Virtual Reality Visual Perceptual Plastic Training Promotes Retinal Structure and Macular Function Recovery in Glaucoma Patients

Twenty-seven glaucoma patients (54 eyes in total) with well-controlled intraocular pressure were trained with binocular virtual reality visual software for 3 months to investigate whether virtual reality visual perceptual plastic training promotes macular retinal structure and macular function recovery in glaucoma patients. The thickness of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer-inner plexiform layer (mGCIPL), and mean macular sensitivity (mMS) were evaluated 3 months after training. The mean value of pRNFL thickness in glaucoma patients did not change significantly (Z = 0.642, p = 0.521), nor did the mean value (t = 1.916, p = 0.061) and minimum value (Z = 1.428, p = 0.153) of mGCIPL after 3 months. However, the significant increases were found in superior temporal mGCIPL thickness (t = 2.430, p = 0.019) as well as superior mGCIPL thickness (t = 2.262, p = 0.028). Additionally, the mMS was increased (Z = 2.259, p < 0.05), with the inferior square to be a more pronounced mMS increase (Z = 2.070, p = 0.038). In conclusion, virtual reality visual perceptual plastic training can increase the thickness of retinal ganglion cells complexes in the macular area of glaucoma patients and improve the macular function of the corresponding area. Clinical Trial registration number: ChiCTR1900027909.

Stroboscopic vision prolongs visual motion perception in the central nervous system

Stroboscopic training has repeatedly been shown to improve visual and visuomotor performance in sports. Although recent research suggests that stroboscopic vision puts a training stimulus to the central nervous system, the underlying mechanism how it affects motion perception and processing in the brain is still unknown. Twenty-six participants performed a computer-based simple reaction test in response to a visual motion stimulus under normal (baseline) and stroboscopic conditions (5 Hz frequency, 40% duty cycle) (stroboscopic). A third condition under normal vision intermittently stopped the motion stimulus at the same frequency and duty cycle as in the stroboscopic condition. This condition controlled for the amount of visual motion information independent of the shutter glasses (screen shutter) and provided information about the effect of luminance changes induced by the stroboscopic eyewear. A 64-channel EEG was recorded to determine the amplitude and latency of the N2 component as a correlate of visual motion perception in the motion-sensitive visual area MT. Reaction time under stroboscopic conditions was significantly delayed when compared to both the baseline (p < 0.001) and screen shutter (p < 0.001) conditions. This was accompanied by a significantly prolonged N2 latency (p < 0.001) and lower N2 amplitude (p < 0.001) with the shutter glasses. There was no difference in reaction time or N2 amplitude/latency between the baseline and screen shutter condition (p ≥ 0.176). Stroboscopic eyewear delays the speed of visual motion perception and processing in the central nervous system and reduces the visuomotor reaction speed. This may form the neurophysiological basis for performance gains following stroboscopic training.

Visual rehabilitation indicating neuroplasticity in an esotropic adult patient with diplopia after sudden visual acuity loss in the non-amblyopic eye: A case report

BACKGROUND

The aim of this case report is to present the successful management of both diplopia and amblyopia in a specific clinical situation, demonstrating neuroplasticity of the visual system in an adult patient. Causes of diplopia include eye pathologies in monocular diplopia and ischemic ocular motor nerve palsies, sudden life-threatening and chronic conditions in central nervous system in binocular diplopia. Strabismic amblyopia and nonarteritic anterior ischemic optic neuropathy are quite often ophthalmic conditions, first one is caused by suppression during developmental period and the latter one by ischemia of the optic nerve in adults. Coexistence of aforementioned conditions may cause unusual clinical situation in which ability of nervous system to functional reorganization could be demonstrated.

CASE PRESENTATION

In our adult patient, diplopia was incited by the loss of suppression of the strabismic amblyopic eye, which was the consequence of a sudden decrease of the visual acuity in the previously better eye in the course of nonarteritic anterior ischemic optic neuropathy. This led to impairment in daily activities.

RESULTS

Visual training rehabilitation improved distance and near visual acuity in the amblyopic eye over three months, and prescribing two pairs of glasses with prisms enabled the patient to return to daily activities.

CONCLUSION

The discussed patient lost the suppression of the strabismic amblyopic eye. Management of amblyopia is usually undertaken in children, however considering neuroplasticity we successfully attempted to improve visual functioning of our patient, despite lower intensity of neuroplasticity functions in an adult brain.

