Postural Training in Age-Related Macular Degeneration Subjects: Issues and Impact

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Postural Training in Age-Related Macular Degeneration Subjects: Issues and Impact

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 3

Abstract

Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness after fifty years old in developed countries [1,2]. It is estimated AMD will affect 288 million of elderly in 2040 [3]. This pathology is defined by a uni- or bilateral progressive degeneration of photoreceptors in macular area, peripheral vision is conserved. The early level of AMD is characterized by an accumulation of extracellular material (“drusen”) underneath the retinal pigment epithelium and/or irregularities of retinal pigment epithelium. At the advanced level of AMD, the disease gets complicated with a geographic atrophy in dry AMD, or a choroidal neovascularization (growth of pathologic blood vessel from the choroide into the subretinal space) in the wet AMD. This one just affects 10-15% of AMD subjects but emerges and progresses quickly to blindness without intravitreal injection (IVT) of anti-VEGF [4]. Thus, the majority of patients (dry AMD) has no curative treatment, loses visual acuity and his autonomy step by step [5]. AMD gives functional disability (risk of falls, difficulty reading, driving restriction, etc). Some authors evaluated that 33% of subjects older than 65 years have experienced at least one fall per year [6,7]. The loss of autonomy in elderly subjects generates also an augmentation of some pathologies (anxiety and depressive disorders, cardiovascular and metabolic diseases, etc) with a high medical cost [8-10]. One of the solutions to reduce the functional disability and preserve the autonomy of AMD subjects is the development of low-vision rehabilitation. Nowadays, this coverage lacks of evidence and studies while the functional benefit seems admitted by patients.Postural control is an elaborated process which allows a coordinated relationship of body segments [11,12], and is controlled by vestibular, proprioceptive, and visual information [13-15]. The vestibular system contributes to postural stability with eyes open [16]. Vision and proprioception participate to the detection of slow movements in the visual environment. When the visual or the vestibular system is affected, subjects need to compensate with other sensorial inputs [17]. Some visual factors have a high impact of postural stability and falls: contrast sensitivity and visual field loss [18]. The visual impairment subjects due to increase their somatosensory contribution in order to conserve a good postural stability [19]. However, mechanoreceptors sensibility decreases with aging as well as the capacity of treatment of sensorial information by the central nervous system [20]. Thus, AMD subjects have a deficit of postural control and poor postural adaptive mechanisms [21]. Few studies investigate the impact of AMD on postural control probably because of difficulty of recruitment (age, comorbidities, etc). Most of them use the visual acuity like inclusion criteria.

Authors and Affiliations

Hortense Chatard, Maria Pia Bucci1

Keywords

Hortense Chatard Accumulation Retinal Pigment Pathologies Rehabilitation Sensorial Inputs Postural Adaptive Hypothesis Cerebral Oculomotor

EP ID EP591775
DOI 10.26717/BJSTR.2018.09.001816
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