Effectiveness of visual and acoustic biofeedback eccentric viewing training in conjunction with home exercises on visual function: a retrospective observational review.

The aim of this study is to evaluate the effectiveness of an eccentric viewing training program that combines biofeedback training using micro-perimetry with home exercises on multiple visual function parameters and to explore potential relationships between post-treatment visual function parameters. A retrospective observational review of 27 participants who underwent the training program was performed. Eligible participants were diagnosed with bilateral central scotomas secondary to age-related macular degeneration. All participants undertook up to 15 visual and acoustic biofeedback training sessions and were required to partake in traditional home exercises between sessions. The biofeedback training was conducted in the better eye using the Macular Integrity Assessment microperimeter (MAIA). Distance and near acuity, contrast sensitivity and fixation stability quantified by the P1 and P2 values and the 63% and 95% bivariate contour ellipse area (BCEA) before and after the rehabilitation program were recorded. Significant improvement was noted post-training for distance visual acuity (t(26) = 4938 p = .000), near visual acuity (Z = -4.461 p = .000), contrast sensitivity (Z = -3.647 p = .000) and fixation stability for all measures, including P1 (t(26) = -9.490 p = .000), P2 (t(26) = -7.338 p = 0.000), 63% BCEA (Z = 3.569 p = .000) and 95% BCEA (t(26) = 4.687 p = .000). Significant medium-to-large correlations were also found between most visual function variables. Visual and acoustic biofeedback in conjunction with home exercises has the potential to improve visual function parameters in patients with age-related macular degeneration and irreversible central vision loss.

Perspectives of people with late age-related macular degeneration on mental health and mental wellbeing programmes: a qualitative study.

PURPOSE: People with age-related macular degeneration (AMD) experience high rates of depression, but rarely engage in or have access to tailored mental wellbeing programmes. This qualitative study investigated the perspectives of those primarily with late AMD on mental health and mental wellbeing programmes. METHODS: Twenty-eight people with late AMD in at least one eye, and one person with early AMD in both eyes, aged 56-87 years (mean age 78 years) attending a private eye clinic between December 2019 and January 2020 in Sydney, New South Wales, Australia, participated. Individual semi-structured interviews were conducted and analysed deductively using content analysis, following the individual level factors for health promotion interventions in the behaviour change wheel: Capability (Physical & Psychological), Opportunity (Physical & Social), and Motivation (Reflective & Automatic). RESULTS: Six major themes were identified: Capability: (1) Impact of vision loss on mobility and leisure pursuits; (2) Adjustment to living with vision loss; Opportunity: (3) Program considerations for those with AMD; (4) Stigma and self-perception of vision loss and mental health; Motivation: (5) Accumulation of vision-related issues as a barrier to participation; (6) Examples of others living with vision loss. General personal factors relevant to delivery of a programme in this age group were also identified: Comorbidities; Limitations using technology; Isolation; Financial concerns and Beliefs that undesired effects of aging are inevitable. CONCLUSIONS: Complex individual, environmental and social factors influence the perspectives of people with late AMD on mental health, and potential participation in mental wellbeing programmes. These factors should be considered when developing and implementing mental wellbeing programmes to improve the emotional and functional rehabilitation outcomes for people with AMD.

Efficacy of biofeedback rehabilitation based on visual evoked potentials analysis in patients with advanced age-related macular degeneration.

Age-related macular degeneration (AMD) is a progressive and degenerative disorder of the macula. In advanced stages, it is characterized by the formation of areas of geographic atrophy or fibrous scars in the central macula, which determines irreversible loss of central vision. These patients can benefit from visual rehabilitation programmes with acoustic "biofeedback" mechanisms that can instruct the patient to move fixation from the central degenerated macular area to an adjacent healthy area, with a reorganization of the primary visual cortex. In this prospective, comparative, non-randomized study we evaluated the efficacy of visual rehabilitation with an innovative acoustic biofeedback training system based on visual evoked potentials (VEP) real-time examination (Retimax Vision Trainer, CSO, Florence), in a series of patients with advanced AMD compared to a control group. Patients undergoing training were subjected to ten consecutive visual training sessions of 10 min each, performed twice a week. Patients in the control group did not receive any training. VEP biofeedback rehabilitation seems to improve visual acuity, reading performances, contrast sensitivity, retinal fixation and sensitivity and quality of life in AMD patients.

