Visual Stimulation for Vision Impairment
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Alberta
Disqualifiers: Light-induced seizures
No Placebo Group
Approved in 1 Jurisdiction
Trial Summary
What is the purpose of this trial?In patients with hemianopsia following stroke or brain injury, we will determine if stimulating the visual field with images from a PowerPoint slide set can increase the visual field.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment PowerPoint program visual stimulation, Visual Field Stimulation Therapy, Hemianopsia Rehabilitation Program for vision impairment?
Research shows that visual rehabilitation programs, like Vision Restoration Therapy and home-based virtual-reality stimulation, can improve visual fields and quality of life in patients with hemianopia (loss of half the visual field). These therapies have been shown to enhance visual perception and daily living skills, even years after the onset of vision loss.
12345Is visual stimulation therapy safe for humans?
The available research on visual stimulation therapies, such as those used for hemianopia rehabilitation, suggests they are generally safe for humans, as no adverse effects were reported in the studies reviewed.
12367How does the PowerPoint program visual stimulation treatment differ from other treatments for vision impairment?
The PowerPoint program visual stimulation treatment is unique because it uses a home-based, virtual-reality approach to improve visual perception and quality of life in patients with vision impairment, allowing for remote administration and reducing the need for frequent clinic visits. This contrasts with traditional treatments that often require in-clinic sessions and may not utilize immersive technology.
12368Eligibility Criteria
This trial is for individuals who have lost part of their field of vision, known as hemianopsia, due to a stroke or brain injury. Specific eligibility criteria are not provided.Inclusion Criteria
I am 18 or older, have partial vision loss, can consent, and speak English.
Exclusion Criteria
I do not have seizures triggered by flashing lights.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Treatment
Participants are divided into two groups based on birth year to receive visual stimulation therapy: Group 1 views online news, and Group 2 views a PowerPoint program, each for 15 minutes, three days per week for 2 months.
2 months
3 visits (in-person) for perimetry testing
Crossover Treatment
Participants switch interventions for another 2 months, with Group 1 switching to the PowerPoint program and Group 2 switching to online news.
2 months
1 visit (in-person) for perimetry testing
Follow-up
Participants are monitored for changes in visual field index after the treatment phases.
4 weeks
Participant Groups
The study is testing whether using a PowerPoint program to stimulate the visual field can help improve vision in patients with hemianopsia after a stroke or brain injury.
2Treatment groups
Active Control
Group I: Group 2 (PowerPoint program)Active Control1 Intervention
Group 2 with an even number year of birth will be asked to view the 15-minute PowerPoint program three days per week for 2 months.
Group II: Group 1 (online news)Active Control1 Intervention
Group 1 with an odd number year of birth will be asked to view 15 minutes of online news three days per week for 2 months. LIVE: Canadian News \| Weather \& Traffic - Latest Sports \| Breaking News (globalnews.ca)
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Eye Institute of Alberta, Royal Alexandra HospitalEdmonton, Canada
Loading ...
Who Is Running the Clinical Trial?
University of AlbertaLead Sponsor
References
Visual field changes after a rehabilitation intervention: vision restoration therapy. [2023]The objective of this study was to determine the effect of a visual rehabilitation intervention on visual field defects in a US cohort. Vision Restoration Therapy (VRT) consists of a specific pattern of stimulation that is directed at the border of the blind field.
Case Report: Visual Rehabilitation in Hemianopia Patients. Home-Based Visual Rehabilitation in Patients With Hemianopia Consecutive to Brain Tumor Treatment: Feasibility and Potential Effectiveness. [2021]Background/Objectives: Visual field loss is frequent in patients with brain tumors, worsening their daily life and exacerbating the burden of disease, and no supportive care strategies exist. In this case series, we sought to characterize the feasibility and potential effectiveness of a home-based visual rehabilitation program in hemianopia patients using immersive virtual-reality stimulation. Subjects/Methods: Two patients, one with homonymous hemianopia and the other with bitemporal hemianopia, consecutive to pediatric brain tumors, with no prior visual rehabilitation performed 15 min of home-based audiovisual stimulation every 2 days for 6 weeks (case 2) and 7 weeks (case 1) between February and August 2020. Patients used a virtual-reality, stand-alone, and remotely controlled device loaded with a non-commercial audiovisual stimulation program managed in real time from the laboratory. Standard visual outcomes assessed in usual care in visual rehabilitation were measured at the clinic. Following a mixed method approach in this pragmatic study of two cases, we collected quantitative and qualitative data on feasibility and potential effectiveness and compared the results pre- and post-treatment. Results: Implementation and wireless delivery of the audiovisual stimulation, remote data collection, and analysis for cases 1 and 2 who completed 19/20 and 20/20 audiovisual stimulation sessions at home, respectively, altogether indicated feasibility. Contrast sensitivity increased in both eyes for cases 1 and 2. Visual fields, measured by binocular Esterman and monocular Humphrey full-field analyses, improved in case 1. A minor increase was observed in case 2. Cases 1 and 2 enhanced reading speed. Case 2 strongly improved quality of life scores. Conclusion: This is the first report of a home-based virtual-reality visual rehabilitation program for adult patients with hemianopia consecutive to a pediatric brain tumor. We show the feasibility in real-world conditions and potential effectiveness of such technology on visual perception and quality of life.
