视网膜优选位点及其临床应用
Preferred retinal locus and its clinical application
黄斑病变通常导致中心视力丧失,伴随固视稳定性显著降低,导致精细视觉、阅读,甚至人脸识别障碍,严重影响患者生活质量。目前尚无明确及有效的治疗方法能够逆转萎缩性黄斑病变造成的视功能损害,但中心视力丧失患者可自发在功能尚可的旁中心视网膜形成偏心注视以缓解中心暗点的视觉干扰,该位点被称为视网膜优选位点(PRL);然而,自然形成的PRL通常不是视功能康复的最佳视网膜位点,部分患者需要偏心注视训练进行PRL重定位实现更佳的视觉康复。目前基于生物反馈的偏心注视训练已被证实可稳定自然形成的PRL或诱导形成新的PRL,实现黄斑病变患者的低视力康复;然而关于PRL的发生和发展过程、定位特征及偏心注视训练的具体实施方案均存在争议。本文总结了PRL的相关概念及特征,包括PRL的形成特点、PRL形成的理论基础、PRL的定位特点、PRL重定位的临床效果及相关评估指标;并综述了黄斑病变导致中心视力丧失患者基于偏心注视训练的低视力康复训练方案和疗效,以期为临床上中心视力丧失患者的低视力康复提供指导。
更多Macular diseases usually lead to central vision loss, accompanied by a significant unstable fixation, resulting in disorders of fine vision, reading, and even face recognition, which seriously affect the quality of life of patients.There is no clear and effective treatment to reverse the visual impairment caused by atrophic macular diseases, yet patients with central vision loss secondary to macular diseases commonly adopt a region outside the central macular area as the surrogate fovea for vision, which is named preferred retinal locus (PRL).However, natural PRLs are not optimal in common for low-vision rehabilitation.Therefore, some patients need eccentric fixation training for PRL relocation to achieve better visual rehabilitation.Studies have shown that eccentric fixation training based on biofeedback can stabilize the natural PRL or induce a new PRL to improve low-vision rehabilitation in patients with macular diseases.So far, the development and location characteristics of PRL and the clinical applications and efficacy of training remain controversial.This review concludes the concept and features of PRL, including the characteristics and possible rationale of PRL development, the location and relocation of PRL, and the evaluation indicators of PRL relocation.Furthermore, in order to provide clinical guidance for low-vision rehabilitation of patients with central vision loss, the programs and efficacy of eccentric fixation training for low-vision rehabilitation are also reviewed.
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