Apical Scotomata, Confusion, and Diplopia
For many of us, it is easy to imagine the phrase “translational research” referring to a clinician-scientist performing experimental surgery in the laboratory to test a new drug delivery device or a biomaterial for cell-based therapy. Perhaps we are less likely to think of ray tracings, nodal points, and Goldmann visual field diagrams as the basis of translational research. Of course, this bias is not valid. Expertise in optics applied to the design of spectacles is a common part of clinical ophthalmic practice around the world. Logically, this expertise can be applied to develop novel treatments for patients with visual disability. A report by Apfelbaum et al1 illustrates this example of translational research very well.
- [Show abstract] [Hide abstract] ABSTRACT: To determine the functional utility for general mobility of peripheral prism glasses, a novel visual field expansion device for hemianopia, in a large-scale, community-based, multicenter study with long-term follow-up. Forty-three participants with homonymous hemianopia were fitted with temporary press-on Fresnel peripheral prism segments of 40 prism diopters. Follow-up questionnaires evaluating functional benefits for mobility were administered in the office at week 6. Participants who continued wearing the prisms were interviewed again by telephone after a median of 12 months. Primary outcome measures included clinical success (a clinical decision to continue wear) and 5-point ratings of prism helpfulness for obstacle avoidance when walking. Thirty-two participants (74%) continued prism wear at week 6, and 20 (47%) were still wearing the prisms after 12 months (median time, 8 hours per day). These participants rated the prism glasses as very helpful for obstacle avoidance and reported significant benefits for obstacle avoidance in a variety of mobility situations. Success rates varied among clinic groups (27%-81%), with higher rates at the clinics that fitted more patients. Our results demonstrate the functional utility of peripheral prism glasses as a general mobility aid for patients with hemianopia.0Comments 49Citations
- [Show abstract] [Hide abstract] ABSTRACT: Aims. Homonymous hemianopia (HH), a severe visual consequence of stroke, causes difficulties in detecting obstacles on the nonseeing (blind) side. We conducted a pilot study to evaluate the effects of oblique peripheral prisms, a novel development in optical treatments for HH, on detection of unexpected hazards when driving. Methods. Twelve people with complete HH (median 49 years, range 29–68) completed road tests with sham oblique prism glasses (SP) and real oblique prism glasses (RP). A masked evaluator rated driving performance along the 25 km routes on busy streets in Ghent, Belgium. Results. The proportion of satisfactory responses to unexpected hazards on the blind side was higher in the RP than the SP drive (80% versus 30%; P = 0.001), but similar for unexpected hazards on the seeing side. Conclusions. These pilot data suggest that oblique peripheral prisms may improve responses of people with HH to blindside hazards when driving and provide the basis for a future, larger-sample clinical trial. Testing responses to unexpected hazards in areas of heavy vehicle and pedestrian traffic appears promising as a real-world outcome measure for future evaluations of HH rehabilitation interventions aimed at improving detection when driving.0Comments 16Citations