Influence of open-source virtual-reality based gaze training on navigation performance in Retinitis pigmentosa patients in a crossover randomized controlled trial

Abstract

MotivationPeople living with tunnel vision caused by Retinitis pigmentosa (RP) oftentimes face challenges navigating and avoiding obstacles due to a severely decreased Visual Field. Previous studies have shown that gaze training – guided tasks to encourage specific gaze behavior – help improve visual performance in patients with limited Visual Field. We propose a Virtual-Reality based, at-home gaze training – to the best of our knowledge the first of its kind – to increase effective eye movements and navigation performance of RP patients in a real-world obstacle course.MethodsA group of RP patients (n=8) participated in a study consisting of two 4-week-phases, both carried out by the same patient group in randomized order: In the ‘training phase’, participants carried out a Virtual-Reality gaze training for 30 minutes per day; In the ‘control phase’, no training occurred. Before and after each phase, participants were tasked to move through a randomized real-world obstacle course. Navigation performance in the obstacle course as well as eye-tracking data during the trials were evaluated. The study is registered at the German Clinical Trials Register (DRKS) with the ID DRKS00032628.ResultsOn average, the time required to move through the obstacle course decreased by 17.0% after the training phase (p <0.001), the number of collisions decreased by 50.0% (p <0.001) and the average visual area observed by participants increased by 4.41% (p <0.001). In comparison, after the control phase, the time required to move through the obstacle course was found to have decreased by 5.9% (p= 0.003), collisions decreased by 10.4% (p= 0.609) and the observed visual area increased by 2.06% (p= 0.0835).ConclusionThe performance increase over the training phase significantly surpasses the natural learning effect found in the control phase, suggesting that Virtual-Reality based gaze training can improve real-world navigation performance and effective gaze movements of patients with RP. The training is available as work-in-progress open-source software.