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Asher JM, Hibbard PB. Visual Field Loss: Integrating Overlayed Information to Increase the Effective Field of View. VISION (BASEL, SWITZERLAND) 2022; 6:vision6040067. [PMID: 36412648 PMCID: PMC9680509 DOI: 10.3390/vision6040067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Visual field loss is a debilitating impairment that can impact normal daily activities. The advancement of augmented and virtual realities brings opportunities for potential substitutive technologies for visual field loss. Here we outline a conceptual approach to increasing the amount of useful information by overlaying the blind field into the sighted field. In this proof-of-concept experiment, 33 observers were allocated to either a left or right blind condition (with a simulated scotoma). All observers completed a line bisection task in all three conditions (baseline, scotoma, manipulation), with the baseline condition always completed first. The scotoma condition (baseline with the addition of a simulated scotoma) and the manipulated condition (baseline with the addition of a simulated scotoma, and a "minified window overlay") were randomised in order of presentation. Predictably, our results show that a simulated scotoma impaired performance on the task. However, observers were able to make use the overlay to improve their estimation of the line's midpoint. Our results show that a substitutive augmentation of this type improved accuracy in estimating the midpoint of a line with a (simulated) scotoma.
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Mena-Garcia L, Pastor-Jimeno JC, Maldonado MJ, Coco-Martin MB, Fernandez I, Arenillas JF. Multitasking Compensatory Saccadic Training Program for Hemianopia Patients: A New Approach With 3-Dimensional Real-World Objects. Transl Vis Sci Technol 2021; 10:3. [PMID: 34003888 PMCID: PMC7873505 DOI: 10.1167/tvst.10.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/25/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine whether a noncomputerized multitasking compensatory saccadic training program (MCSTP) for patients with hemianopia, based on a reading regimen and eight exercises that recreate everyday visuomotor activities using three-dimensional (3D) real-world objects, improves the visual ability/function, quality of life (QL), and functional independence (FI). Methods The 3D-MCSTP included four in-office visits and two customized home-based daily training sessions over 12 weeks. A quasiexperimental, pretest/posttest study design was carried out with an intervention group (IG) (n = 20) and a no-training group (NTG) (n = 20) matched for age, hemianopia type, and brain injury duration. Results The groups were comparable for the main baseline variables and all participants (n = 40) completed the study. The IG mainly showed significant improvements in visual-processing speed (57.34% ± 19.28%; P < 0.0001) and visual attention/retention ability (26.67% ± 19.21%; P < 0.0001), which also were significantly greater (P < 0.05) than in the NTG. Moreover, the IG showed large effect sizes (Cohen's d) in 75% of the total QL and FI dimensions analyzed; in contrast to the NTG that showed negligible mean effect sizes in 96% of these dimensions. Conclusions The customized 3D-MCSTP was associated with a satisfactory response in the IG for improving complex visual processing, QL, and FI. Translational Relevance Neurovisual rehabilitation of patients with hemianopia seems more efficient when programs combine in-office visits and customized home-based training sessions based on real objects and simulating real-life conditions, than no treatment or previously reported computer-screen approaches, probably because of better stimulation of patients´ motivation and visual-processing speed brain mechanisms.
