psychology, 35, 201–226.
Zeffren, B. S., Applegate, R. A., Bradley, A., & van Heuven, W. A. J. (1990). Retinal fixation point location in the foveal avascular zone. Investigative Ophthalmology & Visual Science, 31, 2099–2105.
Acknowledgements
We would like to thank very much Kornél Szekeres, Miklós Maczkó, and Ágnes Urbin for their support to develop the software. We would also like to acknowledge financial support from the Sao Paulo Research Foundation - FAPESP (Grant Nos. 2016/22007-5 and 2016/04538-3), National Council for Scientific and Technological Development – CNPq (Grant Nos. 470785/2014-4 and 404239/2016-1), and the János Bolyai Scholarship of the Hungarian Academy of Sciences. We also thank the patients and the healthy volunteers for their participation in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Barboni, M.T.S., Récsán, Z., Szepessy, Z. et al. Preliminary Findings on the Optimization of Visual Performance in Patients with Age-Related Macular Degeneration Using Biofeedback Training. Appl Psychophysiol Biofeedback 44, 61–70 (2019). https://doi.org/10.1007/s10484-018-9423-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10484-018-9423-3