A New Immersive Rehabilitation Therapy (MoveR) Improves More Than Classical Visual Training Visual Perceptual Skills in Dyslexic Children

In this study, we wonder how to compare the improvement in visual perceptual skills (by using the test of visual perceptual skills, TVPS) in children with dyslexia after two visual training types (a new immersive rehabilitation therapy called MoveR, and the classical vision therapy). Thirty-nine children with dyslexia were enrolled in the study. They were split into two groups (G1 and G2) matched in IQ (intelligence quotient), sex, and age. Children of the group G1 underwent to MoveR training while children of the group G2 underwent to visual training. TVPS scores of four subtests were assessed twice before and 6 months after the two different types of training (MoveR or visual). MoveR training is an immersive therapy to reinforce visual discrimination, visual attention, saccadic/vergence system and spatial orientation. Visual therapy is based by training different types of eyes movements (horizontal, vertical and oblique pursuits and saccades, convergence and divergence movements), reading task and some exercise for improving eyes-head coordination. Each training type lasted 30 min a day, five days a week, for two weeks. Before training, the TVPS scores of the four subtests measured were statistically similar for both groups of children with dyslexia (G1 and G2). After training, both group of children (G1 and G2) improved the TVPS score of the four subtests assessed; however, such improvement reached significance in G1 only. We conclude that MoveR training could be a more useful tool than classical visual training to improve visual perceptual abilities in dyslexic children. Follow up studies on a larger number of dyslexic children will be necessary in order to explore whether such improvement persists over time and its eventual implication in reading or other classroom's activities.

Perspectives on the Combined Use of Electric Brain Stimulation and Perceptual Learning in Vision

A growing body of literature offers exciting perspectives on the use of brain stimulation to boost training-related perceptual improvements in humans. Recent studies suggest that combining visual perceptual learning (VPL) training with concomitant transcranial electric stimulation (tES) leads to learning rate and generalization effects larger than each technique used individually. Both VPL and tES have been used to induce neural plasticity in brain regions involved in visual perception, leading to long-lasting visual function improvements. Despite being more than a century old, only recently have these techniques been combined in the same paradigm to further improve visual performance in humans. Nonetheless, promising evidence in healthy participants and in clinical population suggests that the best could still be yet to come for the combined use of VPL and tES. In the first part of this perspective piece, we briefly discuss the history, the characteristics, the results and the possible mechanisms behind each technique and their combined effect. In the second part, we discuss relevant aspects concerning the use of these techniques and propose a perspective concerning the combined use of electric brain stimulation and perceptual learning in the visual system, closing with some open questions on the topic.

Efficacy of Visual Training Program for Students with Visual Impairment

This pilot study investigated the effects of a visual training program for students with low vision. A pre and post design was used. The Beery-Buktenica Developmental Test of Visual-Motor Integration and the Test of Visual-Perceptual Skills were used to assess the perceptual and visual motor skills of fifteen students with low vision. Their mean age was (8.47 ± 1.12); and the mean of their visual acuity of was (0.12 ± 0.11). The three-part intervention program (physical worksheets, a computer-based intervention program, activities of visual perceptual skills) was implemented over four weeks (three sessions/week). Kruskal Wallis tests were used to examine the effect of visual acuity on the progress achieved, and the Wilcoxon-Signed Ranks test was used to identify differences in the scores pre-post intervention. Results showed statistically significant improvement in the visual perceptual and visual-motor integration skills. There was not any statistically significant effect of visual acuity on the progress achieved.

Effectiveness of Computer-Based Auditory Training for Adult Cochlear Implant Users: A Randomized Crossover Study

The aim of this study was to assess whether a computer-based speech-in-noise auditory training (AT) program would lead to short- and long-term changes in trained and untrained measures of listening, cognition, and quality of life. A secondary aim was to assess whether directly training the underlying cognitive abilities required for speech perception in noise, using a computer-based visual training (VT) program without the auditory component, would elicit comparable outcomes as the AT program. A randomized crossover study with repeated measures was conducted with 26 adult cochlear implant users. Participants completed either 6 weeks of speech perception in noise training followed by 6 weeks of masked text recognition training, or vice versa. Outcome measures were administered twice before each training program, as well as twice after the completion of each program. The test battery was designed to evaluate whether training led to improvements in listening abilities, cognitive abilities, or quality of life. Mixed-effects models were conducted to analyze whether changes occurred on the trained tasks and on untrained outcome measures after training. Statistically significant improvements were shown for verbal recognition performance during both training programs, in particular for consonants in words, and during the first 2 weeks of training. This on-task learning, however, did not lead to clear improvements in outcomes measured beyond the training programs. This suggests that experienced cochlear implant users may not show transfer of on-task learning to untrained tasks after computer-based auditory and visual training programs such as the ones used in this study.

