Virtual Reality Navigation for Partial Vision Loss

Overseen By Evan Burr

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Rochester

Disqualifiers: Ocular disease, Brain injury, Cognitive disorders, others

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

Compensation: Varies

Number of Visits: 1

40 Participants Needed

Trial Summary

What is the purpose of this trial?

The purpose of this research is to better understand the impact of cortically-induced blindness (CB) and the compensatory strategies subjects with this condition may develop on naturalistic behaviors, specifically, driving. Using a novel Virtual Reality (VR) program, the researchers will gather data on steering behavior in a variety of simulated naturalistic environments. Through the combined use of computer vision, deep learning, and gaze-contingent manipulations of the visual field, this work will test the central hypothesis that changes to visually guided steering behaviors in CB are a consequence of changes to the visual sampling and processing of task-related motion information (i.e., optic flow).

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 Virtual Reality Driving Task for partial vision loss?

Research shows that virtual reality can help improve visual field functionality and orientation skills in people with vision impairments. For example, a study found that virtual reality training led to significant improvements in visual field expansion and street safety skills, suggesting it could be effective for partial vision loss as well. ^{1 2 3 4 5}

Is virtual reality navigation safe for people with partial vision loss?

Research shows that virtual reality training can improve street safety for people with low vision, and it is as effective as real street training. Additionally, virtual reality environments are used to safely test and train assistive technologies for visually impaired individuals, suggesting a general safety in its application. ^{2 3 5 6 7}

How does the virtual reality treatment for partial vision loss differ from other treatments?

The virtual reality treatment for partial vision loss is unique because it uses a simulated environment to help patients improve their navigation and mobility skills, which can be directly applied to real-world situations. Unlike traditional methods, this approach allows for safe, controlled practice and can be as effective as real-world training in enhancing street safety for individuals with low vision. ^{3 4 5 6 8}

Eligibility Criteria

This trial is for US or Canadian residents aged 21-75 who've had a one-sided stroke affecting vision, confirmed by MRI/CT scans. Participants must have consistent visual field defects in both eyes and be able to understand instructions in English. They should consent themselves and can wear contacts if needed.

Inclusion Criteria

I had a stroke affecting my vision between ages 21-75, confirmed by MRI or CT.

Reliable visual field defects in both eyes (homonymous defects) as measured by Humphrey or equivalent perimetry.

I am capable and willing to give my consent for treatment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Virtual Reality Driving Task

Participants perform a driving task in VR, steering through parameterized turns while maintaining their virtual vehicle centered between road edges

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the VR task

4 weeks

Treatment Details

Interventions

• Virtual Reality Driving Task

Trial Overview Researchers are using Virtual Reality (VR) to study how people with cortically-induced blindness from strokes adapt when driving. The VR program simulates real-world environments, tracking steering behavior to learn about changes in visual processing.

Participant Groups

Group I: Virtual Reality (VR) Driving Task: Healthy Control Cohort Experimental Treatment 1 Intervention

Healthy controls with no vision loss will perform a driving task in VR, in which they must steer through a series of parameterized turns while maintaining their virtual vehicle centered between the two red lines delineating the "road" edge.

Group II: Virtual Reality (VR) Driving Task: Cortically Blind Cohort Experimental Treatment 1 Intervention

Persons who have sustained cortical blindness will perform a driving task in VR, in which they must steer through a series of parameterized turns while maintaining their virtual vehicle centered between the two red lines delineating the "road" edge.

Who Is Running the Clinical Trial?

University of Rochester

Lead Sponsor

Trials

883

Recruited

555,000+

Rochester Institute of Technology

Collaborator

Trials

15

Recruited

5,500+

Findings from Research

A patient with visuo-spatial neglect showed significant improvement after using the 'Salzburg Visual Field Trainer' VR system for 254 days, achieving a visual field expansion of 48.8% in the left eye and 36.8% in the right eye.

Subjective reports indicated a remarkable 317% improvement in visual field functionality, suggesting that VR-based interventions can be effective for patients with visual field loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visual field improvement in neglect after virtual reality intervention: a single-case study. Leitner, MC., Hawelka, S.[2021]

A new virtual reality platform was developed to objectively assess functional vision in individuals with low vision, specifically targeting those with central and peripheral vision loss.

The pilot study revealed that participants with low vision performed significantly worse on visual tasks compared to those with normal vision, with the peripheral field loss group taking the longest to complete tasks, highlighting the challenges faced by these individuals in realistic scenarios.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Development of Immersive Virtual Reality Environment for Assessment of Functional Vision in people with Low Vision: A Pilot Study. Gopalakrishnan, S., Samson, CE., Kumar, M., et al.[2022]

The study involved 10 patients with retinitis pigmentosa and tested their ability to navigate obstacles in a virtual shopping mall environment while either walking on a treadmill or standing, revealing that walking improved their accuracy in identifying obstacles compared to standing.

