Table 1

 Characteristics of included studies

StudyMethodParticipantsInterventionOutcome measuresEffectRemarks
exp, experimental; HRP, High- resolution perimetry; Ich, intracerebral haemorrhage; Inf, infarction; LH, left-sided hemianopia; OD, right eye; OS, left eye; VRT, vision restoration therapy; VEP, Visual evoked potential; plac.,placebo; RCT, randomised controlled trial; RH, right-sided hemianopia; rm, repeated measures; RMD, repeated-measures design; S, significant; SLO, scanning laser ophthalmoscope; TAP, Tübinger automatic perimeter.
Reinhard et al (2005)13RMD study17 patients, time after onset: >1 year, lesion location in central visual pathwaysVRT: Nova Vision, 6 days a week, 60 min sessions, length of intervention 6 monthsObjectiveObjectivePathology heterogeneous
rm: 2Mean age: 49 (range 24–72) yearsFixation control: noSLO difference of ratio before and after training  =  E, 0.14E  = 1 degreeSLO: no increase in border shiftOutcome not comparable with other studies, no comparison between SLO and HRP/TAP
Before trainingHead and eye movements: noADL: text presented in the SLO, reading speed, wpmADL: reading speed: 6% improvement: not relevantNo correlation of objective results with subjective reports, no clear data
After trainingSubjectiveGood internal validity
No follow-upSubjective2/3 satisfied with training
Reports of patients6 satisfied with reading; 4 not satisfied, 4 no reading problem before training
Sabel et al (2004)14RMD study16 patients, post hoc 2 groups, COM (n = 9) and INC (n = 7), time after onset: >1 year, lesion locationVRT: Nova Vision, 6 days, twice a week, 30 min sessions, length of intervention 6 monthsObjectiveObjectivePathology: heterogeneous
rm: 2Post-chiasmaticFixation control: noSLO difference of ratio before after training = E, 0.14E = 1 degreeSLO: no increase in border shiftEfficacy of VRT depends on which outcome measure is used
Before trainingMean age: 49.3 (range 24–72) yearsHead and eye movements: noHRP, number of hitsHRP: 5.28–7.01° (0.20°) increase in border shiftSubjective: reading: no clear data
After trainingTAP, number of missesHRP and TAP: OD 4.56–6.05° (0.20°); OS 4.49–5.47° (0.21°) increase in border shiftNo relationship between improvement in perimetric procedures and subjective vision
No follow-upSubjective:
Standardised vision state questionnaireSubjective:Good internal validity
Vision change questionnaire87.5% satisfied with VRT
Reports of patientsVision state questionnaire: 10% improvement
Vision change questionnaire: 14/15 patients improved
Julkunen et al (2003)6RMD study5 patients, time after onset: >1 year, lesion locationVRT: developed computer program training, 3 times a week, 60 min sessionsObjectiveObjective:Pathology: homogeneous
rm: 3Left occipital inf 1Length of intervention: 33–47 h (3–4 months)Kinetic: Goldmann, degreesPerimetry: yes, VEP: yesDetailed description of patients
Before trainingLeft occipital ich 1Fixation control: yesStatic: Octopus101, degreesNo clear data of objective outcome measures and subjective data of reading
After trainingRight temporal ich 1Head and eye movements: noVEP, latency in msSubjective improvement 2, decline 2, no change 1No general conclusions due to small group
After follow-upLeft multiple ich 1Subjective questionnaireModerate internal validity
Follow-up period: 3 monthsRight temperooccipital inf extending to thalamus:1
Age: 18–70 years
Kasten et al (2001)5Randomised trial double blind22 patients, exp. group (n = 16)VRT: exp. group: Visure, Seetrain, plac. group: Fixtra, daily, 60 min sessions, length intervention 150 h within 6 monthsObjectiveObjectivePathology: heterogeneous
Follow-up study RCT 1998Plac group (n = 6), time after onset: >1 year, lesion locationFixation control: yesPeriMa, number of stimuli; PeriForm, number of forms; PeriColor, number of colours; TAP, number of hits and missesMean (SD) increase 0.4 (0.9°), plac. group increase 0.13° (0.6°)Different outcome measures and VRT in comparison with pretreatment and post-treatment periods (Kasten, 1998); hence incomparable with data before- and after training
Follow-up period:Post-chiasmatic-optic nerveHead and eye movements: noSubjectiveNo blinding of participants
