**7. VR for mobility and ADLs**

There is little scientific evidence of the impact of the use of eccentric viewing on ADLs and safe mobility. Some researchers have determined that development of PRL can occur naturally and that there may even be several PRLs used by the subject [95].

Vukicevic et al. conducted a study with 48 people diagnosed with AMD, aged 60 or over with visual acuity equal to or less than 20/200 (1.0 LogMAR unit) with the aim of investigating the impact of eccentric viewing training on daily self-care activities. To this end, two groups were formed, of which one received eccentric viewing training while the other did not [96]. The results show that even if the subjects had already established their PRL, the execution of daily life tasks improved.

In the case of ADLs, in addition to eccentric viewing training there are other factors that can significantly affect the performance of ADLs, such as lighting, familiarity with the environment, and contrast in materials and surroundings [97].

Illumination is an important method for improving the use of remanent vision, but there are differences between people as to what they consider adequate or comfortable. This is why specialists have to take into account not only the intensity and type of light, but also the surface on which it is to be applied and its position in relation to the subject, adapting it to the preferred viewing area [98].

In other words, being familiar with an environment, with the organization in space of its elements and the appropriate use of lighting can favor the use of PRL, and, hence, the execution of ADLs in an efficient manner.

Liu reviews interventional therapies to improve ADL performance and highlights that patients with AMD can benefit from vision training and the use of optical AVLs, but they need more than that; such as developing skills, using devices or learning problem-solving strategies, so intervention should be multidisciplinary and carried out in multiple sessions to give people enough time to adapt to new devices and skills [99].

Safe mobility for AMD patients is clearly conditioned by the risk of falls, which in the older population can lead to other serious consequences. Displacement in the elderly population is characterized by the involvement of different factors like balance, hearing, reaction capacity and decision-making. From the perspective of vision, the effects on the visual field, contrast sensitivity or the way in which lighting conditions affect the subject are determining factors in how the person will be able to travel [100]. It can be seen that, once again, there are multiple factors involved in the performance of this activity, which implies a multidisciplinary intervention and training in multiple sessions until adaptation to the new skills is achieved.

It is important to properly assess the visual field and information processing in this area in people with low vision, since the processing itself is more complex in detecting objects in the mobile environment while when using the microperimetry test only simple items are detected [101].

Eye and head searching movements when crossing are more difficult in AMD than in normally-sighted people, and there are no stable patterns as in reading. They also involve decision making such as the right time to cross, where the speed of walking among other aspects is crucial for safe movement and good decision making. To this must be add that, as mentioned, the ability to react in older people is diminished. Geruschat et al. confirms that patients with AMD present a higher risk due to increased latency when identifying the right moment to cross a street [102].

The optical devices that patients with AMD mainly use for mobility are telescopes; so are the filters as mentioned above. As for other activities, training and perceptual learning are presented as a decisive factor for the successful rehabilitation of patients with the aim of safe movement.
