Central vision loss from macular degeneration creates blind spots that impair reading, face recognition, and navigation. Individuals must learn to use peripheral vision, requiring retraining of eye movements. Our preliminary research using high-speed eye tracking demonstrated that people with larger scotomas have impaired eye movement control, and that single-session visual feedback training showed limited immediate benefit, though combining feedback types showed promise. This study will evaluate whether extended binocular training (5 weekly sessions) with multimodal feedback improves eye movement control in 8-15 participants with bilateral central vision loss. Unlike conventional monocular rehabilitation systems, our approach trains both eyes simultaneously using real-time visual and auditory feedback during saccadic and smooth pursuit tasks. Participants will receive gaze-contingent scotoma awareness feedback, preferred retinal locus feedback, and auditory cues while performing eye tracking exercises. Primary outcomes include saccadic accuracy (latency, landing error, amplitude) and smooth pursuit parameters (gain, tracking accuracy). Secondary outcomes include contrast sensitivity and self-reported visual function. Success could establish an evidence base for accessible home-based training using virtual reality technology, potentially benefiting millions with macular degeneration.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
12
Participants will complete 5 weekly training sessions (approximately 60 minutes each) performing eye movement exercises while receiving real-time multimodal feedback. Training includes: Saccadic Training: Visually-guided saccades to targets appearing at randomized locations with instructions to use peripheral (inferior) retinal locus. Targets shift horizontally, vertically, and obliquely to train all saccadic directions. Smooth Pursuit Training: Circular pursuit of moving targets at 2.6°/s in randomized directions with instructions to maintain peripheral gaze above the target. Feedback Modalities (systematically varied across sessions):Scotoma Awareness: Gaze-contingent black circle overlay representing participant's blind spot; Preferred Retinal Locus (PRL) Feedback: Dynamic gaze-contingent ring showing real-time fixation location; Auditory Feedback: Tone modulation indicating fixation stability, PRL accuracy, and target acquisition success; Combined multimodal feedback
New England College of Optometry
Boston, Massachusetts, United States
RECRUITINGChange in Saccadic Accuracy (Landing Error)
Mean distance in degrees between saccade landing position and target location, measured using binocular eye tracking during visually-guided saccade tasks. Lower values indicate better accuracy.
Time frame: At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Saccadic Latency
Time in milliseconds from target appearance to saccade initiation, measured using binocular eye tracking. Faster latencies indicate improved oculomotor response.
Time frame: At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Smooth Pursuit Gain
Ratio of eye velocity to target velocity during smooth pursuit tasks (optimal gain = 1.0). Higher gain values indicate better pursuit tracking accuracy.
Time frame: At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Number of Catch-up Saccades During Pursuit
Mean number of corrective saccades per trial during smooth pursuit tasks. Fewer catch-up saccades indicate smoother, more accurate pursuit performance.
Time frame: At First study visit - Baseline, At each training visit (week 1, week 2, week 3, week 4, week 5, and post training (week 11 )
Change in Contrast Sensitivity Function
Area under the log contrast sensitivity function (AULCSF) measured using adaptive Gabor presentations during eye movement tasks. Higher values indicate better contrast sensitivity.
Time frame: Baseline, Post-training (Week 6)
Change in Fixation Stability
Area of the bivariate contour ellipse at 95% confidence interval of fixation positions during stationary target fixation tasks, measured in square degrees. Smaller ellipse area indicates more stable fixation.
Time frame: Baseline, Post-training (Week 6)
Change in Vision Related Quality of Life
Baseline, Post-training (Week 6)
Time frame: At First study visit - Baseline, at last training session - week 5, and post training (week 11 )
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