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Affiliation(s)
- Laura Mena-Garcia
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
| | - Jose C. Pastor-Jimeno
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel J. Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Eye Institute, Universidad de Valladolid, Valladolid, Spain
- Universidad de Valladolid, Valladolid, Spain
- Red Temática de Investigación Colaborativa en Oftalmología (OftaRed), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria B. Coco-Martin
- Universidad de Valladolid, Valladolid, Spain
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Itziar Fernandez
- Universidad de Valladolid, Valladolid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Juan F. Arenillas
- Universidad de Valladolid, Valladolid, Spain
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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van Nispen RMA, Virgili G, Hoeben M, Langelaan M, Klevering J, Keunen JEE, van Rens GHMB. Low vision rehabilitation for better quality of life in visually impaired adults. Cochrane Database Syst Rev 2020; 1:CD006543. [PMID: 31985055 PMCID: PMC6984642 DOI: 10.1002/14651858.cd006543.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Low vision rehabilitation aims to optimise the use of residual vision after severe vision loss, but also aims to teach skills in order to improve visual functioning in daily life. Other aims include helping people to adapt to permanent vision loss and improving psychosocial functioning. These skills promote independence and active participation in society. Low vision rehabilitation should ultimately improve quality of life (QOL) for people who have visual impairment. OBJECTIVES To assess the effectiveness of low vision rehabilitation interventions on health-related QOL (HRQOL), vision-related QOL (VRQOL) or visual functioning and other closely related patient-reported outcomes in visually impaired adults. SEARCH METHODS We searched relevant electronic databases and trials registers up to 18 September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs) investigating HRQOL, VRQOL and related outcomes of adults, with an irreversible visual impairment (World Health Organization criteria). We included studies that compared rehabilitation interventions with active or inactive control. DATA COLLECTION AND ANALYSIS We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We included 44 studies (73 reports) conducted in North America, Australia, Europe and Asia. Considering the clinical diversity of low vision rehabilitation interventions, the studies were categorised into four groups of related intervention types (and by comparator): (1) psychological therapies and/or group programmes, (2) methods of enhancing vision, (3) multidisciplinary rehabilitation programmes, (4) other programmes. Comparators were no care or waiting list as an inactive control group, usual care or other active control group. Participants included in the reported studies were mainly older adults with visual impairment or blindness, often as a result of age-related macular degeneration (AMD). Study settings were often hospitals or low vision rehabilitation services. Effects were measured at the short-term (six months or less) in most studies. Not all studies reported on funding, but those who did were supported by public or non-profit funders (N = 31), except for two studies. Compared to inactive comparators, we found very low-certainty evidence of no beneficial effects on HRQOL that was imprecisely estimated for psychological therapies and/or group programmes (SMD 0.26, 95% CI -0.28 to 0.80; participants = 183; studies = 1) and an imprecise estimate suggesting little or no effect of multidisciplinary rehabilitation programmes (SMD -0.08, 95% CI -0.37 to 0.21; participants = 183; studies = 2; I2 = 0%); no data were available for methods of enhancing vision or other programmes. Regarding VRQOL, we found low- or very low-certainty evidence of imprecisely estimated benefit with psychological therapies and/or group programmes (SMD -0.23, 95% CI -0.53 to 0.08; studies = 2; I2 = 24%) and methods of enhancing vision (SMD -0.19, 95% CI -0.54 to 0.15; participants = 262; studies = 5; I2 = 34%). Two studies using multidisciplinary rehabilitation programmes showed beneficial but inconsistent results, of which one study, which was at low risk of bias and used intensive rehabilitation, recorded a very large and significant effect (SMD: -1.64, 95% CI -2.05 to -1.24), and the other a small and uncertain effect (SMD -0.42, 95%: -0.90 to 0.07). Compared to active comparators, we found very low-certainty evidence of small or no beneficial effects on HRQOL that were imprecisely estimated with psychological therapies and/or group programmes including no difference (SMD -0.09, 95% CI -0.39 to 0.20; participants = 600; studies = 4; I2 = 67%). We also found very low-certainty evidence of small or no beneficial effects with methods of enhancing vision, that were imprecisely estimated (SMD -0.09, 95% CI -0.28 to 0.09; participants = 443; studies = 2; I2 = 0%) and multidisciplinary rehabilitation programmes (SMD -0.10, 95% CI -0.31 to 0.12; participants = 375; studies = 2; I2 = 0%). Concerning VRQOL, low-certainty evidence of small or no beneficial effects that were imprecisely estimated, was found with psychological therapies and/or group programmes (SMD -0.11, 95% CI -0.24 to 0.01; participants = 1245; studies = 7; I2 = 19%) and moderate-certainty evidence of small effects with methods of enhancing vision (SMD -0.24, 95% CI -0.40 to -0.08; participants = 660; studies = 7; I2 = 16%). No additional benefit was found with multidisciplinary rehabilitation programmes (SMD 0.01, 95% CI -0.18 to 0.20; participants = 464; studies = 3; I2 = 0%; low-certainty evidence). Among secondary outcomes, very low-certainty evidence of a significant and large, but imprecisely estimated benefit on self-efficacy or self-esteem was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -0.85, 95% CI -1.48 to -0.22; participants = 456; studies = 5; I2 = 91%). In addition, very low-certainty evidence of a significant and large estimated benefit on depression was found for psychological therapies and/or group programmes versus waiting list or no care (SMD -1.23, 95% CI -2.18 to -0.28; participants = 456; studies = 5; I2 = 94%), and moderate-certainty evidence of a small benefit versus usual care (SMD -0.14, 95% CI -0.25 to -0.04; participants = 1334; studies = 9; I2 = 0%). ln the few studies in which (serious) adverse events were reported, these seemed unrelated to low vision rehabilitation. AUTHORS' CONCLUSIONS In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the included studies on low vision rehabilitation had a short follow-up, Despite these limitations, the consistent direction of the effects in this review towards benefit justifies further research activities of better methodological quality including longer maintenance effects and costs of several types of low vision rehabilitation. Research on the working mechanisms of components of rehabilitation interventions in different settings, including low-income countries, is also needed.
