1
|
Misawa M, Pyatova Y, Sen A, Markowitz M, Markowitz SN, Reber M, Daibert-Nido M. Innovative vision rehabilitation method for hemianopsia: Comparing pre- and post audio-luminous biofeedback training for ocular motility improving visual functions and quality of life. Front Neurol 2023; 14:1151736. [PMID: 37114220 PMCID: PMC10126773 DOI: 10.3389/fneur.2023.1151736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
Background Homonymous hemianopsia (HH) corresponds to vision loss in one hemi-field secondary to retro-chiasmal injury. Patients with HH experience difficulties in scanning and orientation in their environment. Near vision daily activities such as reading can also be impaired. There is an unmet need for standardized vision rehabilitation protocols for HH. We investigated the effectiveness of biofeedback training (BT), used for vision rehabilitation in patients with central vision loss, in individuals with HH. Methods In this prospective pilot pre/post study, 12 participants, with HH consecutive to brain injury, performed 5 weekly BT sessions for 20 min each under supervision using the Macular Integrity Assessment microperimeter. BT consisted of relocation of the retinal locus 1-4° toward the blind hemi-field. Outcomes measured post-BT were paracentral retinal sensitivity, visual acuity (near vision), fixation stability, contrast sensitivity, reading speed, and visual functioning questionnaire. Statistical analysis was performed using Bayesian paired t-tests. Results Paracentral retinal sensitivity significantly increased by 2.7 ± 0.9 dB in the treated eye in 9/11 of the participants. Significant improvements with medium-to-large effect size were observed for fixation stability (8/12 participants), contrast sensitivity (6/12 participants) and near vision visual acuity (10/12 participants). Reading speed increased by 32.5 ± 32.4 words per minute in 10/11 participants. Quality of vision scores improved significantly with large effect size for visual ability, visual information and mobility. Conclusion BT led to encouraging improvements in visual functions and functional vision in individuals with HH. Further confirmation with larger trials is required.
Collapse
Affiliation(s)
- Mariana Misawa
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Yulia Pyatova
- Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Atri Sen
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michelle Markowitz
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Samuel N. Markowitz
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Michael Reber
- Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Monica Daibert-Nido
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
- Department of Ophthalmology and Vision Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Monica Daibert-Nido,
| |
Collapse
|
2
|
Wijesundera C, Crewther SG, Wijeratne T, Vingrys AJ. Vision and Visuomotor Performance Following Acute Ischemic Stroke. Front Neurol 2022; 13:757431. [PMID: 35250804 PMCID: PMC8889933 DOI: 10.3389/fneur.2022.757431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients. Methods Sixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission. Results Of the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores. Conclusions EHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.
Collapse
Affiliation(s)
- Chamini Wijesundera
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sheila G Crewther
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Sunshine Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
3
|
Leonard BT, Kontos AP, Marchetti GF, Zhang M, Eagle SR, Reecher HM, Bensinger ES, Snyder VC, Holland CL, Sheehy CK, Rossi EA. Fixational eye movements following concussion. J Vis 2021; 21:11. [PMID: 34940825 PMCID: PMC8709928 DOI: 10.1167/jov.21.13.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to evaluate fixational eye movements (FEMs) with high spatial and temporal resolution following concussion, where oculomotor symptoms and impairments are common. Concussion diagnosis was determined using current consensus guidelines. A retinal eye-tracking device, the tracking scanning laser ophthalmoscope (TSLO), was used to measure FEMs in adolescents and young adults following a concussion and in an unaffected control population. FEMs were quantified in two fixational paradigms: (1) when fixating on the center, or (2) when fixating on the corner of the TSLO imaging raster. Fixational saccade amplitude in recent concussion patients (≤ 21 days) was significantly greater, on average, in the concussion group (mean = 1.03°; SD = 0.36°) compared with the controls (mean = 0.82°; SD = 0.31°), when fixating on the center of the imaging raster (t = 2.87, df = 82, p = 0.005). These fixational saccades followed the main sequence and therefore also had greater peak velocity (t = 2.86, df = 82, p = 0.006) and peak acceleration (t = 2.80, df = 82, p = 0.006). These metrics significantly differentiated concussed from controls (AUC = 0.67-0.68, minimum p = 0.005). No group differences were seen for the drift metrics in either task or for any of the FEMs metrics in the corner-of-raster fixation task. Fixational saccade amplitudes were significantly different in the concussion group, but only when fixating on the center of the raster. This task specificity suggests that task optimization may improve differentiation and warrants further study. FEMs measured in the acute-to-subacute period of concussion recovery may provide a quick (<3 minutes), objective, sensitive, and accurate ocular dysfunction assessment. Future work should assess the impact of age, mechanism of injury, and post-concussion recovery on FEM alterations following concussion.
