Visual cortex training boosts acuity, contrast sensitivity after IOL implantation

The computer-based program is designed to exercise the brain’s visual center during a series of sessions after a lengthy postop adjustment period.

George O. Waring IV

Visual cortex training improved uncorrected visual acuity and contrast sensitivity in patients implanted with a variety of IOL types after cataract extraction, a speaker said.

George O. Waring IV, MD, presented study results at Refractive Subspecialty Day preceding the joint meeting of the American Academy of Ophthalmology and Middle East Africa Council of Ophthalmology in Chicago.

Regarding improved contrast sensitivity after IOL implantation, Dr. Waring said, “Our data are encouraging. Similar results have been shown at different time points in multiple studies.”

In a prospective pilot study conducted with Richard L. Lindstrom, MD, and John Hunkeler, MD, patients used the RevitalVision cortex vision training program (CVT, RevitalVision) after receiving one of five aspheric monofocal, multifocal or accommodating IOLs.

The computer-based, interactive program is designed to adapt to the patient’s individual visual abilities. Lateral masking and collinear alignment of the Gabor patches improve the efficiency of neuronal activity in the visual cortex by reducing the noise-to-signal ratio. Through a series of biofeedback training sessions, contrast sensitivity function is improved by modifying neuroplasticity through perceptual learning.

Near, distance visual acuity

The prospective pilot study included 62 eyes of 60 patients implanted with the ReZoom multifocal IOL (Abbott Medical Optics), the ReSTOR multifocal IOL (Alcon), Crystalens accommodating IOL (Bausch + Lomb), Alcon monofocal IOL or AMO monofocal IOL.

Investigators evaluated ETDRS uncorrected near and distance visual acuity and contrast sensitivity at 1 month and 3 months after IOL implantation. Each patient underwent 20 visual training sessions between 1 month and 3 months after surgery. Mean patient age was 68 years.

“With a minimum of 2 months of cortical training, we had statistically significant improvement in distance acuity at all time points and for all IOLs. When we look at near, you can see similar findings,” Dr. Waring said.

Overall uncorrected distance visual acuity improved 1.2 lines and uncorrected near visual acuity improved 0.7 lines. Both gains were statistically significant (P < .0001 and P < .0008, respectively).

Uncorrected distance visual acuity improved a mean 1.2 lines in 19 eyes implanted with the ReZoom, 1.4 lines in 10 eyes implanted with the ReSTOR multifocal IOL, 0.8 lines in 13 eyes implanted with the Crystalens, 1.3 lines in 10 eyes implanted with the Alcon monofocal IOL and 1.4 lines in 10 eyes implanted with the AMO monofocal IOL.

Uncorrected near visual acuity improved a mean 0.4 lines with the ReZoom lens, 1.2 lines with the ReSTOR lens, 0.6 lines with the Crystalens, 0.6 lines with the Alcon monofocal lens and 0.7 lines with the AMO monofocal.

Contrast sensitivity

Overall distance contrast sensitivity improved 172%; near contrast sensitivity improved 101%. Both gains were statistically significant (P < .0001).

Distance contrast sensitivity improved 135% in eyes implanted with the ReZoom lens, 149% in eyes implanted with the ReSTOR lens, 119% in the eyes implanted with the Crystalens, 206% in eyes implanted with the Alcon monofocal lens and 265% in eyes implanted with the AMO monofocal.

Near contrast sensitivity improved 26% in the eyes implanted with the ReZoom lens, 171% with the ReSTOR, 80% with the Crystalens, 160% with the Alcon monofocal and 289% with the AMO monofocal.

“The treatment group alone improved both at distance and near, and this was statistically significant across time points,” Dr. Waring said.

Corroborating data

Dr. Waring cited a study by Joao Marcelo Lyra, MD, showing that visual cortex training stimulated cortical activity and significantly improved visual function.

Dr. Lyra’s study included 40 eyes of 20 patients implanted with the AcrySof ReSTOR apodized diffractive IOL with a +3 D addition. Patients underwent 20 cortical training sessions during a 5-week period following a 6-month postoperative waiting period.

At 6 months, mean distance visual acuity improved 1.2 ETDRS lines and mean near or intermediate visual acuity improved 0.8 lines. Mesopic contrast sensitivity at distance improved 132%. All three visual improvements were statistically significant (P < .05).

Quality of Vision Questionnaire scores showed that at 6 months, visual cortex training reduced visual disturbances and improved driving at night and in the rain.

Although this pilot study was not designed to establish efficacy, a number of studies have demonstrated efficacy of CVT for other indications such as myopia and amblyopia. Dr. Waring said that the similar findings at different time points in these studies are encouraging, and a prospective controlled study for the post-IOL indication is under way.

“This is evidence that you can actually modulate neuroplasticity for therapeutic purposes,” he said. – by Matt Hasson

• George O. Waring IV, MD, is a cornea, cataract and refractive surgeon at ReVision Advanced Laser Eye Center in Columbus, Ohio, and is Medical Director, Division of Ophthalmology, at the St. Joseph’s Translational Research Center in Atlanta. He can be reached at 1080 Polaris Parkway, Columbus, OH 43240-6035; 614-781-0499; fax: 614-781-1974; email: georgewaring@me.com.
• Disclosure: Dr. Waring is a consultant for RevitalVision, AcuFocus, Topcon and Ista Pharmaceuticals.