Expert consensus on low vision rehabilitation for patients with macular disease in China_Chinese Journal of Ocular Fundus Diseases

Authors：

 Yu Suqin ,  Xu Xun

Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai Clinical Research Center for Eye Diseases, Shanghai 200080, China;

Corresponding author：

Yu Suqin, Email: sq-yu@163.com; Xu Xun, Email: drxuxun@sjtu.edu.cn

Keywords：

Maculopathy; Low vision; Preferred retinal locus; Target retinal locus; Rehabilitation training; Expert consensus

DOI：

10.3760/cma.j.cn511434-20230404-00150

Video：

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Abstract Full text Figures/Tables Video References Cited by

Maculopathy caused by various fundus diseases in the late stage is a common cause of low vision. Medical technology is difficult to reverse the loss of macular function currently, so interventions that help improve the visual system, utilize residual visual function, and improve quality of life deserve attention. Damage to the fovea of the macula does not mean that the entire retinal function is impaired. There may be one or more retinal regions adjacent to the fovea that can serve as a fixation center. It is possible to form stable paracentral fixation, complete functional remodeling of the visual system, and effectively utilize residual visual function by taking appropriate training on these potential paracentral fixation points for most patients. In 2021, a clinical guideline has been published for low vision rehabilitation in China. In order to strengthen the precise management of diseases and develop a standard operating procedure for visual training specifically for patients with low vision due to macular disease, the National Clinical Research Center for Eye Diseases initiated and organized relevant domestic experts, utilizing the latest research experience at home and abroad, and through repeated discussions, this consensus (International Practice Guideline Registration Number: PREPARE-2023CN199) was formed as a reference for ophthalmologists, optometrists and rehabilitation physicians in their clinical research and practice.

Citation： Yu Suqin, Xu Xun. Expert consensus on low vision rehabilitation for patients with macular disease in China. Chinese Journal of Ocular Fundus Diseases, 2023, 39(5): 360-367. doi: 10.3760/cma.j.cn511434-20230404-00150 Copy

