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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.
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
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| vision restoration training | Active Comparator | 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). |
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| Discrimination training | Placebo Comparator | 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| vision restoration training | Behavioral | 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). |
| Measure | Description | Time Frame |
|---|---|---|
| Detection accuracy change in percent over baseline of the visual field | visual stimulus detection in residual and absolutely defect field of vision will be assessed using computer-based high resolution perimetry (HRP) | between baseline and 3 months of training |
| Measure | Description | Time Frame |
|---|---|---|
| change in visual stimulus perimetric detection rate | improvement of visual field in near-threshold perimetry measured by static perimetry (average threshold in db, average excentricity in degrees of visual angle | between baseline and 3 months of training |
| improvement of reaction time |
| Measure | Description | Time Frame |
|---|---|---|
| Eye movement control | visual stimulus detection in residual and absolutely defect field of vision will be assessed using computer-based high resolution perimetry (HRP) | between baseline and 3 months of training |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Bernhard A Sabel, PhD | University of Magdeburg | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 24504128 | Derived | Sabel BA, Gudlin J. Vision restoration training for glaucoma: a randomized clinical trial. JAMA Ophthalmol. 2014 Apr 1;132(4):381-9. doi: 10.1001/jamaophthalmol.2013.7963. |
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| ID | Term |
|---|---|
| D005901 | Glaucoma |
| ID | Term |
|---|---|
| D009798 | Ocular Hypertension |
| D005128 | Eye Diseases |
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| Discrimination Training | Behavioral | 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. |
|
change in average reaction time in ms, measured by HRP |
| between baseline and 3 months of training |