Vision Restoration Training in Glaucoma

Overview

Importance: Visual field loss after retinal damage in glaucoma is considered irreversible and methods are needed to achieve vision restoration. Behavioral vision restoration training (VRT), shown to improve visual fields in hemianopia and optic nerve damage, might comprise such a method. Objective: To determine if behaviorally activating areas of residual visual (ARV) using VRT by daily one hour training for 3 months improves detection performance in perimetry compared to a vision discrimination task in the intact visual field sector.

Full Title of Study: “Vision Restoration Training in Glaucoma – A Double-blind, Randomized, Placebo-controlled Clinical Trial”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: August 2007

Detailed Description

Design: Prospective, randomized, double-blind, placebo controlled trial. Setting: Ambulatory care and home training Participants: Volunteer sample of glaucoma patients (25-80 yrs old) with stable visual fields and well controlled intraocular pressure (IOP). Intervention: Computer-based home training with VRT (n=15) or placebo discrimination training (n=15). Main Outcome Measures: The primary endpoint is change in detection performance in High Resolution Perimetry (HRP). Secondary endpoints are 30° white/white and 30° blue/yellow near-threshold perimetry. Further measures are eye movements, vision-related quality of life (vQoL) as assessed with (NEI-VFQ) and health-related quality of life (hQoL) using SF-36 Health Survey-Short Form. Investigators hypothesize that VRT will improve visual performance in glaucoma

Interventions

  • Behavioral: vision restoration training
    • visual stimuli repetitively presented to stimulate areas of residual vision. The training consists of luminance increment stimuli similar to perimetry and the task isa simple detection task (pressing a key whenever a target stimulus was detected).
  • Behavioral: Discrimination Training
    • the stimulus is a line segment (bar) which is always presented within the central ±5° visual field in one of four possible random orientations: horizontal, vertical, oblique to the right or oblique to the left. If the patient has visual field defects in this central area, 80% of the stimuli are presented in the intact part of the training region. The task is to identify the orientation of the line segment and press, as fast as possible, one of 4 assigned buttons on the keyboard.

Arms, Groups and Cohorts

  • Active Comparator: vision restoration training
    • Vision restoration training (VRT): visual stimuli repetitively presented to stimulate areas of residual vision. The training consists of luminance increment stimuli similar to perimetry and the task isa simple detection task (pressing a key whenever a target stimulus was detected).
  • Placebo Comparator: Discrimination training
    • Discrimination training. Here, the stimulus is a line segment (bar) which is always presented within the central ±5° visual field in one of four possible random orientations: horizontal, vertical, oblique to the right or oblique to the left. If the patient has visual field defects in this central area, 80% of the stimuli are presented in the intact part of the training region. The task is to identify the orientation of the line segment and press, as fast as possible, one of 4 assigned buttons on the keyboard.

Clinical Trial Outcome Measures

Primary Measures

  • Detection accuracy change in percent over baseline of the visual field
    • Time Frame: between baseline and 3 months of training
    • visual stimulus detection in residual and absolutely defect field of vision will be assessed using computer-based high resolution perimetry (HRP)

Secondary Measures

  • change in visual stimulus perimetric detection rate
    • Time Frame: between baseline and 3 months of training
    • improvement of visual field in near-threshold perimetry measured by static perimetry (average threshold in db, average excentricity in degrees of visual angle
  • improvement of reaction time
    • Time Frame: between baseline and 3 months of training
    • change in average reaction time in ms, measured by HRP

Participating in This Clinical Trial

Inclusion Criteria

  • Visual filed defect caused by glaucoma – Presence of a reproducible and stable visual field defect inside 30° eccentricity in at least one eye in 2 consecutive ophthalmologic visits during the last 12 months before recruitment – Well controlled intraocular pressure (IOP), and (iv) age between 25 and 80 years Exclusion Criteria:

  • History of any medical condition precluding scheduled study visits or completion of the study (e.g. unstable cardiovascular disease) – History of any chronic degenerative or chronic inflammatory disease that could affect the visual field (e.g. multiple sclerosis, tumor – History of trauma or any non-glaucoma ocular diseases (e.g. diabetic retinopathy, age-related macular degeneration, macular detachment, vascular occlusion – Severe cognitive or motor impairments – Insufficient fixation ability – Photosensitivity – Intraocular surgery or laser treatment performed within the previous 12 months before recruitment; OR – Scheduled intraocular surgery

Gender Eligibility: All

Minimum Age: 25 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Magdeburg
  • Provider of Information About this Clinical Study
    • Principal Investigator: Bernhard A. Sabel, Director, Principle Investigator and Study Director – University of Magdeburg
  • Overall Official(s)
    • Bernhard A Sabel, PhD, Principal Investigator, University of Magdeburg

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