Collapse
Affiliation(s)
- Bianca T Leonard
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Anthony P Kontos
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | | | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Shawn R Eagle
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | - Hope M Reecher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Ethan S Bensinger
- Vision Science Group, University of California, Berkeley, Berkeley, CA, USA.,
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Cyndi L Holland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | - Christy K Sheehy
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA., rossilab.org
| |
Collapse
|
4
|
Abstract
This work presents a visual analytics approach to explore microsaccade distributions in high-frequency eye tracking data. Research studies often apply filter algorithms and parameter values for microsaccade detection. Even when the same algorithms are employed, different parameter values might be adopted across different studies. In this paper, we present a visual analytics system (VisME) to promote reproducibility in the data analysis of microsaccades. It allows users to interactively vary the parametric values for microsaccade filters and evaluate the resulting influence on microsaccade behavior across individuals and on a group level. In particular, we exploit brushing-and-linking techniques that allow the microsaccadic properties of space, time, and movement direction to be extracted, visualized, and compared across multiple views. We demonstrate in a case study the use of our visual analytics system on data sets collected from natural scene viewing and show in a qualitative usability study the usefulness of this approach for eye tracking researchers. We believe that interactive tools such as VisME will promote greater transparency in eye movement research by providing researchers with the ability to easily understand complex eye tracking data sets; such tools can also serve as teaching systems. VisME is provided as open source software.
Collapse
|
5
|
Bulboaca1 AE, Bulboaca A, Stanescu I, Boarescu PM, Chirilă I, Bulboaca A, Dogaru G. Homonymous hemianopsia versus unilateral spatial neglect rehabilitation strategies in stroke patients. BALNEO RESEARCH JOURNAL 2019. [DOI: 10.12680/balneo.2019.242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract Visual rehabilitation therapy is one of the most problematic issue in stroke rehabilitation. The difficulties consist in specific assessment of visual deficit and poor results reports by the authors of the clinical studies. Opposite, experimental studies reports encouraging results that give hopes in this specific rehabilitation therapy. There are still difficult to analyze different aquisitions concerning various visual residual deficits after stroke, the main rehabilitation targgets being motor rehabilitation in order to ensure at least a partial autonomy in day by day life. All the studies that proved there are chances for a better quality of life if there is an improvement of visual abilities together with motor and cognitive skills with a better rehabilitation prognosis. The aim of this paper is to make a brief report regarding two of the most important visual deficits after stroke as are homonymous hemianopsia and neglect. Starting with differential diagnosis, neuroplasticity and specific rehabilitation available method, the main issues are discussed. a better understanding of phenomena that are associated with spontaneous rehabilitation, or enhancing the progress of recuperation by various method, could be able to bring a new light and hopefully better results in rehabilitation for these patients Key words: stroke, visual impairment, visual rehabilitation, neuroplasticity, homonymous hemianopsia,
Collapse
Affiliation(s)
| | - Angelo Bulboaca
- "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Ioana Stanescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Paul-Mihai Boarescu
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Chirilă
- County Clinical Emergency Hospital, Cluj-Napoca, Romania
| | - Alexandra Bulboaca
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Gabriela Dogaru
- 1. "Iuliu-Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania 2. Clinical Rehabilitation Hospital, Cluj-Napoca, Romania
| |
Collapse
|
6
|
