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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Ophthalmology

How Does Eccentric Viewing Work for ADOA?

At a Glance

Eccentric viewing training is a low-vision rehabilitation technique for ADOA patients with central vision loss. It teaches you to use a healthy 'sweet spot' in your peripheral retina to bypass your central blind spot, improving your ability to read and recognize faces.

In this answer

3 sections

01

How Does Eccentric Viewing Work?

02

What Happens During Training?

03

Managing Long-Term Expectations

When autosomal dominant optic atrophy (ADOA) damages the optic nerve, it often creates a “blind spot” or area of severe blurriness in the very center of your vision. This central vision loss, known as a central scotoma, can make looking directly at faces or reading text incredibly frustrating. Eccentric viewing training is a specialized low-vision rehabilitation technique that teaches you to use your remaining healthy vision to bypass this blind spot [1].

By learning to look slightly away from the object you want to see, you can direct the image onto a healthy, undamaged part of your retina (the light-sensitive tissue at the back of your eye) [2]. Over time and with practice, this technique can help you regain the ability to read, recognize faces, and perform daily tasks more comfortably [3].

How Does Eccentric Viewing Work?

Normally, when you look straight ahead at an object, the light focuses directly on your fovea—the central part of your retina responsible for sharp, detailed vision. Because ADOA primarily affects this central visual pathway, looking straight at an object places it right in your blind spot [1].

Eccentric viewing training helps you identify a “sweet spot” of healthy tissue in your peripheral vision, referred to clinically as a preferred retinal locus or PRL [4][5]. Once you find this spot, a low-vision specialist or occupational therapist will teach you how to shift your gaze so that the object you want to see lands on this healthy area rather than the damaged center [6].

This process requires your brain to adapt. Through neuroplasticity—the brain’s ability to rewire itself—your brain can learn to automatically direct your gaze to this peripheral spot when you want to look at something, even though peripheral vision will never be quite as sharp as a healthy fovea [7][8].

What Happens During Training?

Eccentric viewing training is not a quick fix; it requires dedication and repetition [9]. While clinical programs vary, training often involves 10 to 15 clinic sessions over several weeks or months [10][11]. Your experience will typically involve the following steps:

1. Mapping Your Blind Spot

First, your low-vision rehabilitation specialist will help you understand exactly where your central blind spot is and how large it is. They will work with you to identify the healthiest, most effective area of your peripheral retina to use as your new PRL [12][13].

2. Guided Practice and Biofeedback

To help you train your eyes to use this new spot, specialists often use a combination of exercises and technology. Some clinics use microperimetry, a specialized machine that provides visual or audio “biofeedback” (like a beep) when you successfully hold your gaze using the correct healthy patch of retina [14][9]. This feedback helps you understand exactly what it feels like when you are using your vision correctly [15].

3. Eye Movement Exercises

Using your peripheral vision for detailed tasks requires different eye movements than you are used to. You will practice fixation stability (keeping your eye steady on the target) and saccades (making precise, jumping eye movements between words or objects) [16][17]. In the clinic, this might look like practicing tracking a moving dot on a computer screen or rapidly finding specific letters on a wall chart [18].

4. At-Home Practice

Your success heavily relies on homework. Most specialists will ask you to practice these visual exercises for 10 to 20 minutes a day at home. This daily repetition is what builds the automatic “muscle memory” needed to use your new sweet spot without having to consciously think about it [10].

5. Real-World Application

Once you can consistently find your sweet spot, your therapist will introduce practical tasks. You might practice reading larger print, looking at photographs of faces, or identifying objects on a shelf [19]. Often, your specialist will combine eccentric viewing with low-vision aids, like digital magnifiers or high-contrast lighting, to get the best possible results [20].

Managing Long-Term Expectations

Eccentric viewing training aims to improve your functional vision in your day-to-day life by maximizing the vision you have [15]. Research shows that with dedicated practice, patients can experience improved reading speeds, better face recognition, and increased independence [19][21][3].

However, it is important to remember that this training does not heal or reverse the underlying optic nerve damage caused by ADOA. Additionally, because ADOA can be progressive, your central scotoma may enlarge or change over time [22]. If you notice your trained “sweet spot” is no longer working as well, you can return to a specialist to map out your vision again and adjust your PRL to a new, healthier area [22].

Common questions in this guide

What is eccentric viewing training?
Eccentric viewing training is a specialized low-vision rehabilitation technique that teaches you to use healthy peripheral vision to bypass a central blind spot. By learning to look slightly away from an object, you can direct the image onto an undamaged part of your eye.
What is a preferred retinal locus (PRL)?
A preferred retinal locus, or PRL, is a 'sweet spot' of healthy tissue in your peripheral vision. During training, a specialist helps you find this spot and teaches you how to shift your gaze so that light focuses there instead of on your damaged central vision.
How long does eccentric viewing training take?
Training typically involves 10 to 15 clinical sessions over several weeks or months. It also requires 10 to 20 minutes of daily at-home practice to build the automatic muscle memory needed to effectively use your new visual sweet spot.
Will eccentric viewing training restore my central vision?
No, this training does not heal or reverse the optic nerve damage caused by ADOA. Instead, it maximizes your remaining healthy vision to improve daily functioning, such as your reading speed and face recognition.
Can I use low-vision aids with eccentric viewing?
Yes, specialists frequently combine eccentric viewing techniques with low-vision aids. Using digital magnifiers or high-contrast lighting alongside your training can help you achieve the best possible visual results in your daily life.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Can you refer me to an occupational therapist or low-vision rehabilitation specialist who has experience working with central scotomas?
  2. 2.Is there a clinic nearby that offers microperimetry with biofeedback for eccentric viewing training?
  3. 3.Based on the current size and location of my central blind spot, do you believe I am a strong candidate for this type of training?
  4. 4.What other low-vision aids, like specific magnifiers, should I consider pairing with eccentric viewing training?
  5. 5.Are these low-vision rehabilitation sessions typically covered under standard medical insurance for my condition?

Questions For You

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References

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    Changes in the Properties of the Preferred Retinal Locus with Eccentric Viewing Training.

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This information about eccentric viewing training is for educational purposes only. Always consult a low-vision specialist or ophthalmologist to determine the best rehabilitation plan for your specific vision needs.

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