Brain activity associated with stimulation therapy of the visual borderzone in hemianopic stroke patients. [2022]Visual restoration therapy is a home-based treatment program intended to expand visual fields of hemianopic patients through repetitive stimulation of the borderzone adjacent to the blind field. We hypothesized that the training itself would induce visual field location-specific changes in the brain's response to stimuli, a phenomenon demonstrated in animal experiments but never in humans with brain injury.
Significant visual improvement with vision rehabilitation delayed three decades from disease onset. [2022]This is a report of an adult patient showing improvement in visual function from rehabilitation for longstanding homonymous hemianopsia. We present his medical history and visual function testing pre- and post-therapy, demonstrating an improvement in both subjective and objective measures.
Compensatory visual field training for patients with hemianopia after stroke. [2022]Twenty-one patients with hemianopia received 4 weeks of compensatory visual field training. Detection of and reaction time to visual stimuli were measured with eyes fixating (condition A) and with use of exploratory eye movements (condition B) before and after training. Twenty-three healthy individuals served as control subjects for measurements of parameters during both conditions. Patients with hemianopia to either side showed a marked improvement of detection and reaction time during condition B, but minimum or no change during condition A. Improvements were maintained 8 months after training. Activity of daily living skills also improved in all patients. The size of scotoma on computerized perimetry, in contrast, remained unchanged. Training improved detection of and reaction to visual stimuli without restitution of the visual field defect.
Acquired visual field defects rehabilitation: critical review and perspectives. [2012]Visual field deficit (VFD) is one of the most commonly observed symptoms following brain injury. Persistent VFD and defective exploratory oculomotor scanning patterns often cause severe impairment in daily activities, particularly as regards visual exploration and reading. Homonymous hemianopia is consequently a powerful negative predictor of patient outcome. In spite of these quantitative and qualitative factors, there currently exists no consensus on rehabilitative therapy and treatment. Different approaches have nevertheless been developed, all of them having one therapeutic principle in common; repeated practice of a specific visual task, with the hope/expectation that improved performance will extend to a wide range of ecologically useful visual functions. The four main available methods aim at replacing part of the intact visual field with part of the damaged visual field (optical therapy using prisms), at partially restoring the lost visual field region (restorative therapies), at stimulating detection capacities in the blind field (stimulation or blindsight) or at substituting for the lost region by reorganizing the control of visual information processing and eye movements (compensatory therapies). This review explores the key data relative to these different approaches in terms of behavioral or imagery results. It also aims at critically analyzing the advantages and limits of each one. The importance of strict assessment in terms of deficiencies or disabilities is underlined. Finally, upon consideration of these data taken as a whole, it is suggested that efficient treatment would probably have to associate general components and more specific elements, according to what may be done with regard to other aspects of cognitive rehabilitation.
Pattern flash visual evoked potentials in patients with homonymous hemianopia. [2019]Visual evoked potentials from seven horizontally spaced electrodes were recorded from normal subjects and subjects with homonymous hemianopia in response to hemifield pattern flash stimulation. Stimulation produced a large early peak that was positive on the scalp contralateral to the hemifield and negative on the ipsilateral scalp. From computer fitting of the amplitudes versus electrode position, the position of the equivalent source was found to be in the contralateral hemisphere. The horizontal orientation of the dipole source was approximately tangential (parallel) to the occipital scalp surface with negative polarity toward the medial fissure. In normal subjects, visual evoked potential amplitudes at the first peak were positive on the left and negative on the right for right hemifield stimulation. Left hemifield stimulation showed the opposite results. Three patients with homonymous hemianopia showed normal visual evoked potential results from their functional hemifields and nearly flat results from their hemianopic hemifields. The normal visual evoked potentials originated in their intact cortical hemispheres.
An Audiovisual 3D-Immersive Stimulation Program in Hemianopia Using a Connected Device. [2021]BACKGROUND Homonymous hemianopia is a loss of conscious vision in one hemifield, strongly affecting everyday life. Audiovisual stimulation programs improve visual perception in the blind hemifield; however, they use large equipment operated in clinical settings. Such treatments require frequent visits at the clinic, hampering the patient's adherence and compliance. In one hemianopia patient, we tested a 4-week dynamic audiovisual rehabilitation program in the stand-alone, remotely controlled, virtual-reality, head-mounted display Oculus Go and measured the effect on visual perception. CASE REPORT A 15-year-old Caucasian male was diagnosed with a right homonymous hemianopia with splitting of central fixation after a traumatic occipital contusion at age 7 months. Visual assessment showed impaired binocular contrast sensitivity and retinal sensitivity. Fixation stability and visual fields were strongly affected. After a 4-week audiovisual rehabilitation program, including 3 hours 20 minutes of stimulation, the contrast sensitivity, fixation stability, and paracentral visual perception were significantly enhanced, improving quality of life. CONCLUSIONS This pioneering work reports the use of virtual-reality in a head-mounted display to provide an audiovisual stimulation protocol for low-vision rehabilitation in a hemianopia patient. Real-time data recording and remote control of the stimulation program demonstrate that such rehabilitation treatment can be performed by the patient at home without interruption of care, decreasing the burden of disease. Beneficial effects on visual function were measured according to clinical guidelines of low-vision assessment. Improvement in visual function and quality of life challenge the prevailing belief that post-acute vision loss is both permanent and unchangeable.