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Clinical trials show good results for neuroadaptation technology
Investigators said they are impressed with study outcomes of software that aims to help patients with amblyopia, mild myopia and presbyopia.
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Researchers have been looking to the brain to help improve visual function in patients with conditions such as amblyopia, mild myopia and presbyopia. So far, they say they have been impressed with the results of several clinical trials for one company’s program.
Singapore-based NeuroVision has developed a computer software program that “solely focuses in optimizing the visual processing in the brain” and “neurologically trains the brain to see better,” according to company literature.
 Richard L. Lindstrom |
The system was approved by the U.S. Food and Drug Administration in 2001 to treat adult amblyopia. Now, researchers want to find out if it has broader applications.
NeuroVision called on leading U.S. researchers to try the software in clinical trials, including OSN Chief Medical Editor Richard L. Lindstrom, MD, and OSN Refractive Surgery Section Editor Daniel S. Durrie, MD.
“This particular device has some pretty solid science behind it,” Dr. Lindstrom said in an interview. “It seems to be real. It keeps generating the same outcome – about a two-line improvement in visual acuity – regardless of the indication, which is reassuring. That’s enough to matter to patients.”
Dr. Lindstrom and colleagues at Minnesota Eye Consultants are in the process of testing the software on presbyopic patients who have undergone multifocal IOL surgery.
 Daniel S. Durrie |
“We are getting ready to enroll post-LASIK patients who are not happy – a few who have low refractive error,” he said.
The science behind NeuroVision has existed for about 15 years, and it was developed in Israel and Asia, where myopia is almost epidemic, said Dr. Durrie, who admitted that he was a skeptic at first, but now is on NeuroVision’s medical advisory board.
“The history of visual training processes, specifically in the United States with the See Clearly and Bates methods, has been spotty at best, as far as its scientific basis,” Dr. Durrie said. “Generally, it has not been accepted as working very well, if at all, and has gotten a bad name over the years. The company realizes that, and that is why they are doing scientific studies in the United States to validate whether this process really is helpful to patients.
“I went into this very skeptical,” he said. “I didn’t think this was going to work, but I did see a positive effect for the patients in the clinical studies. In general, I was impressed that we could improve vision without doing surgery or without changing the optical structure of the eye but just by improving the brain’s ability to see.”
Clinical trials
Dr. Durrie said the technology has been validated in research projects with patients who have low myopia and early presbyopia, after refractive surgery and past multifocal IOL implants.
“There’s an ongoing project with adolescent amblyopia,” he said. “There’s also a project for people with multiple sclerosis with optic nerve disease, or glaucoma, to see if we can bypass some true pathology and make the brain see better. We’re also studying the neuroLASIK concept.”
Dr. Durrie encouraged other researchers to consider participating in a clinical trial on the technology. “If somebody thinks it’s absolute hogwash and they want to prove that it doesn’t work, those are the people I’d like to get involved,” he said.
How it works
The science behind NeuroVision is one of neuroadaptation, researchers said. “You are developing the neural pathways to respond better and more efficiently to visual stimuli,” Peter G. Shaw-McMinn, OD, said in an interview. “It improves the lateral interactions between neurons on the visual pathway and improves contrast sensitivity – and that improves visual acuity.”
Dr. Shaw-McMinn, who has tested more than 70 patients for NeuroVision, said adults have more plasticity than researchers realized. It was thought that the brain lost neurons with age and that no new neurons were gained. However, adults are able to gain neurons and improve retinal and visual pathway processing, even as they age.
During the program, a patient sits in a darkened room about 5 feet from a computer screen. The screen flashes a series of Gabor patches, and the patient answers questions with a click of the mouse.
“Single cells in the visual cortex respond optimally to a bar of light as opposed to a flash of light,” Dr. Shaw-McMinn said. “That is what gives rise to our contrast sensitivity.”
Gabor patches have a particular shape that matches the layout of the neurons at the central cortex, Dr. Durrie said. The patient’s vision is measured during an orientation session, and then the software measures his or her visual weaknesses in spatial frequency, contrast sensitivity, orientation and displacement defects in picking out small images.
The technology then customizes a visual training program for that patient. Each time the patient comes into the office for treatment, the program updates and sends information to a server in Singapore.
“At the end of every treatment, you essentially have a score, and then it recalibrates the next lesson for you,” Dr. Durrie said. “It is constantly stimulating your weak spot, then testing your strong spots and moving them up.”
The technology requires a series of 30 treatments of 30 minutes each, about three sessions each week.
“Overall, our myopia and presbyopia test groups improved by 2 to 2.4 lines of improvement in high-contrast vision, which was significant enough for the patients that many of them quit wearing their glasses for distance or quit wearing their reading glasses for near,” he said.