Biofeedback Low Vision Rehabilitation with Retimax Vision Trainer in Patients with Advanced Age-related Macular Degeneration: A Pilot Study.

PURPOSE: To evaluate the effectiveness of Visual Evoked Potential (VEP) biofeedback rehabilitation in selected low vision patients with advanced age-related macular degeneration (AMD). DESIGN: Retrospective observational cohort study. METHODS: Patients affected by advanced AMD, central macular atrophy with unstable fixation and best corrected visual acuity (BCVA) between 20/100 and 20/320 were considered. Selected patients underwent fundus photography and microperimetry with fixation analysis for the selected eye (highest BCVA). Ten consecutive training sessions of 10 min each were performed twice a week in the selected eye with Retimax Vision Trainer (CSO, Florence). BCVA, reading acuity and reading speed, contrast sensitivity, fixation, retinal sensitivity and quality of life questionnaire (VFQ-25) were evaluated at baseline and 7 days following the final session. RESULTS: Significant improvements in terms of BCVA [p = .011], reading speed [p = .007], VFQ-25 score [p = .007], retinal sensitivity [p = .021] and fixation stability in the central 2° and 4° [p = .048; p = .037] post-treatment were observed for the 9 patients enrolled, with insignificant improvements observed in reading acuity and contrast sensitivity [p = .335; p = .291]. CONCLUSIONS: Preliminary results support VEP biofeedback rehabilitation improvements for visual function and quality of life in advanced AMD patients with low vision.

Behavioural responses to a photovoltaic subretinal prosthesis implanted in non-human primates.

Retinal dystrophies and age-related macular degeneration related to photoreceptor degeneration can cause blindness. In blind patients, although the electrical activation of the residual retinal circuit can provide useful artificial visual perception, the resolutions of current retinal prostheses have been limited either by large electrodes or small numbers of pixels. Here we report the evaluation, in three awake non-human primates, of a previously reported near-infrared-light-sensitive photovoltaic subretinal prosthesis. We show that multipixel stimulation of the prosthesis within radiation safety limits enabled eye tracking in the animals, that they responded to stimulations directed at the implant with repeated saccades and that the implant-induced responses were present two years after device implantation. Our findings pave the way for the clinical evaluation of the prosthesis in patients affected by dry atrophic age-related macular degeneration.

Effects of home reading training on reading and quality of life in AMD-a randomized and controlled study.

BACKGROUND: Age-related macular degeneration (AMD) causes reading impairment, reduced quality of life (QoL), and secondary depression. We have shown that support with magnifying aids improved reading speed (RS), emotional and cognitive status, and QoL. The present study investigates whether additional reading training (RT) (after adapting to appropriate visual aids) can further improve vision rehabilitation. METHODS: Patients with dry AMD were randomly assigned to 2 groups. The primary RT group (P-RTG, n = 25) trained with sequentially presented text (RSVP), and the control group (CG, n = 12) performed placebo training (crossword puzzles) and later crossed over to RT, so that altogether 37 participants performed reading training. Patients trained at home on a PC for 6 weeks. RS was assessed during reading printed paragraphs of text aloud. Using a scanning laser ophthalmoscope, we examined fixation stability and preferred retinal locus (PRL) for fixating a cross, as well as PRL and eye movements during reading single words. We assessed emotional status by Montgomery-Åsberg Depression Rating Scale (MADRS), cognitive status by dementia detection test ( DemTect ) and QoL by Impact of Vision Impairment (IVI) profile. Visual acuity and magnification requirement were examined by standard procedures. All variables were measured before and after placebo training, before and after RT, and after 6 weeks without training (follow-up). RESULTS: RS improved significantly in the P-RTG during RT, but not in the CG during placebo training. The effect remained stable at follow-up. Fixation performance and eye movement variables did not change. Emotional status (MADRS) improved in P-RTG during RT and showed a significant difference of the change of scores between the 2 groups. Complete IVI scores improved significantly during RT and remained stable. CONCLUSION: The results indicate that patients with AMD, who already use magnifying aids, benefit from additional RT and that it can contribute in preventing depression and improve QoL. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register (DRKS00015609).

