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.	陳建華, 徐亮, 胡愛蓮, 等. 北京市城鄉限定人群低視力與盲的患病率及其病因的調查[J]. 中華醫學雜志, 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.	鄒海東, 張皙, 許迅, 等. 上海市北新涇街道老年人低視力和盲的流行病學調查[J]. 中華眼科雜志, 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.	中華人民共和國民政部. 低視力康復[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, 王衛峻, 鄒海東, 等. 黃斑區脈絡膜新生血管患者的微視野檢查[J]. 中華眼底病雜志, 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, 王衛峻, 許迅. 濕性年齡相關性黃斑變性患者的視功能研究[J]. 上海交通大學學報(醫學版), 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. 病理性近視患者黃斑功能的微視野檢查[J]. 中華眼底病雜志, 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, 劉玉燕, 韓泉洪. 微視野生物反饋訓練及其在黃斑疾病中的應用研究現狀及進展[J]. 中華眼底病雜志, 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.	鄒海東, 張晳, 許迅, 等. 低視力者生活質量量表中文版的研制和信度與效度考評[J]. 中華眼科雜志, 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, 鄒海東. 中文版低視力者生活質量量表的rasch模型分析及優化[J]. 中華眼科雜志, 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.	劉文織. 低視力患者心理健康狀況與社會支持相關性研究. 中醫臨床研究, 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.	張海平, 譚伙連, 吳偉霞, 等. 護理干預對低視力患者心理健康狀況的影響[J]. 齊魯護理雜志, 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. 國家重點研發計劃2020YFC2008200項目組, 中華醫學會眼科學分會眼視光學組, 中國醫師協會眼科醫師分會眼視光專業委員會. 中國低視力康復臨床指南(2021)[J]. 中華眼視光學與視覺科學雜志, 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. 陳建華, 徐亮, 胡愛蓮, 等. 北京市城鄉限定人群低視力與盲的患病率及其病因的調查[J]. 中華醫學雜志, 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. 鄒海東, 張皙, 許迅, 等. 上海市北新涇街道老年人低視力和盲的流行病學調查[J]. 中華眼科雜志, 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. 中華人民共和國民政部. 低視力康復[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, 王衛峻, 鄒海東, 等. 黃斑區脈絡膜新生血管患者的微視野檢查[J]. 中華眼底病雜志, 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, 王衛峻, 許迅. 濕性年齡相關性黃斑變性患者的視功能研究[J]. 上海交通大學學報(醫學版), 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. 病理性近視患者黃斑功能的微視野檢查[J]. 中華眼底病雜志, 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, 劉玉燕, 韓泉洪. 微視野生物反饋訓練及其在黃斑疾病中的應用研究現狀及進展[J]. 中華眼底病雜志, 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. 鄒海東, 張晳, 許迅, 等. 低視力者生活質量量表中文版的研制和信度與效度考評[J]. 中華眼科雜志, 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, 鄒海東. 中文版低視力者生活質量量表的rasch模型分析及優化[J]. 中華眼科雜志, 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. 劉文織. 低視力患者心理健康狀況與社會支持相關性研究. 中醫臨床研究, 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. 張海平, 譚伙連, 吳偉霞, 等. 護理干預對低視力患者心理健康狀況的影響[J]. 齊魯護理雜志, 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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