A Visual Telerehabilitation Program in Virtual Reality for Age-Related Macular Degeneration: Randomized Feasibility and Proof-of-Concept Trial.
Yulia Pyatova, Bill Zhang, Mariana Misawa and 9 others
Adding a home VR eye-tracking game to standard biofeedback training was safe and mostly workable for 14 older adults with macular degeneration, but it did not consistently improve vision over training alone.
The one reading-speed gain faded by one month.
Key findings
1Feasibility was only partial: recruitment was far below target (0.13 and 0.11 participants per week versus a target of at least 1.5), one VR participant dropped out because the headset was too heavy for the neck, and 75% of the VR group completed the programme versus the 80% threshold. However, those who continued completed 90.6% of scheduled sessions and no one experienced cybersickness.
2After four weeks there were no significant between-group differences in visual acuity, fixation stability, retinal sensitivity, or contrast sensitivity. In the VR group, fixation stability actually worsened to a degree above the minimum detectable change in the per-protocol subset.
3Reading speed rose above the minimum detectable change (8.6 words per minute) in the VR group (mean gain of 13.2 wpm intention-to-treat, 21.3 wpm per-protocol) but not in the biofeedback-only group. By one-month follow-up the VR group's reading speed had fallen by 18.2 wpm, again above the minimum detectable change.
Still to come
How it was doneWhat they found
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What it does not show
Only 14 people were randomised against a planned 32, so every between-group comparison is very imprecise and the authors explicitly say the results should not be read as evidence for or against effectiveness. The study was open-label: participants knew whether they were getting the VR programme or not, which can influence how they report symptoms and effort. Recruitment and follow-up were heavily disrupted by pandemic restrictions in Ontario, and the authors note that participants who stayed in the study may have been more motivated than the general AMD population. Missing data grew over time (5 of 70 data points missing at 4 weeks, 25 of 70 at 6 months) and the authors could not confirm it was random, so the available-case analyses may be biased. The study did not measure how patients actually used their preferred retinal locus during reading, eye movements, or brain-level adaptation, so the mechanism behind the reading-speed signal is unknown. The VR group's reading-speed gain was not sustained at one month, suggesting four weeks of every-other-day training may be too short to produce a lasting change.
Declared interests
Funded by the Krembil Collaborative Seed grant and the University Health Network Foundation. The funders had no role in study design, data collection, analysis, interpretation, manuscript preparation, or the decision to submit. No conflicts of interest were declared.
The easy way to misread this
Do not read the reading-speed increase in the VR group as proof that home VR training improves vision in macular degeneration. The confidence intervals for the gain cross zero, the group had only 8 participants, the study was open-label, the gain was not maintained at one month, and the authors state plainly that these results 'should not be interpreted as evidence of effectiveness.' This is a feasibility study asking whether the programme can be delivered, not whether it works.
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