Vision Restoration Therapy (VRT) to Treat Non-Arteritic Anterior Ischemic Optic Neuropathy

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
Valerie Biousse, Emory University
ClinicalTrials.gov Identifier:
NCT00140491
First received: August 30, 2005
Last updated: October 22, 2013
Last verified: October 2013
  Purpose

The goal of this pilot study is to evaluate the effect of Vision Restoration Therapy, VRT, on the visual function of patients with unilateral or bilateral AION, who have good central vision (at least 20/60) and altitudinal visual field defects.


Condition Intervention
Non-Arteritic Anterior Ischemic Optic Neuropathy
Device: Vision Restoration Therapy (NOVAVISION)

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: Visual Field Defects in Non-Arteritic Anterior Ischemic Optic Neuropathy: Effect of Vision Restoration Therapy (VRT)

Resource links provided by NLM:


Further study details as provided by Emory University:

Primary Outcome Measures:
  • Visual Function

Estimated Enrollment: 20
Study Start Date: August 2005
Study Completion Date: April 2007
Primary Completion Date: April 2007 (Final data collection date for primary outcome measure)
Detailed Description:

Anterior ischemic optic neuropathy (AION) is one of the most common causes of optic neuropathy after the age of 50. There is currently no available treatment and although up to 40% of patients have some spontaneous improvement within the first few months, most patients remain visually devastated. About 50% of patients retain relatively spared central visual acuity with an inferior altitudinal visual field defect. These patients usually complain of difficulty reading and loss of depth perception.

Recently, training-induced enlargement of visual field defects has been demonstrated in some patients with VF defects secondary to lesions of the retrochiasmal visual pathways. This computer-based Vision Restoration Therapy (VRT) was developed in Germany and has been FDA-cleared in the United States for the past one year.

VRT is currently available at Emory for patients with homonymous hemianopia. Patients work on personally-designed software (on a laptop at home) twice daily (30 minutes each) for 6 months. Zones of partially damaged neurons, which are usually located between the intact and damaged area of the visual field (transition zone) are deliberately stimulated by VRT. There is only anecdotal evidence that this visual restoration therapy may be helpful in enlarging the visual field of patients with optic neuropathies.

The goal of this pilot study is to evaluate the effect of VRT on the visual function of patients with unilateral or bilateral AION, who have good central vision (at least 20/60) and altitudinal visual field defects. The effect of VRT will be evaluated by visual acuity, color vision, stereo vision, Humphrey VF (24-2 SITA standard) testing, and scales evaluating reading speed and vision-based quality of life. These measures will be repeated before VRT, at 3 months, at 6 months, and at 1 year after VRT. 20 patients will be included in the study. Patients will be randomized at inclusion between VRT and sham (placebo)-training (10 in each group). The 10 patients receiving sham training will then receive VRT for the following 6 months if they so choose. All data will be analyzed in a blinded fashion. The company developing VRT in the United States (NOVAVISION) has agreed to provide VRT and sham-training.

  Eligibility

Ages Eligible for Study:   30 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients seen by Dr Biousse or Dr Newman in the Neuro-Ophthalmology Unit at Emory University.
  • Age ≥ 30 years.
  • Diagnosis of non-arteritic ischemic optic neuropathy at least 6 months prior to inclusion.
  • Uni- or bilateral AION (in case of bilateral AION, only one eye will be included in the study).
  • Best corrected visual acuity of at least 20/60 in the study eye
  • Altitudinal or arcuate visual field defect, splitting fixation by >10 decibel difference above and below horizontal meridian.
  • Stable visual function demonstrated by more than two stable visual acuity measurements and two automated visual field testings prior to inclusion in the study.
  • Patient willing, and able, to spend 60 minutes-a-day for 6 months working on a computer.

Exclusion Criteria:

  • Patient cognitively or physically unable to perform reliable automated perimetry testing (on the 24-2 SITA Standard program) (which is grossly equivalent to the effort and attention needed to perform VRT daily at home).
  • Other cause of optic neuropathy.
  • Associated ocular disease requiring treatments or responsible for visual loss (such as untreated significant cataract, glaucoma, age related macular degeneration, etc…).
  • Visual acuity worse than 20/60 in the study eye.
  • Non-stable visual field defect on previous evaluations.
  • Epilepsy.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00140491

Locations
United States, Georgia
Emory Eye Center
Atlanta, Georgia, United States, 30322
Sponsors and Collaborators
Emory University
Investigators
Principal Investigator: Valerie Biousse, MD Emory Eye Center
  More Information

Publications:
Responsible Party: Valerie Biousse, Principal Investigator, Emory University
ClinicalTrials.gov Identifier: NCT00140491     History of Changes
Other Study ID Numbers: 0435-2005, Valerie Biousse 404-778-5158
Study First Received: August 30, 2005
Last Updated: October 22, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Emory University:
Non-Arteritic Anterior Ischemic Optic Neuropathy
Visual Field Defect
Neuroplasticity
Rehabilitation

Additional relevant MeSH terms:
Ischemia
Optic Nerve Diseases
Scotoma
Optic Neuropathy, Ischemic
Demyelinating Diseases
Polyneuropathies
Nerve Compression Syndromes
Neurologic Manifestations
Neurotoxicity Syndromes
Pathologic Processes
Cranial Nerve Diseases
Nervous System Diseases
Eye Diseases
Vision Disorders
Sensation Disorders
Signs and Symptoms
Vascular Diseases
Cardiovascular Diseases
Peripheral Nervous System Diseases
Neuromuscular Diseases
Poisoning
Substance-Related Disorders

ClinicalTrials.gov processed this record on April 17, 2014