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2.	陈建华, 徐亮, 胡爱莲, 等. 北京市城乡限定人群低视力与盲的患病率及其病因的调查[J]. 中华医学杂志, 2003, 83(16): 1413-1418. DOI: 10.3760/j:issn:0376-2491.2003.16.012.Chen JH, Xu L, Hu AL, et al. Prevalence of low vision and blindness in defined populations in rural and urban areas in Beijing[J]. Natl Med J China, 2003, 83(16): 1413-1418. DOI: 10.3760/j:issn:0376-2491.2003.16.012.
3.	邹海东, 张皙, 许迅, 等. 上海市北新泾街道老年人低视力和盲的流行病学调查[J]. 中华眼科杂志, 2002, 38(12): 744-746. DOI: 10.3760/j:issn:0412-4081.2002.12.011.Zou HD, Zhang X, Xu X, et al. An epidemiological survey of low vision and blindness of senile persons in Beixinjing blocks, Shanghai[J]. Chin J Ophthalmol, 2002, 38(12): 744-746. DOI: 10.3760/j:issn:0412-4081.2002.12.011.
4.	Fletcher DC, Schuchard RA. Preferred retinal loci relationship to macular scotomas in a low-vision population[J]. Ophthalmology, 1997, 104(4): 632-638. DOI: 10.1016/s0161-6420(97)30260-7.
5.	Crossland MD, Culham LE, Kabanarou SA, et al. Preferred retinal locus development in patients with macular disease[J]. Ophthalmology, 2005, 112(9): 1579-1585. DOI: 10.1016/j.ophtha.2005.03.027.
6.	Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
7.	Tarita-Nistor L, González EG, Markowitz SN, et al. Plasticity of fixation in patients with central vision loss[J]. Vis Neurosci, 2009, 26(5-6): 487-494. DOI: 10.1017/S0952523809990265.
8.	Holocomb JG, Goodrich GL. Eccentric viewing training[J]. J Am Optom Assoc, 1976, 47(11): 1438-1443.
9.	Goodrich GL, Quillman RD. Eccentric viewing training[J]. JVIB, 1977, 71(9): 377-381. DOI: 10.1177/0145482X7707100.
10.	Inde K. Low vision training in Sweden[J]. JVIB, 1978, 72(8): 307-310. DOI: 10.1177/0145482X7807200803.
11.	Peli E. Control of eye movement with peripheral vision: implications for training of eccentric viewing[J]. Am J Optom Physiol Opt, 1986, 63(2): 113-118. DOI: 10.1097/00006324-198602000-00006.
12.	Maplesden C. A subjective approach to eccentric viewing training[J]. JVIB, 1984, 78(1): 5-6. DOI: 10.1177/0145482X8407800102.
13.	Sabel BA, Henrich-Noack P, Fedorov A, et al. Vision restoration after brain and retina damage: the "residual vision activation theory"[J]. Prog Brain Res, 2011, 192: 199-262. DOI: 10.1016/B978-0-444-53355-5.00013-0.
14.	Kasten E, Wüst S, Behrens-Baumann W, et al. Computer-based training for the treatment of partial blindness[J]. Nat Med, 1998, 4(9): 1083-1087. DOI: 10.1038/2079.
15.	Chung STL. The Glenn A. Fry Award Lecture 2012: plasticity of the visual system following central vision loss[J]. Optom Vis Sci, 2013, 90(6): 520-529. DOI: 10.1097/OPX.0b013e318294c2da.
16.	Liu T, Cheung SH, Schuchard RA, et al. Incomplete cortical reorganization in macular degeneration[J]. Invest Ophthalmol Vis Sci, 2010, 51(12): 6826-6834. DOI: 10.1167/iovs.09-4926.
17.	Dilks DD, Baker CI, Peli E, et al. Reorganization of visual processing in macular degeneration is not specific to the “preferred retinal locus”[J]. J Neurosci, 2009, 29(9): 2768-2773. DOI: 10.1523/JNEUROSCI.5258-08.2009.
18.	中华人民共和国民政部. 低视力康复[S]. 2020-10-23.Ministry of Civil Affairs of the People's Republic of China. Low vision rehabilitation. 2020-10-23.
19.	Fontenot JL, Bona MD, Kaleem MA, et al. Vision rehabilitation preferred practice patternp[J]. Ophthalmology, 2018, 125(1): 228-278. DOI: 10.1016/j.ophtha.2017.09.030.
