Houston Kevin E, Bowers Alex R, Peli Eli, Woods Russell L
Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts.
Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts *
Optom Vis Sci. 2018 Sep;95(9):795-804. doi: 10.1097/OPX.0000000000001280.
The first report on the use of peripheral prisms (p-prisms) for patients with left neglect and homonymous visual field defects (HVFDs).
The purpose of this study was to investigate if patients with left hemispatial neglect and HVFDs benefit from p-prisms to expand the visual field and improve obstacle detection.
Patients (24 with HVFDs, 10 of whom had left neglect) viewed an animated, virtual, shopping mall corridor and reported if they would have collided with a human obstacle that appeared at various offsets up to 13.5° from their simulated walking path. There were 40 obstacle presentations on each side, with and without p-prisms. No training with p-prisms was provided, and gaze was fixed at the center of expansion.
Detection on the side of the HVFD improved significantly with p-prisms in both groups, from 26 to 92% in the left-neglect group and 43 to 98% in the non-neglect group (both P < .001). There was a tendency for greater improvement in the neglect patients with p-prisms. For collision judgments, both groups exhibited a large increase in perceived collisions on the side of the HVFD with the prisms (P < .001), with no difference between the groups (P = .93). Increased perceived collisions represent a wider perceived safety margin on the side of the HVFD.
Within the controlled conditions of this simulated, collision judgment task, patients with left neglect responded well to initial application of p-prisms exhibiting improved detection and wider safety margins on the side of the HVFD that did not differ from non-neglect patients. Further study of p-prisms for neglect patients in free-gaze conditions after extended wear and in real-world mobility tasks is clearly warranted.
关于使用周边棱镜（p-棱镜）治疗左侧忽视和同侧视野缺损（HVFD）患者的首份报告。
本研究旨在调查患有左侧半侧空间忽视和HVFD的患者是否能从p-棱镜中获益，以扩大视野并改善障碍物检测能力。
患者（24例患有HVFD，其中10例有左侧忽视）观看一条动画虚拟商场走廊，并报告他们是否会与出现在距其模拟行走路径最远达13.5°的不同偏移位置处的人体障碍物发生碰撞。每侧有40次障碍物呈现，分别在有和没有p-棱镜的情况下进行。未提供p-棱镜使用培训，且注视点固定在扩展中心。
两组中，使用p-棱镜后，HVFD一侧的检测能力均显著提高，左侧忽视组从26%提高到92%，非忽视组从43%提高到98%（P均<.001）。使用p-棱镜的忽视患者有更大改善的趋势。对于碰撞判断，两组在使用棱镜时，HVFD一侧感知到的碰撞次数均大幅增加（P<.001），两组之间无差异（P =.93）。感知到的碰撞次数增加代表HVFD一侧有更宽的感知安全边际。
在这个模拟碰撞判断任务的受控条件下，左侧忽视患者对p-棱镜的初次应用反应良好，在HVFD一侧表现出检测能力提高和安全边际变宽，这与非忽视患者无异。显然有必要对忽视患者在长时间佩戴后的自由注视条件下以及现实世界移动任务中使用p-棱镜进行进一步研究。
