Low Vision Clinic and Research Laboratory, Centre for Ophthalmology, University of Tübingen, Germany.
Acta Ophthalmol. 2011 Feb;89(1):e82-8. doi: 10.1111/j.1755-3768.2010.02081.x.
In this study, we examined the clinical application of two training methods for optimizing reading ability in patients with juvenile macular dystrophy with established eccentric preferred retinal locus and optimal use of low-vision aids.
This randomized study included 36 patients with juvenile macular dystrophy (35 with Stargardt's disease and one with Best's disease). All patients have been using individually optimized low-vision aids. After careful ophthalmological examination, patients were randomized into two groups: Group 1: Training to read during rapid serial visual presentation (RSVP) with elimination of eye movements as far as possible (n = 20); Group 2: Training to optimize reading eye movements (SM, sensomotoric training) (n = 16). Only patients with magnification requirement up to sixfold were included in the study. Training was performed for 4 weeks with an intensity of ½ hr per day and 5 days a week. Reading speed during page reading was measured before and after training. Eye movements during silent reading were recorded before and after training using a video eye tracker in 11 patients (five patients of SM and six of RSVP training group) and using an infrared reflection system in five patients (three patients from the SM and two patients of RSVP training group).
Age, visual acuity and magnification requirement did not differ significantly between the two groups. The median reading speed was 83 words per minute (wpm) (interquartile range 74-105 wpm) in the RSVP training group and 102 (interquartile range 63-126 wpm) in the SM group before training and increased significantly to 104 (interquartile range 81-124 wpm) and 122, respectively (interquartile range 102-137 wpm; p = 0.01 and 0.006) after training, i.e. patients with RSVP training increased their reading speed by a median of 21 wpm, while it was 20 wpm in the SM group. There were individual patients, who benefited strongly from the training. Eye movement recordings before and after training showed that in the RSVP group, increasing reading speed correlated with decreasing fixation duration (r = -0.75, p = 0.03), whereas in the SM group, increasing reading speed correlated with a decreasing number of forward saccades (r = -0.9, p = 0.01).
Although the median effect of both training methods was limited, individual patients benefited well. Our results may indicate a difference in the training effect between both methods on the reading strategy: the RSVP method reduces fixation duration, the SM method decreases the number of forward saccades. Patients can apply their newly learned reading strategy in the natural reading situation, e.g. in page reading without special presentation of the text. These results can be used as a basis for further improvement in training methods for optimizing reading performance in patients with a central scotoma.
本研究旨在探讨两种训练方法在患有青少年黄斑营养不良、已建立偏心最佳视网膜位置且最佳使用低视力辅助器具的患者中优化阅读能力的临床应用。
这项随机研究纳入了 36 名患有青少年黄斑营养不良的患者（35 名 Stargardt 病患者和 1 名 Best 病患者）。所有患者均使用个体化优化的低视力辅助器具。在仔细的眼科检查后，患者被随机分为两组：组 1：使用快速连续视觉呈现（RSVP）进行阅读训练，尽可能消除眼球运动（n=20）；组 2：进行优化阅读眼球运动（SM，感觉运动训练）的训练（n=16）。仅纳入需要放大至六倍的患者进行研究。训练持续 4 周，每天进行 1/2 小时，每周进行 5 天。在训练前和训练后测量阅读页面时的阅读速度。在 11 名患者（5 名 SM 患者和 6 名 RSVP 训练组患者）中，使用视频眼动仪记录训练前后的默读眼球运动，在 5 名患者（3 名 SM 患者和 2 名 RSVP 训练组患者）中使用红外反射系统记录训练前后的眼球运动。
两组患者的年龄、视力和放大需求无显著差异。RSVP 训练组训练前的中位阅读速度为 83 个单词/分钟（四分位距 74-105 个单词/分钟），SM 组为 102 个单词/分钟（四分位距 63-126 个单词/分钟），训练后分别显著增加至 104 个单词/分钟（四分位距 81-124 个单词/分钟）和 122 个单词/分钟（四分位距 102-137 个单词/分钟；p=0.01 和 0.006），即 RSVP 训练组的患者阅读速度中位数提高了 21 个单词/分钟，而 SM 组提高了 20 个单词/分钟。有些患者从训练中获益匪浅。训练前后的眼球运动记录显示，在 RSVP 组中，阅读速度的提高与注视持续时间的缩短相关（r=-0.75，p=0.03），而在 SM 组中，阅读速度的提高与前向扫视次数的减少相关（r=-0.9，p=0.01）。
尽管两种训练方法的中位效果都有限，但个别患者受益良好。我们的结果可能表明，两种方法对阅读策略的训练效果存在差异：RSVP 方法减少注视持续时间，SM 方法减少前向扫视次数。患者可以将新学到的阅读策略应用于自然阅读情境中，例如在没有特殊呈现文本的页面阅读中。这些结果可以作为进一步改进中央暗点患者阅读表现优化训练方法的基础。
