Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany.
Restor Neurol Neurosci. 1995 Jan 1;8(3):113-27. doi: 10.3233/RNN-1995-8302.
Brain damage is often accompanied by homonymous hemianopia, but few therapeutic approaches exist for visual field deficits. In this open pilot study we describe a computerized training program which may possibly reduce the size of the 'blind' visual field in patients with homonymous visual field deficits. Various stimuli to test light perception and discrimination of colors and shapes were presented on a monitor which permitted the examination or training of the central section of the visual field up to about 25° vertical and 40° horizontal eccentricity. Eleven patients trained at home for 1 h each day for a total of 80-300 h. Their results were compared with those of three patients who opted not to participate in the training procedure or those with very little therapy. These latter subjects had a slight decrease in the visual field size after about 1 year. In contrast, the treatment group displayed a reliable enlargement of visual field size. This was revealed by a significant improvement in the detection of small light stimuli, an increase in the ability to discriminate colors and a minor, but notable, improvement of shape discrimination in the blind areas of the visual field. Additional training of shape recognition led to further improvement of shape discriminations, even when the patients trained with very different kinds of shapes, e.g. lines or letters. Outcome depended on age of the patients and the size of the lesion, but it was independent of on-set of treatment and cause of the lesion. Only two of the 11 patients with treatment showed no significant improvement. This study suggests that regular home training of the 'blind' visual field with computer-controlled stimuli may lead to improvement in vision. However, because of the following methodological limitations results are only preliminary: (1) the trial did not contain a true placebo group, (2) the patients were not assigned randomly to a control or treatment condition, (3) the lack of defined inclusion criteria considerably increased the variance in neuropsychological performance, (4) because the experimental design was not double blind, experimenter bias cannot be ruled out, and (5) the conditions of the home training could not be standardized. The results warrant a larger randomized, double-blind controlled trial.
脑损伤通常伴有同侧偏盲，但目前针对视野缺损的治疗方法很少。在这项开放性的初步研究中，我们描述了一种计算机化的训练程序，该程序可能会使同侧偏盲患者的“盲”视野缩小。通过显示器呈现各种刺激来测试光觉和颜色、形状的辨别能力，该显示器可以检查或训练中央视野区，范围可达垂直 25°，水平 40°的偏心度。11 名患者每天在家中训练 1 小时，总计 80-300 小时。他们的结果与 3 名不参与训练程序或仅接受少量治疗的患者进行了比较。这些患者在大约 1 年后视野范围略有缩小。相比之下，治疗组显示出视野大小可靠的扩大。这表现在小光刺激检测能力的显著提高，颜色辨别能力的提高以及视野盲区的形状辨别能力的轻微但显著的提高。对形状识别的额外训练，甚至当患者用非常不同类型的形状（如线条或字母）进行训练时，也会进一步提高形状辨别能力。结果取决于患者的年龄和病变的大小，但与治疗的开始时间和病变的原因无关。在 11 名接受治疗的患者中，仅有 2 名患者没有显著改善。本研究表明，使用计算机控制的刺激对“盲”视野进行定期家庭训练可能会改善视力。然而，由于以下方法学限制，结果只是初步的：（1）试验没有包含真正的安慰剂组；（2）患者没有随机分配到对照组或治疗组；（3）缺乏明确的纳入标准大大增加了神经心理学表现的变异性；（4）由于实验设计不是双盲的，因此不能排除实验者偏见；（5）家庭训练的条件无法标准化。这些结果证明了更大规模的随机、双盲对照试验的必要性。
