Computer based vision restoration therapy in glaucoma patients: A small open pilot study

Abstract

Purpose: Several studies have shown that computer-based visual stimulation improves detection performance in brain damaged patients with post-chiasmatic lesions after stroke or trauma. Because it is not known whether visual field defects after retinal lesions can also be modified by visual stimulation we explored if visual field enlargements are possible in patients with glaucoma.

Methods: Five patients with primary open angle glaucoma (POAG) performed Vision Restoration Training (VRT), a computer-based vision training for a total of 6 months in two 3-months blocks with a 3-months training-free interval between the two training periods. Perimetric testing was performed with High Resolution Perimetry (HRP) as well as with 30° and 70° white/white (W/W) and 30° blue/yellow (B/Y) conventional automatic perimetry (Oculus Twinfield).

Results: After the first 3 months of training the average detection performance significantly increased in HRP (Z = -2.023, p < 0.05) and in 30° W/W perimetry (Z = -2.023, p < 0.05), but not in B/Y perimetry (Z = -1.214, p = 0.225) or in the 70° W/W perimetry, which included more peripheral, non-trained areas (Z = -0.406, p = 0.684). Visual improvements remained stable after the training-free interval. Measured by HRP after the second VRT period 3 patients achieved an increase in the ability to detect visual stimuli, however, this improvement did not reach significance (Z = -1.826, p = 0.068).

Conclusions: While a small patient sample does not permit general conclusions on visual field recovery after glaucoma, this pilot study suggests that visual field defects caused by retinal lesion may be improved by systematic vision stimulation. A larger sample, randomized clinical trial is now warranted.