Posters

Importance of cortical plasticity for the success of an add-on bifocal aspherical intraocular lens in low-vision patients

Poster Details

First Author: J.Nekolova CZECH REPUBLIC

Co Author(s):    J. Kremlacek   M. Stredova   N. Jiraskova              

Abstract Details

Purpose:

To present the first experience with intensive visual rehabilitation supported by modulation of cortical plasticity with transcranial electrical stimulation (tES) in patients after Scharioth macula lens (SML) implantation. The SML improves near vision in patients with several maculopathies. The brain activity is modulated with intensive reading training and by the tES. At low electrical currents between the surface electrodes, the tES causes subliminal changes in excitability in nearby cortical regions and supports so-called associative plasticity. The main goal of the project is to improve the quality of life in low-vision patients with stable maculopathy.

Setting:

Department of Ophthalmology, University Hospital in Hradec Kralove, Czech Republic and Department of Pathological Physiology, Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic

Methods:

During 3 years, the project will include 20 patients with stable maculopathy who underwent cataract surgery in the past. All participants must meet the indication criteria and SML is implanted into the better-seeing eye. On the third postoperative day, the tES sessions start and are applied 20 times, delivered in double-blind design. Visual exercises and rehabilitation take place during the tES. Using questionnaires, the effect is assessed of intervention on the quality of life and reading speed (RS) is measured as an average time for reading 10 words of text size 10 of Jaeger test (J.T.).

Results:

We present pilot results of 4 patients after the first year of the project. Before the implantation, the patients read J.T.15 uncorrected, with +6.0 sphere J.T. 4.5. After the surgery and visual stimulation, the visual acuity at near was uncorrected J.T.7.5 three weeks, J.T.7 two months and J.T.5 six months postoperatively. At the beginning, the RS was 11, 31, and 124, after a month of visual rehabilitation, the RS was 8, 13 and 33 s, one was not applicable. The patients reported an improvement in 8 and decline in 1 question out of total 18 questions of MacDAQ questionnaire.

Conclusions:

In spite that SML offers magnification 'on-demand’, ‘hands-free’, with natural eye movements, the patient must learn to "look" with the implanted IOL. The visual rehabilitation uses an appropriate and repetitive training to induce 'use-dependent' plasticity to improve visual skills. In the project, we also study whether tES can facilitate and/or accelerate vision rehabilitation. According to the pilot results, the project has a positive impact on near vision and on satisfaction of patients with maculopathy, who would otherwise be limited in their daily activities. We proved the safety of all methods. The study is supported by grant AZVMZ CR NV18-06-00488.

Financial Disclosure:

None