Clinical treatment options for patients with homonymous visual field defects

Abstract

The objective of this review is to evaluate treatments for homonymous visual field defects (HVFDs). We distinguish between three treatments: visual restoration training (VRT), optical aids, and compensatory training. VRT is both the most ambitious and controversial approach, aiming to restore portions of the lost visual field. While early studies suggested that VRT can reduce the visual field defect, recent studies using more reliable means of monitoring the patients’ fixation could not confirm this effect. Studies utilizing modern optical aids have reported some promising results, but the extent to which these aids can reliably reduce the patients’ visual disability has yet to be confirmed. Compensatory approaches, which teach patients more effective ways of using their eyes, are currently the only form of treatment for which behavioral improvements have been demonstrated. However, with the exception of one study using a reading training, placebo-controlled clinical evaluation studies are lacking. It is also not yet clear whether the training benefits found in laboratory tasks lead to reliable improvements in activities of daily living and which of the various forms of compensatory training is the most promising. It is therefore too early to recommend any of the currently available treatment approaches.

Efficacy and Feasibility of Home-Based Training for Individuals With Homonymous Visual Field Defects

“…Although a variety of experimental rehabilitation techniques have been developed (including restorative, compensatory and substitution methods; see Lane, Smith & Schenk 12 for a review) these are rarely used in standard practice, possibly because evidence for the efficacy of any technique is inconclusive 13 . Compensatory training, which encourages individuals to develop more effective eye-movements to cope with their visual loss, is consistently identified as the most promising [12][13][14][15] .…”

“…Compensatory training, which encourages individuals to develop more effective eye-movements to cope with their visual loss, is consistently identified as the most promising [12][13][14][15] .…”

Arm position does not attenuate visual loss in patients with homonymous field deficits

“…This visual loss is most frequently observed in one half of the visual field of both of their eyes, and is known as homonymous hemianopia. Hemianopia is associated with significant chronic disability, and although attempts to restore vision to the blind fields have been reported since 1979 (Zihl & von Cramon, 1979), they have often produced disappointing results (Lane, Smith, & Schenk, 2008). More recent attempts to restore vision have used a computerized training which utilises repeated presentation of stimuli along the border between the blind and seeing field (visual restoration training; VRT).…”

Comments about outcome measures for clinical trials of interventions for post-stroke patients with hemianopia

“…Systematic reviews 15, 17 have highlighted the need for randomized clinical trials of interventions for patients with homonymous visual field loss, and we would fully support this contention. The pilot trial by Rowe and colleagues was undoubtedly well intentioned in this respect.…”