Visual field improvement in neglect after virtual reality intervention: a single-case study

Leitner, Michael Christian; Hawelka, Stefan

doi:10.1080/13554794.2021.1951302

Cited by 6 publications

(2 citation statements)

References 50 publications

(60 reference statements)

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“…We therefore argue that a possible explanation for the partly divergent findings in previous studies on RT should be considered against this background. This hypothesis is also based on our recent findings on RT and neglect (55). We argue that RT could have a potential positive therapeutic effect for lesions in higher cortical areas, such as in parietal areas impairing attention.…”

Section: Discussionsupporting

confidence: 60%

Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke

et al. 2023

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IntroductionA significant number of Restitution Training (RT) paradigms claim to ameliorate visual field loss after stroke by re-activating neuronal connections in the residual visual cortex due to repeated bright light-stimulation at the border of the blind and intact fields. However, the effectiveness of RT has been considered controversial both in science and clinical practice for years. The main points of the controversy are (1) the reliability of perimetric results which may be affected by compensatory eye movements and (2) heterogeneous samples consisting of patients with visual field defects and/or visuospatial neglect.MethodsBy means of our newly developed and validated Virtual Reality goggles Salzburg Visual Field Trainer (SVFT) 16 stroke patients performed RT on a regular basis for 5 months. By means of our newly developed and validated Eye Tracking Based Visual Field Analysis (EFA), we conducted a first-time full eye-movement-controlled perimetric pre-post intervention study. Additionally, patients subjectively rated the size of their intact visual field.ResultsAnalysis showed that patients’ mean self-assessment of their subjective visual field size indicated statistically significant improvement while, in contrast, objective eye tracking controlled perimetric results revealed no statistically significant effect.DiscussionBright-light detection RT at the blind-field border solely induced a placebo effect and did not lead to training-induced neuroplasticity in the visual cortex of the type needed to ameliorate the visual field size of stroke patients.

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Section: Discussionsupporting

confidence: 60%

Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke

et al. 2023

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“…These limitations of SAP have been studied in glaucoma (Glen et al, 2014) and neuro-ophthalmic case findings (Szatmáry et al, 2002). Consequently, approaches using eye-movements (Murray et al, 2009;Mazumdar et al, 2014;Leitner et al, 2021b;Mao et al, 2021;Soans et al, 2021;Tatham et al, 2021) including tablet-based (Jones et al, 2019(Jones et al, , 2021 and VR perimetry techniques (Deiner et al, 2020;Leitner and Hawelka, 2021;Leitner et al, 2021a;Narang et al, 2021;Razeghinejad et al, 2021) have been developed.…”

Section: Virtual Reality Is Preferred Across All Aspects Of the User Experience Questionnairementioning

confidence: 99%

Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects

et al. 2021

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Standard automated perimetry (SAP) is the gold standard for evaluating the presence of visual field defects (VFDs). Nevertheless, it has requirements such as prolonged attention, stable fixation, and a need for a motor response that limit application in various patient groups. Therefore, a novel approach using eye movements (EMs) – as a complementary technique to SAP – was developed and tested in clinical settings by our group. However, the original method uses a screen-based eye-tracker which still requires participants to keep their chin and head stable. Virtual reality (VR) has shown much promise in ophthalmic diagnostics – especially in terms of freedom of head movement and precise control over experimental settings, besides being portable. In this study, we set out to see if patients can be screened for VFDs based on their EM in a VR-based framework and if they are comparable to the screen-based eyetracker. Moreover, we wanted to know if this framework can provide an effective and enjoyable user experience (UX) compared to our previous approach and the conventional SAP. Therefore, we first modified our method and implemented it on a VR head-mounted device with built-in eye tracking. Subsequently, 15 controls naïve to SAP, 15 patients with a neuro-ophthalmological disorder, and 15 glaucoma patients performed three tasks in a counterbalanced manner: (1) a visual tracking task on the VR headset while their EM was recorded, (2) the preceding tracking task but on a conventional screen-based eye tracker, and (3) SAP. We then quantified the spatio-temporal properties (STP) of the EM of each group using a cross-correlogram analysis. Finally, we evaluated the human–computer interaction (HCI) aspects of the participants in the three methods using a user-experience questionnaire. We find that: (1) the VR framework can distinguish the participants according to their oculomotor characteristics; (2) the STP of the VR framework are similar to those from the screen-based eye tracker; and (3) participants from all the groups found the VR-screening test to be the most attractive. Thus, we conclude that the EM-based approach implemented in VR can be a user-friendly and portable companion to complement existing perimetric techniques in ophthalmic clinics.

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Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques

Salatino,

Zavattaro,

Gammeri

et al. 2023

Neuroscience & Biobehavioral Reviews

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Visual field improvement in neglect after virtual reality intervention: a single-case study

Cited by 6 publications

References 50 publications

Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke

Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke

Patients Prefer a Virtual Reality Approach Over a Similarly Performing Screen-Based Approach for Continuous Oculomotor-Based Screening of Glaucomatous and Neuro-Ophthalmological Visual Field Defects

Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques

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