Neuroadaptation Treatment Using Specialized Software In A Dissatisfied Patient After Unilateral Cataract Surgery With Implantation Of A Continuous Range Of Vision Intraocular Lens

To show the potential clinical usefulness of a validated visual training technology based on Gabor sinusoidal gratings to facilitate neuroadaptation through cortical activation in a patient with unilateral implantation of a continuous range of vision intraocular lens (IOL) and severe complaints of loss of quality of vision

Vithas Medimar International Hospital, Alicante, Spain

A 56-year-old woman who had cataract surgery in her right eye (RE) with implantation of the Tecnis Synergy IOL (Johnson & Johnson Vision Care) attended to our consultation referring significant loss of visual quality. The left eye (LE) had an uncorrected distance visual acuity (UDVA) of 0.00 logMAR, with the presence of a transparent crystalline lens. UDVA in RE was 0.05 logMAR, subjective refraction -1,00 at 180º and corrected distance visual acuity (CDVA) 0.00 logMAR. In this same eye, uncorrected intermediate (UIVA) and near visual acuities (UNVA) were 0.5 and 0.4 logMAR, respectively. Distance log contrast sensitivities (CS) values for 3, 6, 12 and 18 cycles/º (CSV-1000E test) in RE were 1.49, 1.70, 1.08 and 0.81, respectively. She referred the perception of quite bothersome hazy vision and blurred vision, being extremely dissatisfied with her vision.
We opted after conversation with the patient to offer the possibility of using an innovative visual training through the OpticTrain® software (Visitrain S.L.). A total of 6 weeks of training at home using the application in a tablet was prescribed (5 days/week, 25-min sessions). After the training, the patient reported subjective improvement (no perception of hazy vision), as well as increased measurements of CS (1.63, 1.84, 1.54 and 0.96 for 3, 6, 12 and 18 cycles/º), which would indicate an improvement in the
quality of vision. In addition, the UDVA, UIVA and UNVA improved to 0.00, 0.20 and 0.20 logMAR, respectively, in RE.

Treatment with a new visual training technology based on gamification has been shown in the clinical case presented to be a potential therapeutic option of visual rehabilitation in a patient severely affected by quality of vision loss after multifocal IOL implantation in one eye in cases of unilateral cataract. It would be advisable to confirm this aspect in future studies with more symptomatic patients after this type of surgery. Finally, the inclusion of neurological tests such as functional magnetic resonance imaging would have allowed us to confirm neuronal changes associated with neuroadaptation in the present clinical case and is something to include in future studies