Rehabilitation with biofeedback training in age-related macular degeneration for improving distance vision.

OBJECTIVES: Biofeedback training (BT) is a modern method for enhancing the use of preferred retinal loci (PRL) retraining for new retinal loci (TRL), hence improving far and near vision. This article attempts to clarify the optimal methodology for BT and the types of patients who can benefit most from BT. METHODS: This is a retrospective review of cases who received BT with the macular integrity assessment (MAIA) microperimetre. Outcome measures selected for analysis were visual acuity, PRL location, fixation stability, fixation pattern orientation, reading acuity, critical print size, and reading speed. RESULTS: Out of 30 cases who received BT, only those with age-related macular degeneration and visual acuity of logMAR 0.8 (20/126) or poorer showed a visual acuity gain (statistically significant of 12 letters) after BT. Those with other diagnoses and those with residual Early Treatment Diabetic Retinopathy Study best-corrected visual acuity of logMAR of 0.7 (20/100) or better showed only positive trends for visual acuity and a negative trend for fixation stability. All subjects showed a shift in PRL location toward the superior quadrant of the retina (p < 0.02) in those who received BT. CONCLUSION: BT seems to offer patients a unique and efficient modality to improve distance vision outside of using optical devices.

Ejercicios de rehabilitación visual en pacientes con degeneración macular asociada a la edad y diversidad funcional visual / Visual rehabilitation exercises in patients with macular degeneration associated with age and visual functional diversity

Introducción: la degeneración macular asociada a la edad (DMAE) es una enfermedad degenerativa de la retina, que causa pérdida de la visión central en individuos mayores de 50 años. Es considerada una de las causas más comunes de pérdida de visión en países occidentales y en países desarrollados es la causa más frecuente de baja visión. Objetivo: describir el comportamiento de la rehabilitación visual, mediante la realización de ejercicios de fijación y localización, en estos pacientes. Método: se realizó un estudio observacional descriptivo retrospectivo en pacientes con degeneración macular asociada a la edad y diversidad funcional visual atendidos en consulta de baja visión de la provincia Granma durante febrero 2017 hasta enero 2018; la degeneración macular asociada a la edad constituye la segunda causa de diversidad funcional visual o ceguera en la provincia Granma. Resultados: fue más efectivo el rastreo y existió motivación en la totalidad de la muestra y en más de la mitad de los casos la agudeza visual mejor corregida de cerca aumentó, la velocidad de lectura mejoró, desapareció la fatiga, existió una adecuada autoestima y buena inserción social. Conclusiones: todo esto evidencia que dicha rehabilitación mejora la capacidad visual y propicia una mayor calidad de vida(AU)

Introduction: age-related macular degeneration (AMD) is a degenerative disease of the retina, which causes loss of central vision in individuals older than 50 years. It is considered one of the most common causes of vision loss in Western countries and in developed countries it is the most frequent cause of low vision. Objective: to describe the behavior of visual rehabilitation, by performing fixation and localization exercises, in these patients. Method: a retrospective descriptive observational study was conducted in patients with age-related macular degeneration and visual functional diversity treated in low vision consultation of Granma province during February 2017 to January 2018; Macular degeneration associated with age is the second cause of visual functional diversity or blindness in the Granma province. Results: the tracking was more effective and there was motivation in the whole sample and in more than half of the cases the best corrected visual acuity increased, the reading speed improved, the fatigue disappeared, there was an adequate self-esteem and good Social insertion. Conclusions: all this shows that said rehabilitation improves visual capacity and promotes a higher quality of life(EU)

The influence of word frequency on word reading speed when individuals with macular diseases read text.

