Maculopathy
Neuro-visual rehabilitation of maculopathy and geographic atrophy with multisensory stimulation
What is maculopathy?
Maculopathy is a pathology of the macula, the central portion of the retina responsible for seeing details, which progressively impairs the ability to read, recognize faces, and perform activities that require fine vision. It includes several forms: the most frequent in the elderly is age-related macular degeneration (AMD), in its dry (atrophic) and exudative (neovascular) variants; there are also maculopathies of other origins, such as myopic or diabetic.
The advanced atrophic variant of AMD is geographic atrophy (GA), characterized by progressive areas of atrophy of the retinal pigment epithelium (RPE) and irreversible loss of central vision; it represents approximately 35% of advanced AMD cases. It is for this form that the efficacy of neuro-visual rehabilitation with AvDesk is now documented by a peer-reviewed clinical study.
As the disease progresses, the patient spontaneously develops one or more alternative retinal loci (PRL, Preferred Retinal Loci), outside the atrophic area, used for fixation instead of the compromised zone. However, these PRLs are often unstable, and this instability significantly limits functional recovery: it is the primary target of rehabilitative training.
Causes and prevalence
GA is a consequence of the evolution of age-related macular degeneration, the leading cause of severe vision loss in elderly people in industrialized countries. Currently, there are no definitive pharmacological therapies: visual rehabilitation represents one of the few concrete options for preserving independence and quality of life.
Epidemiological data on AMD are significant:
- in Italy, it is estimated that over 1 million people live with AMD
- in Europe, there are approximately 5 million
- at a global level, estimated cases exceed 196 million
How AvDesk supports geographic atrophy rehabilitation
The therapeutic rationale for AvDesk in GA is based on the stabilization of PRLs through the stimulation of visual neural plasticity. The training offers coincident audio-visual stimuli (light + sound presented in a temporally overlapping manner); the patient must respond by pressing a button upon perceiving the stimulus.
Repeated multisensory stimulation is hypothesized to promote cortical reorganization of the areas associated with the new PRLs, increasing their stability and, consequently, improving the effectiveness of residual vision. The approach is non-invasive, non-pharmacological, and safe even for fragile patients.
The clinical protocol
The treatment is delivered in dim light conditions under medical supervision, with modular features that can be customized by the operator based on the patient's clinical picture. In summary:
- training sessions of short duration (approximately 30 minutes)
- frequency of twice a week for 3 consecutive weeks in the published study protocol
- preliminary trial with a few stimuli to verify the patient's cognitive response
- pre- and post-treatment evaluations with standardized ophthalmic examination, microperimetry (BCEA for fixation stability, macular sensitivity), and the NEI-VFQ 25 quality of life questionnaire
The stimulation preset (intensity, frequency, position, duration) is set by the operator based on the individual patient; the device can also be used for home-based continuity, with remote monitoring by the specialist.
Clinical evidence
The efficacy of AvDesk in the neuro-visual rehabilitation of patients with geographic atrophy is documented by a pilot study conducted at the Department of Ophthalmology of the San Raffaele Hospital and published in peer-reviewed literature. The study included 17 patients (mean age 81 years) with GA from AMD stable for at least 12 months, evaluating changes before and after the training cycle.
Main results:
- significant improvement in best-corrected visual acuity (BCVA) of 29.1%, from 0.55 to 0.39 LogMAR (p = 0.0002) — equivalent to approximately two additional lines on the ETDRS scale
- increase in fixation stability (reduction in BCEA values)
- trend toward improvement in macular sensitivity
- increase in the NEI-VFQ 25 quality of life score, from 55.05 to 62.18 (p < 0.01)
Bibliographic reference:
- Neurovisual rehabilitation of patients with geographic atrophy secondary to age-related macular degeneration with AvDesk system — Del Fabbro S., Jimenez B., Bianco L., Battaglia Parodi M., Bandello F. et al., European Journal of Ophthalmology, 2025. DOI: 10.1177/11206721251349039.
This is a pilot study on a limited sample and without a control group: the results are preliminary but promising and support the utility of further clinical studies. For the complete scientific literature, please consult the dedicated page.
Frequently Asked Questions
If you have further questions, please contact us.
What is maculopathy and what types exist?
Maculopathy is a disease of the macula, the central part of the retina. The most common form is age-related macular degeneration (AMD), which can be dry (atrophic) or wet (neovascular); there are also myopic and diabetic maculopathies. The advanced atrophic form of AMD is geographic atrophy, for which the efficacy of rehabilitation with AvDesk is documented.
What are the symptoms of maculopathy?
The main symptom is the progressive loss of central vision: difficulty reading, recognizing faces, and distinguishing details, with possible distorted vision of lines (metamorphopsia) or a central spot (scotoma). Peripheral vision generally remains preserved. Symptoms should always be evaluated by an ophthalmologist with dedicated examinations.
Are there medications or cures for maculopathy?
It depends on the form. Wet (neovascular) maculopathy is treated with intravitreal injections of anti-VEGF drugs. For the advanced dry form — geographic atrophy — there are no definitive pharmacological therapies: neuro-visual rehabilitation is one of the few concrete options for preserving independence and quality of life by utilizing residual vision.
What does neuro-visual rehabilitation with AvDesk consist of?
AvDesk offers multisensory audio-visual stimulation training: light and sound stimuli presented coincidently, to which the patient responds. The repetition aims to stabilize alternative retinal loci (PRL) through neural plasticity, improving the effectiveness of residual vision. It is a non-invasive and non-pharmacological approach, delivered under the supervision of a specialist.
Does rehabilitation with AvDesk replace eye care?
No. AvDesk is a neuro-visual rehabilitation device complementary to the ophthalmological path, not an alternative to medical or surgical therapies. It must be used under the supervision of a healthcare professional, who evaluates its indication based on the individual patient's clinical picture.
Is treatment with AvDesk invasive or painful?
No. The training is completely non-invasive, non-pharmacological, and painless: it consists of observing light and sound stimuli in dim light conditions and responding to them. It is considered safe even for elderly or fragile patients and takes place in short sessions, approximately 30 minutes.
Can AvDesk also be used at home?
Yes. AvDesk can be used both in a clinical setting and at home, with remote monitoring by the specialist. Continuity of training is particularly important for elderly patients, for whom home use facilitates adherence to the rehabilitation path.
What results have been clinically documented?
A pilot study on 17 patients with geographic atrophy (San Raffaele Hospital, European Journal of Ophthalmology, 2025) found an improvement in best-corrected visual acuity of 29.1% (from 0.55 to 0.39 LogMAR; p=0.0002) and in the NEI-VFQ 25 quality of life score. As this was a pilot study without a control group, the results are preliminary but promising.
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