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

J Neurol Sci. 2008 May 15;268(1-2):145-9. doi: 10.1016/j.jns.2007.12.001. Epub 2008 Jan 22.


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.

Trial registration: NCT00140491.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Contrast Sensitivity / physiology*
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Optic Neuropathy, Ischemic / physiopathology
  • Optic Neuropathy, Ischemic / psychology
  • Optic Neuropathy, Ischemic / rehabilitation*
  • Photic Stimulation / methods*
  • Pilot Projects
  • Quality of Life
  • Surveys and Questionnaires
  • Therapy, Computer-Assisted / methods*
  • Visual Acuity / physiology*
  • Visual Field Tests / methods
  • Visual Fields / physiology*

Associated data