Visual discrimination training improves Humphrey perimetry in chronic cortically induced blindness.
Visual discrimination training improves Humphrey perimetry in chronic cortically induced blindness.
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DOI：
10.1212/wnl.0000000000003921
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发表时间：
2017-05-09
期刊：
影响因子：
9.9
通讯作者：
Huxlin KR
中科院分区：
文献类型：
--
作者：
Cavanaugh MR;Huxlin KR
目的：评估视觉辨别训练是否能改善视皮层受累的慢性中风患者的视野检查成绩。对17例慢性皮质盲卒中患者视觉辨别训练前后的24-2和10-2 Humphrey视野进行了分析，并与5名未经训练的皮质盲人对照进行了比较。受过训练的患者在不重叠的盲野位置进行方向辨别或方向辨别，或两者兼而有之。所有训练前和训练后的辨别表现和汉弗莱领域都通过在线眼球跟踪收集，确保呈现与凝视有关的刺激。受过训练的患者平均视力恢复∼108度2，而未受过训练的患者自发地改善了∼16度2。改善不受患者年龄、病变时间、初始缺陷大小或训练类型的影响，但与所进行的训练量成正比。未经训练的患者在其视野的∼9度以上的敏感度恶化抵消了他们的改善。在训练有素的患者中，病情恶化的程度很小。最后，尽管所有受训地点的辨别能力都有所改善，但汉弗莱敏感度的变化在受训地区内外都发生了，并沿着盲区边界延伸到更大的区域。在患有慢性皮质视力障碍的成年人中，盲区边界似乎具有增强的可塑性，这可以通过凝视控制的视觉辨别训练来招募，以扩大可见视野。我们的发现强调了未来研究的迫切需要，以衡量视力恢复方法对更大患者队列中视野检查的影响。
To assess if visual discrimination training improves performance on visual perimetry tests in chronic stroke patients with visual cortex involvement. 24-2 and 10-2 Humphrey visual fields were analyzed for 17 chronic cortically blind stroke patients prior to and following visual discrimination training, as well as in 5 untrained, cortically blind controls. Trained patients practiced direction discrimination, orientation discrimination, or both, at nonoverlapping, blind field locations. All pretraining and posttraining discrimination performance and Humphrey fields were collected with online eye tracking, ensuring gaze-contingent stimulus presentation. Trained patients recovered ∼108 degrees2 of vision on average, while untrained patients spontaneously improved over an area of ∼16 degrees2. Improvement was not affected by patient age, time since lesion, size of initial deficit, or training type, but was proportional to the amount of training performed. Untrained patients counterbalanced their improvements with worsening of sensitivity over ∼9 degrees2 of their visual field. Worsening was minimal in trained patients. Finally, although discrimination performance improved at all trained locations, changes in Humphrey sensitivity occurred both within trained regions and beyond, extending over a larger area along the blind field border. In adults with chronic cortical visual impairment, the blind field border appears to have enhanced plastic potential, which can be recruited by gaze-controlled visual discrimination training to expand the visible field. Our findings underscore a critical need for future studies to measure the effects of vision restoration approaches on perimetry in larger cohorts of patients.