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Computer-based training for the treatment of partial blindness

Abstract

Partial blindness after brain injury has been considered non-treatable. To evaluate whether patients with visual-field defects can profit from computer-based visual restitution training (VRT), two independent clinical trials were conducted using patients with optic nerve ( n = 19) or post-chiasmatic brain injury ( n = 19). In post-chiasma patients, VRT led to a significant improvement (29.4%) over baseline in the ability to detect visual stimuli; in optic nerve patients, the effects were even more pronounced (73.6% improvement). Visual-field enlargements were confirmed by the observation of a visual-field expansion of 4.9°–5.8° of visual angle and improved acuity in optic nerve patients. Ninety five percent of the VRT-treated patients showed improvements, 72.2% confirmed visual improvements subjectively. Patients receiving a placebo training did not show comparable improvements. In conclusion, VRT with a computer program improves vision in patients with visual-field defects and offers a new, cost-effective therapy for partial blindness.

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Figure 1: In the visual restitution training [NovaVision VRT (Medinova Medical Cons GmbH, Magdeburg, Germany)], visual stimuli are presented on the screen in such a manner that the majority of stimuli appear in the transition zone (gray area), as well as near the border of the transition zone and the defective field.
Figure 2: High resolution perimetry (HRP).
Figure 3: Visual functions before (white bars) and after (black bars) restitution training or placebo (fixation training) of patients that sustained either optic nerve or post-chiasmatic damage (mean ± s.e.m.).
Figure 4: The border in HRP or TAP was determined by measuring the distance of the black squares (that is, location without hits, see legend to Fig. 1) from the zero vertical meridian at the vertical position of +20°, +10°, 0°, -10° and -20° of visual angle.

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Acknowledgements

We thank U. Bunzenthal, E. Berger and K. Hahn for excellent technical and administrative assistance and U. Schiefer (U. Tübingen) and K. Saatman (U. Pennsylvania) for helpful technical and editorial comments. Supported by DFG Sa 433/6-2, the Cultural Ministry of Sachsen-Anhalt and the Kuratorium ZNS.

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Correspondence to Bernhard A. Sabel.

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Kasten, E., Wüst, S., Behrens-Baumann, W. et al. Computer-based training for the treatment of partial blindness. Nat Med 4, 1083–1087 (1998). https://doi.org/10.1038/2079

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