Optometry

Just as patients undergo postsurgical therapy for knees and hips, there is now a rehabilitation option for ocular surgery.

RevitalVision training systems (RevitalVision LLC, Lawrence, Kan.) are computer-based vision therapy programs that can be used at home by patients after LASIK and cataract surgery and also by those with presbyopia or amblyopia – or anyone else wishing to improve their visual performance.

The sessions are customized to the patient’s pace and visual ability and are monitored by a personal RevitalVision specialist. The length of the individual sessions and duration of the program vary by patient and specific need.

Primary Care Optometry News Editorial Board member Richard L. Lindstrom, MD, told PCON, “I use it primarily to enhance visual outcomes and patient satisfaction after presbyopia correcting IOL surgery.

“Most patients like it,” he continued. “It’s like physical therapy for the eye after surgery – somewhat boring, but effective. The computer outcome monitoring indicates when maximum benefit has been achieved, but generally patients need to continue for 4 to 6 weeks, completing sessions three to four times a week.”

In the 5 years he has been using the program, patients have shown an objective improvement in Snellen acuity of 1.5 to 2.0 lines as well as an improvement in contrast sensitivity, according to Dr. Lindstrom.

“We began a few years ago by offering it to post-cataract patients who were not satisfied with their vision even though the dry eye or residual refractive error had been treated and there were no signs of other causes for decreased visual acuity,” Paul M. Karpecki, OD, FAAO, PCON Editorial Board member, said.

“Post-cataract patients were probably the most challenging group, and we were witnessing about 1.5 lines of improvement in Snellen acuity, which was more than sufficient to change an unhappy patient into being very satisfied with their vision,” he continued.

Program uses Gabor targets

Dr. Karpecki described the program as computer-based visual cortex training using Gabor targets that are presented as stimuli.

The Gabor patch science was created and named for Nobel Prize winner Dennis Gabor. In the RevitalVision system, they work as an effective stimulus target for the primary visual cortex, reducing the noise-to-signal ratio, he said.

During the training sessions the user is presented with a series of precise visual tasks consisting of patterned images with subtle differences in orientation, size and contrast, according to company literature.

Clinical findings have shown that the noise of individual cortical neurons can be modulated by the appropriate choice of stimulus conditions. Contrast sensitivity at low levels can be increased through a lateral masking technique, which displays the target Gabor image with collinearly oriented flanking Gabors. This technique is tailored to an individual computerized training regimen using various parameters of the stimulus including spatial frequencies, spatial arrangement of the Gabor patches, contrast level, orientation (local and global), task order, context and exposure duration, according to RevitalVision.

The system puts these principles together in a patient-specific learning regimen that facilitates neural connections at the cortical level to improve the optical input received from the eye and the neural processing of that input in the visual cortex, both of which are necessary for vision enhancement.

Effective for amblyopia, athletes

“I have reviewed the published data and it shows that RevitalVision can help amblyopic patients at any age, although I would suspect that the earlier the better, given the development of pathways and neuronal connections earlier in life,” Dr. Karpecki said.

It is also beneficial to athletes, such as ball players, who have remarked about its effectiveness, he added.

“Everything is self-contained in the software that the patients are provided — they just need to put the CDs in a computer. Patients have stated that it takes about 30 to 45 minutes per session and that they are fatigued afterwards, but it gets easier and they are pleased with the improvements the see,” Dr. Karpecki said. “Patients must be motivated, as it is a visual work-out; they go through a series of visual rehab exercises.”

Dr. Karpecki said his practice includes the cost of the program in the premium IOL fee. Otherwise, as in an athlete’s case, the user is charged directly.

“We charge patients directly or sometimes include it in the global fee for the advanced technology presbyopia-correcting IOLs,” Dr. Lindstrom added. – by Daniel Morgan

• Paul M. Karpecki, OD, FAAO, can be reached at Koffler Vision Group, Lexington, Ky.; (859) 263-4631; paul@karpecki.com.
• Richard L. Lindstrom, MD, can be reached at Minnesota Eye Consultants, Bloomington, Minn.; (952) 888-5800; rllindstrom@mneye.com.
• Disclosures: Dr. Karpecki has no relevant financial interest to disclose. Dr. Lindstrom is a member of the Medical Advisory Board for RevitalVision.