People with central field loss (CFL) use peripheral vision to identify words. Eccentric vision provides ambiguous visual inputs to the processes leading to lexical access. Our purpose was to explore the hypothesis that this ambiguity leads to strong influences of inferential processes, our prediction being that increasing word frequency would decrease word reading time. Individuals with bilateral CFL induced by macular diseases read French sentences displayed with a self-paced reading method. Reading time of the last word of each sentence (target word) was recorded. Each target word (in sentence n) was matched with a synonym word (in sentence n+1) of the same length. When using absolute frequency value (Analysis 1), we found that reading time of target words decreased when word frequency increases, even when controlling for word length. The amplitude of this effect is larger than reported in previous investigations of reading with normal subjects. When comparing the effect of relative frequency (low vs. high) within each pair of synonyms (Analysis 2), results show the same pattern as the one observed in Analysis 1. Our results demonstrate clear-cut frequency effects on word reading time and suggest that inferential processes are stronger in CFL readers than in normally sighted observers. These results might also help design text simplification tools tailored for low-vision patients.

Caricaturing faces to improve identity recognition in low vision simulations: How effective is current-generation automatic assignment of landmark points?

PURPOSE: Previous behavioural studies demonstrate that face caricaturing can provide an effective image enhancement method for improving poor face identity perception in low vision simulations (e.g., age-related macular degeneration, bionic eye). To translate caricaturing usefully to patients, assignment of the multiple face landmark points needed to produce the caricatures needs to be fully automatised. Recent development in computer science allows automatic face landmark detection of 68 points in real time and in multiple viewpoints. However, previous demonstrations of the behavioural effectiveness of caricaturing have used higher-precision caricatures with 147 landmark points per face, assigned by hand. Here, we test the effectiveness of the auto-assigned 68-point caricatures. We also compare this to the hand-assigned 147-point caricatures. METHOD: We assessed human perception of how different in identity pairs of faces appear, when veridical (uncaricatured), caricatured with 68-points, and caricatured with 147-points. Across two experiments, we tested two types of low-vision images: a simulation of blur, as experienced in macular degeneration (testing two blur levels); and a simulation of the phosphenised images seen in prosthetic vision (at three resolutions). RESULTS: The 68-point caricatures produced significant improvements in identity discrimination relative to veridical. They were approximately 50% as effective as the 147-point caricatures. CONCLUSION: Realistic translation to patients (e.g., via real time caricaturing with the enhanced signal sent to smart glasses or visual prosthetic) is approaching feasibility. For maximum effectiveness software needs to be able to assign landmark points tracing out all details of feature and face shape, to produce high-precision caricatures.

Assessment of visual acuity improvement in patients with AMD referred to the low vision department / Avaliação da melhora da acuidade visual em pacientes com DMRI encaminhados ao setor de visão subnormal

Abstract Purpose: To evaluate the vision improvement through the use of visual aids of patients with Age-Related Macular Degeneration (AMD) those were examined in the low vision department. Methods: A retrospective study was conducted by reviewing medical records of 61 patients with AMD who were referred to the Low Vision Department from January 2012 to December 2014. The data collected included age, sex, diagnosis of the type of AMD and previous use of vascular endothelium growth factor inhibitor or antioxidants. In addition, far acuity, with and without optical aid, was indicated as well as which aid was prescribed. Results: In this study with 61 patients, 54.1% were male and 45.9% female. The most prevalent age group was 71-80 years old (44.3%) and most of the patients had the dry form of AMD (70.5%). With the use of visual aids, 73.8% of the patients improved visual acuity for far vision. The most prescribed optical aid was the Galileu 2.8x telescope (50.8%). Conclusion: Patients with visual impairment and AMD can benefit significantly from the visual aids if they are properly prescribed and fitted. Most patients in the study were fitted with at least one of the indicated visual aids, resulting in a significant improvement in far acuity.

