To evaluate the efficacy of motion discrimination training as a potential therapy for stroke-induced hemianopic visual field defects.
Clinical Trial SUBJECTS: Forty-eight subjects with stroke-induced homonymous hemianopia were randomized into two training arms, an intervention and a control. Subjects were between 21-75 years of age and presented with no ocular issues.
Subjects were trained on a motion discrimination task previously evidenced to reduce visual field deficits, but not in a randomized clinical trial. Subjects were randomized with equal allocation to receive training in either their sighted or deficit visual fields. Training was performed at home for six months, consisting of repeated visual discriminations at a single location for 20-30 minutes per day. Study staff and subjects were masked to training type. Pre- and post-training testing was identical, consisting of Humphrey Visual Fields, Macular Integrity Assessment Perimetry, Ocular Coherence Tomography, motion discrimination performance, and visual quality of life questionnaires.
Primary outcome measures were changes in perimetric mean deviation (PMD) on Humphrey Visual Field Analyzer in both eyes.
Mean PMDs improved over 6 months in Deficit-trained subjects (mean change OD 0.58 dB, 95% confidence interval [CI] 0.07, 1.08; mean change OS 0.84 dB, 95% CI 0.22, 1.47). No improvement was observed in Sighted-trained subjects (mean change OD 0.12 dB, 95% CI -0.38, 0.62; mean change OS 0.10 dB, 95% CI -0.52, 0.72). However, there were no significant differences between the alternative training modalities (OD: p = 0.19; OS: p = 0.10).
To date, no widely accepted therapy is available to treat homonymous hemianopia. This study evaluated the efficacy of a promising potential treatment – visual perceptual training. We failed to find a difference between treatment training within the deficit field and control training within the sighted field, when performed in a home environment.

Copyright © 2020. Published by Elsevier Inc.