Neuroadaptation Treatment Using Specialized Software In A Patient Suffering Loss Of Contrast Sensitivity And Dysphotopsias After Corneal Refractive Surgery

To report the potential use of specialized visual training in subjects with problems of visual quality after corneal refractive surgery. Specifically, we used an innovative visual training technology based on Gabor sinusoidal networks, with proven evidence in the treatment of dysphotoptic phenomena associated with multifocal intraocular lenses (MF IOL) through cortical activation that facilitates neuroadaptation, in a patient previously operated on by LASIK refractive surgery and a decrease in the quality of vision associated to symptoms such as glare or starbursts.

Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain

A 38-year-old patient who had LASIK surgery for myopia and astigmatism some months ago reported loss of visual quality, especially at night, with high sensitivity to light during the day and dysphotoptic phenomena such as halos, starbursts, and glare at night. He is radiologist. The subjective refraction data in our first examination were +0.25 -1.25 at 170º in the right eye (RE) and +0.25 -1.00 at 5º in the left eye (LE), with corrected distance visual acuity (CDVA) of 0.00 logMAR in both eyes. Although he achieved optimal visual acuity with spectacles, far (CSV-1000E test) and near contrast sensitivity (CS) (OpticTrainCS test) were reduced. Scleral contact lens fitting was tried for a better control of his corneal aberration profile, but with minimal impact on his symptomatology. Finally, we offered to the patient the possibility of using an innovative visual training through the OpticTrain® software (Proconsi SL, León, Spain). This software to facilitate neuroadaptation is based on the combination of sinusoidal Gabor networks with environments that favours controlled activation of the cingulate, caudate, and fronto-parietal areas. Changes in far and near CS as well as in symptomatology (McAlinden questionnaire) were evaluated. After 3 weeks of training, the patient reported a subjective improvement (less bothersomeness associated to photic phenomena), with enhanced far and near CS (especially for high spatial frequencies). In addition, CDVA became -0.1 logMAR in both eyes.

Treatment with a new visual training technology based on gamification has been shown in the clinical case presented here to be a potential therapeutic option in a patient affected by dysphotopic phenomena after LASIK refractive surgery. This treatment option must be investigated further. It would be advisable to confirm this aspect in future studies with larger sample sizes, including functional magnetic resonance imaging analysis to confirm the presence of neurological changes associated with neuroadaptation.