Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: An eye tracker study

Kasten, Erich; Bunzenthal, Ulrike; Sabel, Bernhard A.

doi:10.1016/j.bbr.2006.07.024

Cited by 81 publications

(62 citation statements)

References 12 publications

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“…Visual improvement also cannot be explained by eye movement artifacts because eye tracker recordings showed neither signs of shifted gaze positions nor more frequent saccades. Fixation actually improved with vision training 64 (indicating more stable eye position), and when fixation inaccuracies occur, they do not correlate with detection improvement, confirming prior observations. 6,32,64,65 Nevertheless, we found that significant visual field improvement correlated with increases in delayed responses as noted earlier.…”

Section: Research Original Investigationsupporting

confidence: 87%

Vision Restoration Training for Glaucoma

Sabel

Gudlin

2014

JAMA Ophthalmol

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IMPORTANCE Visual field loss due to retinal damage is considered irreversible, and methods are needed to achieve vision restoration. Behavioral vision training, shown to improve visual fields in hemianopia and optic nerve damage, might comprise such a method. OBJECTIVE To determine if behavioral activation of areas of residual vision using daily 1-hour vision restoration training for glaucoma for 3 months improves detection accuracy compared with placebo. DESIGN AND SETTING Prospective, double-blind, randomized, placebo-controlled clinical trial in an ambulatory care and home training setting. PARTICIPANTS Volunteer sample of patients with glaucoma (mean age, 61.7 years; age range, 39-79 years) with stable visual fields and well-controlled intraocular pressure. After randomization, 4 patients withdrew from the trial because of mild headaches (n = 2) or lack of time to complete the schedule (n = 2). INTERVENTIONS Computer-based vision restoration training for glaucoma (n = 15) or visual discrimination placebo training in the intact visual field (n = 15). MAIN OUTCOMES AND MEASURESThe primary end point was change in detection accuracy in high-resolution perimetry. Secondary end points were 30°white-on-white and 30°b lue-on-yellow near-threshold perimetry, as well as reaction time, eye movements, and vision-related and health-related quality of life.RESULTS Vision restoration training for glaucoma led to significant detection accuracy gains in high-resolution perimetry (P = .007), which were not found with white-on-white or blue-on-yellow perimetry. Furthermore, the pre-post differences after vision restoration training for glaucoma were greater compared with placebo in all perimetry tests (P = .02 for high-resolution perimetry, P = .04 for white on white, and P = .04 for blue on yellow), and these results were independent of eye movements. Vision restoration training for glaucoma (but not placebo) also led to faster reaction time (P = .009). Vision-related quality of life was unaffected, but the health-related quality-of-life mental health domain increased in both groups.CONCLUSIONS AND RELEVANCE Visual field defects caused by glaucoma can be improved by repetitively activating residual vision through training the visual field borders and areas of residual vision, thereby increasing their detection sensitivity. Our randomized clinical trial revealed evidence that visual field loss is in part reversible by behavioral, computer-based, online controlled vision training, comprising a new rehabilitation treatment option in glaucoma. Neuroplasticity of the visual cortex or higher cortical areas is the proposed mechanism of action.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01799707.

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Section: Research Original Investigationsupporting

confidence: 87%

Vision Restoration Training for Glaucoma

Sabel

Gudlin

2014

JAMA Ophthalmol

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“…Computer-based visual stimulation therapy targeting the borderzone of the scotomous field has been developed for the rehabilitation of patients with partial visual field defects [2,3]. This approach intends to partly restore visual function, although reports of visual field enlargement are unequivocal [4,5].…”

Section: Introductionmentioning

confidence: 99%

Eye-movement training-induced changes of visual field representation in patients with post-stroke hemianopia

et al. 2010

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Changes in neuronal activity have been described in patients with hemianopia following ischemic lesions of the visual cortex. This reorganization may facilitate compensation of lost visual function that is rarely fully restituted. Improving exploratory eye movements with appropriate training has been shown to partially compensate for the visuoperceptive impairment during daily life activities. The changes in cortical processing of visual stimuli that may be induced by these training strategies, however, are less well described. We used fMRI to study the training effects of eye-movement training on cortical representation of visual hemifields. Brain activation during hemifield stimulation was measured in eight patients with an occipital cortical lesion of the striate cortex causing homonymous hemianopia. Starting 8 weeks after the stroke, patients received 4 weeks of eye movement training. fMRI measurements were performed at baseline and after training. In five patients, follow-up fMRI was performed 4 weeks after the end of training. Differences in activation between rest and hemifield stimulation as well as before and after training were assessed with statistical parametric mapping. Twelve healthy subjects were scanned twice at a 4-week interval. During stimulation of the affected hemifield, significant activation at baseline was found bilaterally in extrastriate cortical areas, with the strongest increases in the contralesional hemisphere. This activation pattern was maintained after training. Four weeks after the end of training, there was an additional activation of the extrastriate cortex in the contralesional hemisphere compared to baseline. No changes in the size of visual field defects were found. In this group of patients, eye-movement training induced altered brain activation in the unaffected extrastriate cortex.

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“…In trials where eye movement recording was not undertaken, improvement in visual field due to eye movements cannot be excluded (Reinhard et al., 2005; Schmielau & Wong, 2007). However, studies where eye movements were measured did confirm visual field recovery, arguing against the hypothesis that compensatory eye movements alone can explain vision recovery (Gall et al., 2016; Kasten, Bunzenthal, & Sabel, 2006). …”

Section: Resultsmentioning

confidence: 99%

Adaptation to poststroke visual field loss: A systematic review

Howard

Rowe

2018

Brain and Behavior

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AimTo provide a systematic overview of the factors that influence how a person adapts to visual field loss following stroke.MethodA systematic review was undertaken (data search period 1861–2016) inclusive of systematic reviews, randomized controlled trials, controlled trials, cohort studies, observational studies, and case controlled studies. Studies including adult subjects with hemifield visual field loss, which occured as a direct consequence of stroke, were included. Search terms included a range of MESH terms as well as alternative terms relating to stroke, visual field loss, visual functions, visual perception, and adaptation. Articles were selected by two authors independently, and data were extracted by one author, being verified by the second. All included articles were assessed for risk of bias and quality using checklists appropriate to the study design.ResultsForty‐seven articles (2,900 participants) were included in the overall review, categorized into two sections. Section one included seventeen studies where the reviewers were able to identify a factor they considered as likely to be important for the process of adaptation to poststroke visual field loss. Section two included thirty studies detailing interventions for visual field loss that the reviewers deemed likely to have an influence on the adaptation process. There were no studies identified which specifically investigated and summarized the factors that influence how a person adapts to visual field loss following stroke.ConclusionThere is a substantial amount of evidence that patients can be supported to compensate and adapt to visual field loss following stroke using a range of strategies and methods. However, this systematic review highlights the fact that many unanswered questions in the area of adaptation to visual field loss remain. Further research is required on strategies and methods to improve adaptation to aid clinicians in supporting these patients along their rehabilitation journey.

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Visual field recovery after vision restoration therapy (VRT) is independent of eye movements: An eye tracker study

Cited by 81 publications

References 12 publications

Vision Restoration Training for Glaucoma

Vision Restoration Training for Glaucoma

Eye-movement training-induced changes of visual field representation in patients with post-stroke hemianopia

Adaptation to poststroke visual field loss: A systematic review

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