Resumo Objetivo: Avaliar a melhora da visão através de auxílios visuais em pacientes portadores de Degeneração Macular Relacionada a Idade (DMRI) encaminhados ao serviço de visão subnormal. Métodos: Foi realizado um estudo retrospectivo, através da revisão 61 prontuários de pacientes com diagnóstico de DMRI que foram encaminhados ao departamento de Visão Subnormal (VSN), no período de janeiro 2012 a dezembro de 2014. Foram coletados dados sobre idade, sexo, diagnóstico do tipo de DMRI e uso prévio de inibidor do fator de crescimento do endotélio vascular (anti-VEGF) ou antioxidante. Além disso, outras informações foram colhidas como acuidade visual para longe sem auxílio e com auxílio óptico, indicando o(s) auxílio(s) óptico(s) prescrito(s). Resultados: Dos 61 pacientes avaliados, 54,1% eram do sexo masculino e 45,9% do sexo feminino. A faixa etária mais prevalente foi de 71-80 anos (44,3%) e a maioria (70,5%) apresentava a forma seca de DMRI. Com o uso de recursos visuais, 73,8% dos tiveram melhora da acuidade visual para longe. O auxilio óptico mais prescrito foi o telescópio do tipo Galileu 2,8x (50,8%). Conclusão: Pacientes com deficiência visual e DMRI podem se beneficiar significativamente dos recursos visuais se esses forem devidamente indicados e adaptados. A maioria dos pacientes aceitou pelo menos um dos recursos visuais indicados resultando numa melhora importante da acuidade visual de longe.

Rehabilitation of reading skills in patients with age-related macular degeneration.

Reading is the most frequent clinical complaint and the primary goal for patients with macular degeneration seeking vision rehabilitation. The current prevalent methods for reading skills training across the globe are still magnification and basic scotoma awareness training. More recent studies showed that specific eccentric training, comprehension ability training, and specific oculomotor training are all beneficial to reading skills rehabilitation. In clinical practice, ophthalmologists should strive to implement reading skills methods that include assessment of cognitive skills, optimal eyewear, optimal reading material, PRL assessment, training of better oculomotor control, and efficient perceptual training.

Word Mode: a crowding-free reading protocol for individuals with macular disease.

Central retinal loss through macular disease markedly reduces the ability to read largely because identification of a word using peripheral vision is negatively influenced by nearby text, a phenomenon termed visual crowding. Here, we present a novel peripheral reading protocol, termed Word Mode, that eliminates crowding by presenting each word in isolation but in a position that mimics its natural position in the line of text being read, with each new word elicited using a self-paced button press. We used a gaze-contingent paradigm to simulate a central scotoma in four normally-sighted observers, and measured oral reading speed for text positioned 7.5° in the inferior field. Compared with reading whole sentences, our crowding-free protocol increased peripheral reading speeds by up to a factor of seven, resulted in significantly fewer reading errors and fixations per sentence, and reduced both the critical print size and the text size required for spot reading by 0.2-0.3 logMAR. We conclude that the level of reading efficiency afforded by the crowding-free reading protocol Word Mode may return reading as a viable activity to many individuals with macular disease.

Implementing a multi-modal support service model for the family caregivers of persons with age-related macular degeneration: a study protocol for a randomised controlled trial.

INTRODUCTION: Age-related macular degeneration (AMD) is a leading cause of blindness and low vision among older adults. Previous research shows a high prevalence of distress and disruption to the lifestyle of family caregivers of persons with late AMD. This supports existing evidence that caregivers are 'hidden patients' at risk of poor health outcomes. There is ample scope for improving the support available to caregivers, and further research should be undertaken into developing services that are tailored to the requirements of family caregivers of persons with AMD. This study aims to implement and evaluate an innovative, multi-modal support service programme that aims to empower family caregivers by improving their coping strategies, enhancing hopeful feelings such as self-efficacy and helping them make the most of available sources of social and financial support. METHODS AND ANALYSIS: A randomised controlled trial consisting of 360 caregiver-patient pairs (180 in each of the intervention and wait-list control groups). The intervention group will receive the following: (1) mail-delivered cognitive behavioural therapy designed to improve psychological adjustment and adaptive coping skills; (2) telephone-delivered group counselling sessions allowing caregivers to explore the impacts of caring and share their experiences; and (3) education on available community services/resources, financial benefits and respite services. The cognitive behavioural therapy embedded in this programme is the best evaluated and widely used psychosocial intervention. The primary outcome is a reduction in caregiver burden. Secondary outcomes include improvements in caregiver mental well-being, quality of life, fatigue and self-efficacy. Economic analysis will inform whether this intervention is cost-effective and if it is feasible to roll out this service on a larger scale. ETHICS AND DISSEMINATION: The study was approved by the University of Sydney human research ethics committee. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles. TRIAL REGISTRATION NUMBER: The trial registration number is ACTRN12616001461482; pre-results.