Mean (SD) 23.5 (2.3) monthsMean ageQuestionnaireSubjectiveNo subjective data from this study
Exp. group 47.7 (12.9), plac. group 55.3 (range 16.2)From study 1998< poor internal validity >
Kasten et al (1998)4Two randomised controlled trials46 patientsVRT exp. group: Nova Vision, plac. group: fixation training programme,ObjectiveObjectivePathology heterogeneous
1. Optic nerveExp. group (n = 18)daily, 60 min sessions, length intervention 6 months.Primary: HRP,Primary: improvementSubjective measures: no separate outcome measures optic nerve lesion and postchiasmatic
2. PostchiasmaticPlac. group (n = 30), time after onset: >1 year, lesion locationFixation control; noSecondary: TAPExp HRP: 29.4% border shift 4.9° (1.7), placebo HRP: 7.7%< good internal validity>
included: postchiasmatic trialPost-chiasmatic andHead and eye movements: noSubjectiveBorder shift −0.9° (±0.8)
No follow-upOptic nervePre-trial: history interviewSecondary: improvement
Mean (SD) agePost-trial: questionnaireExp TAP border shift 0.43° (0.34)
Exp group 47.7 (12.9), plac. group 55.3 (16.2)Placebo TAP −0.51° (0.34)
Subjective improvements:
Exp 72.2%, placebo: 16.6%
Kasten et al (1995)8RMD study14 patients, time after onset: 0.5–240 months, lesion location:VRT Visure, Seetrain, Formtrain, daily, 60 min sessions, length intervention 80–300 hours.ObjectiveObjectivePathology heterogeneous
rm 2Post-chiasmatic.Fixation control: noStatic perimetry:Improvement:Specific training effect light, form and colour: modality specific
Before trainingMean age 48.5Head and eye movements: noPerimatPerimat: 41.6% in 9 of 11 patientsWithin first 20 hours no training effect, increase effect from 30 hours
After trainingPeriformPeriform: 37.4%, depending on hours of training< moderate to poor internal validity>
No follow-upPericolor:Pericolor: 25.7%
Dynamic: TAPTAP: unclear
Balliet et al (1985)12RMD study12 patients, time after onset: 5–36 months, lesion location:VRT Goldmann perimeter, compensation training for patients who failed VRT: Goldmann,ObjectiveObjective:Pathology homogeneous
rm 2Occipital.2–5 days weekly, 60 min sessions, length interventionGoldmann perimeterRestitution: Goldmann perimeter: 1°Used same instrument for test and training (Goldmann), bias on training effect
Before trainingAge: 56–662–11 months.Subjective:Compensation: 0°Emphasis on discussing measurement error caused by compensation eccentric fixation and on good fixation control
After trainingFixation control: yesReports of patientsSubjective:< moderate to poor internal validity>
No follow-upHead and eye movements: noreport of patients: no changes in visual field
Pambakian et al (2004)10RMD study31 patients, time after onset: 3 to >12 months, lesion location:Compensation trainingObjectiveObjectivePathology: heterogeneous
rm 4PostchiasmaticDeveloped home training on a monitor, daily 40 min sessions, length intervention 1 monthHumphreyRestitution: 0°Used same instrument for test and training, bias on training effect
2 before trainingMean age: 49.7 (range 24–75)Response time, error ratesCompensation:76% improvementControlled for age: elderly patients benefited more from training
2 after trainingADL: response timeADL: 31 patients 25% improvement< moderate internal validity >
Follow-up: 1 monthSubjective
Standardised questionnaire KerkhoffSubjective:
Improvement of 27 patients
S (p = <0.0002)
Nelles et al (2001)9RMD stduy21 patients, mean time after onset:VRT and compensation training on a board (CVFT), two daily, 30 min sessions, length intervention 1 monthObjectiveObjectivePathology: no description
rm: 21. 5 months (range 0.5–24),TAPRestition: not mentionedOutcome measure and intervention are alike: bias on training effect
Before trainingno description lesion location.CVFTCompensation: improvementFollow-up effect: no outcome measures
After trainingMean age: 59.2 (±3.5)Reponse time, error ratesGroup A: NS<poor internal validity >
follow-up periodSubgroupSubjectiveGroup B: S (p⩽0.02)
8 months from 15 patientsA: eyes fixating B:exploratory eye movementsStandardised questionnaire Kerkhoff with item reading addedSubjective
Improvement S(p⩽0.05)
Zihl (1995)2RMD study14 patients, mean time after onset:Compensation trainingObjectiveObjective:Pathology: homogeneous
