Personalized visual perceptual learning digital therapy may improve vision post-stroke

1. In this multicenter randomized controlled trial, a 12-week personalized visual perceptual learning (VPL) program significantly improved visual field function in stroke patients with visual field defects (VFDs) compared to no treatment.

Evidence Rating Level: 1 (Excellent) 

Brain damage, such as from a stroke, can cause visual field defects (VFDs) that reduce vision and impair quality of life, with limited spontaneous recovery beyond three months. These usually affect the same side of the visual field in both eyes, and depending on where the damage is, may block a quarter (quadrantanopia) or half (hemianopia) of what a person can see. Current treatment strategies include compensation, substitution, and restitution, but no approach has been proven effective in randomized trials. Visual perceptual learning (VPL) is a promising therapy using repetitive training to improve vision in the blind field. This multicenter randomized clinical trial compared 12 weeks of personalized VPL training to no training to assess the impact of visual recovery in patients with chronic stroke-related VFDs. Participants were randomly assigned 1:1 to either the training or control group. To assess visual fields, the Humphrey visual field (HVF) test was conducted at baseline and 12-week follow-up. The final sample included 82 participants, with 41 in the training group and 41 in the control group (median [IQR] age 52 [42-65] years). Over the 12 weeks, the training group experienced significantly greater improvement than the control group in the visual field and the damaged half. In the full field, the median improvement was 72 degrees squared (95% CI, 36-108; P=.003), with average improvements of 194.1 [SD 197.3] vs 82.5 [SD 95.0] degrees squared. In the damaged hemifield, the median improvement was also 72 degrees squared (95% CI, 36-108; P=.002) with average improvements of 158.9 (SD 159.0) vs 72.0 (91.4) degrees squared. All improvements reflected sensitivity gains of at least 6 dB. In summary, this randomized clinical trial proved that VPL led to significant improvements in both overall and damaged visual fields in people with long-term VFDs after stroke. 

Click to read the study in JAMA Network Open

Image: PD

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