A technique to train new oculomotor behavior in patients with central macular scotomas during reading related tasks using scanning laser ophthalmoscopy: immediate functional benefits and gains retention.
BACKGROUND
Reading with a central scotoma involves the use of preferred retinal loci (PRLs) that enable both letter resolution and global viewing of word. Spontaneously developed PRLs however often privilege spatial resolution and, as a result, visual span is commonly limited by the position of the scotoma. In this study we designed and performed the pilot trial of a training procedure aimed at modifying oculomotor behavior in subjects with central field loss. We use an additional fixation point which, when combined with the initial PRL, allows the fulfillment of both letter resolution and global viewing of words.


METHODS
The training procedure comprises ten training sessions conducted with the scanning laser ophthalmoscope (SLO). Subjects have to read single letters and isolated words varying in length, by combining the use of their initial PRL with the one of an examiner's selected trained retinal locus (TRL). We enrolled five subjects to test for the feasibility of the training technique. They showed stable maculopathy and persisting major reading difficulties despite previous orthoptic rehabilitation. We evaluated ETDRS visual acuity, threshold character size for single letters and isolated words, accuracy for paragraphed text reading and reading strategies before, immediately after SLO training, and three months later.


RESULTS
Training the use of multiple PRLs in patients with central field loss is feasible and contributes to adapt oculomotor strategies during reading related tasks. Immediately after SLO training subjects used in combination with their initial PRL the examiner's selected TRL and other newly self-selected PRLs. Training gains were also reflected in ETDRS acuity, threshold character size for words of different lengths and in paragraphed text reading. Interestingly, subjects benefited variously from the training procedure and gains were retained differently as a function of word length.


CONCLUSIONS
We designed a new procedure for training patients with central field loss using scanning laser ophthalmoscopy. Our initial results on the acquisition of newly self-selected PRLs and the development of new oculomotor behaviors suggest that the procedure aiming primarily at developing an examiner's selected TRL might have initiated a more global functional adaptation process.
Déruaz
Anouk
A
Ophthalmology Clinic, Department of Clinical Neurosciences and Dermatology, Geneva University Hospitals, Switzerland. aderuaz@yahoo.fr
Goldschmidt
Mira
M
Whatham
Andrew R
AR
Mermoud
Christophe
C
Lorincz
Erika N
EN
Schnider
Armin
A
Safran
Avinoam B
AB
D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D006801:Humans; D007834:Lasers; D008266:Macula Lutea; D009801:Oculomotor Muscles / Q000503:physiopathology*; D009887:Ophthalmoscopy; D010865:Pilot Projects; D011932:Reading; D012164:Retinal Diseases / Q000150:complications*; D012607:Scotoma / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*