Multifocal study
Marlane J. Brown, OD, FAAO, is conducting a study with nine multifocal IOL patients at Minnesota Eye Consultants.
“It isn’t changing their prescription,” she said. “It is just training their brains to see better with the new lens implant.”
Dr. Brown said she, too, was skeptical about the technology at first.
“I’m impressed with the results I am seeing,” she said. “I don’t have any hard data yet, but the sponsor, NeuroVision, reports to me that the patients are showing improvement in visual acuity and contrast sensitivity. The patients themselves are reporting it. They are feeling they can, for example, see the computer better or they are putting on their reading glasses less often.”
Commitment, hope
Researchers admit the treatment is rigorous.
“It’s kind of like going to the gym,” Dr. Durrie said. “You’re going to have to dedicate yourself to go do your workout. You have to be in a dark room. You have to concentrate. It really does make you tired. It is something for which you have to be dedicated enough to do the treatments.”
For now, the patients in the clinical trials have to go to a doctor’s office several times a week to do the treatments. The company’s goal is to make it an at-home program.
That possibility is exciting, Dr. Brown said. “I can see patients doing this at home and running it like an exercise video,” she said.
Dr. Durrie said he hopes that optometry and ophthalmology will embrace research on NeuroVision. “There is no risk to the patient other than wasting their time and effort to do it. If we find that there’s a use for certain patients groups, I think that would be very helpful,” he said.
The challenge, he said, is getting clinicians to accept that the technology works. “Here’s something that could potentially help every patient that comes into our office,” Dr. Durrie said. “Everybody has the benefit of seeing better at their brain level. We haven’t taught them how to do that yet.
“We’re challenging it every way we can, and so far, we haven’t derailed it,” he said. “We’re still working on it. I just hope that people look at it with an open mind and believe it’s worth continued research.”
Follow-up results
Retests done on a group of patients in Singapore found that 85% of the patients kept their visual improvements a year later, Dr. Durrie said.
“Of the people who started dropping off, they could do a refresher and perk right back up again,” he said. “What’s nice about it is once you’ve done it, you’ll always get the advantages of it. Even patients who may have cataract surgery at some time or refractive surgery will still get the benefits of their brain seeing better.”
Essilor, Stereo Optical
Essilor International acquired a minority interest in NeuroVision in February 2007. Stereo Optical, a subsidiary of Essilor, was appointed as distributor.
R. Michael Daley, president and chief operating officer of Essilor Lenses, said Essilor is conducting beta testing in the United States for myopia and presbyopia and is evaluating its clinical and commercial viability. “We will target one city, train the eye doctors there, have them offer it for a year and see how successful it is,” Mr. Daley said.
The company plans to conduct commercial distribution trials in three test markets: Chicago, the United Kingdom and Singapore and also test the software for at-home and laptop use.
This article also appeared in Primary Care Optometry News, a SLACK Incorporated publication.
For more information:
- Richard L. Lindstrom, MD, can be reached at Minnesota Eye Consultants, 9801 DuPont Ave. S, Suite 200, Bloomington, MN 55431; 952-888-5800; fax: 952-567-6182; e-mail: rllindstrom@mneye.com. Dr. Lindstrom owns equity and consults for NeuroVision.
- Daniel S. Durrie, MD, can be reached at Durrie Vision, 5520 College Blvd., Suite 201, Overland Park, KS 66211; 913-491-3330; fax: 913-491-9650; e-mail: ddurrie@durrievision.com. Dr. Durrie is a paid researcher for NeuroVision.
- Peter G. Shaw-McMinn, OD, can be reached at 17675 Van Buren Blvd., Riverside, CA 92504; 951-672-4971; fax: 951-780-4807; e-mail: shawmc@cox.net. Dr. Shaw-McMinn has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.
- Marlane J. Brown, OD, FAAO, can be reached at Minnesota Eye Consultants, 710 E. 24th St., Suite 106, Minneapolis, MN 55404; 612-813-3621; fax: 612-813-3600; e-mail: mjbrown@mneye.com. NeuroVision is sponsoring a panel that Dr. Brown will speak on.
- R. Michael Daley can be reached at 13555 N. Stemmons Freeway, Dallas, TX 75234; 800-215-7249, ext. 4900; fax: 972-241-8601; e-mail: mdaley@essilorusa.com; Web site: www.essilorusa.com.
- NeuroVision, maker of the NeuroVision system, can be reached at 18 Cross St., #07-12, Marsh & McLennan Centre, Singapore 048423; 800-684-7466; Web site: www.neuro-vision.com.
- Jena Passut is an OSN Correspondent who writes primarily for Primary Care Optometry News.