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Affiliation(s)
- Ruth MA van Nispen
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Gianni Virgili
- University of FlorenceDepartment of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA)Largo Palagi, 1FlorenceItaly50134
| | - Mirke Hoeben
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
| | - Maaike Langelaan
- Netherlands institute for health services, NIVEL researchP.O. Box 1568UtrechtNetherlands3500 BN
| | - Jeroen Klevering
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Jan EE Keunen
- Radboud University Medical CenterDepartment of OphthalmologyNijmegenNetherlands
| | - Ger HMB van Rens
- Amsterdam University Medical Centers, Vrije UniversiteitDepartment of Ophthalmology, Amsterdam Public Health research instituteAmsterdamNetherlands
- Elkerliek HospitalDepartment of OphthalmologyHelmondNetherlands
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Pollock A, Hazelton C, Rowe FJ, Jonuscheit S, Kernohan A, Angilley J, Henderson CA, Langhorne P, Campbell P. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev 2019; 5:CD008388. [PMID: 31120142 PMCID: PMC6532331 DOI: 10.1002/14651858.cd008388.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both. OBJECTIVES To determine the effects of interventions for people with visual field defects after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and PDQT Databse, and clinical trials databases, including ClinicalTrials.gov and WHO Clinical Trials Registry, to May 2018. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts. SELECTION CRITERIA Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events, and death. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS Twenty studies (732 randomised participants, with data for 547 participants with stroke) met the inclusion criteria for this review. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses. Only two of these eight studies presented data relating to our primary outcome of functional abilities in activities of daily living. One study reported evidence relating to adverse events.Three studies (88 participants) compared a restitutive intervention with a control, but data were only available for one study (19 participants). There was very low-quality evidence that visual restitution therapy had no effect on visual field outcomes, and a statistically significant effect on quality of life, but limitations with these data mean that there is insufficient evidence to draw any conclusions about the effectiveness of restitutive interventions as compared to control.Four studies (193 participants) compared the effect of scanning (compensatory) training with a control or placebo intervention. There was low-quality evidence that scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (two studies, 96 participants, mean difference (MD) 9.36, 95% confidence interval (CI) 3.10 to 15.62). However, there was low or very-low quality evidence of no effect on measures of visual field, extended activities of daily living, reading, and scanning ability. There was low-quality evidence of no significant increase in adverse events in people doing scanning training, as compared to no treatment.Three studies (166 participants) compared a substitutive intervention (a type of prism) with a control. There was low or very-low quality evidence that prisms did not have an effect on measures of activities of daily living, extended activities of daily living, reading, falls, or quality of life, and very low-quality evidence that they may have an effect on scanning ability (one study, 39 participants, MD 9.80, 95% CI 1.91 to 17.69). There was low-quality evidence of an increased odds of an adverse event (primarily headache) in people wearing prisms, as compared to no treatment.One study (39 participants) compared the effect of assessment by an orthoptist to standard care (no assessment) and found very low-quality evidence that there was no effect on measures of activities of daily living.Due to the quality and quantity of evidence, we remain uncertain about the benefits of assessment interventions. AUTHORS' CONCLUSIONS There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events.
