Ophthalmology Science · 9 authors, 1 centre
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This large randomized controlled trial found that eccentric viewing training did not improve task ability, reading performance, or fixation stability in patients with age-related macular disease. Visual acuity and contrast sensitivity worsened in all groups, suggesting disease progression outweighed any potential training benefits. The results do not support routine use of eccentric viewing training for progressing age-related macular disease.
**Background:** Eccentric viewing training has been used for over 40 years to help patients with macular disease use noncentral retina for vision, but prior studies lacked control groups and had methodological flaws. The EFFECT trial aimed to rigorously evaluate two types of eccentric viewing training compared to control groups.
**Methods:** This randomized controlled trial enrolled 200 adults with age-related macular disease from Moorfields Eye Hospital. Participants had visual acuity 6/12 to 3/60 (0.3 to 1.30 logMAR) and at least one point of absolute scotoma. They were randomized into four groups: (1) control (standard low-vision rehabilitation only), (2) supervised reading (standard rehabilitation plus three 45-minute reading sessions), (3) PRL training (three 45-minute sessions training at the preferred retinal locus), and (4) TRL training (three 45-minute sessions using biofeedback to train a superior retinal locus). All groups received standard low-vision rehabilitation including refraction, optical aids, and referrals. The primary outcome was change in patient-reported visual task ability measured by the Activity Inventory (AI) at 6 months. Secondary outcomes included reading performance (MNREAD maximum reading speed, critical print size, reading acuity; magnifier-assisted reading speed; Morgan comprehension test) and fixation stability (bivariate contour ellipse area on microperimetry). Analysis was intention-to-treat.
**Key Results:** There was no significant difference between groups in the primary outcome of task ability change (ANOVA F(3,174)=1.48, P=0.22). Visual acuity deteriorated by a mean of 0.20 logMAR (SD 0.47) across all groups, and contrast sensitivity fell by 0.18 log units (SD 0.34). Maximum reading speed dropped from 104 to 84 words per minute (matched pairs t(171)=-7.04, P<0.001), with no between-group difference (F(3,168)=1.17, P=0.32). Reading acuity worsened from 0.83 to 0.89 logMAR (P<0.001), with no group effect (F(3,170)=0.91, P=0.44). Fixation stability deteriorated by 0.10 log degrees² (SD 0.44, P<0.01), with no group difference (F(3,137)=0.57, P=0.64). No significant differences were found for critical print size, magnifier-assisted reading speeds, or comprehension. Disease progression appeared to outweigh any training benefits.
**Clinical Implications:** This large, well-controlled trial found no benefit of eccentric viewing training for patients with progressing age-related macular disease. The authors do not recommend routine use of this training, though they acknowledge potential benefit for some individuals with end-stage disease. Future research should focus on identifying which patients might benefit and consider home-based or online delivery to improve access.