Vision Restoration Training for Glaucoma

IMPORTANCE Visual field loss due to retinal damage is considered irreversible, and methods are needed to achieve vision restoration. Behavioral vision training, shown to improve visual fields in hemianopia and optic nerve damage, might comprise such a method. OBJECTIVE To determine if behavioral activation of areas of residual vision using daily 1-hour vision restoration training for glaucoma for 3 months improves detection accuracy compared with placebo. DESIGN AND SETTING Prospective, double-blind, randomized, placebo-controlled clinical trial in an ambulatory care and home training setting. PARTICIPANTS Volunteer sample of patients with glaucoma (mean age, 61.7 years; age range, 39-79 years) with stable visual fields and well-controlled intraocular pressure. After randomization, 4 patients withdrew from the trial because of mild headaches (n = 2) or lack of time to complete the schedule (n = 2). INTERVENTIONS Computer-based vision restoration training for glaucoma (n = 15) or visual discrimination placebo training in the intact visual field (n = 15). MAIN OUTCOMES AND MEASURES The primary end point was change in detection accuracy in high-resolution perimetry. Secondary end points were 30° white-on-white and 30° blue-on-yellow near-threshold perimetry, as well as reaction time, eye movements, and vision-related and health-related quality of life. RESULTS Vision restoration training for glaucoma led to significant detection accuracy gains in high-resolution perimetry (P = .007), which were not found with white-on-white or blue-on-yellow perimetry. Furthermore, the pre-post differences after vision restoration training for glaucoma were greater compared with placebo in all perimetry tests (P = .02 for high-resolution perimetry, P = .04 for white on white, and P = .04 for blue on yellow), and these results were independent of eye movements. Vision restoration training for glaucoma (but not placebo) also led to faster reaction time (P = .009). Vision-related quality of life was unaffected, but the health-related quality-of-life mental health domain increased in both groups. CONCLUSIONS AND RELEVANCE Visual field defects caused by glaucoma can be improved by repetitively activating residual vision through training the visual field borders and areas of residual vision, thereby increasing their detection sensitivity. Our randomized clinical trial revealed evidence that visual field loss is in part reversible by behavioral, computer-based, online controlled vision training, comprising a new rehabilitation treatment option in glaucoma. Neuroplasticity of the visual cortex or higher cortical areas is the proposed mechanism of action. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01799707.