Houston Kevin E, Peli Eli, Goldstein Robert B, Bowers Alex R
Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
Transl Vis Sci Technol. 2018 Jan 18;7(1):5. doi: 10.1167/tvst.7.1.5. eCollection 2018 Jan.
Drivers with homonymous hemianopia (HH) were previously found to have impaired detection of blind-side hazards, yet in many jurisdictions they may obtain a license. We evaluated whether oblique 57Δ peripheral prisms (p-prisms) and perceptual-motor training improved blind-side detection rates.
Patients with HH ( = 11) wore p-prisms for 2 weeks and then received perceptual-motor training (six visits) detecting and touching stimuli in the prism-expanded vision. In a driving simulator, patients drove and pressed the horn upon detection of pedestrians who ran toward the roadway (26 from each side): (1) without p-prisms at baseline; (2) with p-prisms after 2 weeks acclimation but before training; (3) with p-prisms after training; and (4) 3 months later.
P-prisms improved blind-side detection from 42% to 56%, which further improved after training to 72% (all < 0.001). Blind-side timely responses (adequate time to have stopped) improved from 31% without to 44% with p-prisms ( < 0.001) and further improved with training to 55% ( = 0.02). At the 3-month follow-up, improvements from training were maintained for detection (65%; = 0.02) but not timely responses ( = 0.725). There was wide between-subject variability in baseline detection performance and response to p-prisms. There were no negative effects of p-prisms on vehicle control or seeing-side performance.
P-prisms improved detection with no negative effects, and training may provide additional benefit.
In jurisdictions where people with HH are legally driving, these data aid in clinical decision making by providing evidence that p-prisms improve performance without negative effects.
先前发现患有同向性偏盲（HH）的驾驶员对盲侧危险的察觉能力受损，但在许多司法管辖区，他们仍可获得驾照。我们评估了倾斜57Δ周边棱镜（p-棱镜）和感知运动训练是否能提高盲侧检测率。
HH患者（n = 11）佩戴p-棱镜2周，然后接受感知运动训练（6次就诊），在棱镜扩展视野中检测并触摸刺激物。在驾驶模拟器中，患者驾驶并在检测到朝着道路奔跑的行人时按喇叭（每侧各26名）：（1）基线时不佩戴p-棱镜；（2）适应2周后但训练前佩戴p-棱镜；（3）训练后佩戴p-棱镜；以及（4）3个月后。
p-棱镜将盲侧检测率从42%提高到56%，训练后进一步提高到72%（均P < 0.001）。盲侧及时反应（有足够时间停车）从不佩戴时的31%提高到佩戴p-棱镜时的44%（P < 0.001），训练后进一步提高到55%（P = 0.02）。在3个月随访时，训练带来的检测改善得以维持（65%；P = 0.02），但及时反应未维持（P = 0.725）。基线检测性能和对p-棱镜的反应存在较大的个体间差异。p-棱镜对车辆控制或可见侧性能没有负面影响。
p-棱镜提高了检测能力且无负面影响，训练可能带来额外益处。
在HH患者合法驾驶的司法管辖区，这些数据通过提供p-棱镜可改善性能且无负面影响的证据，有助于临床决策。
