Computer-based training for the treatment of partial blindness

Abstract

Partial blindness after brain injury has been considered non-treatable. To evaluate whether patients with visual-field defects can profit from computer-based visual restitution training (VRT), two independent clinical trials were conducted using patients with optic nerve (n = 19) or post-chiasmatic brain injury (n = 19). In post-chiasma patients, VRT led to a significant improvement (29.4%) over baseline in the ability to detect visual stimuli; in optic nerve patients, the effects were even more pronounced (73.6% improvement). Visual-field enlargements were confirmed by the observation of a visual-field expansion of 4.9 degrees-5.8 degrees of visual angle and improved acuity in optic nerve patients. Ninety five percent of the VRT-treated patients showed improvements, 72.2% confirmed visual improvements subjectively. Patients receiving a placebo training did not show comparable improvements. In conclusion, VRT with a computer program improves vision in patients with visual-field defects and offers a new, cost-effective therapy for partial blindness.

The second face of blindness: Processing speed deficits in the intact visual field after pre- and post-chiasmatic lesions

“…Judging the patients vision loss based solely on detection accuracy in perimetry underestimates the subjective visual impairment. This has also implication for neurovisual rehabilitation methods such as vision restoration training [25,27], non-invasive current stimulation [66,67], or both combined [68,69]. They might be used to also improve these less obvious deficits in the intact visual field sector.…”

“…Moreover, HRP provides an excellent spatial resolution and enables reaction time recording and analysis. Details of HRP are described elsewhere [16,[24][25][26][27].…”

Adaptation to poststroke visual field loss: A systematic review

“…The primary outcome measure used for this review was functional ability in activities of daily living, with secondary outcome measures including extended activities of daily living, visual field, balance, falls, depression/anxiety, discharge destination, quality of life, visual scanning, adverse events, and death. The review was limited to randomized trials and studies included in Cochrane systematic reviews involving adult stroke patients, and a total of thirteen studies met the authors’ inclusion criteria (Roth et al., 2009; Bainbridge & Reding, 1994; Carter, Howard, & O'Neil, 1983; Jobke, Kasten, & Sabel, 2009; Kasten, Wüst, Behrens‐Baumann, & Sabel, 1998; Kasten, Bunzenthal, Müller‐Oehring, Mueller, & Sabel, 2007; Plow et al., 2010; Poggel, Kasten, & Sabel, 2004; Rossi, Kheyfets, & Reding, 1990; Spitzyna et al., 2007; Szlyk, Seiple, Stelmack, & McMahon, 2005; Weinberg et al., 1977, 1979). The Cochrane authors concluded there is some limited evidence to support the use of compensatory scanning therapy to improve scanning and reading outcomes in this patient group.…”

The application of online transcranial random noise stimulation and perceptual learning in the improvement of visual functions in mild myopia

“…Although this view still holds true, it has been challenged and reassessed by many authors, who have demonstrated that the visual system continues to mature and respond to environmental changes even in adulthood (Fregnac, Shulz, Thorpe, & Bienenstock, 1988;Karni & Sagi, 1991;Sale, et al, 2011). This notion of visual network plasticity is paramount not only in helping us achieve a better understanding of the human visual system and of visual plasticity mechanisms, but also in identifying noninvasive treatment tools and protocols to provide visual rehabilitation following injury, such as hemianopia following stroke (Huxlin, et al, 2009;Kasten, Wust, Behrens-Baumann, & Sabel, 1998), amblyopia, and even when the visual deficit is at the non-cortical level such as in cases of myopia and presbyopia. In the latter case especially, being able to manipulate neuroplasticity might help us achieve visual recovery through compensatory strategies (Camilleri, Pavan, Ghin, Battaglini, & Campana, 2014;Casco, et al, 2014;Durrie & McMinn, 2007;Tan & Fong, 2008).…”

“…So far, PL has been shown to be effective in improving, among other dysfunctions, visual abilities in amblyopia (Campana, Camilleri, Pavan, Veronese, & Lo Giudice, 2014;Hussain, Webb, Astle, & McGraw, 2012;Levi & Li, 2009;Li, Young, Hoenig, & Levi, 2005;Polat, 2009;Polat, Ma-Naim, Belkin, & Sagi, 2004;Zhou, et al, 2006), mild refractive defects like myopia (Camilleri, Pavan, Ghin, Battaglini, et al, 2014;Tan & Fong, 2008) and presbyopia (Polat, et al, 2012), and central or peripheral vision loss and cortical blindness (Chung, 2011;Das, Tadin, & Huxlin, 2014;Huxlin, et al, 2009;Kasten, et al, 1998;Plank, et al, 2014;Rosengarth, et al, 2013;Sabel, Kenkel, & Kasten, 2005). In myopia, visual input is limited by an optical de-focus, despite normal neuronal connectivity and image processing.…”