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Marie-Chantal Wanet-Defalque, PhD 1,2,3 Josée Duquette, MSc 1,3

Development of a home-based Eccentric Viewing training program for clients with age-related macular degeneration through a researcher-clinician partnership. Marie-Chantal Wanet-Defalque, PhD 1,2,3 Josée Duquette, MSc 1,3 3 rd International SensAge Conference York, June 23 rd 2014

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Marie-Chantal Wanet-Defalque, PhD 1,2,3 Josée Duquette, MSc 1,3

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  1. Development of a home-based Eccentric Viewing training program for clients with age-related macular degeneration through a researcher-clinician partnership Marie-Chantal Wanet-Defalque, PhD1,2,3 Josée Duquette, MSc1,3 3rd International SensAge Conference York, June 23rd 2014 1. Institut Nazareth & Louis-Braille 2. University of Montreal, School of Optometry 3. Center for Interdisciplinary Research in Rehabilitation of Greater Montreal

  2. Context  • Age-related macular degeneration (AMD)  most frequent diagnosis • Some patients • spontaneously find a new retinal fixation point (PRL) • Others • need training to understand eccentric viewing (EV) and improve their functional vision • Few materials were available in French to assist in training EV • Structured and standardized EV program  developed and implemented at INLB (VisExc-INLB)

  3. Purpose and Method • Evaluate the effectiveness of Vis-Exc training program • Characterize the clinical population  Retrospective study

  4. EV training program • The EV program (VisExc-INLB) • at home by qualified low vision rehabilitation specialists • homework exercises given between sessions • The program is provided in two parts: • basic  instrumental activities of daily living (IADL) 4 sessions • optional advanced  reading  3 sessions

  5. EV training program • Basic EV program / Instrumental Activities of Daily Living • PRL estimation, near and distance vision • Oculomotor • Hand-eye coordination • Perceptual-cognitive • Spot reading • Magnification device training during final session

  6. EV training program Advanced program / reading skills in eccentric fixation • Perceptual-cognitive exercise McGill Low Vision Manual (Overbury et al.) • Reading their own material

  7. Retrospectivestudy:clients characteristics 136 Clients Basic only: 54% Advanced: 46% Gender Age

  8. Distance vision acuity, pre-interventions Visual acuity, ICD-9-CM Ranges of Low Vision Moderate 20/80 - 20/160 49%; n=66 Subjects Visual acuity (logMAR)

  9. Visual acuity • Distance VA • Before training : 0.95 log MAR(20/200+) • After training : 0.93 log MAR (20/200+)  ≠ NS • Near VA • Before training: 1.13 log MAR (4M+ at 33 cm) • After training: 1.15 log MAR (4M+ at 33 cm)  ≠ NS

  10. Global satisfaction

  11. Clinical assessment of the impact of the basic eccentric viewing training Comments from central chart; n=87 • Improvement of… • Reading skills (fluency, accuracy and speed) • At least 9 subjects resume advanced reading activities • Instrumental activities of daily living (55) • Leisure / hobbies (24) • Far vision • etc. • functional autonomy and quality of life

  12. Impact of the advanced program on reading skills • Post basic vs post advanced program (n=28) • Quebec-French assessment tool (ÉCLec-DV) • Reading Speed • 150 wordstext; average speed calculated • Comprehension • Answers 3 questions about the text just read.

  13. Conclusions • VisExc-INLB: EV training in French; 41 trained professionals • Study on a real clinical population in a real clinical environment • Unexpectedly profound LV or moderate LV • Benefits • Clinical files • Reported satisfaction • Improvedreadingskills • Limitations: • No standardizedtesting conditions (clinicalenvironment) • Delay Pre/Post for VA tests

  14. The story had to becontinued… in the Lab

  15. Further research:Prospective study in a Lab environmnent • Evaluate EV training program effect (VisExc-INLB ) standardized measures OCT-SLO

  16. This willmakeanother story… Thankyou! marie-chantal.wanet.inlb@ssss.gouv.qc.ca

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