Ramírez Estudillo Juan Abel, León Higuera Mario Isaías, Rojas Juárez Sergio, Ordaz Vera Maria de Lourdes, Pablo Santana Yessica, Celis Suazo Benito
Retina Department, Fundación Hospital Nuestra Señora de la Luz, Ezequiel Montes 135, Cuauhtemoc, Tabacalera, 06030 Ciudad de México, México.
Retina and Vitreous Research Fellow, Fundación Hospital Nuestra Señora de la Luz, Ezequiel Montes 135, Cuauhtemoc, Tabacalera, 06030 Ciudad de México, México.
Int J Retina Vitreous. 2017 May 22;3:21. doi: 10.1186/s40942-017-0071-1. eCollection 2017.
Age-related macular degeneration (AMD) is the leading cause of blindness in the western world. As a consequence of AMD, patients develop structural damage that comprises the fovea and subsequently present loss of central vision, low visual acuity and unstable fixation. Contrary to what happens with anti-angiogenic treatment in neovascular AMD, there is currently no definitive treatment to reverse geographic atrophy progression. The aim of this study was to determine the effectiveness of the visual rehabilitation treatment via microperimetry in patients with geographic atrophy.
Longitudinal and prospective study, 18 patients with areas of geographic atrophy in their eye of better visual acuity were included. Macular integrity assessment (Maia) microperimeter (CentreVue, Padova, Italy) was used to diagnose retinal fixation and sensitivity in these patients. Based on these data and using the training module available in the equipment, the patients underwent visual rehabilitation sessions intended to allow the patient to establish the best possible fixation in the best area of retinal sensitivity. To determine the training effectiveness, the following variables were compared before and after: visual acuity in LogMAR scale with ETDRS charts, reading speed with Minnesota Low-Vision Reading Test (MN Read), average sensitivity threshold in microperimetry; P1 and 95% Bivariate Contour Ellipse Area (BCEA) values were used for fixation stability measurement.
Mean age was 77 years old (65-92). Visual acuity of the trained eye was on average 0.7 versus 0.6 LogMAR ( = 0.006) before and one week after training. Reading speed, using both eyes, was 47 words per minute (wpm) before training and 69 wpm after training ( = 0.04). Average retinal sensitivity was 14.1 versus 14.6 db ( = 0.4). Fixation stability improved with P1 values of 45% versus 51% ( = 0.05) and 95% BCEA values of 43 versus 25 ( = 0.02) before and after training, respectively.
Visual training via microperimetry in patients with age-related macular degeneration is effective in improving fixation stability, reading speed, and visual acuity, measured one week after training is completed.
年龄相关性黄斑变性（AMD）是西方世界失明的主要原因。由于AMD，患者会出现包括中央凹在内的结构损伤，随后出现中心视力丧失、低视力和注视不稳定。与新生血管性AMD的抗血管生成治疗不同，目前尚无确定的治疗方法来逆转地图样萎缩的进展。本研究的目的是确定微视野检查视觉康复治疗对地图样萎缩患者的有效性。
纵向前瞻性研究，纳入18例视力较好眼存在地图样萎缩区域的患者。使用黄斑完整性评估（Maia）微视野计（意大利帕多瓦的CenterVue公司）诊断这些患者的视网膜注视和敏感度。基于这些数据并使用设备中的训练模块，患者接受视觉康复训练，旨在使患者在视网膜敏感度最佳区域建立尽可能好的注视。为确定训练效果，比较训练前后的以下变量：使用ETDRS图表的LogMAR视力表视力、使用明尼苏达低视力阅读测试（MN Read）的阅读速度、微视野检查的平均敏感度阈值；使用P1和95%双变量轮廓椭圆面积（BCEA）值测量注视稳定性。
平均年龄为77岁（65 - 92岁）。训练眼的视力在训练前平均为LogMAR 0.7，训练后1周为0.6（P = 0.006）。双眼的阅读速度在训练前为每分钟47个单词（wpm），训练后为69 wpm（P = 0.04）。平均视网膜敏感度为14.1 dB对14.6 dB（P = 0.4）。训练前后注视稳定性有所改善，P1值分别为45%对51%（P = 0.05），95%BCEA值分别为43对25（P = 0.02）。
年龄相关性黄斑变性患者通过微视野检查进行视觉训练，在训练完成1周后测量，对改善注视稳定性、阅读速度和视力有效。