Morpho-functional analysis of Stargardt Disease for reading.

OBJECTIVE: To analyze Stargardt disease (STGD) by morpho-functional examination and investigate the relationship between morpho-functional measures and reading performance. DESIGN: Observational case series study. PARTICIPANTS: Fifteen patients with STGD. METHODS: Twenty-six eyes of 15 patients underwent complete ophthalmic evaluation. Spectral domain optical coherence tomography, fundus autofluorescence (FAF), best corrected visual acuity (BCVA), and microperimetric examinations were performed. FAF and optical coherence tomography (OCT) overlap on microperimetric images was obtained in order to evaluate both tomographic and FAF features passing through the eccentric fixation area. Both morphologic features and functional data were correlated with magnification of prescribed device and reading rate. RESULTS: Univariable analysis showed a significant correlation between magnification power and greatest linear dimension of both OCT and FAF (r = 0.69 and r = 0.67; p < 0.05). Magnification power was related to best corrected visual acuity (r = 0.56; p < 0.05). Retinal sensitivity map (r = 0.57; p < 0.05) was considered an indicator of reading rate. Magnification levels showed a positive correlation with eccentric preferred retinal location (p = 0.03) and the degree of FAF alteration (normal, dishomogeneous, ipoautofluorescence; p < 0.0001). CONCLUSIONS: As a result of the overlapping of OCT/FAF imaging on microperimetric exam, residual activity of outer retinal layers passing through the eccentric fixation area seems to be related with required magnification and reading rate. Identification of morpho-functional parameters is helpful for designing a customized rehabilitative program.

The Evaluation of Reading Performance with Minnesota Low Vision Reading Charts in Patients with Age-related Macular Degeneration.

PURPOSE: To evaluate the reading performance using the Minnesota low vision reading (MNREAD) charts, of patients with age-related macular degeneration (AMD) who use low vision aid (LVA) devices. MATERIALS AND METHODS: This prospective study enrolled 27 patients with AMD. Distance visual acuity (VA) was evaluated with a distance chart designed for patients with low vision. Near vision and reading performance were evaluated with the Turkish version of the MNREAD charts. Unaided vision and vision with LVA devices and high spherical add near glasses was measured. P <0.05 was considered statistically significant. RESULTS: The mean unaided near VA was 1.05 ± 0.27 log of the minimum angle of resolution (LogMAR). The mean VA with the LVA devices was 0.71 ± 0.41 LogMAR. Reading acuity ranged between 1.15 and 0.21 LogMAR, critical print size was between - 1.2 and 0.2 LogMAR. Maximum reading speeds were between 0 and 103 words/min. The cases are divided into groups in terms of reading speed according to age, gender, diagnosis, and education. Reading speed was negatively correlated to increasing age. CONCLUSION: MNREAD reading charts can be used to evaluate reading performance in patients with AMD with low vision. The outcomes of the present study indicate that optical correction is adequate for near VA requirements in this patient population. However, optical correction was inadequate for improving reading performance. Appropriate rehabilitation programs can be used to increase reading speed.

Electrophysiological testing of visual function after mirror telescope implantation: a case report.

