Mobility-Related Gaze Training in Individuals With Glaucoma: A Proof-of-Concept Study

Overview

Journal Transl Vis Sci Technol

Specialties Biomedical Engineering
Ophthalmology

Date 2019 Oct 16

PMID 31612095

Citations 6

Authors

Shaila M Gunn

Kim Lajoie

Kim T Zebehazy

Robert A Strath

David R Neima

Daniel S Marigold

Affiliations

Soon will be listed here.

Abstract

Purpose: Older adults with glaucoma show inappropriate gaze strategies during routine mobility tasks. Furthermore, glaucoma is a risk factor for falling and colliding with objects when walking. However, effective interventions to rectify these strategies and prevent these adverse events are scarce. We designed a gaze training program with the goal of providing proof-of-concept that we could modify mobility-related gaze behavior in this population.

Methods: A total of 13 individuals with moderate glaucoma participated in this study. We taught participants general and task-specific gaze strategies over two 1-hour sessions. To determine the efficacy of this gaze training program, participants performed walking tasks that required accurate foot placement onto targets and circumventing obstacles before and after training. We used a mobile eye tracker to quantify gaze and a motion-capture system to quantify body movement.

Results: After training, we found changes in the timing between gaze shifts away from targets relative to stepping on them ( < 0.05). In the obstacle negotiation task, we found a greater range of gaze shifts early in walking trials and changes in the timing between gaze shifts away from obstacles after training ( < 0.05), each suggesting better route planning. A posttraining reduction in foot-placement error and obstacle collisions accompanied these changes ( < 0.05).

Conclusions: Our results demonstrated that it is possible to modify mobility-related gaze behavior and mobility performance in older adults with glaucoma.

Translational Relevance: This study provides proof-of-concept for a gaze training program for glaucoma. A larger, randomized controlled trial is warranted.

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References

Nelson P, Aspinall P, Papasouliotis O, Worton B, OBrien C . Quality of life in glaucoma and its relationship with visual function. J Glaucoma. 2003; 12(2):139-50. DOI: 10.1097/00061198-200304000-00009. View

Peli E, Luo G, Bowers A, Rensing N . DEVELOPMENT AND EVALUATION OF VISION MULTIPLEXING DEVICES FOR VISION IMPAIRMENTS. Int J Artif Intell Tools. 2010; 18(3):365-378. PMC: 2790207. DOI: 10.1142/S0218213009000184. View

Black A, Wood J, Lovie-Kitchin J . Inferior field loss increases rate of falls in older adults with glaucoma. Optom Vis Sci. 2011; 88(11):1275-82. DOI: 10.1097/OPX.0b013e31822f4d6a. View

Chapman G, Hollands M . Evidence that older adult fallers prioritise the planning of future stepping actions over the accurate execution of ongoing steps during complex locomotor tasks. Gait Posture. 2006; 26(1):59-67. DOI: 10.1016/j.gaitpost.2006.07.010. View

Freeman E, Munoz B, Rubin G, West S . Visual field loss increases the risk of falls in older adults: the Salisbury eye evaluation. Invest Ophthalmol Vis Sci. 2007; 48(10):4445-50. DOI: 10.1167/iovs.07-0326. View

Lamoureux E, Lamoreux E, Chong E, Wang J, Saw S, Aung T . Visual impairment, causes of vision loss, and falls: the singapore malay eye study. Invest Ophthalmol Vis Sci. 2008; 49(2):528-33. DOI: 10.1167/iovs.07-1036. View

Yamada M, Higuchi T, Tanaka B, Nagai K, Uemura K, Aoyama T . Measurements of stepping accuracy in a multitarget stepping task as a potential indicator of fall risk in elderly individuals. J Gerontol A Biol Sci Med Sci. 2011; 66(9):994-1000. DOI: 10.1093/gerona/glr073. View

Nummenmaa L, Hyona J, Hietanen J . I'll walk this way: eyes reveal the direction of locomotion and make passersby look and go the other way. Psychol Sci. 2009; 20(12):1454-8. DOI: 10.1111/j.1467-9280.2009.02464.x. View

Mihailovic A, Swenor B, Friedman D, West S, Gitlin L, Ramulu P . Gait Implications of Visual Field Damage from Glaucoma. Transl Vis Sci Technol. 2017; 6(3):23. PMC: 5484170. DOI: 10.1167/tvst.6.3.23. View

10.

Wilson M, Vine S, Bright E, Masters R, Defriend D, McGrath J . Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study. Surg Endosc. 2011; 25(12):3731-9. PMC: 3213335. DOI: 10.1007/s00464-011-1802-2. View

11.

Miller A, Lajoie K, Strath R, Neima D, Marigold D . Coordination of Gaze Behavior and Foot Placement During Walking in Persons With Glaucoma. J Glaucoma. 2017; 27(1):55-63. DOI: 10.1097/IJG.0000000000000819. View

12.

Tanabe S, Yuki K, Ozeki N, Shiba D, Tsubota K . The association between primary open-angle glaucoma and fall: an observational study. Clin Ophthalmol. 2012; 6:327-31. PMC: 3295630. DOI: 10.2147/OPTH.S28281. View

13.

Curzon-Jones B, Hollands M . Route previewing results in altered gaze behaviour, increased self-confidence and improved stepping safety in both young and older adults during adaptive locomotion. Exp Brain Res. 2018; 236(4):1077-1089. PMC: 5887007. DOI: 10.1007/s00221-018-5203-9. View

14.

Beurskens R, Bock O . Age-related deficits of dual-task walking: a review. Neural Plast. 2012; 2012:131608. PMC: 3403123. DOI: 10.1155/2012/131608. View

15.

Iester M, ZINGIRIAN M . Quality of life in patients with early, moderate and advanced glaucoma. Eye (Lond). 2002; 16(1):44-9. DOI: 10.1038/sj.eye.6700036. View

16.

Pundlik S, Tomasi M, Luo G . Evaluation of a Portable Collision Warning Device for Patients With Peripheral Vision Loss in an Obstacle Course. Invest Ophthalmol Vis Sci. 2015; 56(4):2571-9. DOI: 10.1167/iovs.14-15935. View

17.

Luo G, Woods R, Peli E . Collision judgment when using an augmented-vision head-mounted display device. Invest Ophthalmol Vis Sci. 2009; 50(9):4509-15. PMC: 4754790. DOI: 10.1167/iovs.08-2916. View

18.

Friedman D, Freeman E, Munoz B, Jampel H, West S . Glaucoma and mobility performance: the Salisbury Eye Evaluation Project. Ophthalmology. 2007; 114(12):2232-7. DOI: 10.1016/j.ophtha.2007.02.001. View

19.

Greany J, Di Fabio R . Saccade to stepping delays in elders at high risk for falling. Aging Clin Exp Res. 2008; 20(5):428-33. DOI: 10.1007/BF03325148. View

20.

Haymes S, LeBlanc R, Nicolela M, Chiasson L, Chauhan B . Risk of falls and motor vehicle collisions in glaucoma. Invest Ophthalmol Vis Sci. 2007; 48(3):1149-55. DOI: 10.1167/iovs.06-0886. View