20.	俞素勤, 王卫峻, 邹海东, 等. 黄斑区脉络膜新生血管患者的微视野检查[J]. 中华眼底病杂志, 2004, 20(2): 116-117. DOI: 10.3760/j.issn:1005-1015.2004.02.016.Yu SQ, Wang WJ, Zou HD, et al. Microscopical examination of choroidal neovascularization in macular area[J]. Chin J Ocul Fundus Dis, 2004, 20(2): 116-117. DOI: 10.3760/j.issn:1005-1015.2004.02.016.
21.	俞素勤, 王卫峻, 许迅. 湿性年龄相关性黄斑变性患者的视功能研究[J]. 上海交通大学学报(医学版), 2008, 28(6): 688-690.Yu SQ, Wang WJ, Xu X, et al. Visual function in patients with wet age-related macular degeneration[J]. Journal of Shanghai Jiaotong University(Medical Science), 2008, 28(6): 688-690.
22.	徐吉, 魏璐, 俞素勤, 等. 病理性近视患者黄斑功能的微视野检查[J]. 中华眼底病杂志, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J]. Chin J Ocul Fundus Dis, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.
23.	梁冬青, 刘玉燕, 韩泉洪. 微视野生物反馈训练及其在黄斑疾病中的应用研究现状及进展[J]. 中华眼底病杂志, 2020, 36(10): 817-820. DOI: 10.3760/cma.j.cn511434-20190521-00180.Liang DQ, Liu YY, Han QH, et al. Current situation and progress of microperimeter biofeedback training and its application in macular diseases[J]. Chin J Ocul Fundus Dis, 2020, 36(10): 817-820. DOI: 10.3760/cma.j.cn511434-20190521-00180.
24.	邹海东, 张晳, 许迅, 等. 低视力者生活质量量表中文版的研制和信度与效度考评[J]. 中华眼科杂志, 2005, 41(3): 246-251. DOI: 10.3760/j:issn:0412-4081.2005.03.013.Zou HD, Zhang X, Xu X, et al. Development and evaluation of psychometric tests of the Chinese-version of low vision quality of life questionnaire[J]. Chin J Ophthalmol, 2005, 41(3): 246-251. DOI: 10.3760/j:issn:0412-4081.2005.03.013.
25.	Mangione CM, Lee PP, Gutierrez PR, et al. Development of the 25-item National Eye Institute Visual Function Questionnaire[J]. Arch Ophthalmol, 2001, 119(7): 1050-1058. DOI: 10.1001/archopht.119.7.1050.
26.	Wolffsohn JS, Cochrane AL. Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation[J]. Am J Ophthalmol, 2000, 130(6): 793-802. DOI: 10.1016/s0002-9394(00)00610-3.
27.	薛文文, 邹海东. 中文版低视力者生活质量量表的rasch模型分析及优化[J]. 中华眼科杂志, 2019, 55(8): 582-588. DOI: 10.3760/cma.j.issn.0412-4081.2019.08.007.Xue WW, Zou HD. Rasch analysis of the Chinese Version of the Low Vision Quality of Life Questionnaire[J]. Chin J Ophthalmol, 2019, 55(8): 582-588. DOI: 10.3760/cma.j.issn.0412-4081.2019.08.007.
28.	Schumacher EH, Jacko JA, Primo SA, et al. Reorganization of visual processing is related to eccentric viewing in patients with macular degeneration[J]. Restor Neurol Neurosci, 2008, 26((4-5): 391-402.
29.	Dilks DD, Julian JB, Peli E, et al. Reorganization of visual processing in age-related macular degeneration depends on foveal loss[J]. Optom Vis Sci, 2014, 91(8): 199-206. DOI: 10.1097/OPX.0000000000000325.
30.	刘文织. 低视力患者心理健康状况与社会支持相关性研究. 中医临床研究, 2016, 8(16): 108-109. DOI: 10.3969/j.issn.1674-7860.2016.16.057.Liu WZ. A study on the relationship between mental health status and social support in patients with low vision[J]. Clinical Journal of Chinese Medicine, 2016, 8(16): 108-109. DOI: 10.3969/j.issn.1674-7860.2016.16.057.
31.	张海平, 谭伙连, 吴伟霞, 等. 护理干预对低视力患者心理健康状况的影响[J]. 齐鲁护理杂志, 2014, 20(19): 50-51. DOI: 10.3969/j.issn.1006-7256.2014.19.023.Zhang HP, Tan HL, Wu WX, et al. Effect of nursing intervention on mental health status of patients with low vision. Journal of Qilu Nursing, 2014, 20(19): 50-51. DOI: 10.3969/j.issn.1006-7256.2014.19.023.

