New methods to quantify and train eye movement strategies in macular degeneration

项目摘要 该提案测试了一种新的“暗点意识”方法，以帮助黄斑变性（MD）患者。MD 是全球中心视力丧失的主要原因。MD患者自发地制定眼科治疗策略 以克服中心视力的丧失，例如开发新的周边固定点来代替中央凹 （优选视网膜位点，或PRL）。然而，PRL的开发和开发PRL的成功率 差异很大，这意味着一些患者在没有有效利用其备用视力的情况下生活了数年。最近， 视觉科学的研究表明，训练健康的参与者与凝视特遣队显示，阻碍 中央视觉（“模拟暗点”），导致PRL的发展在更快的时间尺度比发现的MD 患者此外，在我们的实验室中开发的视力指标在表征个体眼睛方面是有效的。 模拟暗点参与者的运动模式。能够描述代偿性 MD的策略是迈向个性化康复策略的关键一步， 通过加快PRL的发展进一步改善。然而，目前还不清楚这些结果是否可以 在MD患者中复制。有人认为，凝视中可见的、边缘锋利的遮挡物- 偶然显示增加暗点意识，从而加速PRL的发展。许多MD患者 不知道他们暗点的位置，有些人坚持使用他们受损的中央凹作为固定点。 迄今为止，还没有研究表明模拟暗点的使用可以促进MD中催乳素的快速发展 患者作为解决患者个体差异的第一步， 科学范式可以作为MD的康复工具，我们提出了两个目标：在目标1中，我们将使用一组 来表征个体的补偿情况。在目标2中，我们将测试 可见的，模拟暗点作为一种技术，以促进PRL的快速发展。患者将 接受“暗点意识”培训，其中模拟暗点，为每个患者单独定制， 将被用来帮助他们可视化他们的视力丧失区域。患者将接受相同指标的测试， 目标1和一组视觉和认知评估之前和之后的“盲点意识”（或控制） sessions.这将使得能够量化暗点意识在视觉能力方面的影响， 眼科策略，并测试假设，意识到视网膜损伤的位置和程度， 促进PRL快速发育。虽然具有挑战性，但在患者中使用眼动追踪技术可能会 如果这个意识盲点的程序被证明是有效的，那就非常值得。一个null结果将等于 信息，表明生理和模拟暗点之间的根本差异，因此， 在使用视网膜损伤的模拟作为视网膜病理学研究的框架方面提供了限制 例如MD。这将提供一个独特的数据集，以帮助那些制定中央视力丧失干预措施的人 了解视觉康复方法和个体差异如何产生训练结果。

Project summary This proposal tests a novel `scotoma awareness' approach to aid those with Macular Degeneration (MD). MD is the leading cause of central vision loss worldwide. MD patients spontaneously develop oculomotor strategies to overcome loss of central vision, such as developing a new peripheral fixation spot to replace the fovea (preferred retinal locus, or PRL). However, development of a PRL and the rate of success in developing one vary greatly, meaning some patients live years without making effective use of their spared vision. Recent, studies in Vision Science show that training healthy participants with gaze-contingent displays, obstructing central vision (`simulated scotoma'), leads to development of PRLs at a faster time scale than found for MD patients. Additionally, oculomotor metrics developed in our lab, are effective in characterizing individual eye movement patterns in simulated scotoma participants. The ability to describe differences in compensatory strategies in MD represents a crucial step towards individualized rehabilitative strategies, which could be further improved by accelerating PRL development. However, it is unclear whether these results can be reproduced in those with MD. It has been suggested that the visible, sharp-edged occluder in the gaze- contingent displays increases scotoma awareness, thus accelerating PRL development. Many MD patients are unaware of the location of their scotoma, with some persisting to use their damaged fovea as a fixation spot. No study to date has translated the use of a simulated scotoma to promote rapid PRL development in MD patients. As a first step towards addressing individual differences in patients and examine whether Vision Science paradigms can be used as a rehabilitative tool in MD, we propose two Aims: In Aim 1 we will use a set of oculomotor metrics to characterize individual profiles of compensation. In Aim 2 we will test the effectiveness of the visible, simulated scotoma as a technique to promote the rapid development of a PRL. Patients will undergo a `scotoma awareness' training, in which a simulated scotoma, individually tailored for each patient, will be used to help them visualize their region of vision loss. Patients will be tested on the same metrics from Aim 1 and a battery of visual and cognitive assessments before and after the `scotoma awareness' (or control) sessions. This will enable quantification of the effect of scotoma awareness both in terms of visual abilities and oculomotor strategies, and test the hypothesis that awareness of the location and extent of retinal damage promotes fast PRL development. While challenging, the use of eye tracking techniques in patients could be highly rewarding if this scotoma awareness procedure proves to be effective. A null result would be equally informative, suggesting fundamental differences between physiological and simulated scotomas, thus providing a limit in the use of simulations of retinal damage as a framework for the study of retinal pathologies such as MD. This will provide a unique data set to help those developing interventions for central vision loss understand how approaches to visual rehabilitation, and individual differences, give rise to training outcomes.