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

项目总结 这项提议测试了一种新的帮助黄斑变性(MD)患者的“暗点意识”方法。国防部 是全球中心视力丧失的主要原因。MD患者自发地发展眼球运动策略 为了克服中心视力的丧失，例如开发一个新的外围固定点来取代中心凹 (首选视网膜位置，或PRL)。然而，PRL的开发和开发的成功率 差异很大，这意味着一些患者在没有有效利用他们保留的视力的情况下活了几年。最近， 《视觉科学》的研究表明，训练健康参与者时会出现视线反应、遮挡 中央视觉(模拟暗点)导致PRL发生的时间比MD快 病人。此外，我们实验室开发的眼球运动测量方法在描述个体眼睛特征方面是有效的 模拟暗点受试者的运动模式。描述补偿性差异的能力 MD的策略是朝着个性化康复策略迈出的关键一步，这可能是 通过加快PRL的发展进一步完善。然而，目前还不清楚这些结果是否会 在那些患有MD的人身上复制。有人提出，凝视中可见的、锋利的遮盖物- 临时展示提高了盲点意识，从而加速了PRL的发展。许多MD患者都是 他们不知道自己暗点的位置，一些人坚持使用受损的中心凹作为注视点。 到目前为止，还没有研究表明使用模拟暗点来促进MD患者PRL的快速发展 病人。作为解决患者个体差异的第一步，并检查视力 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，我们将使用集合 动眼神经测量指标来描述个体的补偿情况。在目标2中，我们将测试其有效性 可视的、模拟的暗点作为一种促进PRL快速发展的技术。患者会 接受“暗点意识”培训，即为每个患者量身定做一个模拟暗点， 将被用来帮助他们可视化他们的视力丧失区域。患者将接受相同的指标测试， 目标1和在“暗点意识”(或对照)前后的一系列视觉和认知评估 会话。这将能够量化暗点意识的影响，包括视觉能力和 眼球运动策略，并测试对视网膜损伤位置和程度的认识这一假设 促进PRL快速发展。虽然具有挑战性，但眼球跟踪技术在患者中的使用可能是 如果这种暗点意识程序被证明是有效的，那将是非常有回报的。如果结果为空，则 信息性的，表明生理暗点和模拟暗点之间的根本区别，因此 限制使用模拟视网膜损伤作为研究视网膜病理的框架 例如MD。这将提供一个独特的数据集，帮助那些制定中央视力丧失干预措施的人 了解视力康复的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.