Preliminary Evaluation of the Clinical Benefit of a Novel Visual Rehabilitation Program in Patients Implanted with Trifocal Diffractive Intraocular Lenses: A Blinded Randomized Placebo-Controlled Clinical Trial

The authors of this study evaluated the potential benefit on visual performance of a novel 3 week visual rehabilitation program based on the use of Gabor patches in patients undergoing bilateral cataract surgery with the implantation of two models of trifocal diffractive intraocular lens (IOL). A total of 30 patients were randomly assigned to two groups: a study group (15 patients) that used a videogame based on Gabor patches and a placebo group (15 patients) that used a videogame without specific stimuli for improving visual performance. No statistically significant differences between groups were found in distance, intermediate, and near post-training visual acuity (p ≥ 0.15). Significantly better distance contrast sensitivity (CS) was found for the spatial frequencies of 6 (p = 0.02) and 12 cpd (p = 0.01) in the study group. Likewise, significantly better values of near CS were found in the study group compared to the placebo group for the spatial frequency of 1.5 cpd (p = 0.02). In conclusion, a 3 week visual rehabilitation program based on the use of Gabor patches in the immediate postoperative period after the bilateral implantation of trifocal diffractive IOLs seems to be beneficial for improving both distance and near visual performance achieved with the implant.

Visual Training in Virtual Reality in Adult Patients with Anisometric Amblyopia

PURPOSE

Amblyopia is one of the most common childhood disease. The average prevalence of amblyopia in children is estimated at 2-5 %. It arises during the child development until the age of six, if not treated then, it persist throught adulthood. The aim of our work is to retrospectively analyze the results of treatment of anisometropic amblyopia using dichoptical training in virtual reality in adult amblyopic patients.

MATERIALS AND METHODS

Our group consisted of 84 amblyopic patients with anisometropic amblyopia with an average age of 33.8 ± 9.4 years. Patients played a video game twice a week in the Oculus Rift 3D virtual reality. Together they completed 8 visual trainings, with one training lasting 60 minutes. Before and after the training we evaluated the best corrected visual acuity (BCVA).

DISCUSSION

Throughout the group, we observed an improvement of 0.1 BCVA from 0.48 to 0.58 Sloan table (p.

Individualized Visual Reality Training Improves Visual Acuity and Visual Field Defects in Patients with Glaucoma: A Preliminary Study Report

To explore whether individualized visual training improves the visual acuity and visual field defects of patients with glaucoma. Patients with established primary glaucoma who visited the glaucoma clinic of Beijing Shijitan Hospital, Capital Medical University from January 2018 to April 2018 were recruited. The binocular visual perception examination was performed by using the visual perception examination system, and a personalized training program was developed according to the relevant threshold conditions between the eyes of the patients. The binocular visual perception training session for 20 minutes for two sessions was completed at home by using a virtual reality helmet. The visual function, intraocular pressure, and Octopus visual field were examined, before and at the first month and the third month after training. Seven patients completed the study. None of the seven patients has fine stereopsis, four of them have large stereopsis, and two patients are without large stereopsis. The visual acuity at 3 months after training was significantly improved compared with that before training. The mean defect value after 1 month of training was significantly lower than that before training, and it was further decreased after 3 months. Similarly, the mean sensitivity value was significantly increased in both follow-ups after training. There was no significant difference in loss variance after 1 and 3 months of training when compared with that before training (p > 0.05). Our small prospective observational study indicated that individualized visual perception training can improve the visual function and improve the visual field in patients with glaucoma, and a large sample size study is warranted to further assess the value of this novel treatment.

Visual training could be useful for improving reading capabilities in dyslexia

The term dyslexia originated in 1887 when an ophthalmologist described the difficulty of learning to read. After more than a century of research, we still do not know the etiology of such pathology. Several hypotheses have been suggested to explain dyslexia and in the present article we will describe in detail the visual attentional deficits reported in dyslexia. Reading is a complex cognitive process during which several mechanisms are involved (visual perception, eye movements -saccades and fixations-, semantic and linguistic abilities); consequently, a deficit in one of these different components could cause impairment in reading acquisition. In children with dyslexia, we observed abnormal oculomotor patterns during reading: frequent saccades of small amplitude, long-term fixation, high number of saccades to the left (retro-saccades), and poor binocular coordination during and after the saccades. These results suggest a deficit of visual information processing as well as an immaturity of the interaction between the saccade and vergence systems. In the present review, we will discuss different methods that use short periods of visual rehabilitation or text manipulation, and by using an eye tracker in order to obtain objective information on eye movement's performance during reading, assist in improved reading performance of dyslexic children.