Sabel BA, Flammer J, Merabet LB. Residual vision activation and the brain-eye-vascular triad: Dysregulation, plasticity and restoration in low vision and blindness - a review. Restor Neurol Neurosci 2019; 36:767-791. [PMID: 30412515 PMCID: PMC6294586 DOI: 10.3233/rnn-180880] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Vision loss due to ocular diseases such as glaucoma, optic neuropathy, macular degeneration, or diabetic retinopathy, are generally considered an exclusive affair of the retina and/or optic nerve. However, the brain, through multiple indirect influences, has also a major impact on functional visual impairment. Such indirect influences include intracerebral pressure, eye movements, top-down modulation (attention, cognition), and emotionally triggered stress hormone release affecting blood vessel dysregulation. Therefore, vision loss should be viewed as the result of multiple interactions within a “brain-eye-vascular triad”, and several eye diseases may also be considered as brain diseases in disguise. While the brain is part of the problem, it can also be part of the solution. Neuronal networks of the brain can “amplify” residual vision through neuroplasticity changes of local and global functional connectivity by activating, modulating and strengthening residual visual signals. The activation of residual vision can be achieved by different means such as vision restoration training, non-invasive brain stimulation, or blood flow enhancing medications. Modulating brain functional networks and improving vascular regulation may offer new opportunities to recover or restore low vision by increasing visual field size, visual acuity and overall functional vision. Hence, neuroscience offers new insights to better understand vision loss, and modulating brain and vascular function is a promising source for new opportunities to activate residual vision to achieve restoration and recovery to improve quality of live in patients suffering from low vision.
Collapse
Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Josef Flammer
- Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Lotfi B Merabet
- Department of Ophthalmology, The Laboratory for Visual Neuroplasticity, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
| |
Collapse
|
7
|
Alexander RG, Macknik SL, Martinez-Conde S. Microsaccade Characteristics in Neurological and Ophthalmic Disease. Front Neurol 2018; 9:144. [PMID: 29593642 PMCID: PMC5859063 DOI: 10.3389/fneur.2018.00144] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/27/2018] [Indexed: 12/01/2022] Open
Abstract
Microsaccade research has recently reached a critical mass of studies that allows, for the first time, a comprehensive review of how microsaccadic dynamics change in neurological and ophthalmic disease. We discuss the various pathological conditions that affect microsaccades, their impact on microsaccadic and other fixational eye movement dynamics, and the incipient studies that point to microsaccadic features as potential indicators of differential and early diagnoses of multiple clinical conditions, from movement disorders to attention-deficit hyperactivity disorder to amblyopia. We propose that the objective assessment of fixational eye movement parameters may help refine differential diagnostics in neurological disease and assist in the evaluation of ongoing therapy regimes. In addition, determining the effects of ophthalmic disease on fixational eye movement features may help evaluate visual impairment in an objective manner, particularly in young patients or those experiencing communication difficulties.
Collapse
Affiliation(s)
- Robert G Alexander
- State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, United States
| | - Stephen L Macknik
- State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, United States
| | - Susana Martinez-Conde
- State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, United States
| |
Collapse
|
8
|
Sabel BA, Cárdenas-Morales L, Gao Y. Vision Restoration in Glaucoma by Activating Residual Vision with a Holistic, Clinical Approach: A Review. J Curr Glaucoma Pract 2018; 12:1-9. [PMID: 29861576 PMCID: PMC5981087 DOI: 10.5005/jp-journals-10028-1237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 01/07/2023] Open
Abstract
How to cite this article: Sabel BA, Cárdenas-Morales L, Gao Y. Vision Restoration in Glaucoma by activating Residual Vision with a Holistic, Clinical Approach: A Review. J Curr Glaucoma Pract 2018;12(1):1-9.
Collapse
Affiliation(s)
- Bernhard A Sabel
- Professor, SAVIR Center, Magdeburg, Germany; Institute for Medical Psychology, Otto von Guericke University of Magdeburg Magdeburg, Germany
| | - Lizbeth Cárdenas-Morales
- Lecturer, Institute for Medical Psychology, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Ying Gao
- Researcher, SAVIR Center, Magdeburg, Germany; Institute for Medical Psychology, Otto von Guericke University of Magdeburg Magdeburg, Germany
| |
Collapse
|