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The effect of visual training for patients with visual field defects due to brain damage: a systematic review
  1. Lies Bouwmeester1,
  2. Joost Heutink1,2,
  3. Cees Lucas3
  1. 1Royal Visio, National Foundation for the Visual Impaired and Blind, Haren, The Netherlands
  2. 2Department of Psychology, University of Groningen, Groningen, The Netherlands
  3. 3Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to:
 L Bouwmeester
 Royal Visio, National Foundation for the Visual Impaired and Blind, PO Box 144, 9750 AC Haren, The Netherlands; liesbouwmeester{at}


The objective of this review was to evaluate whether systematic visual training leads to (1) a restitution of the visual field (restoration), (2) an increase in the visual search field size or an improvement in scanning strategies (compensation) and (3) a transfer of training-related improvements in activities of daily living such as reading. To retrieve relevant publications, computer-aided searches of databases (Medline, Embase, Cinahl, Cochrane Central Registers of Controlled Trials) and extensive reference tracing and hand searching were performed. Subsequently, all retrieved and blinded studies were scored on methodological quality. 14 studies were included, 2 randomised controlled trials (RCTs) and 12 within-subject repeated-measures designs (RMD). One of the two RCT studies had good quality. The internal validity of the RMD studies varied from poor to good. Five studies reported a significant effect of the vision restoration therapy (VRT), whereas two studies reported no effect using scanning laser ophthalmoscopy or Goldmann perimetry as outcome measure. All authors of the studies on scanning compensatory therapy (SCT) found a significant effect of up to 30° visual search field, a significant increase in reading speed or decrease in reading errors. It is 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 avoid obstacles in a better way. No study has given a satisfactory answer. SCT seems to provide a more successful 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. Hence, SCT is recommended until the effect of the VRT is defined.

  • HRP, high-resolution perimetry
  • HVFD, homonymous visual field defect
  • RCT, randomised controlled trial
  • RMD, repeated-measures design
  • SCT, scanning compensatory therapy
  • SLO, scanning laser ophthalmoscope
  • TAP, Tuebinger automatic perimeter
  • VRT, vision restoration therapy

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  • Published Online First 29 November 2006

  • Competing interests: None declared.