Visual Stimulation for Vision Impairment

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Alberta

Disqualifiers: Light-induced seizures

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

Duration: 2 months

40 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to assist individuals with vision problems following a stroke or brain injury. It tests whether viewing images on a PowerPoint slide show (PowerPoint program visual stimulation) can enhance the visual field for those with hemianopsia (loss of half the field of vision). Participants will either view a PowerPoint program or watch online news to determine which is more beneficial. Individuals who have experienced a stroke or brain injury and suffer from vision loss, specifically homonymous hemianopsia (loss of the same side of the visual field in both eyes) or quadrantopsia (loss of one-quarter of the visual field), may be suitable for this trial. As an unphased trial, this study provides a unique opportunity to explore innovative treatments for vision loss.

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 prior data suggests that this visual stimulation technique is safe for vision impairment?

Research has shown that visual stimulation techniques, like the one used in this trial, are generally safe for people. One study on visual rehabilitation found that similar methods, such as visual scanning and using multiple senses, were well-tolerated. These techniques aim to help patients adjust and improve their vision.

Another study examined a similar method using a home-based program to enhance visual perception. This study suggested that such visual exercises are safe and can be done at home. Although specific side effects of the PowerPoint program weren't detailed, these related methods have demonstrated safety.

Participants in this trial will use a PowerPoint program for visual stimulation. Based on existing research, this method is likely safe and without significant side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the potential of using visual stimulation techniques for vision impairment, as they could offer a non-invasive and easily accessible method for vision improvement. Unlike traditional treatments that might involve surgery or medication, this approach uses a simple PowerPoint program designed to stimulate visual processing in the brain. This method is unique because it could be conveniently administered at home, potentially making vision therapy more accessible and less intimidating. Additionally, it might offer a new way to engage the brain’s plasticity, encouraging improvement without the need for more invasive procedures.

What evidence suggests that this PowerPoint program visual stimulation is effective for vision impairment?

Research has shown that using a PowerPoint program for visual exercises might help people with hemianopsia, a condition where they lose sight in half of their field of vision. In this trial, participants in Group 2 will use the PowerPoint program as part of their visual rehabilitation. Previous studies have found that visual rehabilitation, such as virtual reality or computer programs, can improve vision for those with this condition. Even short sessions of these exercises have sometimes led to better vision. While this specific PowerPoint program is still being tested, the idea is that regularly exposing the brain to visual images could help it relearn to see better. This method relies on the concept that the brain can change and reorganize itself, even after an injury. ^{1 3 6 7 8}

Are You a Good Fit for This Trial?

This trial is for individuals who have lost part of their field of vision, known as hemianopsia, due to a stroke or brain injury. Specific eligibility criteria are not provided.

Inclusion Criteria

I am 18 or older, have partial vision loss, can consent, and speak English.

Exclusion Criteria

I do not have seizures triggered by flashing lights.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are divided into two groups based on birth year to receive visual stimulation therapy: Group 1 views online news, and Group 2 views a PowerPoint program, each for 15 minutes, three days per week for 2 months.

2 months

3 visits (in-person) for perimetry testing

Crossover Treatment

Participants switch interventions for another 2 months, with Group 1 switching to the PowerPoint program and Group 2 switching to online news.

2 months

1 visit (in-person) for perimetry testing

Follow-up

Participants are monitored for changes in visual field index after the treatment phases.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• PowerPoint program visual stimulation

Trial Overview The study is testing whether using a PowerPoint program to stimulate the visual field can help improve vision in patients with hemianopsia after a stroke or brain injury.

How Is the Trial Designed?

Group I: Group 2 (PowerPoint program) Active Control 1 Intervention

Group 2 with an even number year of birth will be asked to view the 15-minute PowerPoint program three days per week for 2 months.

Group II: Group 1 (online news) Active Control 1 Intervention

Group 1 with an odd number year of birth will be asked to view 15 minutes of online news three days per week for 2 months. LIVE: Canadian News \| Weather \& Traffic - Latest Sports \| Breaking News (globalnews.ca)

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Published Research Related to This Trial

Visual field deficits (VFD), particularly homonymous hemianopia, significantly impair daily activities and are linked to poor patient outcomes after brain injury, yet there is no consensus on effective rehabilitation therapies.

Various therapeutic approaches exist, including optical therapy, restorative therapies, stimulation techniques, and compensatory strategies, each aiming to improve visual function through repeated practice, but a combination of these methods may be necessary for optimal recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acquired visual field defects rehabilitation: critical review and perspectives. Pouget, MC., Lévy-Bencheton, D., Prost, M., et al.[2012]

Visual evoked potentials (VEPs) were recorded from normal subjects and those with homonymous hemianopia, revealing that stimulation of the visual field produced distinct electrical responses in the contralateral hemisphere, indicating the brain's processing of visual information.

Patients with homonymous hemianopia exhibited normal VEPs from their functional visual fields, but nearly flat responses from their affected hemifields, suggesting that visual processing remains intact in the healthy hemisphere despite the visual loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pattern flash visual evoked potentials in patients with homonymous hemianopia. Biersdorf, WR., Bell, RA., Beck, RW.[2019]

In a study of 161 patients with homonymous visual field defects, Vision Restoration Therapy (VRT) led to a significant average improvement of 12.8% in stimulus detection and a shift of 4.87 degrees in the border of the blind field.

