Development of a home-based Eccentric Viewing training program for clients with age-

related macular degeneration through a researcher-clinician partnership

Marie-Chantal Wanet-Defalque, PhD1,2,3

Josée Duquette, MSc1,3

3rd International SensAge ConferenceYork, June 23rd 2014

1. Institut Nazareth & Louis-Braille2. University of Montreal, School of Optometry 3. Center for Interdisciplinary Research in Rehabilitation of Greater Montreal

Context • Age-related macular degeneration (AMD)

most frequent diagnosis • Some patients

– spontaneously find a new retinal fixation point (PRL)

• Others– need training to understand eccentric viewing

(EV) and improve their functional vision

• Few materials were available in French to assist in training EV

• Structured and standardized EV program developed and implemented at INLB (VisExc-INLB)

Purpose and Method

• Evaluate the effectiveness of Vis-Exc training program

• Characterize the clinical population

Retrospective study

EV training program

• The EV program (VisExc-INLB)– at home by qualified low

vision rehabilitation specialists– homework exercises given

between sessions

• The program is provided in two parts: – basic instrumental activities

of daily living (IADL) 4 sessions

– optional advanced reading 3 sessions

EV training program

Basic EV program / Instrumental Activities of Daily Living

• PRL estimation, near and distance vision

• Oculomotor • Hand-eye coordination• Perceptual-cognitive• Spot reading• Magnification device training

during final session

EV training program

Advanced program / reading skills in eccentric fixation • Perceptual-cognitive

exercise McGill Low Vision Manual (Overbury et al.)

• Reading their own material

Retrospective study:clients characteristics

64%

36% Female

Male

136 ClientsBasic only: 54%Advanced: 46%

10%

12%

47%

33%

<65

66 - 75

76 - 85

> 86

AMD84%

Others16%

Diagnosis

Gender Age

Distance vision acuity, pre-interventions

0,4 0,6 0,7 0,8 0,9 1 1,1 1,2 1,3 1,4 1,50

5

10

15

20

25

Severe 20/200 - 20/400

45%; n=61

Profound 20/500 & 20/630

6%; n=8

Moderate 20/80 - 20/160

49%; n=66

Visual acuity (logMAR)

Subj

ects

Visual acuity, ICD-9-CM Ranges of Low Vision

9

Visual acuity

• Distance VA– Before training : 0.95 log MAR (20/200+)– After training : 0.93 log MAR (20/200+) ≠ NS

• Near VA– Before training: 1.13 log MAR (4M+ at 33 cm)– After training: 1.15 log MAR (4M+ at 33 cm) ≠ NS

Global satisfaction

22 (65%)

9 (26%)

2

1

Very satisfied

Satisfied

Slightly satisfied

Not very satisfied

Clinical assessment of the impact of the basic eccentric viewing training

Comments from central chart; n=87 • Improvement of…

– Reading skills (fluency, accuracy and speed) • At least 9 subjects resume advanced reading activities

– Instrumental activities of daily living (55)– Leisure / hobbies (24)– Far vision– etc.

functional autonomy and quality of life

12

Impact of the advanced program on reading skills

ÉCLec-DV Post Basic

Post Advanced

P value

Reading Speed (word/min.)

31 40 0,025

Comprehension (/3) 2,04 2,68 0,001

• Post basic vs post advanced program (n=28) – Quebec-French assessment tool (ÉCLec-DV)

• Reading Speed– 150 words text; average speed calculated

• Comprehension– Answers 3 questions about the text just read.

Conclusions• VisExc-INLB: EV training in French; 41 trained professionals• Study on a real clinical population in a real clinical

environment• Unexpectedly profound LV or moderate LV• Benefits

– Clinical files – Reported satisfaction– Improved reading skills

• Limitations: – No standardized testing conditions (clinical environment)– Delay Pre/Post for VA tests

IN THE LABThe story had to be continued…

Further research:Prospective study in a Lab environmnent

• Evaluate EV training program effect (VisExc-INLB ) standardized measuresOCT-SLO

• This will make another story…

Thank you!

marie-chantal.wanet.inlb@ssss.gouv.qc.ca