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The effect of visual training for patients with visual field defects due to brain damage. A systematic review
  1. Lies Bouwmeester (ecm.bouwmeester{at}planet.nl)
  1. Visio, Netherlands
    1. Joost Heutink (joostheutink{at}visio.nu)
    1. Visio, Netherlands
      1. Cees Lucas (c.lucas{at}amc.uva.nl)
      1. AMC, University of Amsterdam, Netherlands

        Abstract

        Objectives: This review evaluates whether systematic visual training leads (1) to a restitution of the visual field (restoration), (2) to an increase of the visual search field size or an improvement of scanning strategies (compensation), and (3) to a transfer of training-related improvements in activities of daily life, such as reading.

        Methods: In order to retrieve relevant publications, computer aided searches of databases were performed (Medline, Embase, Cinahl, Cochrane Central Registers of Controlled Trials) and extensive reference tracing and hand-searching. Subsequently, all retrieved and blinded studies were scored on methodological quality. Fourteen studies were included, two randomised controlled studies (RCT) and twelve within-subject repeated measures designs (RMD).

        Results: Of the RCT studies one had good quality. The internal validity of the RMD studies varied from poor to good. Five studies reported significant effect of the vision restoration therapy (VRT), whereas two studies reported no effect using scanning laser ophthalmoscope (SLO) or Goldmann perimetry as outcome measure. All authors of the studies on scanning compensatory therapy (SCT) found a significant effect up to 30° visual search field, a significant increase of reading speed or reduction of reading errors.

        Conclusions: We conclude that it remains unclear to what extent patients benefit from restoration therapy in relation to a more efficient scanning strategy which enables them to read faster or to better avoid obstacles. No study has given a satisfactory answer. SCT seems to provide a more succesful rehabilitation with more simple and user-friendly training techniques. Validated questionnaires provide the most reliable subjective data to assess the transfer of the relevance of training procedures to activities of daily living of the patient. We recommend SCT until the effect of the VRT will be defined.

        • hemianopia
        • hemianopic reading
        • oculomotor rehabilitation
        • vision restoration therapy
        • visual training

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