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Réapprendre à voir le monde : Rééduquer les personnes atteintes de dégénérescence maculaire en exploitant les capacités perceptives et cognitives de la vision périphérique

Published online by Cambridge University Press:  31 March 2010

Guillaume Giraudet ,
Christian Corbé  and
Corinne Roumes
Guillaume Giraudet*
Affiliation:
Centre Recherche & Développement de la société Essilor
Christian Corbé
Affiliation:
L'Association Représentative des Initiatives en basse Vision Université Paris V
Corinne Roumes
Affiliation:
l'Institut de médecine aérospatiale du Service de santé des armées
*
Les demandes de tirés-à-part doivent être addressées à : / Requests for offprints should be sent to: Guillaume Giraudet, Essilor International–R&D, Dépt Système Visuel et Design, 57 av de Condé, 94106 Saint Maur, France. (giraudeg@essilor.fr)
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Abstract

Age-related macular degeneration (ARMD) is a frequent cause of vision loss among people over age of 60. It is an aging process involving a progressive degradation of the central retina. It does not induce total blindness, since it does not affect the peripheral vision. Nonetheless, it makes difficult to read, drive, and perform all daily activities requiring fine details perception. Low-vision care consists in inducing an eccentric fixation so that relevant visual targets impact an unaffected retinal locus. It is necessary but not sufficient to enhance visual extraction. The present work aims to draw the attention of low-vision professionals to the necessity of developing new re-education tools. Beyond the perceptual re-education linked to an optimization of visual information extraction, a cognitive re-education should also be provided in order to enhance the interpretation processes. Indeed, the spatial-frequency properties of the visual world no longer match patient perceptual habits. The visually impaired person has to learn again to use these new sensory data in an optimal way. Contextual information can be a precious help in this learning process. An experimental study involving young people provides elements for another method of low-vision care, in terms of visual cognitive re-education.

Résumé

La Dégénérescence maculaire liée à l'âge (DMLA), cause trés fréquente d'altération de la vision, est un processus de vieillissement provoquant une dégradation progressive de la rétine centrale. Elle ne provoque jamais de cécité totale puisque la vision périphérique demeure fonctionnelle. Néanmoins, elle perturbe sensiblement la lecture, la conduite et toutes les tâches de la vie courante nécessitant une perception des détails fins. La prise en charge du malvoyant consiste à provoquer une fixation excentrée de façon à ce que les cibles visuelles se projettent sur des zones rétiniennes saines. Cette amélioration de la prise d'information est nécessaire mais pas suffisante. l'objectif du présent article est d'attirer l'attention des professionnels de la malvoyance sur la nécessité de faire évoluer les outils de rééducation pour proposer, au-delà de la rééducation «perceptive» liée à l'optimisation de l'extraction de l'information, une rééducation «cognitive» qui aurait trait à l'amélioration de l'interprétation des ces nouvelles données sensorielles. En effet, les propriétés fréquentielles de l'environnement ne correspondent plus aux habitudes visuelles du patient. Il faut donc lui réapprendre à utiliser de façon optimale ces nouvelles informations. Le contexte spatial dans lequel se trouve l'élément recherché pourrait à ce niveau constituer une aide précieuse. Une étude expérimentale sur des sujets jeunes donne des voies d'amélioration de la prise en charge du malvoyant dans le sens d'une rééducation visuelle cognitive.

Keywords

agingARMDeccentric fixationscene contextspatial signatureplasticityre-educationvieillissementDMLAfixation excentréecontexte de la scènesignature spatialeplasticitérééducation
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue 4 , Winter/Hiver 2005 , pp. 339 - 352
Copyright
Copyright © Canadian Association on Gerontology 2005

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