Pacella E, Pacella F, Mazzeo F, Turchetti P, Carlesimo S C, Cerutti F, Lenzi T, De Paolis G, Giorgi D
Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Italy.
Clin Ter. 2012 Nov;163(6):e423-8.
To evaluate the effectiveness of biofeedback treatment for low-vision rehabilitation in patients affected by macular disease.
171 eyes of 99 patients (42 female and 57 male) between 50 to 75 years old (mean age: 64.6) were included in this study. All patients were suffering from age-related macular degeneration (AMD) (122 eyes) or macular myopic degeneration (MMD) (49 eyes). All patients underwent an assessment of examinations including visual acuity, reading speed test, slit lamp examination and tonometry, ophthalmoscopic fundus examination, microperimetry, fixation test, retinal sensitivity, fluorangiography (FAG), optical coherence tomography (OCT). The treatment was divided in 16 sessions, the patients underwent other examination assessment at 6 and 12 months, except for FAG and OCT. Statistical analysis was performed using Student's t-test, and p-value <=0.05 was considered statistically significant.
After training 130 eyes of 171 in the study group (76.02%) had a statistically significant improvement of the distant visual acuity (p<0.01): 38 eyes suffering from MMD and 92 eyes suffering from AMD. After 12 months of follow-up a group of 25 eyes of 130 (19.23%) had a loss of benefits that were observed at the end of the treatment sessions: 16 eyes and 9 eyes were suffering from MMD and AMD respectively. Examination assessment during follow-up showed that 4 eyes and 2 eyes of the group that lost benefits had a worsening of MMD and AMD primary disease respectively.
It is not yet understood how biofeedback produces amelioration of visual function. According to the 'Eccentric fixation' theory, with biofeedback rehabilitation patients are trained to use the non-damaged retina areas to develop a new preferred retinal locus. In our study group we found a significant improvement in both visual acuity and fixation.
评估生物反馈疗法对黄斑疾病患者低视力康复的有效性。
本研究纳入了99例患者（42例女性和57例男性）的171只眼，年龄在50至75岁之间（平均年龄：64.6岁）。所有患者均患有年龄相关性黄斑变性（AMD）（122只眼）或黄斑近视性变性（MMD）（49只眼）。所有患者均接受了包括视力、阅读速度测试、裂隙灯检查和眼压测量、眼底镜眼底检查、微视野检查、注视测试、视网膜敏感度、荧光血管造影（FAG）、光学相干断层扫描（OCT）在内的检查评估。治疗分为16个疗程，患者在6个月和12个月时接受其他检查评估，但FAG和OCT除外。采用学生t检验进行统计分析，p值<=0.05被认为具有统计学意义。
研究组171只眼中有130只眼（76.02%）在训练后远视力有统计学显著改善（p<0.01）：38只患有MMD的眼和92只患有AMD的眼。随访12个月后，130只眼中有25只眼（19.23%）失去了治疗疗程结束时观察到的益处：分别有16只眼和9只眼患有MMD和AMD。随访期间的检查评估显示，失去益处的组中有4只眼和2只眼的MMD和AMD原发性疾病分别恶化。
目前尚不清楚生物反馈如何改善视觉功能。根据“偏心注视”理论，通过生物反馈康复训练，患者被训练使用未受损的视网膜区域来形成新的首选视网膜位点。在我们的研究组中，我们发现视力和注视都有显著改善。
