Visual Retraining for Stroke-Related Vision Loss

(urochester Trial)

Overseen By Evan Burr

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Rochester

Must not be taking: Neuroactive medications

Disqualifiers: Eye disease, Brain injury, Drug/alcohol abuse, Cognitive/seizure disorders, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 8-12 months

100 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores "Training in the Blind Field," a method designed to assist individuals who have lost vision due to a stroke. The researchers aim to determine how this training might enhance the brain's processing of visual information and its application in daily life. The trial includes two groups: one for individuals with vision loss in part of their visual field due to a stroke, and a control group with healthy vision for comparison. Candidates for the study are those who have experienced a stroke affecting their vision and can focus on targets. Participants need a home computer and reliable internet to engage in the training from home. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could improve rehabilitation strategies for stroke survivors.

Will I have to stop taking my current medications?

The trial requires that participants not be taking neuroactive medications (drugs that affect the brain) that could impact the training, as determined by the principal investigator. If you are on such medications, you may need to stop taking them to participate.

What prior data suggests that this visual retraining method is safe for stroke-related vision loss?

Research has shown that visual training can help individuals who lost vision due to a stroke regain some ability to see and recognize objects in their blind spots. One study found that a 12-week training program using visual perceptual learning (VPL) improved stroke patients' vision. While the results are promising, the effectiveness of the treatment can depend on the duration and location of the training. Reports of negative effects from this type of visual training are rare, suggesting it is generally safe. However, individual experiences may vary. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the visual retraining for stroke-related vision loss because it offers a novel approach that differs from traditional methods like vision therapy and compensatory strategies. This treatment specifically involves training in the blind field, which targets the brain's ability to adapt and potentially recover lost visual functions, rather than just helping patients cope with their vision loss. Unlike standard care options that mainly focus on adjusting to the deficit, this method aims to leverage neuroplasticity to improve vision itself, which could lead to more meaningful and lasting improvements in daily life for stroke survivors.

What evidence suggests that this visual retraining is effective for stroke-related vision loss?

This trial will compare the effects of visual retraining in cortically blind subjects with a control group. Research has shown that special training can help people who have lost vision after a stroke. Studies have found that this type of training can improve vision more quickly and over larger areas of the affected vision. It also enhances more types of visual skills compared to other methods. One study found that a 12-week training program improved patients' vision problems. Another study showed that this training can prevent further vision loss. These findings suggest that intensive visual retraining may help stroke survivors regain some of their lost vision. ^{2 3 4 6 7}

Are You a Good Fit for This Trial?

This trial is for U.S. or Canadian residents aged 21-75 who've had a stroke causing visual field defects, can focus on visual targets, and have normal cognitive abilities to follow instructions in English. Excluded are those with eye diseases affecting vision, certain brain damages, drug/alcohol abuse history, neuroactive medication use impacting training, cognitive/seizure disorders, attentional neglect or inability to perform exercises.

Inclusion Criteria

Residents of the United States or Canada

I am between 21 and 75 years old.

Normal cognitive abilities, able to understand written and oral instructions in English, and competent and responsible adults in order to complete the visual training at home, independently, as instructed, for several months

Exclusion Criteria

You have a record of using drugs or drinking too much alcohol.

You have had a head injury in the past.

You have difficulty paying attention to one side of your body or surroundings.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Baseline Assessment

Initial assessments including Goldmann perimetry and contrast sensitivity tests

1-2 weeks

1 visit (in-person)

Treatment

Participants undergo intensive visual retraining to assess effects on visual system and perception

8-12 months

Monthly visits (in-person)

Follow-up

Participants are monitored for changes in visual perception and brain function post-treatment

4-6 months

2 visits (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Training in the Blind Field

Trial Overview The study tests the impact of intensive visual retraining on people with vision loss due to stroke-related damage to the primary visual cortex. It aims to understand how this training might improve perception and spatial awareness by assessing changes in brain function and real-world application.

How Is the Trial Designed?

Group I: Experimental: Cortically Blind (CB) Subjects Experimental Treatment 1 Intervention

Cortically Blind subjects will be enrolled to perform a daily home visual training task.

Group II: Normative Comparator: Control Subjects Active Control 1 Intervention

Healthy control subjects will be recruited to collect normative data by which to compare test results from CB subjects. No home training will be asked.

Who Is Running the Clinical Trial?

University of Rochester

Lead Sponsor

Trials

883

Recruited

555,000+

Published Research Related to This Trial

A visual training program for seven participants with occipital lobe damage led to significant improvements in visual tasks, with an average increase of 9.6% in Gabor detection and 9.9% in direction discrimination after 3-6 months of training.

Neuroimaging revealed that these improvements were associated with increased activity in the motion area V5/hMT of the brain, suggesting that targeted training can enhance visual function even in areas of the visual field that were previously considered permanently damaged.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increased Visual Sensitivity and Occipital Activity in Patients With Hemianopia Following Vision Rehabilitation. Ajina, S., Jünemann, K., Sahraie, A., et al.[2022]

In a study of 19 patients with visual field loss due to cerebral lesions, six months of Vision Restoration Training (VRT) significantly increased visual field size and improved cognitive functions, particularly attention.

The strongest predictor of visual field improvement was the size of areas of residual vision, while demographic and lesion-related factors had minimal impact on training success, suggesting that clinicians can use specific variables to predict training outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multifactorial predictors and outcome variables of vision restoration training in patients with post-geniculate visual field loss. Poggel, DA., Mueller, I., Kasten, E., et al.[2008]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10775322/

Training in cortically-blind fields confers patient-specific ... Participants trained in their intact-field exhibited increased LIGCL-IPL. Those trained in their blind-field had no significant change in LIGCL-IPL.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11033601/

Training in Cortically Blinded Fields Appears to Confer Patient ... Training in cortically-blind fields confers patient-specific benefit against retinal thinning after occipital stroke.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/B9780128194102000308

Rehabilitation of visual perception in cortical blindness It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2834246

Personalized Visual Perceptual Learning Digital Therapy ... The 12-week training session, which used visual perceptual learning, effectively enhanced visual field defect recovery in poststroke patients.

5. thejcn.com thejcn.com/DOIx.php?id=10.3988/jcn.2024.0015

Customized Visual Discrimination Digital Therapy ... We developed a customized 8-week VPL program that involves dual tasks of visual discrimination in individualized blind visual fields and ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9682408/

Rehabilitation of visual perception in cortical blindness - PMC While visual training does recover chronic stroke patients' ability to perform a range of detection and discrimination tasks in their blind field, recovery ...

7. journals.sagepub.com journals.sagepub.com/doi/10.1177/17474930251330140

A randomized controlled trial of Scanning Eye trAining as ... Hemianopia is common after stroke. We aimed to evaluate clinical effectiveness of visual scanning training (VST) versus sham training, ...