PURPOSE: The implantation of an intraocular telescope increases life quality in patients with end-stage age-related macular degeneration (AMD). The present study monitored changes in electrophysiological markers of visual processing before and during seventeen months after a novel mirror telescope implantation in two patients (OV-male 90 years, MZ-female 70 years) with the final-stage form of AMD. METHODS: Visual evoked potentials were recorded to high-contrast pattern-reversal (PR-VEP for check size 40' and 10'), low-contrast motion-onset stimuli (in visual periphery M-VEP M20°, and in central part M-VEP C8°), and event-related potentials (ERPs) in the oddball visual paradigm. RESULTS: MZ's more systematic responses showed attenuation and prolongation of the M-VEP M20° and the PR-VEP 40' immediately after the telescope implantation with a slow amplitude recovery with unchanged prolonged latency. The implantation completely eradicated the M-VEP C8° without any restoration. The PR-VEP 10' were not readable. Only a part of OV's PR-VEP 40' and M-VEP M20' were of a repeatable and expected morphology. These OV's VEPs were consistent with MZ's findings. The ERPs did not show any effect of implantation in both patients. Post-implantation visual acuity and reaction time overcame the pre-implantation levels. CONCLUSIONS: The mirror telescope preserved peripheral vision in contrast to classic telescopes; however, the telescope concurrently reduced the luminance of the magnified retinal image, which was likely responsible for the prolongation of the VEP latencies.

The Effects of Low-Vision Rehabilitation on Reading Speed and Depression in Age Related Macular Degeneration: A Meta-Analysis.

IMPORTANCE: Age related macular degeneration (AMD) is a progressive eye disease that, as of 2015, has affected 11 million people in the U.S. and 1.5 million in Canada causing central vision blindness. By 2050, this number is expected to double to 22 million. Eccentric vision is the target of low-vision rehabilitation aids and programs for patients with AMD, which are thought to improve functional performance by improving reading speed and depression. OBJECTIVE: This study evaluates the effect of various low-vision rehabilitation strategies on reading speed and depression in patients 55 and older with AMD. DATA SOURCES: Computer databases including MEDLINE (OVID), EMBASE (OVID), BIOSIS Previews (Thomson-Reuters), CINAHL (EBSCO), Health Economic Evaluations Database (HEED), ISI Web of Science (Thomson-Reuters) and the Cochrane Library (Wiley) were searched from the year 2000 to January 2015. STUDY SELECTION: Included papers were research studies with a sample size of 20 eyes or greater focused on AMD in adults aged 55 or older with low vision (20/60 or lower). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened and extracted relevant data from the included articles. Standardized mean difference (SMD) was chosen as an effect size to perform meta-analysis using STATA. Fixed- and random-effect models were developed based on heterogeneity. MAIN OUTCOMES: Reading Speed and Depression Scores. RESULTS: A total of 9 studies (885 subjects) were included. Overall, a significant improvement in reading speed was found with a SMD of 1.01 [95% CI: 0.05 to 1.97]. Low-vision rehabilitation strategies including micro-perimetric biofeedback, microscopes teaching program significantly improved reading speed. Eccentric viewing training showed the maximum improvement in reading speed. In addition, a non-significant improvement in depression scores was found with a SMD of -0.44 [95% CI: -0.96 to 0.09]. CONCLUSION: A considerable amount of research is required in the area of low-vision rehabilitation strategies for patients with AMD. Based on current research, low-vision rehabilitation aids improve reading speed. However, they do not have a significant effect on depression scores in those 55 and older with AMD.

Vision for improvement: Expressive writing as an intervention for people with Stargardt's disease, a rare eye disease.

This study implemented and evaluated the effectiveness of an expressive writing intervention among patients with Stargardt's disease, a rare disease due to macular degeneration. Participants were randomly assigned to either an expressive writing intervention or a neutral writing condition. Participants completed measures at three time points: baseline, 3 weeks, and 6 weeks post-intervention. Psychological health outcomes improved at the 3-week follow-up for the intervention condition compared to control. Self-reported physical health improved at the 6-week follow-up in the intervention condition compared to control. These results suggest that expressive writing may be an effective, practical, and low-cost intervention for those with Stargardt's disease.