Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00746668
Other study ID # C6246-R
Secondary ID
Status Completed
Phase N/A
First received September 3, 2008
Last updated February 24, 2015
Start date August 2008
Est. completion date September 2012

Study information

Verified date February 2015
Source VA Office of Research and Development
Contact n/a
Is FDA regulated No
Health authority United States: Federal Government
Study type Interventional

Clinical Trial Summary

The purpose of this study is to measure the effectiveness of a newly-designed oculomotor training program for patients with macular disease, including age-related macular degeneration.


Description:

Age-related macular degeneration (AMD) is currently among the top three leading causes of central vision loss in veterans (Chomsky et al., 1995) and is the most prevalent cause of blindness among veterans (37.2%, Quillen & Henry, 2000). The loss of central vision associated with these diseases has a profound impact on the quality of life to those affected, with many suffering depression. It is devastating to no longer be able to read a newspaper or recognize facial expressions. The use of preferred retinal locations (PRLs) to compensate for diseased foveae has offered hope to these patients in regaining some function. The investigators have developed a protocol that includes training in two major visual skills areas:

- Visual awareness and eccentric viewing; and

- Reading practice with sequentially lexical information

Module 1 focuses on making the patient aware of better vision at an eccentric location relative to degraded vision at the diseased fovea. Module 2 is focused on reading practice without eye movements. These program curriculums and preliminary results are provided in the present proposal. The primary aim of this proposal is to quantitatively assess the relative effectiveness for improving reading and to establish the minimum training time need for skill improvement. One hundred and twenty patients with macular disease who are already using a PRL and similar in visual characteristics (e.g., visual acuity, contrast sensitivity, size of scotoma, duration of the disease) will be included the study. All patients will be trained with both modules using a repeated measures-completely counterbalanced - design to control for training order effects. In addition, all patients will be assessed using the same outcome measures of reading (using MNRead Acuity Charts and the View Sentences Test). The performance of the patients on the outcomes battery post-training will be compared to their pre-training performance on the same battery. Questionnaires (the Veterans Administration Low Vision Visual Functioning Questionnaire, CES-D, Short Form-36, and Adaptation to Vision Loss Scale) will also be administered to assess perceived abilities to perform everyday tasks, adaptation to vision loss, moods, and general health. In addition, patients will also be assessed on the exercises practiced during the module at the end of each daily training session to determine exactly when in the training protocol an improvement in performance on the exercises being trained has occurred. These daily performance measures provide for a finer scale for detecting performance changes. Statistical analyses will be conducted to answer the following questions:

- Does a combination of eccentric viewing awareness and oculomotor training produce significant improvements in reading rate?

- Which exercises are most effective in training the visual skills associated with reading and at what point during the course of training do the patients reach asymptotic performance?

- How do co-factors such as age, PRL size and location, and cognitive capabilities relate to training outcomes?

Advancements are being made in the area of retinal cell transplantation, gene therapy, and retinal prosthetics. When these techniques become part of the standard clinical care, it is likely that all the patients will require vision rehabilitation techniques to help them make sense of their potentially fragmented percepts. This research offers an evaluation of relative successes of the components of reading rehabilitation and will lead to the design of an efficient and effective composite training strategy.


Recruitment information / eligibility

Status Completed
Enrollment 36
Est. completion date September 2012
Est. primary completion date September 2012
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Patients with a diagnosis of macular disease, such as age-related macular degeneration

- An established preferred retinal locus

- Visual acuity of less than or equal to 20/70 and greater than or equal to 20/400 (in the better eye)

Exclusion Criteria:

- Those with other major ophthalmologic and neurologic disease

- choroidal neovascularization ("wet" AMD)

- moderate to severe media opacities, and cognitive impairment

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Outcomes Assessor)