1. 国家重点研发计划2020YFC2008200项目组, 中华医学会眼科学分会眼视光学组, 中国医师协会眼科医师分会眼视光专业委员会. 中国低视力康复临床指南(2021)[J]. 中华眼视光学与视觉科学杂志, 2021, 23(3): 161-170. DOI: 10.3760/cma.j.cn115909-20210221-00068.Research Panel of the National Key R&D Project 2020YFC2008200, Chinese Optometric Association of Chinese Ophthalmological Society, Optometry Committee of Chinese Ophthalmologists. Chinese Low Vision Rehabilitation Clinical Guideline (2021)[J]. Chin J Optom Ophthalmol Vis Sci, 2021, 23(3): 161-170. DOI: 10.3760/cma.j.cn115909-20210221-00068.
2. 陈建华, 徐亮, 胡爱莲, 等. 北京市城乡限定人群低视力与盲的患病率及其病因的调查[J]. 中华医学杂志, 2003, 83(16): 1413-1418. DOI: 10.3760/j:issn:0376-2491.2003.16.012.Chen JH, Xu L, Hu AL, et al. Prevalence of low vision and blindness in defined populations in rural and urban areas in Beijing[J]. Natl Med J China, 2003, 83(16): 1413-1418. DOI: 10.3760/j:issn:0376-2491.2003.16.012.
3. 邹海东, 张皙, 许迅, 等. 上海市北新泾街道老年人低视力和盲的流行病学调查[J]. 中华眼科杂志, 2002, 38(12): 744-746. DOI: 10.3760/j:issn:0412-4081.2002.12.011.Zou HD, Zhang X, Xu X, et al. An epidemiological survey of low vision and blindness of senile persons in Beixinjing blocks, Shanghai[J]. Chin J Ophthalmol, 2002, 38(12): 744-746. DOI: 10.3760/j:issn:0412-4081.2002.12.011.
4. Fletcher DC, Schuchard RA. Preferred retinal loci relationship to macular scotomas in a low-vision population[J]. Ophthalmology, 1997, 104(4): 632-638. DOI: 10.1016/s0161-6420(97)30260-7.
5. Crossland MD, Culham LE, Kabanarou SA, et al. Preferred retinal locus development in patients with macular disease[J]. Ophthalmology, 2005, 112(9): 1579-1585. DOI: 10.1016/j.ophtha.2005.03.027.
6. Whittaker SG, Budd J, Cummings RW. Eccentric fixation with macular scotoma[J]. Invest Ophthalmol Vis Sci, 1988, 29(2): 268-278.
7. Tarita-Nistor L, González EG, Markowitz SN, et al. Plasticity of fixation in patients with central vision loss[J]. Vis Neurosci, 2009, 26(5-6): 487-494. DOI: 10.1017/S0952523809990265.
8. Holocomb JG, Goodrich GL. Eccentric viewing training[J]. J Am Optom Assoc, 1976, 47(11): 1438-1443.
9. Goodrich GL, Quillman RD. Eccentric viewing training[J]. JVIB, 1977, 71(9): 377-381. DOI: 10.1177/0145482X7707100.
10. Inde K. Low vision training in Sweden[J]. JVIB, 1978, 72(8): 307-310. DOI: 10.1177/0145482X7807200803.
11. Peli E. Control of eye movement with peripheral vision: implications for training of eccentric viewing[J]. Am J Optom Physiol Opt, 1986, 63(2): 113-118. DOI: 10.1097/00006324-198602000-00006.
12. Maplesden C. A subjective approach to eccentric viewing training[J]. JVIB, 1984, 78(1): 5-6. DOI: 10.1177/0145482X8407800102.
13. Sabel BA, Henrich-Noack P, Fedorov A, et al. Vision restoration after brain and retina damage: the "residual vision activation theory"[J]. Prog Brain Res, 2011, 192: 199-262. DOI: 10.1016/B978-0-444-53355-5.00013-0.
14. Kasten E, Wüst S, Behrens-Baumann W, et al. Computer-based training for the treatment of partial blindness[J]. Nat Med, 1998, 4(9): 1083-1087. DOI: 10.1038/2079.
15. Chung STL. The Glenn A. Fry Award Lecture 2012: plasticity of the visual system following central vision loss[J]. Optom Vis Sci, 2013, 90(6): 520-529. DOI: 10.1097/OPX.0b013e318294c2da.
16. Liu T, Cheung SH, Schuchard RA, et al. Incomplete cortical reorganization in macular degeneration[J]. Invest Ophthalmol Vis Sci, 2010, 51(12): 6826-6834. DOI: 10.1167/iovs.09-4926.
17. Dilks DD, Baker CI, Peli E, et al. Reorganization of visual processing in macular degeneration is not specific to the “preferred retinal locus”[J]. J Neurosci, 2009, 29(9): 2768-2773. DOI: 10.1523/JNEUROSCI.5258-08.2009.
18. 中华人民共和国民政部. 低视力康复[S]. 2020-10-23.Ministry of Civil Affairs of the People's Republic of China. Low vision rehabilitation. 2020-10-23.
