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Visual function in anterior ischemic optic neuropathy: effect of Vision Restoration Therapy--a pilot study.

Jung CS, Bruce B, Newman NJ, Biousse V

Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.

OBJECTIVE: To evaluate the effects of Vision Restoration Therapy (VRT) on the visual function of patients with anterior ischemic optic neuropathy. DESIGN: Randomized controlled double-blind pilot trial. PATIENTS: 10 patients with stable anterior ischemic optic neuropathy (AION). INTERVENTION: All patients were evaluated before VRT and after 3 and 6 months of treatment by Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, contrast sensitivity, reading speed, 24-2 SITA-standard Humphrey visual field (HVF), High Resolution Perimetry (HRP) (perimetry obtained during VRT), and vision-based quality of life questionnaire. Patients were randomized between two VRT strategies (5 in each group): I) VRT in which stimulation was performed in the seeing VF of the affected eye ("seeing field-VRT"); II) VRT in which stimulation was performed along the area of central fixation and in the ARV (areas of residual vision) of the affected eye ("ARV-VRT"). MAIN OUTCOME MEASURES: The results of the HRP, HVF, and clinical assessment of visual function were compared for each patient and between the two groups at each evaluation. RESULTS: Visual acuity qualitatively improved in the ARV-VRT group, however the change was not statistically significant (p=0.28). Binocular reading speed significantly improved in the ARV-VRT group (p=0.03). HVF foveal sensitivity increased mildly in both groups (p=0.059). HRP analysis showed a similar increase in stimulus accuracy in both groups (mean improvement of about 15%). All patients reported functional improvement after VRT. CONCLUSIONS: Despite a small sample, the study showed a trend toward improvement of visual function in the ARV-VRT group. Improvement of HRP in both groups may reflect diffusely increased visual attention (neuronal activation), or improvement of an underlying sub-clinical abnormality in the "seeing" visual field of patients with optic neuropathies.

Published 24 March 2008 in J Neurol Sci, 268(1): 145-9.
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