Related Conditions & MeSH terms


Intervention

Behavioral:
Module 1: Visual Awareness and Eccentric Viewing
In this module, awareness of the PRL location and eccentric viewing were trained. Exercises based on published sources were administered. One example of these exercises is the clock face display adapted from Holcomb and Goodrich and Maplesden. This module also focused on awareness of the perceptual consequences of using a PRL. The purpose of these training exercises was to allow the subjects to appreciate perceptual alterations that occur when using a PRL and to practice making perceptual discriminations with the peripheral retina. Previously published work has demonstrated that perception in the peripheral retina can be affected by practice.
Module 2: Control of Reading Eye Movements
In this module, control of eye movements was trained. These exercises began with a series of saccade tasks to nonalphabetical stimuli and then progressed to single letter, letter pairs, and word stimuli. Subjects were instructed to make a saccade between the dots. The experimenter provided feedback concerning the appropriateness of the saccades, and the alternation rate of the dots was increased as performance improved.
Module 3: Reading Practice with RSVP
In module 3, we wanted to assess only the higher-level effects of reading practice. Subjects practiced reading using stimuli that did not require reading eye movements. An example is short sentences that were presented one word at a time at a single location on a screen (Rapid Serial Visual Presentation [RSVP]). At the end of the sentence, subjects reported whether the sentence made sense or not. We also had our subjects practice reading scrolled text. Although, eye movements and saccades may spontaneously occur under the text presentation conditions of this module, they are not the efficient saccades necessary for reading.

Locations

Country Name City State
United States Jesse Brown VAMC (WestSide Division) Chicago Illinois

Sponsors (1)

Lead Sponsor Collaborator
VA Office of Research and Development

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Sentence Reading To assess reading performance, after each training module (1-3), two lines of text were presented at the center of the monitor. Each subject was seated with his or her forehead on a head rest at a viewing distance of 40cm. The subject read each sentence aloud and indicated whether it made sense by responding true or false. Reading speed was calculated using an algorithm similar to that used for the MNRead test. The number of words read correctly was divided by the time required to read the sentence to yield a measure of reading speed in words per minute (wpm). Sentences were displayed at sizes of 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6 log units above the subject's letter acuity threshold. Five sentences were presented at each font size. We used 105 different sentences so that no sentence was repeated for any subject. Average speed of reading (log wpm) was plotted as a function of font size (logMAR). Pre-training, 6 weeks, 12 weeks, 18 weeks No
See also
  Status Clinical Trial Phase
Recruiting NCT01432847 - Cell Collection to Study Eye Diseases
Terminated NCT03561922 - Impact on Daily Life of Patients Using the Subretinal Implant RETINA IMPLANT Alpha AMS N/A
Active, not recruiting NCT03872479 - Single Ascending Dose Study in Participants With LCA10 Phase 1/Phase 2
Completed NCT00231010 - Molecular Genetics of Retinal Degenerations
Recruiting NCT03078309 - The Effects of Cannabis on Visual Functions in Healthy and Retinitis Pigmentosa Patients Early Phase 1
Active, not recruiting NCT01736293 - Natural History of Eye Diseases Related to ABCA4 Mutations
Completed NCT03318549 - BCI and Evaluation of Visual and Task Performance in Subjects With Eye Diseases N/A
Completed NCT04919473 - Dose-Escalation Study to Evaluate the Safety and Tolerability of Intravitreal vMCO-I in Patients With Advanced Retinitis Pigmentosa Phase 1/Phase 2
Completed NCT03321253 - Changes of Macular Pigment and Parameters of Eyes After YAG Laser Treatment in Cases With Capsule Opacification N/A
Completed NCT01497379 - Safety & Efficacy of Subretinal Implants for Partial Restoration of Vision in Blind Patients N/A
Recruiting NCT04620876 - Bimodal and Coaxial High Resolution Ophtalmic Imaging N/A
Recruiting NCT03592017 - Performance of Long-wavelength Autofluorescence Imaging N/A
Completed NCT03150654 - The Effect of Laser Treatment on Macular Pigment of Eye in Cases With Diabetes N/A
Recruiting NCT04545736 - Oral Metformin for Treatment of ABCA4 Retinopathy Phase 1/Phase 2
Completed NCT00403195 - Clinical and Pathophysiological Description of Ocular Ischemic Syndrome N/A
Enrolling by invitation NCT06167642 - Retinal Atrophy and Neurofilament Light Chain in People With Multiple Sclerosis Taking Ofatumumab
Enrolling by invitation NCT02144103 - Effectiveness and Safety of Adipose-Derived Regenerative Cells for Treatment of Glaucomatous Neurodegeneration Phase 1/Phase 2
Recruiting NCT06289452 - Safety and Efficacy Study of IVB102 Injection in Subjects With X-linked Retinoschisis Early Phase 1
Recruiting NCT06305416 - A Efficacy and Safety Study of Ranibizumab 10mg/ml Injection (Incepta) in Patients With Diabetic Macular Edema Phase 3
Recruiting NCT02617966 - Rod and Cone Mediated Function in Retinal Disease