Biofeedback Fixation Training in the Rehabilitation of Patients with Geographic Atrophy

Geographic atrophy (GA) is a progressive cause of central vision loss with limited re-habilitation options. This prospective case series aimed to evaluate the effects of bio-feedback fixation training (BFT) on visual function and vision-related quality of life (QoL) in patients with GA. Eighteen patients with total central vision loss in one eye and partial involvement of the fellow eye (study eye) underwent BFT using the Macular Integrity Assessment (MAIA) system, which was used to select a new, previously chosen preferred retinal locus (PRL) on the study eye to stabilize fixation or adopt a new fixation locus. Patients were followed for an average of 13.2 months (range 3-26 months). Functional outcomes included best corrected visual acuity (BCVA, ETDRS), reading performance (Radner test), and contrast sensitivity (CS Spot Checks test). MAIA parameters comprised average retinal sensitivity, fixation distance and stability (P1, P2), and changes in the bivariate contour ellipse area (BCEA). Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Following BFT, BCVA, reading ability and contrast sensitivity improved significantly (p< 0.02), and fixation stability and NEI-VFQ-25 scores showed a positive trend. These findings indicate that BFT is a feasible and promising rehabilitation approach for patients with GA.