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Comparing explorative saccade and flicker training in hemianopia

A randomized controlled study

From the Centre for Ophthalmology, Low Vision Clinic and Research Laboratory (T.R., A.N.S., A.M., S.T.-K.), and Department of Neurology (P.R., M.W.), University of Tübingen, Germany; and Department of Neurology (P.R., M.W.), University Hospital Zurich, Switzerland.

Address correspondence and reprint requests to Dr. Susanne Trauzettel-Klosinski, Low Vision Clinic and Research Laboratory, Centre for Ophthalmology, University of Tübingen, Schleichstr. 12-16, D 72076 Tübingen, Germany susanne.trauzettel-klosinski{at}uni-tuebingen.de

Objective: Patients with homonymous hemianopia are disabled on everyday exploratory activities. We examined whether explorative saccade training (EST), compared with flicker-stimulation training (FT), would selectively improve saccadic behavior on the patients’ blind side and benefit performance on natural exploratory tasks.

Methods: Twenty-eight hemianopic patients were randomly assigned to distinct groups performing for 6 weeks either EST (a digit-search task) or FT (blind-hemifield stimulation by flickering letters). Outcome variables (response times [RTs] during natural search, number of fixations during natural scene exploration, fixation stability, visual fields, and quality-of-life scores) were collected before, directly after, and 6 weeks after training.

Results: EST yielded a reduced (post/pre, 47%) digit-search RT for the blind side. Natural search RT decreased (post/pre, 23%) on the blind side but not on the seeing side. After FT, both sides’ RT remained unchanged. Only with EST did the number of fixations during natural scene exploration increase toward the blind and decrease on the seeing side (follow-up/pre difference, 238%). Even with the target located on the seeing side, after EST more fixations occurred toward the blind side. The EST group showed decreased (post/pre, 43%) fixation stability and increased (post/pre, 482%) asymmetry of fixations toward the blind side. Visual field size remained constant after both treatments. EST patients reported improvements in social domain.

Conclusions: Explorative saccade training selectively improves saccadic behavior, natural search, and scene exploration on the blind side. Flicker-stimulation training does not improve saccadic behavior or visual fields. The findings show substantial benefits of compensatory exploration training, including subjective improvements in mastering daily-life activities, in a randomized controlled trial.

Abbreviations: ANOVA = analysis of variance; CI = confidence interval; EST = explorative saccade training; FT = flicker-stimulation training; HH = homonymous hemianopia; PC = personal computer; RT = response time; SLO = scanning laser ophthalmoscope; TAP = Tübingen automated perimetry; WHOQOL = World Health Organization Quality of Life assessment.

Supplemental data at www.neurology.org

Supported by the Adolf Messer Foundation.

Disclosure: The authors report no disclosures.

Received July 9, 2008. Accepted in final form October 15, 2008.