Modern medicine still cannot treat many forms of retinal damage, and patients often see an ophthalmologist only when visual impairment is already advanced. A team led by Dr. Kalina Burnat at the Nencki Institute will test a self-administered tool for the early detection of visual impairment and investigate how progressive disease affects the entire visual system. The findings may help lay the groundwork for precise vision neurorehabilitation for patients and people at risk of developing retinal disease.

The research will be carried out as part of the grant project “Early self-diagnosis of inherited visual impairment. The ‘shape-from-motion’ visual acuity test.” The study will include ophthalmology patients as well as members of their families who may be at risk of vision loss. Participants will include patients with two genetically determined conditions - Stargardt disease and retinitis pigmentosa - as well as people with the dry form of age-related macular degeneration (AMD).

“A diagnosis often comes with the information that the disease is incurable. Patients are then left with questions such as: how long will I still be able to work, read or move around independently?” says Prof. Jacek P. Szaflik, Director of the Independent Public Clinical Ophthalmology Hospital in Warsaw and Head of the Department of Ophthalmology at the Medical University of Warsaw.

Ophthalmology focuses primarily on the eye affected by disease. Dr Burnat’s team, however, will look at the entire visual system and track the changes taking place in the brain as the disease progresses. The brain can adapt to retinal damage and compensate for missing visual information for a surprisingly long time. As a result, some patients do not reach an ophthalmologist until the disease is already advanced - for example, when they begin bumping into objects or are no longer able to read.

“Working with ophthalmology patients made me realise that they need a tool that shows them not only what they have lost, but also what still works within their visual system and how those preserved functions might be used. I study how the visual system reorganises after retinal damage,” explains Dr. Kalina Burnat.

One such tool is the “shape-from-motion” visual acuity test. The test can be performed on a computer screen, where moving dots form different shapes. These shapes can only be perceived because the dots move at different speeds, and detecting them becomes increasingly difficult for patients experiencing progressive vision loss. The “shape-from-motion” test can therefore help quantify the degree of visual impairment, including at an early stage of disease, and can later be used to monitor its progression.

Previous studies have already shown how the brain adapts to the loss of central or peripheral vision in patients with retinitis pigmentosa and Stargardt disease. The new grant will allow the researchers to take the next step. They will now investigate how the brain and its neural connections function in patients with age-related macular degeneration. Information on how the disease develops from its early stages may in the future help researchers design neurorehabilitation programmes, which are currently unavailable for this group of conditions. Such programmes would aim to make use of visual functions and neural connections that remain intact.

This possibility is supported by earlier findings from Dr Burnat’s team, which showed that visual training started early can effectively limit the degeneration of neural pathways.

The project is intended not only to develop a new self-testing approach, but also to make it easier to access. Every ophthalmological examination currently requires a visit to a specialist centre, which can be difficult for some patients. One element of the project will therefore be to make the test available on publicly accessible computers, for example in local libraries. This would allow people at risk of inherited vision loss to monitor their vision regularly close to home, without the stress and inconvenience of travelling to a specialist facility.

The project “Early self-diagnosis of inherited visual impairment. The ‘shape-from-motion’ visual acuity test” is funded by the Ministry of Science and Higher Education under the Science for the Development of Society programme and is carried out in collaboration with the Independent Public Clinical Ophthalmology Hospital in Warsaw.