Visuomotor Rehabilitation Training for Manual Task Deficits From Macular Scotomas
Condition: Scotoma, Central; Central Visual Impairment
MeSH terms: Vision Disorders; Vision, Low; Scotoma
Study type: Interventional

Summary: 
      The research is aimed at developing and testing a new method of visual-motor rehabilitation
      of Veterans with macular degeneration by using inexpensive "tablet" computers at home.
    

Detailed description: 
      The research objective is to test the hypothesis that practicing eye-hand coordination using
      tablet-computers can improve manual skills of those with Age-related Macular Degeneration
      (AMD). AMD causes the loss of sharp central vision used for reading and many other everyday
      activities. Those with AMD experience a "macular scotoma", a blanked-out area of whatever
      they're attempting to look at, and they must use an area of peripheral vision, the "Preferred
      Retinal Locus (PRL)" to look at objects of interest. The PRL does not provide sharp vision,
      causing deficits in eye-hand coordination needed for manual tasks. There have been few
      studies of visuo-motor rehabilitation training for deficits caused by macular scotomas.
      However, a recent study demonstrated that visuo-motor eye movement training dramatically
      improved reading ability of subjects with AMD. In addition, it has been shown that playing
      action video games can improve certain visual skills. Thus, a small but growing body of
      research suggests that it may be possible to ameliorate manual task deficits caused by AMD
      through computer-based visuo-motor rehabilitation training.

      To test this idea, two visuo-motor training modules will be developed for low-cost tablet
      computers that subjects will use at home. Modules will be for, line and circle tracing, and
      video games. Both modules will involve PRL-hand coordination by moving a stylus on the tablet
      screen in response to stimuli. Line and circle tracing will develop eye-hand coordination
      skills needed for printing. The video game module will provide practice in PRL-hand
      coordination. Progress in PRL-hand coordination will be automatically recorded on the
      tablet-computer.

      Changes in manual task performance from the training modules will be assessed after each
      training module using previously developed Scanning Laser Ophthalmoscope (SLO) tests of
      maze-tracing, and printing. The SLO will also be used to determine the position and fixation
      stability of the subject's PRL and the retinal position of the scotoma. SLO testing will be
      repeated three months after all training. Digitized SLO video images showing the hand,
      stylus, and object on the retina will be measured and analyzed. Several performance measures
      will be derived from the SLO image analysis including maze-tracing accuracy, printing
      legibility, retinal area of the stylus, percentage of time the stylus is in the scotoma, and
      PRL retinal area. This data will be statistically analyzed to determine whether visuo-motor
      training with the computer tablets improves manual task performance and whether one module is
      more effective than other.

      There will be six groups of five subjects. Subjects will be assigned as they are recruited to
      a group until the group is full. Two groups will have training delayed by 6 months and will
      be tested on the SLO 4 times to assess changes in the dependent measure without training.
      Following training on each module, subject will be tested on maze tracing and printing in the
      SLO. Two groups undergo four SLO tests without training and begin training six months later.
    

Intervention name(s): Visuo-motor training
Intervention type(s): Behavioral
Intervention description(s): Participants will undergo training on three developed software modules on Samsung Galaxy Note Pro tablets to see their effect on low vision rehabilitation
Other intervention name(s): Scotoma Awareness; Line and Circle Tracing; Video games (Pong and PacMan)
Intervention model: Single Group Assignment
Intervention model description: All eligible subjects trained on three computer-based training modules. SLO assessment of changes in fine manual task performance and in retinal functional geography was done before and after each training module.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: scotoma, central; visual motor coordination