Improving visual performance in retinitis pigmentosa by new non-invasive personalizedand adaptive training.

本提案的目的是研究视网膜色素变性（RP）患者的病理性视觉行为，并实施能够改善残余视觉性能的新方法。在早期RP阶段，周边视觉受损，而中央视觉相对完整，具有良好的视力。然而，后期RP阶段影响中心视力和敏锐度。周边视觉，尽管其低分辨率，是重要的创建和更新空间结构的准确表示导航，因此RP是一个条件，损害流动性。一种有希望的恢复视觉性能的方法是利用先天神经可塑性并提供特定的眼动训练方案，帮助患者自然地“扩展”其受限的视野（VF）。研究表明，大脑神经可塑性可能涉及整体认知策略的修改，以成功科普新的挑战。在初步工作中，我们证明了神经可塑性的潜力，以改善和部分恢复患者的视觉表现在步行。我们发现，训练患者对非视觉VF进行探索性扫视可以提高患者的行走速度，但日常生活的其他方面，如与物体的碰撞次数并没有改善。这表明，可能需要进一步改进的训练策略，以最终优化RP患者在日常生活中的导航。我们假设，为了最大限度地将训练效果转移到现实生活中，训练期间的运动应该与典型的日常任务非常相似。目前，这可以通过虚拟现实（VR）应用程序来实现，额外的好处是患者可以锻炼走路和处理不同的情况，而不会暴露在日常生活的危险中。我们的新协议旨在有效的训练，允许补偿隧道视觉中有限功能VF之外的区域中多个移动目标的同时跟踪的损失：它将指导患者以系统扫描模式（SSP）进行快速补偿性凝视运动，以创建场景的全局框架并识别可能的目标。此外，还将对可能的目标进行动态扫描跟踪，这将只需要一个注意力焦点，它将在目标之间迅速循环，将索引它们的位置，并在每个目标移动得太远之前返回。不在项目范围内，但相关的是将结果转移到其他视野丧失疾病，例如偏盲。我们建议，基于我们的初步工作，神经可塑性训练可能普遍适用于目前不可逆的视网膜或神经元损伤的一系列眼部疾病。

The aim of this proposal is to study the pathological visual behavior in patients with retinitis pigmentosa (RP) and to implement new methods able to improve residual visual performance. In early RP stages, peripheral vision is damaged, while central vision is relatively intact with good visual acuity. Later RP stages, however, impact central vision and acuity. Peripheral vision, despite its low resolution, is important for creating and updating an accurate representation of spatial structure for navigation and therefore RP is a condition that impairs mobility. One promising approach to recover visual performance, is to use the innate neural plasticity and provide specific eye-movement training protocol that helps patients to naturally "expand" their restricted visual field (VF). It has been shown that brain neural plasticity may involve modifications in overall cognitive strategies to successfully cope with new challenges. In a preliminary work we demonstrated the potential of neural plasticity to improve and to partially recover the patients’ visual performance during walking. We found that training the patients to perform explorative saccades to the non-seeing VF improved walking speed of patients, but other aspects of daily life, such as number of collisions with objects did not improve. This suggests that further, improved training strategies might be required to ultimately optimize navigation of RP patients in daily life. We hypothesize that to maximize transfer of training effect in real-life, exercise during training should resemble closely typical daily tasks. This could currently be achieved via virtual reality (VR) applications, with the added benefit that the patients could exercise to walk and deal with different situations without being exposed physically to the hazards of daily life. Our new protocol aims at efficient training that allows to compensate for the loss of simultaneous tracking of multiple moving targets in areas falling outside the limited functional VFs in tunnel vision: It will instruct the patients to perform in a systematic scanning pattern (SSP) fast compensatory gaze movements, in order to create a global framework of the scene and identify possible targets. Further, dynamic scanning tracking (DST) of possible targets will be practiced, which will require only one focus of attention that will cycle rapidly through the targets, will index their locations and will return to each before it moves too far away. Not in the scope of the project, but relevant is the transfer of the results to other diseases with visual field loss, e.g. hemianopia. We propose, based on our preliminary work, that neural-plasticity training may be generally applicable in a range of eye conditions with currently irreversible retinal or neuronal damage.