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Recovery of visual field defects: A large clinical observational study using vision restoration therapy

Article type: Research Article

Authors: Mueller, Iris | Mast, Henning; ; | Sabel, Bernhard A.

Affiliations: Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany | Department of Neurology, Bergmannstrost Halle/Saale, Germany | Tananbaum Stroke Center, Neurological Institute, New York, USA | Div. Stroke Medicine, City Hospital, University of Nottingham, Nottingham, UK

Note: [] Corresponding author: Iris Mueller, Institute of Medical Psychology, Otto-von-Guericke University of Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany. Tel.: +49 391 611 7100; Fax: +49 391 611 7103; E-mail: Iris.Mueller@med.ovgu.de

Keywords: Vision restoration, hemianopia, visual field deficits, plasticity, neurorehabilitation, visual training, brain damage

Journal: Restorative Neurology and Neuroscience, vol. 25, no. 5-6, pp. 563-572, 2007

Received 29 February 2008
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Accepted 29 February 2008
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Published: 2007
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Abstract

Purpose: In small experimental trials, vision restoration therapy (VRT), a home-based rehabilitation method, has shown to enlarge the visual field and improve reaction times in patients with lesion involving the CNS. We now evaluated the outcome of VRT in a large sample of clinical patients and studied factors contributing to subjective and objective measures of visual field alterations.

Methods: Clinical observational analysis of visual fields of 302 patients before and after being treated with computer-based vision restoration therapy for a period of 6 months at eight clinical centers in central Europe. The visual field defects were due to ischemia, hemorrhage, head trauma, tumor removal or anterior ischemic optic neuropathy. Primary outcome measure was a visual field assessment with super-threshold perimetry. Additionally, conventional near-threshold perimetry, eye movements and subjective reports of daily life activities were assessed in a subset of the patients.

Results: VRT improved patients' ability to detect super-threshold stimuli in the previously deficient area of the visual field by 17.2% and these detection gains were not significantly correlated with eye movements. Notable improvements were seen in 70.9% of the patients. Efficacy was independent of lesion age and etiology, but patients with larger areas of residual vision at baseline and patients > 65 years old benefited most. Conventional perimetry validated visual field enlargements and patient testimonials confirmed the improvement in every day visual functions.

Conclusions: VRT improves visual functions in a large clinical sample of patients with visual field defects involving the CNS, confirming former experimental studies.

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