19. Fontenot JL, Bona MD, Kaleem MA, et al. Vision rehabilitation preferred practice patternp[J]. Ophthalmology, 2018, 125(1): 228-278. DOI: 10.1016/j.ophtha.2017.09.030.
20. 俞素勤, 王卫峻, 邹海东, 等. 黄斑区脉络膜新生血管患者的微视野检查[J]. 中华眼底病杂志, 2004, 20(2): 116-117. DOI: 10.3760/j.issn:1005-1015.2004.02.016.Yu SQ, Wang WJ, Zou HD, et al. Microscopical examination of choroidal neovascularization in macular area[J]. Chin J Ocul Fundus Dis, 2004, 20(2): 116-117. DOI: 10.3760/j.issn:1005-1015.2004.02.016.
21. 俞素勤, 王卫峻, 许迅. 湿性年龄相关性黄斑变性患者的视功能研究[J]. 上海交通大学学报(医学版), 2008, 28(6): 688-690.Yu SQ, Wang WJ, Xu X, et al. Visual function in patients with wet age-related macular degeneration[J]. Journal of Shanghai Jiaotong University(Medical Science), 2008, 28(6): 688-690.
22. 徐吉, 魏璐, 俞素勤, 等. 病理性近视患者黄斑功能的微视野检查[J]. 中华眼底病杂志, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.Xu J, Wei L, Yu SQ, et al. Macular function of pathologic myopic retina evaluated by microperimetry[J]. Chin J Ocul Fundus Dis, 2011, 27(1): 52-55. DOI: 10.3760/cma.j.issn.1005-1015.2011.01.012.
23. 梁冬青, 刘玉燕, 韩泉洪. 微视野生物反馈训练及其在黄斑疾病中的应用研究现状及进展[J]. 中华眼底病杂志, 2020, 36(10): 817-820. DOI: 10.3760/cma.j.cn511434-20190521-00180.Liang DQ, Liu YY, Han QH, et al. Current situation and progress of microperimeter biofeedback training and its application in macular diseases[J]. Chin J Ocul Fundus Dis, 2020, 36(10): 817-820. DOI: 10.3760/cma.j.cn511434-20190521-00180.
24. 邹海东, 张晳, 许迅, 等. 低视力者生活质量量表中文版的研制和信度与效度考评[J]. 中华眼科杂志, 2005, 41(3): 246-251. DOI: 10.3760/j:issn:0412-4081.2005.03.013.Zou HD, Zhang X, Xu X, et al. Development and evaluation of psychometric tests of the Chinese-version of low vision quality of life questionnaire[J]. Chin J Ophthalmol, 2005, 41(3): 246-251. DOI: 10.3760/j:issn:0412-4081.2005.03.013.
25. Mangione CM, Lee PP, Gutierrez PR, et al. Development of the 25-item National Eye Institute Visual Function Questionnaire[J]. Arch Ophthalmol, 2001, 119(7): 1050-1058. DOI: 10.1001/archopht.119.7.1050.
26. Wolffsohn JS, Cochrane AL. Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation[J]. Am J Ophthalmol, 2000, 130(6): 793-802. DOI: 10.1016/s0002-9394(00)00610-3.
27. 薛文文, 邹海东. 中文版低视力者生活质量量表的rasch模型分析及优化[J]. 中华眼科杂志, 2019, 55(8): 582-588. DOI: 10.3760/cma.j.issn.0412-4081.2019.08.007.Xue WW, Zou HD. Rasch analysis of the Chinese Version of the Low Vision Quality of Life Questionnaire[J]. Chin J Ophthalmol, 2019, 55(8): 582-588. DOI: 10.3760/cma.j.issn.0412-4081.2019.08.007.
28. Schumacher EH, Jacko JA, Primo SA, et al. Reorganization of visual processing is related to eccentric viewing in patients with macular degeneration[J]. Restor Neurol Neurosci, 2008, 26((4-5): 391-402.
29. Dilks DD, Julian JB, Peli E, et al. Reorganization of visual processing in age-related macular degeneration depends on foveal loss[J]. Optom Vis Sci, 2014, 91(8): 199-206. DOI: 10.1097/OPX.0000000000000325.
30. 刘文织. 低视力患者心理健康状况与社会支持相关性研究. 中医临床研究, 2016, 8(16): 108-109. DOI: 10.3969/j.issn.1674-7860.2016.16.057.Liu WZ. A study on the relationship between mental health status and social support in patients with low vision[J]. Clinical Journal of Chinese Medicine, 2016, 8(16): 108-109. DOI: 10.3969/j.issn.1674-7860.2016.16.057.
31. 张海平, 谭伙连, 吴伟霞, 等. 护理干预对低视力患者心理健康状况的影响[J]. 齐鲁护理杂志, 2014, 20(19): 50-51. DOI: 10.3969/j.issn.1006-7256.2014.19.023.Zhang HP, Tan HL, Wu WX, et al. Effect of nursing intervention on mental health status of patients with low vision. Journal of Qilu Nursing, 2014, 20(19): 50-51. DOI: 10.3969/j.issn.1006-7256.2014.19.023.

Chinese Journal of Ocular Fundus Diseases

Expert consensus on low vision rehabilitation for patients with macular disease in China

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