rm 211 weeks (range 6–18), lesion location:Saccadic eye movements with TAP, searching task with slides, 30 min sessions, length intervention 16 (range 8–23).TAPRestorative: noEmphasis study oculomotor scanning
Before trainingStriate cortex, thalamus, occipito-parietalVisual scanning: Pupil-corneal-reflection method, search time, length of scanpath,number of fixations.Visual scanning: improvement three variables S (p⩽0.001)Damage in occipito-parietal cortex, optic radioation, striate cortex more training sessions necessary than occipital lesions
After trainingMean age: 44 (range 23–74)SubjectiveSubjective: reduction of complaintsNo clear subjective measures
No follow-upComplaints before and after training<moderate internal validity >
Kerkhoff et al (1994)1RMD study22 patients, mean time after onset:Compensation trainingObjective:Objective:Pathology: homogeneous
rm: 37.5 months (range 1–37), lesion location:Training in 3 steps:TAPRestitution: mean increaseLeft vs right hemianopia, early vs late training no significant differences
Before trainingoccipital: 12large saccades on large screen, visual search with slides, transfer to ADL,Visual search field: TAP, slides, table test6.6° (range 2° to 24°)All patients returned to previous job
After trainingOccipito-temporal: 35 days a week, 30 min sessions, length intervention 1–3 monthsSubjectivevisual search field increase: mean 30°<good internal validity >
After follow-upTemporal: 17Standardised questionnaire Kerkhoffsearch time decrease: S (p = 0.01), reduction of errors: 50%
Follow-up period:Mean age: 46 (range 16–77)Subjective
3 months (1–12)significant improvements p-value 0.01
Kerkhoff et al (1992)11RMD study122 patients,Compensation trainingObjectieveObjective:Pathology: heterogeneous
rm 3VFD group (n = 92),Training in 3 steps:TAPRestitution: mean increase: 1.6° (range 1.0° to 30°)More training sessions necessary during training with head movements.
Before trainingVFD+ group (n = 30),Large saccades on large screen, visual search with slides, transfer to ADLVisual search field increase: mean 30°Time after lesion, etiology, type of visual field defect, visual field sparing and age irrelevant for treatment success
After trainingincluded VFD group,5 days a week, 30SubjectiveSubjective<moderate internal validity >
After follow-upmean time after onset: 32.8(range 1–220), lesion locationmin sessions, length intervention 6 weeksNoneNo data
Follow-up period:Postchiasmatic.
Mean 22 monthsMean age 49 (range 117–74)
SCT focused on reading
Kerkhoff et al (1992)15RMD study56 patients, mean time after onset: 40.2 weeks (range 3–220), no description lesion location.Compensation trainingObjectiveRestitution mean increase: 1.6° (range 1.0° to 20°)Pathology: heterogeneous
rm 3Mean age: 46.8 (range 13–74)Computer-based method with moving text, 5 days a week, 40 min sessions, length intervention 14 sessions in 4–6 weeks.TAPReading time reduction:Most severely disturbed patients benefited most during training
Before trainingReading timeS (p⩽0.02)Reduction reading time irrespective initial reading time before training
After trainingReading errorsReading errors reduction:<good internal validity >
After follow-upSubjective databefore treatment: 4.97 (8.1)
Follow-up periodStandardised questionnaire Kerkhoffafter follow-up: 1.48(1.66)
mean 22 monthsSubjective data
(6 months –5 years)not reported
Zihl (1995)16RMD study20 patients,Compensation trainingObjectiveRestitution: noPathology: heterogeneous
rm: 2LH group (n = 10)Computer based with moving text, 5 days a week. 40 min sessions, mean length intervention LH 11 (range 8–16) sessions, RH 22 (range 9–29).TAPReading speed: wpmClear relationship between improvements in reading performance and changes of eye movements parameters
Before trainingRH group (n = 10), time after onset:Pupil-corneal reflection methodLH 76→113< moderate to good internal validity >
After trainingLH 3–12 weeks (5.8), RH 4–9 weeks(5.9),RH 53→96
No follow-upNo description lesion location. Mean age LH group 39 (range 21–53), RH group 37 (range 19–54)Subjective dataPerceptual span
NoneLH 3.75°→4.03°
RH 2.79°→3.74°
Subjective data