JMIR Publications

ABSTRACT

Background:

Age-related macular degeneration (AMD), characterized by central vision loss, is the leading cause of visual impairment worldwide. Contemporary rehabilitation approaches, including biofeedback training (BFT), improve visual function and quality of life by optimizing use of a healthier or “preferred” retinal locus (PRL) identified by the clinician. BFT is typically delivered weekly or bi-weekly for several weeks in clinical settings under supervision of an eye-care professional. Nevertheless, after clinic-based programs, patients often revert to suboptimal PRLs, worsening disability. Sustaining use of the trained PRL likely requires daily visual rehabilitation. However, such regimens increase treatment burden. Standalone, remotely controlled virtual reality (VR) platforms could offer a practical alternative for at-home daily training.

Objective:

The primary objective of this pilot study was to evaluate feasibility (acceptability, adherence, usability remote data collection and safety) of a home-based VR visual rehabilitation program for older adults with dry AMD. Secondary objectives investigated the effect of the visual telerehabilitation program on visual function and functional vision. Exploratory outcomes addressed performance at the VR program.

Methods:

This study explored combining BFT with 3D single object-tracking in VR (3D-SOT-VR) to enhance visual perception and quality of life in AMD patients. The 4-week, two-arm pilot trial involved 14 patients with dry AMD, randomized to either BFT or BFT-VR groups. The BFT group had weekly sessions of BFT, while the BFT-VR group also engaged in 3D-SOT-VR stimulation at home every other day for 4 weeks. Secondary outcome measures were taken at baseline, after intervention at 4 weeks and at 1-month and 6-month follow-up.

Results:

Feasibility criteria were hampered by low recruitment rates due to the COVID-19 pandemic. The study indicates adoption of the VR technology in older adults with no significant adverse events. Data was collected remotely without any loss. Visual outcomes showed clinically meaningful gains at the individual level in reading speed for the combination of BFT with 3D-SOT-VR. Reading speed improvement was directly correlated to the performance at the 3D-SOT-VR stimulation, emphasizing the beneficial effect of single object tracking on reading abilities.

Conclusions:

Virtual reality represents a tool that can be safely implemented as supportive care in older adults. Further research is required with adapted VR ergonomics for older adults to address effectiveness and long-term benefits of home-based VR interventions for AMD patients. Clinical Trial: clinicaltrials.gov, NCT04685824 posted 28/12/2020.