Rehabilitative approach in patients with ring scotoma

• Published in: Canadian journal of ophthalmology Vol. 48; no. 5; pp. 420 - 426
• Main Authors: Amore, Filippo M., MD, PhD, Silvestri, Valeria, CO, Turco, Simona, MD, PhD, De Rossi, Francesca, MD, PhD, Cruciani, Filippo, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-10-2013
• Subjects: Activities of Daily Living; Aged, 80 and over; Contrast Sensitivity - physiology; Female; Fixation, Ocular - physiology; Humans; Internal Medicine; Macular Degeneration - physiopathology; Macular Degeneration - rehabilitation; Male; Ophthalmology; Ophthalmology - methods; Prospective Studies; Reading; Retina - physiopathology; Scotoma - physiopathology; Scotoma - rehabilitation; Sensory Thresholds; Vision, Low - physiopathology; Vision, Low - rehabilitation; Visual Acuity - physiology; Visual Field Tests; Visual Fields - physiology
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2013.07.012

Abstract Objective To investigate the rehabilitative approach in patients with ring scotoma. A central scotoma is characteristic for patients with age-related macular degeneration (AMD). Sometimes patients with AMD maintain a residual central vision area within the scotoma (ring scotoma). Design Prospective, nonrandomized case series. Participants Twenty-four patients with AMD. Methods A formal low-vision assessment was performed for all study patients. The assessment included best corrected visual acuity (BCVA), contrast sensitivity, reading speed, and microperimetry. All patients were provided a low-vision assessment to satisfy patients’ needs. Devices were prescribed accordingly. Results The BCVA found was 0.4 logMAR (SD 0.1). All had central and stable fixation. Residual central retinal area size and sensitivity measured 2.4° (SD 0.8) and 3.1 dB (SD 0.8), respectively. Twenty patients achieved better vision with optical magnification in the eye with ring scotoma. Mean reading speed achieved was 50.2 words/min (SD 20.9). A linear correlation was found for reading speed with both central area sensitivity ( r ² = 0.5, p < 0.05) and contrast sensitivity ( r ² = 0.3, p < 0.05). Conclusions In patients with AMD with ring scotoma, moderate amounts of magnification seem to provide satisfactory rehabilitation outcomes. Central retinal spared area sensitivity may predict reading speed outcomes, whereas residual central area size is likely to be useful in determining magnification.