Clinical Trial: Visuomotor Rehabilitation Training

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Visuomotor Rehabilitation Training for Manual Task Deficits From Macular Scotomas

Brief 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 Summary:

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, three visuo-motor training modules will be developed for low-cost tablet computers that subjects will use at home. Modules will be for scotoma awareness training, line and circle tracing, and video games. All three modules will involve PRL-hand coordination by moving a stylus on the tablet screen in response to stimuli. Scotoma awareness training is necessary because the majority of those with macular scotomas do not realize they have them. 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.

Images of the subject's hand and stylus on their retina while they trace mazes and print words are recorded with a Scanning Laser Ophthalmoscope. Retinal positions of the stylus, maze, and printed text are measured from the images. The retinal area for fixation (the PRL) is also measured.



Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Change in time required to complete tracing a maze in the SLO. [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The time required to trace mazes before training is compared to the time required after training.
  • Stylus retinal bivariate ellipse area [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    Retinal positions of the stylus tip during maze tracing are measured and used to calculate a dispersion measure, the bivariate normal ellipse The smaller the ellipse, the more accurate the retinal position of the stylus.
  • Percentage of time the Preferred Retinal Locus (PRL) is on the maze during tracing. [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The amount of time the subject's PRL is on the maze is measured from SLO images. The change in percentage time the PRL is on the maze is compared from before training to after training.
  • Percentage of time the stylus is in the subject's scotoma [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The tip of the stylus cannot be seen by the subject when it is in their macular scotoma. It is thought the training regimen may reduce the time the stylus is obscured by the scotoma.
  • Percentage of time the stylus is on the maze [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The tracing stylus should remain on the maze when it is being traced but often leaves the maze. Training may improve the actual amount of time the stylus is on the maze.
  • Legibility of printing in the SLO [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    Subjects print simple words while looking into the SLO. Legibility of printing is scored based on letter legibility and placement relative to the printing guide. Training may improve printing legibility.
  • Printing completion time [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The time to complete printing each word is measured. Printing time before and after training are compared.
  • Stylus retinal bivariate ellipse area during printing [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The dispersion of the position of the stylus tip on the retina (bivariate ellipse area) is measured from SLO images. Pre-training and post-training ellipse areas are compared.
  • Percentage of time the stylus tip is in the subject's scotoma [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The amount of time the stylus tip is in the subject's scotoma during printing is measured. Percentages of time in the scotoma before and after training are compared.
  • Preferred Retinal Locus (PRL) retina area [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The retinal dispersion of a fixation target is measured before and after training. Training may improve fixation ability as indicated by a smaller PRL retinal bivariate area.
  • PRL retinal eccentricity [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    The position of the PRL relative to the position of the non-functional fovea will be measured before and after training. The position may change as a result of the training.
  • PRL visual acuity [ Time Frame: Pre treatment to Post treatment (approximately 3 months) ]
    Visual acuity will be measured at the PRL using the SLO. Visual acuity before training will be compared to that after training.


Original Secondary Outcome:

Information By: VA Office of Research and Development

Dates:
Date Received: September 19, 2012
Date Started: July 2013
Date Completion:
Last Updated: February 16, 2016
Last Verified: February 2016