HOGWAND
Trial question
What is the role of visual perceptual learning digital therapy in patients with stroke-induced visual field defects?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 82
82 patients (25 female, 57 male).
Inclusion criteria: adult patients with stroke-induced persistent visual field defects and imaging-based visual pathway damage.
Key exclusion criteria: complete hemianopsia; epilepsy, photosensitivity, Parkinson's disease; bilateral visual field defect; hemispatial neglect; ophthalmologic disorder that may interfere in the trial; candidate for carotid endarterectomy or stenting; pregnancy or lactation.
Interventions
N=41 visual perceptual training (virtual reality-based visual perceptual learning, orientation and rotation discrimination, 5 days a week for 12 weeks).
N=41 no training (passive control with no training).
Primary outcome
Mean improved visual areas, assessed using Humphrey visual field tests at 12 weeks
194.1 °²
82.5 °²
194.1 °²
145.6 °²
97.0 °²
48.5 °²
0.0 °²
Visual perceptual
training
No
training
Significant
increase ▲
Significant increase in mean improved visual areas, assessed using Humphrey visual field tests at 12 weeks (194.1 °² vs. 82.5 °²; MD 72, 95% CI 36 to 108).
Secondary outcomes
Significant increase in mean improved area in the defective hemifield, assessed using Humphrey visual field tests at 12 weeks (158.9 °² vs. 72 °²; MD 72, 95% CI 36 to 108).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients with stroke-induced persistent visual field defects and imaging-based visual pathway damage, visual perceptual training was superior to no training with respect to mean improved visual areas, assessed using Humphrey visual field tests at 12 weeks.
Reference
Eun Namgung, Bum Joon Kim, Jee Hyun Kwon et al. Personalized Visual Perceptual Learning Digital Therapy for Visual Field Defects Following Stroke: A Randomized Clinical Trial. JAMA Netw Open. 2025 May 1;8(5):e2511068.
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