Macular Disease Clinical Trial
Official title:
Translation of Eye Movement Reading Training to Clinical Practice
Age-related macular degeneration (AMD) is the most common visual impairment in persons over
50 years of age. It has been estimated that 1 in 3 individuals over 75 years of age and 1 in
30 individuals over 52 years of age are affected by AMD. The deficits in visual function as a
result of this disease affecting the central retina are debilitating, as individuals lose
their ability to carry out many of their daily activities that require resolving fine spatial
details. The investigator's previous studies have shown that training with oculomotor control
exercises significantly increases reading speeds in patients with AMD. In the proposed study,
the investigators will examine whether these training exercises are effective when practiced
at home.
In Phase 1, the investigators will develop a standardized user-friendly, Web-based platform
that will allow patients to easily self-administer training exercises. The software platform
will be designed to automatically choose the appropriate exercises based on a patient's
previous performance, run the training exercise, and collect performance data into a
universal patient data file. In Phase 2, the platform will be tested in two settings: in
standard clinical rehabilitation practice and in the patient's home. Reading outcomes in the
two settings will be compared. The investigators will recruit 60 patients per year for each
of the three years for Phase 2 of the study. Half of these patients will be assigned to the
Clinic Training Group, while the other half will be assigned to At-home Training Group. For
all patients, three assessments will be taken: at baseline, after 1 month, and after 2 months
of training.
The investigators will compare reading outcomes to assess the roles of feedback versus the
role of frequent available practice. Because of the extensive cost and clinical resources
required for vision rehabilitation, it is critical to determine whether the training program
can be made less expensive, but as effective, when it is self-trained. If the investigators
demonstrate the utility of at-home practice, clinical facilities and therapists' time can be
made available for those activities requiring face-to-face contact
In the proposed study, the investigators will examine whether these training exercises are
effective when practiced at home. There are two specific aims in this project:
Aim #1 (Year 1): to develop a web-based meta program that will administer the training
exercises. For convenience, in this proposal, the investigators will refer to this platform
as PAECT (Platform for Administering Eye movement Control Training). The PAECT meta program
will incorporate all of the exercises that the investigators have developed and validated
over the course of our previous Merit Review grants (Seiple, Szlyk et al., 2005, 2011). The
PAECT platform will be designed to allow patients to easily run the training exercises in
their homes and to practice at their convenience. The PAECT will employ an executive
component that will keep track of the exercises that are practiced and record performance.
Each time a subject opens the platform, it will choose the exercise for that subject based
upon previous training and performance. The development of the software and the design of the
hardware interface for administering the system will take place during the first year of the
project. This will be done through a series of software/hardware iterations based upon
feedback derived from direct patient testing of the system. The investigators will recruit
ten patients with AMD to test and comment on the system during this phase of the project.
Aim #2 (Years 2-4). To compare the effects of PAECT training on reading outcomes in two
training situations: (1). training done in the clinic with feedback on performance provided
by a trained low-vision therapist, and (2) training done at-home with expanded opportunity
for practicing the exercises, but with no therapist feedback. Patients will be assigned to
one of two groups: Patients in Group 1 ("Clinical") will undergo weekly two-hour training
sessions for three months using the software/hardware system. This training will be conducted
in the low-vision clinic using the PAECT, with feedback on performance provided by a trained
low-vision therapist. Patients in Group 2 ("At-home") will practice all of the exercises at
home using the PAECT system over a three-month period. The subjects will be encouraged to use
the system as often as possible, but no less than two hours per week. Sixty patients (30 in
the clinical setting and 30 at home) will be tested for each of three years.
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