Abstract

SA.15.02

Rehabilitation in Hemianopia – New results for a controversial discussion

Susanne Trauzettel-Klosinski

Department für Augenheilkunde, Universität Tübingen

Patients with homonymous hemianopic field defects are severely disabled in their everyday life, especially regarding reading and orientation
The hemianopic reading disorder depends on the distance of the field defect from the vertical midline, i.e. the size of the reading visual field, the side of the hemianopia in regard to the reading direction and the presence or absence of spontaneous adaptive strategies, such as eccentric fixation or predictive saccades. Specific reading training can be helpful.
Regarding training to improve the hemianopic orientation disorder, there exist 2 main approaches, which have been controversial for a long time: restitution of the visual field by visual stimulation of the blind hemifield versus compensation by explorative eye movements towards the hemianopic side to enlarge the field of gaze. Several studies had shown a beneficial effect of saccadic training, but none had used a control group and therefore could not prove the specificity of the training.
A new randomized and controlled study* will be presented, which shows the effectiveness of a compensatory explorative saccadic training: reaction times for a digit search task and a natural search task decreased and exploration of natural scenes was improved (number of fixations on the affected side increased). Quality of life score for social domain improved. In contrast, the control group, which received a visual field stimulation training (flickering letter in 22° eccentricity), did not show a change in exploration behaviour. Also visual fields remained unchanged.
The study shows that visual stimulation of the visual fields, even if applied in a more peripheral visual field area compared to former studies, does not lead to a restitution of the visual fields. In contrast we could prove the effectiveness of a compensatory saccade training and the ability of the patients to apply the newly learnt strategies to their everyday life.

Copyright: 2009 Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.