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Giovanni Sato, Gianfrancesco Villani, Elisabetta Piccolo, Federica Tiso; Modified Visiocoach training in Hemianopia. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4132.
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Explorative saccade training proved to selectively improve saccadic behavior, natural search, and scene exploration on the blind side of hemianopic patients (Roth T, 2009). We evaluated the acceptance of this type of training (VisioCoach) by patients referred to our low-vision practice, and the outcome of a modified training protocol
Nine patients with hemianopia and no hemineglect were enrolled. The types of VF defects were: 6 left hemianopias, 1 left hemianopia with a macular right-sided scotoma, 2 right hemianopias. Evaluation included Humphrey VF Test 30-2, ETDRS VA, Greene Test, Pelli-Robson CS, binocular reading performance (MN Read, SK Read, IReST), MP-1 microperimetry, and video-recording of eye movements. Standard daily self-training with VisioCoach at home was proposed to all patients (www.visiocoach.de).However,if this was not accepted by the patient, a modified training protocol was put into effect: one supervised VISIOcoach session per week at the low vision clinic, for 8 weeks.Compliance to the schedule was a measure for the acceptance of the intervention
Age median was 43 years (20-84), VA 20/25 (20/20-20/60), log CS 1.5 (1.95-1.35). All patients declined self daily training but accepted the modified protocol. Attended training sessions average was 6.4, median 8, range 3-8. MN READ minimum print size (MPS) median was 0.8 M (0.8-3.2), errors median 0 (0-1). SK READ MPS was 0.8 M (0.8-3.2), errors 6 (0-14). SK READ error (side) pattern matched with the hemianopia side in 5 patients, did not in 2, and was not determinable in 2 (who made no reading error). IReST reading time median (range) was 97 sec (49-476). All reading tests scores did not differ significantly after training (p>0.05). Noticeably, the patient who scored the least at referral improved by about 50% on all tests. Head and eye movements (qualitative assessment) improved in all patients in terms of head position, saccade amplitude and gaze direction towards the blind hemifield.Greene Test improved.
Supervised office-based reduced-frequency Visiocoach training can be more acceptable for some patients than standard daily training. Reading errors could be related to the blind hemifield only on SK READ, as there was almost no error on MN READ. Reading errors on the same side of the VF defect would indicate a fixed gaze, or a delay in performing the compensatory saccade to the blind side
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