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

Trial Summary

What is the purpose of this trial?

In patients with hemianopsia following stroke or brain injury, we will determine if stimulating the visual field with images from a PowerPoint slide set can increase the visual field.

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 PowerPoint program visual stimulation, Visual Field Stimulation Therapy, Hemianopsia Rehabilitation Program for vision impairment?

Research shows that visual rehabilitation programs, like Vision Restoration Therapy and home-based virtual-reality stimulation, can improve visual fields and quality of life in patients with hemianopia (loss of half the visual field). These therapies have been shown to enhance visual perception and daily living skills, even years after the onset of vision loss. ^{1 2 3 4 5}

Is visual stimulation therapy safe for humans?

The available research on visual stimulation therapies, such as those used for hemianopia rehabilitation, suggests they are generally safe for humans, as no adverse effects were reported in the studies reviewed. ^{1 2 3 6 7}

How does the PowerPoint program visual stimulation treatment differ from other treatments for vision impairment?

The PowerPoint program visual stimulation treatment is unique because it uses a home-based, virtual-reality approach to improve visual perception and quality of life in patients with vision impairment, allowing for remote administration and reducing the need for frequent clinic visits. This contrasts with traditional treatments that often require in-clinic sessions and may not utilize immersive technology. ^{1 2 3 6 8}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

Visual field changes after a rehabilitation intervention: vision restoration therapy. [2023]

2. Switzerland 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. [2021]

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

Brain activity associated with stimulation therapy of the visual borderzone in hemianopic stroke patients. [2022]

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

Significant visual improvement with vision rehabilitation delayed three decades from disease onset. [2022]

5. Ireland pubmed.ncbi.nlm.nih.gov

Compensatory visual field training for patients with hemianopia after stroke. [2022]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Acquired visual field defects rehabilitation: critical review and perspectives. [2012]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Pattern flash visual evoked potentials in patients with homonymous hemianopia. [2019]

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

An Audiovisual 3D-Immersive Stimulation Program in Hemianopia Using a Connected Device. [2021]