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A Schreiber, R Vonthein, J Reinhard, S Trauzettel-Klosinski, BA Sabel, E Kasten, S Kenkel, C Connert, U Schiefer; Visual Restitution Training (VRT) in Patients With Homonymous Field Defects. Evaluation With Static Suprathreshold Automated Perimetry by Using Tuebingen Automated Perimeter (TAP) . Invest. Ophthalmol. Vis. Sci. 2002;43(13):230.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the results of visual restitution training (VRT) in patients with homonymous field defects (VFDs) using the Tuebingen Automated Perimeter 30°. Methods: We examined 17 patients with homonymous VFDs before and after VRT with threshold oriented, slightly supraliminal static automated grid perimetry using Tuebingen Automated Perimeter (30° TAP, 191 test locations, central stimulus condensation). Patients (11 female, 6 male) were between 23 and 73 years old and all had stable homonymous VFDs caused by cerebral ischemia or haemorrhage more than one year ago. The patients carried out VRT daily for one hour over a period of six months. The training task requires patients to respond to target stimuli frequently located in the transition zone between intact and defect visual field by pressing a key while fixating a central target. The training parameters were regularly adjusted to the individual pattern of residual vision for each patient. The training effect was investigated by ANCOVA of absolute TAP defects after training by baseline and training. Results: In the central 30° visual field we found an improvement in 11 of 17 patients´ right eyes and in 10 of the left eyes. Visual fields of 5 of 17 patients remained stable in the right and 3 in the left eye; 1 patient got worse in the right and 4 in the left eye. Improvement was seen especially in patients with homonymous sector-like VFDs, while patients with total homonymous hemianopia and with very small defects showed no effects. In most cases the alterations were subtle with regard to absolute defects in TAP 30°: on average 8 of 191 loci improved. It is currently unclear to what extent fixations shifts contribute to apparent visual field changes. Conclusion: The effects of the VRT showed in the majority of patients with homonymous VFDs a slight reduction of absolute defects according to TAP. To what extent fixation instability or spontaneous fixation shifts contribute to these improvements was additionally explored by a special microperimetric technique using the SLO (Reinhard J. et al., subm. to ARVO 02). Further analysis of VRT on relative homonymous VFDs is necessary. The improvement with regard to subjective self-reports of patients (Sabel B.A. et al., subm. to ARVO 02) may be due to other factors than visual field change, e.g. improvement in exploration strategies.
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