Eccentric Viewing Training in the Home Environment: Can It Improve the Performance of Activities of Daily Living?

By Vukicevic, Meri; Fitzmaurice, Kerry | Journal of Visual Impairment & Blindness, May 2009 | Go to article overview

Eccentric Viewing Training in the Home Environment: Can It Improve the Performance of Activities of Daily Living?


Vukicevic, Meri, Fitzmaurice, Kerry, Journal of Visual Impairment & Blindness


Abstract: Macular degeneration has a severe impact on a person's ability to perform activities of daily living. This study investigated the impact of in-home training in eccentric viewing on near acuity and performance of activities of daily living. The results suggest that eccentric viewing can ameliorate the impact of the loss of vision that is due to macular degeneration.

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Visual impairment, such as that caused by age-related macular degeneration (AMD) that affects central vision, has a severe impact on a person's ability to perform activities of daily living, from simple tasks like self-grooming to more complex tasks like reading and writing. The traditional method of vision rehabilitation for persons with AMD has been the use of magnifiers (Bailey, 1986; Chung & Johnston, 1990; Faye, 1984, 1986; Fonda, 1986; Johnston, 2003; Lovie-Kitchin & Whittaker, 1999; Margrain, 2000; Markowitz, 2006; Watson, 1999). Such interventions are widely used and considered successful, but magnifiers are difficult to use for some activities of daily living, such as eating, grooming, and dressing oneself.

Another method of vision rehabilitation, and one that can be used in conjunction with magnification, is an eccentric viewing strategy. With an eccentric viewing strategy, people with macular vision loss use their remaining peripheral vision by relocating fixation to a functioning area of the retina adjacent to the macular scotoma. The use of eccentric viewing as a rehabilitation strategy was first documented in the 1970s with the publication of a manual describing exercises and vision training for persons with macular scotomas, in addition to various other disorders such as nystagmus, decreased peripheral vision, and amblyopia (Backman & Inde, 1979). Other clinicians further developed eccentric viewing training by incorporating various ideas and equipment to facilitate teaching people with a macular scotoma to view eccentrically (Goodrich & Quillman, 1977; Holcomb & Goodrich, 1976; Quillman, 1980). As personal computers became more accessible in the 1990s, several computer-generated methods of eccentric viewing training were developed (Collins, 1990; Fitzmaurice, Kinnear, & Chen, 1994; Frennesson, Jakobsson, & Nilsson, 1995; Leijen, 1996).

There has been some research on the efficacy of the impact of eccentric viewing on reading parameters (Fitzmaurice, 1994; Goodrich et al., 1999; Nilsson, Frennesson, & Nilsson, 2003), but little research has been conducted on the impact of eccentric viewing on activities of daily living. The research has suggested that teaching people with macular scotomas to use eccentric viewing strategies can improve their reading performance and vision. The strategy of eccentric viewing requires the use of either a preferred retinal locus or a trained retinal locus. A preferred retinal locus is an eccentric retinal area that behaves as a pseudo fovea and is adopted by a person to see chosen objects, whereas a trained retinal locus is an eccentric retinal area that a clinician has determined to be the best position in which to train a person in eccentric viewing. Some researchers who have investigated the development of a preferred retinal locus have stated that people with macular vision loss may use several preferred retinal loci and that the development of the preferred retinal locus occurs naturally (Culham, Fitzke, Timberlake, & Marshall, 1993; Cummings, Whittaker, Watson, & Budd, 1985; Fletcher & Schuchard, 1997; Fletcher, Schuchard, Livingston, Crane, & Hu, 1993; Whittaker, Budd, & Cummings, 1988). In terms of research on teaching an individual to use a trained retinal locus, some researchers have advocated for training a retinal locus in a healthy area of the retina as close as possible to the fovea, irrespective of whether its direction is horizontal or vertical (Culham, Silver, & Bird, 1990; Fitzmaurice, 1992, 1994), while others have argued that a vertical trained retinal locus allows for the greatest improvement in visual acuity, reading speed, and efficient eye movement (Nilsson et al. …

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