Visual cortex training may enhance premium IOL results
KAANAPALI, Hawaii — A computer-based visual cortex training system may be able to improve visual results in premium IOL patients, according to results of a pilot study reported here.
At Hawaiian Eye 2011, Jeffrey D. Horn, MD, reported that of 62 eyes undergoing neural vision training (RevitalVision) over a 3-month period after premium IOL implantation, distance vision improved 1.2 lines and near vision improved 0.7 lines. Both improvements were statistically significant (P < .05), Dr. Horn said.
Contrast sensitivity improved 172% for distance vision and 101% for near, he said.
At 1 month postop, uncorrected visual acuity and contrast sensitivity measurements were taken for both near and far distances. The patients then underwent visual cortical training sessions over a 2-month period, after which visual acuity and contrast sensitivity were again measured.
"Pilot data are encouraging for improvement in visual acuity and contrast sensitivity after IOL implantation," Dr. Horn said.
- Disclosure: Dr. Horn is a paid consultant for RevitalVision.
It is a well-confirmed fact that the brain retains plasticity and can learn throughout life. My most poignant reminders of this fact are a small handful of patients with amblyopia who, following loss of central vision in their better eye, returned to 20/20 in the amblyopic eye over time. Neural adaptation to a new visual system, for example following multifocal or accommodating IOL implantation or monovision for that matter, is critical to patient satisfaction. As I read the literature in this area, it appears that around 80% of neural adaptation occurs in the first 3 months, and the remaining 20 % over 1 or more years. I have seen patient function improve for at least 3 years with both multifocal and accommodating IOLs.
Having performed multifocal implantation for over 20 years, I can state that I have no patients that have not adapted to their new vision by 5 years after surgery. Of course, 5 years is a long time with an unhappy patient, but tincture of time is powerful in adaptation to a new visual system. I find it helps to engage the patient in the recovery process, much like an orthopedic surgeon does with physical therapy. I treat the ocular surface, any capsular opacity and evaluate the macula with OCT and treat as indicated. I also encourage use of the new optical system with reading in good light. More recently I have adopted RevitalVision training for select patients.
My results are similar to Dr. Horns, with over a 100% improvement in contrast sensitivity at distance and near and over a one line improvement in Snellen acuity. For Crystalens patients, improvement at near is greater, and for multifocal IOL patients, improvement at distance leads. In addition, patients complain less of night vision symptoms after RevitalVision training. The training sessions are done at home on ones own computer, and are managed by the company. This vision training program is scientifically validated and can enhance visual performance in many settings, including presbyopia-correcting IOLs monofocal IOLs, Lasik, PRK, small refractive errors, early presbyopia, amblyopia, early macular degeneration and sports medicine. The interested physician can learn more on the RevitalVision website.
Richard L. Lindstrom, MD
OSN Chief Medical Editor
Disclosure: Dr. Lindstrom is a consultant for RevitalVision and has a financial interest in the company.