76% of patients experienced an improvement of 3% or more in stimulus detection, indicating that VRT is an effective rehabilitative intervention for many individuals with visual field defects caused by retrochiasmatic lesions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visual field changes after a rehabilitation intervention: vision restoration therapy. Romano, JG., Schulz, P., Kenkel, S., et al.[2023]

A home-based virtual-reality visual rehabilitation program was feasible for two patients with hemianopia due to pediatric brain tumors, with both completing nearly all scheduled sessions (19/20 and 20/20).

The program showed potential effectiveness, as both patients experienced improvements in contrast sensitivity, visual fields, reading speed, and quality of life, particularly notable in case 2.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Case Report: Visual Rehabilitation in Hemianopia Patients. Home-Based Visual Rehabilitation in Patients With Hemianopia Consecutive to Brain Tumor Treatment: Feasibility and Potential Effectiveness. Daibert-Nido, M., Pyatova, Y., Cheung, K., et al.[2021]

A 4-week virtual-reality audiovisual rehabilitation program significantly improved visual perception, contrast sensitivity, and fixation stability in a 15-year-old patient with right homonymous hemianopia, enhancing his quality of life.

This study demonstrates that remote-controlled virtual-reality therapy can effectively provide low-vision rehabilitation at home, challenging the notion that vision loss after injury is permanent and unchangeable.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Audiovisual 3D-Immersive Stimulation Program in Hemianopia Using a Connected Device. Daibert-Nido, M., Pyatova, Y., Cheung, KG., et al.[2021]

Visual restoration therapy can lead to significant changes in brain activity in hemianopic patients, specifically increasing responsiveness in the trained borderzone of their visual field after one month of therapy, as shown by fMRI results.

The therapy appears to shift attention from the nontrained seeing field to the trained borderzone, with key brain areas like the anterior cingulate and dorsolateral frontal cortex playing a crucial role in this process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Brain activity associated with stimulation therapy of the visual borderzone in hemianopic stroke patients. Marshall, RS., Ferrera, JJ., Barnes, A., et al.[2022]

A 40-year-old male with longstanding right homonymous hemianopsia showed significant improvement in visual function after undergoing visual rehabilitation, demonstrating both subjective and objective gains.

This case suggests that visual rehabilitation can be effective even many years after the initial brain injury, highlighting its potential benefits for patients with similar conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Significant visual improvement with vision rehabilitation delayed three decades from disease onset. Wiley, ZC., Bhat, N., Bindiganavile, SH., et al.[2022]

In a study of 21 patients with hemianopia, 4 weeks of compensatory visual field training significantly improved their ability to detect and react to visual stimuli when using exploratory eye movements, with these improvements lasting for 8 months.

Despite the training enhancing visual detection and reaction times, the actual size of the visual field defect (scotoma) did not change, indicating that the training improved functional abilities without restoring the lost visual field.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Compensatory visual field training for patients with hemianopia after stroke. Nelles, G., Esser, J., Eckstein, A., et al.[2022]

Citations

1. withpower.com withpower.com/trial/phase-visual-field-defect-peripheral-2024-5a1d4

Visual Stimulation for Vision Impairment Trial Overview The study is testing whether using a PowerPoint program to stimulate the visual field can help improve vision in patients with hemianopsia after ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06241209

Hemianopsia Rehabilitation After Stroke or Brain Injury Purpose: To determine if a computer screen visual stimulation can improve peripheral field loss in patients with vision pathway brain injury.

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/34354660/

Case Report: Visual Rehabilitation in Hemianopia Patients. ... This is the first report of a home-based virtual-reality visual rehabilitation program for adult patients with hemianopia consecutive to a pediatric brain ...

4. thelancet.com thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00534-0/fulltext

A telerehabilitation program to improve visual perception in ... A telerehabilitation program to improve visual perception in children and adolescents with hemianopia consecutive to a brain tumor.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8202419/

An Audiovisual 3D-Immersive Stimulation Program in ... Here, we obtained promising results demonstrating that a total of 3 h 20 min of audiovisual IVR stimulation procedure is sufficient to improve visual function ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4515568/

Visual rehabilitation: visual scanning, multisensory stimulation ... VST trains patients to make adaptive saccades into the affected blind field and systematically scan the visual scene in order to compensate for their loss by ...

7. slideshare.net slideshare.net/slideshow/visioary-ophthalmology-tbi-presentation-9714/39162995

Visioary ophthalmology tbi presentation 9.7.14 This document discusses neuro-optometric rehabilitation (NOR), which provides coordinated visual care for patients with neurological insults.

8. medrxiv.org medrxiv.org/content/10.1101/2024.01.25.24301666v1.full-text

A telerehabilitation program to improve visual perception in ... This study aims to explore the feasibility, safety, and potential effectiveness of a home-based audiovisual stimulation in immersive virtual-reality (3D-MOT- ...