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Vision training with VEP biofeedback in amblyopia after the critical period

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Abstract

Purpose

The purpose of this study was to investigate the benefits of vision training with visual evoked potentials (VEP) biofeedback in amblyopia after the critical period in 8 to 17-year (11.5 ± 3.1) old children.

Methods

Ten participants with monocular amblyopia after the critical period underwent a 10-week, 20-session vision training program with the Retimax Vision Trainer device. During each session, the participants were instructed to be as focused as possible onto the fixation point in the middle of the screen. The size of the fixation point and the pitch of the background sound were changing according to VEP parameters and thus provided the participants real-time feedback of their visual performance.

Results

The mean BCVA improvement across our group was 0.12 LogMAR (p < 0.01). There was also a significant increase in contrast sensitivity to the FACT chart across all spatial frequencies (all p < 0.05). Electrophysiologic data revealed higher steady-state visual evoked potentials (SS-VEP) amplitudes and correspondingly lower fixation point values in the last 2 weeks of training compared to the first 2 weeks (both p < 0.01). Due to unexplainably low VEP amplitude levels in later trainings compared to those in the beginning in two participants, we have not found a significant correlation between the increase in BCVA and the increase in SS-VEP amplitude (p = 0.88). At the follow-up at 2 and 12 months following the end of training, both BCVA and contrast sensitivity remained within the levels achieved at the end of training. In some participants, however, no improvement of BCVA was observed.

Conclusions

The tested vision training approach demonstrates modest but stable improvement of psychophysical parameters as well as objective characteristics in amblyopia after the critical period. Real-time SS-VEP can be used as an objective parameter to monitor participants’ attention during vision training stimulation.

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Acknowledgments

The preliminary account of this work was presented at European Neuro-Ophthalmology Society (EUNOS) 2017 meeting, where the poster was selected as the Best EUNOS Young Neuro-Ophthalmologist In-Training Presentation. We would like to thank Claudio Baglini and the company CSO, Florence, Italy for upgrading the Retimax Vison Trainer according to our requirements and for the technical support. We would also like to thank Joseph A. Breuer for language editing assistance.

Funding

This research was supported by the Slovenian Research Agency (ARRS) Grant P3-0333.

Author information

Author notes

  1. Martina Jarc-Vidmar and Marko Hawlina have contributed equally to this work.

Authors and Affiliations

  1. Eye Hospital, University Medical Centre, Ljubljana, Slovenia

    Luka Lapajne, Sanja Roškar, Manca Tekavčič Pompe, Martina Jarc-Vidmar & Marko Hawlina

  2. Medical Faculty, University of Ljubljana, Ljubljana, Slovenia

    Luka Lapajne, Manca Tekavčič Pompe & Marko Hawlina

  3. Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia

    Sanja Roškar & Matija Svetina

Authors
  1. Luka Lapajne
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  2. Sanja Roškar
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  3. Manca Tekavčič Pompe
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  4. Matija Svetina
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  5. Martina Jarc-Vidmar
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Corresponding authors

Correspondence to Luka Lapajne or Marko Hawlina.

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Statement of human rights

All research procedures performed in the study followed the tenets of The Declaration of Helsinki and The Slovenian medical deontology codex. The study was approved by the committee for Medical Research Ethics of Slovenia (file number: 0120-678/2015-2, date: 15. 12. 2015).

Informed consent

Informed consent with explanation was obtained from the parents of the children participating in the study.

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The authors declare that they have no conflict of interest.

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Lapajne, L., Roškar, S., Tekavčič Pompe, M. et al. Vision training with VEP biofeedback in amblyopia after the critical period. Doc Ophthalmol 141, 269–278 (2020). https://doi.org/10.1007/s10633-020-09774-z

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  • DOI: https://doi.org/10.1007/s10633-020-09774-z

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