Effects of Video-Based Visual Training on Decision-Making and Reactive Agility in Adolescent Football Players

This study investigated the trainability of decision-making and reactive agility via video-based visual training in young athletes. Thirty-four members of a national football academy (age: 14.4 ± 0.1 years) were randomly assigned to a training (VIS; n = 18) or a control group (CON; n = 16). In addition to the football training, the VIS completed a video-based visual training twice a week over a period of six weeks during the competition phase. Using the temporal occlusion technique, the players were instructed to react on one-on-one situations shown in 40 videos. The number of successful decisions and the response time were measured with a video-based test. In addition, the reactive-agility sprint test was used. VIS significantly improved the number of successful decisions (22.2 ± 3.6 s vs. 29.8 ± 4.5 s; p < 0.001), response time (0.41 ± 0.10 s vs. 0.31 ± 0.10 s; p = 0.006) and reactive agility (2.22 ± 0.33 s vs. 1.94 ± 0.11 s; p = 0.001) pre- vs. post-training. No significant differences were found for CON. The results have shown that video-based visual training improves the time to make decisions as well as reactive agility sprint-time, accompanied by an increase in successful decisions. It remains to be shown whether or not such training can improve simulated or actual game performance.

Visual training and emotional state of people with retinitis pigmentosa

The purpose of the study was to improve the visual functioning of people with restriction in contrast sensitivity (CS), such as retinitis pigmentosa (RP), by means of a visual training program. Twenty-six volunteers with RP participated, distributed in two groups: 15 who made up the experimental group (who received the training program) and 11 who participated as a control group (without training). Participants were evaluated before beginning training, on completion, and 3 mo following completion for CS with the Pelli-Robson Contrast Sensitivity (P&R) test, visual functioning with the Visual Function Questionnaire (VFQ), and in emotional state with the Beck Depression Inventory (BDI). The training program is based on software that generates luminous stimuli of varying duration and intensity and registers the stimuli perceived by the subject. The outcomes showed significant differences posttraining in the experimental group in depression (F1,14 = 5.42; p < 0.04), VFQ (Z = -2.27; p < 0.02), and P&R in the right eye (Z = -1.99; p < 0.046) and left eye (Z = -2.30; p < 0.02) but not in binocular (Z = -0.96; p < 0.34). The outcomes showed that the experimental group made significant progress in all variables and these effects remained after 3 mo, which suggests that the program could be a helpful addition to RP rehabilitation and help mitigate the damage.

Homonymous hemianopia: challenges and solutions

Stroke is the most common cause of homonymous hemianopia (HH) in adults, followed by trauma and tumors. Associated signs and symptoms, as well as visual field characteristics such as location and congruity, can help determine the location of the causative brain lesion. HH can have a significant effect on quality of life, including problems with driving, reading, or navigation. This can result in decreased independence, inability to enjoy leisure activities, and injuries. Understanding these restrictions, as well as the management options, can aid in making the best use of remaining vision. Treatment options include prismatic correction to expand the remaining visual field, compensatory training to improve visual search abilities, and vision restoration therapy to improve the vision itself. Spontaneous recovery can occur within the first months. However, because spontaneous recovery does not always occur, methods of reducing visual disability play an important role in the rehabilitation of patients with HH.

Vision and agility training in community dwelling older adults: incorporating visual training into programs for fall prevention

This study aimed to examine the effect of visual training on obstacle course performance of independent community dwelling older adults. Agility is the ability to rapidly alter ongoing motor patterns, an important aspect of mobility which is required in obstacle avoidance. However, visual information is also a critical factor in successful obstacle avoidance. We compared obstacle course performance of a group that trained in visually driven body movements and agility drills, to a group that trained only in agility drills. We also included a control group that followed the American College of Sports Medicine exercise recommendations for older adults. Significant gains in fitness, mobility and power were observed across all training groups. Obstacle course performance results revealed that visual training had the greatest improvement on obstacle course performance (22%) following a 12 week training program. These results suggest that visual training may be an important consideration for fall prevention programs.

Increased sensitivity after repeated stimulation of residual spatial channels in blindsight

Lesions of the occipital cortex result in areas of cortical blindness affecting the corresponding regions of the patient's visual field. The traditional view is that, aside from some spontaneous recovery in the first few months after the damage, when acute effects have subsided the areas of blindness are absolute and permanent. It has been found, however, that within such field defects some residual visual capacities may persist in the absence of acknowledged awareness by the subject (blindsight type 1) or impaired awareness (type 2). Neuronal pathways mediating blindsight have a specific and narrow spatial and temporal bandwidth. A group of cortically blind patients (n = 12) carried out a daily detection "training" task over a 3-month period, discriminating grating visual stimuli optimally configured for blindsight from homogeneous luminance-matched stimuli. No feedback was given during the training. Assessment of training was by psychophysical measurements carried out before and after training and included detection of a range of spatial frequencies (0.5-7 cycles per degree), contrast detection at 1 cycle per degree, clinical perimetry, and subjective estimates of visual field defect. The results show that repeated stimulation by appropriate visual stimuli can result in improvements in visual sensitivities in the very depths of the field defect.