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Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 6th Floor, Govan Mbeki Building, Cowcaddens Road, Glasgow, UK, G4 0BA
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Visual Function Questionnaire as an outcome measure for homonymous hemianopia: subscales and supplementary questions, analysis from the VISION trial. Eye (Lond) 2019; 33:1485-1493. [PMID: 30996338 DOI: 10.1038/s41433-019-0441-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We conduct supplementary analyses of the NEI VFQ-25 data to evaluate where changes occurred within subscales of the NEI VFQ-25 leading to change in the composite scores between the three treatment arms, and evaluate the NEI VFQ-25 with and without the Neuro 10 supplement. METHODS A prospective, multicentre, parallel, single-blind, three-arm RCT of fourteen UK acute stroke units was conducted. Stroke survivors with homonymous hemianopia were recruited. Interventions included: Fresnel prisms for minimum 2 h, 5 days/week over 6-weeks (Arm a), Visual search training for minimum 30 min, 5 days/week over 6-weeks (Arm b) and standard care-information only (Arm c). Primary and secondary outcomes (including NEI VFQ-25 data) were measured at baseline, 6, 12 and 26 weeks after randomisation. RESULTS Eighty seven patients were recruited (69% male; mean age (SD) equal to 69 (12) years). At 26 weeks, outcomes for 24, 24 and 22 patients, respectively, were compared to baseline. NEI VFQ-25 (with and without Neuro 10) responses improved from baseline to 26 weeks with visual search training compared to Fresnel prisms and standard care. In subscale analysis, the most impacted across all treatment arms was 'driving' whilst the least impacted were 'colour vision' and 'ocular pain'. CONCLUSIONS Composite scores differed systematically for the NEI VFQ-25 (Neuro 10) versus NEI VFQ-25 at all time points. For subscale scores, descriptive statistics suggest clinically relevant improvement in distance activities and vision-specific dependency subscales for NEI VFQ-25 scores in the visual search treatment arm. TRIAL REGISTRATION Current Controlled Trials ISRCTN05956042.
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Fontenot JL, Bona MD, Kaleem MA, McLaughlin WM, Morse AR, Schwartz TL, Shepherd JD, Jackson ML. Vision Rehabilitation Preferred Practice Pattern®. Ophthalmology 2018; 125:P228-P278. [DOI: 10.1016/j.ophtha.2017.09.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022] Open
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Bowers AR, Dickinson C, Peli E. Comments about outcome measures for clinical trials of interventions for post-stroke patients with hemianopia. Acta Neurol Scand 2017; 136:548-550. [PMID: 28980309 DOI: 10.1111/ane.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. R. Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear; Harvard Medical School; Boston MA USA
| | - C. Dickinson
- Division of Pharmacy and Optometry; School of Heath Sciences; Faculty of Biology, Medicine and Health; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
| | - E. Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear; Harvard Medical School; Boston MA USA
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García- Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. Choice of outcome measures for the VISION pilot trial of interventions for hemianopia. Acta Neurol Scand 2017; 136:551-553. [PMID: 28980307 DOI: 10.1111/ane.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | | | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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Rowe FJ, Conroy EJ, Bedson E, Cwiklinski E, Drummond A, García-Fiñana M, Howard C, Pollock A, Shipman T, Dodridge C, MacIntosh C, Johnson S, Noonan C, Barton G, Sackley C. A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia. Acta Neurol Scand 2017; 136:310-321. [PMID: 28028819 DOI: 10.1111/ane.12725] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). METHODS Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. PARTICIPANTS Stroke survivors with homonymous hemianopia. INTERVENTIONS Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). INCLUSION CRITERIA Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. OUTCOMES Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. RANDOMIZATION Randomization block lists stratified by site and partial/complete hemianopia. BLINDING Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. RESULTS Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). CONCLUSIONS No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation.
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Affiliation(s)
- F. J. Rowe
- Department of Health Services Research; University of Liverpool; Liverpool UK
| | - E. J. Conroy
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - E. Bedson
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - E. Cwiklinski
- Clinical Trials Research Unit; University of Liverpool; Liverpool UK
| | - A. Drummond
- School of Health Sciences; University of Nottingham; Nottingham UK
| | - M. García-Fiñana
- Department of Biostatistics; University of Liverpool; Liverpool UK
| | - C. Howard
- Department of Orthoptics; Salford Royal NHS Foundation Trust; Manchester UK
| | - A. Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit; Glasgow Caledonian University; Glasgow UK
| | - T. Shipman
- Department of Orthoptics; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK
| | - C. Dodridge
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - C. MacIntosh
- Department of Orthoptics; Oxford University Hospitals NHS Trust; Oxford UK
| | - S. Johnson
- Eye Clinic Impact Team; Royal National Institute for the Blind; Birmingham UK
| | - C. Noonan
- Department of Ophthalmology; Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - G. Barton
- Department of Elderly Care; Warrington and Halton Hospitals NHS Foundation Trust; Warrington UK
| | - C. Sackley
- Division of Health and Social Care; King's College; London UK
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Hanna KL, Hepworth LR, Rowe FJ. The treatment methods for post-stroke visual impairment: A systematic review. Brain Behav 2017; 7:e00682. [PMID: 28523224 PMCID: PMC5434187 DOI: 10.1002/brb3.682] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 12/23/2022] Open
Abstract
AIM To provide a systematic overview of interventions for stroke related visual impairments. METHOD A systematic review of the literature was conducted including randomized controlled trials, controlled trials, cohort studies, observational studies, systematic reviews, and retrospective medical note reviews. All languages were included and translation obtained. This review covers adult participants (aged 18 years or over) diagnosed with a visual impairment as a direct cause of a stroke. Studies which included mixed populations were included if over 50% of the participants had a diagnosis of stroke and were discussed separately. We searched scholarly online resources and hand searched articles and registers of published, unpublished, and ongoing trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Article selection was performed by two authors independently. Data were extracted by one author and verified by a second. The quality of the evidence and risk of bias was assessed using appropriate tools dependant on the type of article. RESULTS Forty-nine articles (4142 subjects) were included in the review, including an overview of four Cochrane systematic reviews. Interventions appraised included those for visual field loss, ocular motility deficits, reduced central vision, and visual perceptual deficits. CONCLUSION Further high quality randomized controlled trials are required to determine the effectiveness of interventions for treating post-stroke visual impairments. For interventions which are used in practice but do not yet have an evidence base in the literature, it is imperative that these treatments be addressed and evaluated in future studies.
