Current Research Projects

Gary S. Rubin, PhD

Helen Keller Professor of Ophthalmology

UCL Institute of Ophthalmology

Low Vision Patient Day

7 June 2014

Topics

• Basic Research Service Delivery

• New Devices Training

• Two projects undertaken with colleagues from other parts of the University (Dept of Transportation Engineering) and colleagues from other universities (School of Architecture, Kingston University

Is there Brain Remapping in Macular Disease? (Baseler, 2007)

• Specific areas of the brain process information from specific areas of the visual field

• AMD central scotoma silent areas of the brain

• Do these silent areas regain function?

• For vision – No

• For other senses – maybe Yes

Response of Area V1

Silent brain areas before and after

Clinical Predictors of Reading Speed in AMD (Rubin & Feely, 2009)

• Visual acuity does NOT predict reading speed in patients with AMD

Clinical Predictors of Reading Speed in AMD (Rubin & Feely, 2009)

• Visual acuity does NOT predict reading speed in patients with AMD

• Fixation stability and size of forward saccades account for 74% of variance.

Reading Speed (words/min)

Scanning Laser Ophthalmoscope

Scotoma Map

Replacing the SLO? Nidek MP-1

Compensation for Fixation Instability Improves Reading Speed (Macedo, 2013)

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RSVP Improves reading Speed

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Training Possibilities

Eccentric Viewing Eye Movement Training

Perceptual Learning

Electronic Head-Mounted Devices

• Portable• Cosmetically

acceptable• Lightweight• Multipurpose• Affordable (good

value for money)• Commercial support

The ultimate HMD

Electronic Magnification Devices: 1990

Low Vision Enhancement System - LVES

Electronic Magnification Devices: 2001

Jordy®

Reading Performance with Devices

The Demise of Jordy and His Friends

Portable Electronic Low Vision Aids

PELVAs

• Pros– Less expensive (<£400)– Smartphone platform– Battery powered– Light and compact

• Cons– Limited field of view– Limited magnification

• Studies in progress

Implantable Miniature Telescope (IMT)

UK Clinical Trial of IMT (Dunbar, 2010)

• Prospective open label trial of 3x IMT at 4 UK centers

• IMT implanted in better eye of 17 patients• Followed by 12-week rehab course• Results

– 3 line improvement in VA– Contrast sensitivity reduced by 0.4 logCS– Maximum reading rate improved by 10 words/min– Self-reported visual disability (Massof AI) improved by

0.6 logit (equiv to 4 lines of VA)

Retinal Prostheses – ‘Bionic Eye’

• About 10 projects worldwide• Mostly epi-retinal; some sub-

retinal• Well tolerated and apparently

safe• Also optic nerve and cortical

prostheses• Initially, low resolution

– 20 electrodes max due to safety concerns

Winter, et al (2007)

Argus II – Second Sight (California)

Argus II – Second Sight (California)

• Epi-retinal 60 electrode array• Implanted in about two dozen patients worldwide (12 in

UK; 8 Moorfields)• Retinitis pigmentosa with light perception or worse• Outcome measures

– Grating acuity– Phosphene projection– Letter recognition– Mobility

Follow a white line on a black background

Find a white door on a black wall

A Sampler of Clinical Trials Underway

• Impact of LV rehab in patients with diabetic eye disease (Dunbar, 2008-2011)

• Eccentric Fixation From Enhanced Clinical Training, (EFFECT): A Randomised Controlled Trial for Patients with AMD (Rubin, 2011-2013)

• Depression in Visual Impairment Trial (DEPVIT; Margrain, 2011-2013)

• The impact of timely emotional support on the quality of life of blind and partially sighted people (Afsani, 2011-2013)

Summary and Conclusions

• Substantial growth in low vision research during the past 10 years

• Shifting emphasis from head-mounted low vision magnifier to portable hand-held electronic magnifier

• New initiatives in service delivery showing great promise

• Profusion of new outcome measures• Building momentum in establishing a sound

evidence base for the effectiveness of low vision rehabilitation

• Still plenty of additional work to be done!

Acknowledgements

• Collaborators– Louise Culham - Moorfields Eye Hospital– Alan Bird - Moorfields Eye Hospital– Liz Pearce – Moorfields Eye Hospital– Peter Bex – Fred Fitzke

• Postdocs and Students– Michael Crossland– Stamatina Kabanarou – Caren Bellmann– Angela Rees – Thomas Butt– Radhika Gulati– Hannah Dunbar– Anthony Chabra

• Research Assistants– Eugeniu Dinu– Mary Feely– Hannah Roche

• Funding– Wellcome Trust– National Institute of Health

Research– Guide Dogs for the Blind

Association– Macular Disease Society– European Commission– Fight for Sight– Special Trustees of Moorfields

Eye Hospital– Garfield Weston Foundation– Friends of Moorfields Eye

Hospital