Low Vision Rehabilitation of Stargardt'€™s Disease with the Aid of Microperimetry and Prism Relocation

Title Low Vision Rehabilitation of Stargardt'€™s Disease with the Aid of Microperimetry and Prism Relocation
Author, Co-Author Patrick Lee, Kara Crumbliss
Topic Low Vision
Program Number
Ballroom A-B

Abstract: This case represents the combined efforts of prism relocation and microperimetry to improve visual function and activities of daily living.

Case Report: A 36 yo Hispanic female presented for vision rehabilitation with Stargardt disease. Vision was correctable to 20/160- in both eyes at distance and 0.15/2.5M at near. Her complaint was of varying visual discomfort, asthenopia, and blur at distance. Her medical, medication, and allergy history are unremarkable.

MAIA (Macular Integrity Assessment) was performed and the right eye showed a superior and mildly temporal PRL. The patient established a superior and mildly nasal PRL in her left eye. The fixation was graded as relatively unstable from the fixation analysis application compared to a normal elipse.

Prism relocation was performed and resulted in 20/120 BCVA OD, OS, OU with 6 Prism Diopters (PD) at base 165 OD and 6 PD at base 180 OS with no resultant diplopia.  This prism was prescribed as tolerated and the patient and to return for follow-up in 3 months, then 6 months after dispense.

3 month follow-up showed 20/120 OU and improved comfort in overall visual function. The patient stated good compliance with wear of new spectacles with no adverse effects.

On 6 month visit, MAIA microperimetry was repeated. This resulted in improved retinal sensitivity in all points, with previous function surrounding similar PRL OU. Fixation grading was similar showing relatively unstable results OU.  Patient education and analysis review was helpful in improving subjective visual function. Objective visual function improvement was noted with increased retinal sensitivity.

Conclusion: This is an interesting case as retinal threshold sensitivity improved with use of prism and subjective function also improved.  While prism relocation has long been used, the advent of microperimetry may allow us to ascertain the exact mechanism of action of this rehabilitation strategy. 

Affiliation of Co-Authors Illinois College of Optometry, Chicago Lighthouse