A self-administered computer program helps postsurgical patients
maximize visual function.
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
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
“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
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
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
“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; email@example.com.
- Richard L. Lindstrom, MD, can be reached at Minnesota Eye
Consultants, Bloomington, Minn.; (952) 888-5800;
- Disclosures: Dr. Karpecki has no relevant financial interest to
disclose. Dr. Lindstrom is a member of the Medical Advisory Board for