Efficacy of Visual Retraining in the Hemianopic Field after Stroke Results of a Randomized Clinical Trial
Efficacy of Visual Retraining in the Hemianopic Field after Stroke Results of a Randomized Clinical Trial
复制标题
DOI：
10.1016/j.ophtha.2020.11.020
复制
发表时间：
2021-06-18
期刊：
影响因子：
13.7
通讯作者：
Feldon, Steven E.
中科院分区：
文献类型：
--
作者：
Cavanaugh, Matthew R.;Blanchard, Lisa M.;Feldon, Steven E.
目的：评估运动辨别训练作为一种潜在的治疗中风引起的偏盲性视野defics.Design：临床试验。Participants：48例中风引起的同侧偏盲（HH）患者随机分为2个训练组：干预和对照。患者年龄在21岁和75岁之间，并没有表现出眼部问题presentation.Methods：患者接受了训练的运动歧视任务，以前证明，以减少视野缺损，但不是在一个随机的临床试验。患者随机平均分配接受训练，无论是在他们的视力或缺陷的视野。训练在家中进行6个月，包括每天在单一位置重复视觉辨别20至30分钟。研究工作人员和患者对培训类型设盲。训练前后的测试是相同的，包括Humphrey视野（Carl Zeiss Meditech）、黄斑完整性评估视野检查、OCT、运动辨别性能和视觉生活质量问卷。主要结果测量：主要结果测量是双眼Humphrey视野分析仪上视野平均偏差（PMD）的变化。在接受过缺陷训练的患者中，平均PMD在6个月内有所改善（右眼平均变化为0.58 dB; 95%置信区间为0.07-1.08 dB;左眼平均变化为0.84 dB; 95%置信区间为0.22-1.47 dB）。在视力训练的患者中没有观察到改善（右眼的平均变化，0.12 dB; 95%置信区间，-0.38至0.62 dB;左眼的平均变化，0.10 dB; 95%置信区间，-0.52至0.72 dB）。然而，没有发现替代训练方法之间的显着差异（右眼，P = 0.19;左眼，P = 0.10）。结论：迄今为止，没有广泛接受的治疗HH。本研究评估了一种有前途的潜在治疗方法--视知觉训练的疗效。我们没有发现在家庭环境中进行的缺陷领域内的治疗训练和控制训练的视野内的差异。(C)2020年美国眼科学会
Purpose: To evaluate the efficacy of motion discrimination training as a potential therapy for stroke-induced hemianopic visual field defects.Design: Clinical trial.Participants: Forty-eight patients with stroke-induced homonymous hemianopia (HH) were randomized into 2 training arms: intervention and control. Patients were between 21 and 75 years of age and showed no ocular issues at presentation.Methods: Patients were trained on a motion discrimination task previously evidenced to reduce visual field deficits, but not in a randomized clinical trial. Patients were randomized with equal allocation to receive training in either their sighted or deficit visual fields. Training was performed at home for 6 months, consisting of repeated visual discriminations at a single location for 20 to 30 minutes daily. Study staff and patients were masked to training type. Testing before and after training was identical, consisting of Humphrey visual fields (Carl Zeiss Meditech), macular integrity assessment perimetry, OCT, motion discrimination performance, and visual quality-of-life questionnaires.Main Outcome Measures: Primary outcome measures were changes in perimetric mean deviation (PMD) on Humphrey Visual Field Analyzer in both eyes.Results: Mean PMDs improved over 6 months in deficit-trained patients (mean change in the right eye, 0.58 dB; 95% confidence interval, 0.07-1.08 dB; mean change in the left eye 0.84 dB; 95% confidence interval, 0.22-1.47 dB). No improvement was observed in sighted-trained patients (mean change in the right eye, 0.12 dB; 95% confidence interval, -0.38 to 0.62 dB; mean change in the left eye, 0.10 dB; 95% confidence interval, -0.52 to 0.72 dB). However, no significant differences were found between the alternative training methods (right eye, P = 0.19; left eye, P = 0.10).Conclusions: To date, no widely accepted therapy is available to treat HH. This study evaluated the efficacy of a promising potential treatment, visual perceptual training. We failed to find a difference between treatment training within the deficit field and control training within the sighted field when performed in a home environment. (C) 2020 by the American Academy of Ophthalmology