Pilot Experience Evaluating A Visual Training Program For Facilitating The Neuroadaptation In Subjects Implanted With Multifocal Intraocular Lenses And An Unsuccessful Outcome

To evaluate preliminarily the clinical usefulness of a validated visual training technology based on Gabor sinusoidal gratings to facilitate neuroadaptation through cortical activation in a small sample of patients implanted with presbyopia-correcting intraocular lenses IOLs and severe complaints of loss of quality of vision.

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

A total of 7 eyes of 5 patients ranging in age from 29 to 64 years old were included in this study. All subjects underwent uneventful cataract surgery with implantation of different models of presbyopia-correcting IOLs, but with a significant decrease of visual quality at least 6 months after the surgery. All eyes were trained using the OpticTrain® software (Visitrain S.L., Alicante, Spain) that has been designed to facilitate neuroadaptation and is based on the combination of sinusoidal Gabor gratings with environments that favours controlled activation of the cingulate, caudate, and fronto-parietal areas. A total of 6 weeks of training at home using the application in a tablet was prescribed (5 days/week, 25-min sessions).

Mean corrected distance visual acuity improved from 0.20 ± 0.09 logMAR before training to 0.13 ± 0.08 after training (p=0.008). Likewise, mean distance-corrected visual acuity improved from 0.34 ± 0.21 LogMAR to 0.22 ± 0.21 with training (p<0.001). Likewise, distance contrast sensitivity (CS) improved significantly for high spatial frequencies (p<0.001) (CSV1000 test) as well as near CS for the spatial frequencies of 1.5, 3 and 4.5 cycles/º (OpticTrain-CSF test) (p<0.001). The level of bothersomeness of halos, glare and starbursts decreased in all cases after the training (McAlinden quality of vision questionnaire). Furthermore, the symptom of hazy vision also decreased in those patients perceiving it initially.

Treatment with this visual training technology based on gamification seems to be a potential therapeutic option of visual rehabilitation in patients severely affected by quality of vision loss after presbyopia-correcting IOL implantation. 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 be recommendable to confirm neuronal changes associated with neuroadaptation.