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Affiliation(s)
- Kerry Louise Hanna
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
| | | | - Fiona J. Rowe
- Department of Health Services ResearchUniversity of LiverpoolLiverpoolUK
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Rowe FJ, Conroy EJ, Barton PG, Bedson E, Cwiklinski E, Dodridge C, Drummond A, Garcia-Finana M, Howard C, Johnson S, MacIntosh C, Noonan CP, Pollock A, Rockliffe J, Sackley CM, Shipman T. A Randomised Controlled Trial of Treatment for Post-Stroke Homonymous Hemianopia: Screening and Recruitment. Neuroophthalmology 2016; 40:1-7. [PMID: 27928375 DOI: 10.3109/01658107.2015.1126288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/13/2022] Open
Abstract
The authors report the screening process and recruitment figures for the VISION (Visual Impairment in Stroke; Intervention Or Not) trial. This is a prospective, randomised, single-blinded, three-arm controlled trial in 14 UK acute hospital stroke units. Stroke teams identified stroke survivors suspected as having homonymous hemianopia. Interventions included Fresnel prisms versus visual search training versus standard care (information only). Primary outcome was change in visual field assessment from baseline to 26 weeks. Secondary measures included change in quality-of-life questionnaires. Recruitment opened in May 2011. A total of 1171 patients were screened by the local principal investigators. Of 1171 patients, 178 (15.2%) were eligible for recruitment: 87 patients (7.4%) provided consent and were recruited; 91 patients (7.8%) did not provide consent, and 993 of 1171 patients (84.8%) failed to meet the eligibility criteria. Almost half were excluded due to complete/partial recovery of hemianopia (43.6%; n = 511). The most common ineligibility reason was recovery of hemianopia. When designing future trials in this area, changes in eligibility criteria/outcome selection to allow more patients to be recruited should be considered, e.g., less stringent levels of visual acuity/refractive error. Alternative outcomes measurable in the home environment, rather than requiring hospital attendance for follow-up, could facilitate increased recruitment.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool , Liverpool, UK
| | | | - P Graham Barton
- Department of Elderly Care, Warrington and Halton Hospitals NHS Foundation Trust , Warrington, UK
| | - Emma Bedson
- Clinical Trials Research Centre, University of Liverpool , Liverpool, UK
| | - Emma Cwiklinski
- Clinical Trials Research Centre, University of Liverpool , Liverpool, UK
| | - Caroline Dodridge
- Department of Orthoptics, Oxford University Hospitals NHS Trust , Oxford, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham , Nottingham, UK
| | | | - Claire Howard
- Department of Orthoptics, Salford Royal NHS Foundation Trust , Manchester, UK
| | - Stevie Johnson
- Eye Clinic Impact Team, Royal National Institute for the Blind , Birmingham, UK
| | - Claire MacIntosh
- Department of Orthoptics, Oxford University Hospitals NHS Trust , Oxford, UK
| | - Carmel P Noonan
- Department of Ophthalmology, Aintree University Hospital NHS Foundation Trust , Liverpool, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University , Glasgow, UK
| | | | | | - Tracey Shipman
- Department of Orthoptics, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
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