Using control subjects with simulated tunnel vision showed that while they performed well at wide angles, their accuracy decreased at narrow angles, highlighting that a treadmill interface is crucial for mimicking natural movement and perceptual behavior in virtual reality for low vision assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Heading assessment by "tunnel vision" patients and control subjects standing or walking in a virtual reality environment. Apfelbaum, H., Pelah, A., Peli, E.[2022]

The study tested a virtual reality (VR) orientation and mobility (O&M) protocol on 10 participants, including 3 patients with RPE65-associated Leber Congenital Amaurosis, showing that VR-O&M can effectively measure functional vision in patients with inherited retinal degenerations (IRDs).

Post-gene therapy, patients demonstrated significant improvements in visual sensitivity and navigation performance, with fewer collisions and faster navigation times, indicating that VR-O&M can quantify the impact of visual dysfunction and treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Virtual Reality Orientation and Mobility Test for Inherited Retinal Degenerations: Testing a Proof-of-Concept After Gene Therapy. Aleman, TS., Miller, AJ., Maguire, KH., et al.[2022]

Training individuals with low vision using virtual reality can effectively teach them safe street crossing skills, as demonstrated by a study involving 12 participants who improved their timing for crossing streets after training.

Both virtual and real street training resulted in significant safety improvements, with 90% of participants' 'GO' calls occurring in the safer early half of the pedestrian phase after training, indicating that virtual reality can be a viable alternative to traditional training methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individuals with severely impaired vision can learn useful orientation and mobility skills in virtual streets and can use them to improve real street safety. Bowman, EL., Liu, L.[2022]

A virtual reality platform was developed to test and train users on an electronic travel aid, which includes a wearable haptic feedback device, showing significant improvements in navigation for individuals simulating three types of visual impairments.

Participants using the electronic travel aid completed tasks faster and experienced fewer collisions, particularly those simulating diabetic retinopathy and glaucoma, suggesting that this technology could enhance mobility rehabilitation for people with visual impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality as a means to explore assistive technologies for the visually impaired. Ricci, FS., Boldini, A., Ma, X., et al.[2023]

In a study involving 30 participants with normal vision and 30 with hemianopia or quadrantanopia, 73% of hemianopic and 88% of quadrantanopic drivers were rated as safe to drive, indicating that some individuals with these visual field deficits can drive safely.

Driving performance issues in those with hemianopia or quadrantanopia were linked to difficulties in lane positioning, steering steadiness, and gap judgment, suggesting that visual processing speed and sensitivity are critical factors in assessing driving safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

On-road driving performance by persons with hemianopia and quadrantanopia. Wood, JM., McGwin, G., Elgin, J., et al.[2022]

In a driving simulator study with 12 normally sighted participants simulating visual impairment, detection of pedestrians was significantly better when they appeared before using a monocular bioptic telescope (77% detection) compared to when they appeared while using the telescope (28%).

The study suggests that normally sighted individuals with simulated acuity loss can compensate for the ring scotoma effect of a monocular bioptic telescope using their fellow eye, as evidenced by the lack of significant difference in pedestrian detection rates for binocular users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a Paradigm to Investigate Detection of Road Hazards when Using a Bioptic Telescope. Bowers, AR., Bronstad, PM., Spano, LP., et al.[2019]

References

1. England pubmed.ncbi.nlm.nih.gov

Visual field improvement in neglect after virtual reality intervention: a single-case study. [2021]

2. Nepal pubmed.ncbi.nlm.nih.gov

Development of Immersive Virtual Reality Environment for Assessment of Functional Vision in people with Low Vision: A Pilot Study. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Heading assessment by "tunnel vision" patients and control subjects standing or walking in a virtual reality environment. [2022]

4. New Zealand pubmed.ncbi.nlm.nih.gov

A Virtual Reality Orientation and Mobility Test for Inherited Retinal Degenerations: Testing a Proof-of-Concept After Gene Therapy. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Individuals with severely impaired vision can learn useful orientation and mobility skills in virtual streets and can use them to improve real street safety. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Virtual reality as a means to explore assistive technologies for the visually impaired. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

On-road driving performance by persons with hemianopia and quadrantanopia. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Evaluation of a Paradigm to Investigate Detection of Road Hazards when Using a Bioptic Telescope. [2019]