Eyeworld

EW FEATURE 42 has certainly been a role for various cognitive exercises. "Cognitive reha- bilitation in the form of various structured cognitive exercises has been around since the days of World War II," Dr. Goldberg said. "In the olden days it was basically a paper and pencil endeavor and now it is increasingly software-based. In prin- ciple, these tools are moderately ef- fective." Potentially, Dr. Goldberg sees well-designed cognitive exer- cises as possibly benefiting normal individuals as well. Some new visual cortex training software from RevitalVision (Lawrence, Kan.) has recently emerged. "It's a computer software- based biofeedback system that con- tinuously adapts to individual visual ability and essentially optimizes vi- sual processing," Dr. Waring said. This web-based software is pre- scribed by the practitioner for the IOL patient to use at home. This typ- ically is a 2-month treatment pro- gram. "It takes about 20 different sessions of about 20 minutes each at the computer in a dark room," Dr. Waring said. He recently took part in a pilot study trying to gauge the effect of using this software for different IOLs. "We had the idea, what if we take a series of patients with differ- ent IOLs, including multifocal and accommodative IOLs, and give them a month of normal healing, which can allow for some natural neural adaptation, and then measure base- line uncorrected acuities for distance and near and contrast sensitivity for distance and near," Dr. Waring said. In this multicenter trial involv- ing 62 eyes, patients using five dif- ferent types of IOLs were asked to undergo 2 months of cortical visual training. After this they were remea- sured. "What we found was that we basically had just over one line of improvement in distance acuity and just under one line of improvement in near acuity," Dr. Waring said. "There was also about 170% im- provement in contrast sensitivity at distance and about 100% improve- ment in contrast sensitivity at near." In addition to comparing results to the patients' pre-op levels, efforts were made to compare results for those who had undergone the train- ing to those who had simply been left to their own devices. In this case, results from a subset of Crystalens (Bausch & Lomb, Rochester, N.Y.) patients who didn't have any training at all were re- viewed at the same time point. "We have statically significant results that showed that there was no im- provement at all in distance or near acuity in the untrained group," Dr. Waring said. "This doesn't demon- strate efficacy, but the results were encouraging." Likewise, another group led by Joao Marcelo Lyra, M.D., Ph.D., Maceio, Brazil, did a similar study concentrating on the ReSTOR (Alcon, Fort Worth, Texas) multifo- cal lens. In this study, investigators waited 6 months after lens implan- tation before starting patients on the visual cortex training. This training lasted for 2 months. Results were likewise encouraging. "He saw a boost of around 130-150% for con- trast sensitivity and about one line to one and a half lines of improve- ment in acuity," Dr. Waring said. "Here is a separate group with a sep- arate study that showed that we can use different time points. He waited longer to allow for that natural neu- ral adaptation and he saw the same improvement." Dr. Waring sees the visual cortex training as akin to physical therapy after something such as hip surgery. "You undergo physical therapy; you don't go straight out onto the bas- ketball court," he said. "This is basi- cally visual rehabilitation." He sees the data as promising. "Although the data is preliminary, it is encour- aging," Dr. Waring said. "We have a prospective, randomized, control trial underway." While currently technology is limited when it comes to factoring in the neural component with pre- mium IOLs, that is likely to change in the future. Dr. Waring pointed to work being done on adaptive optics simulators. In the future, Dr. Waring thinks that this will help practition- ers to determine who may or may not adapt well to premium lenses. "They'll be able to simulate an opti- cal circumstance so at least they get a feel here," Dr. Waring said. "Then, more importantly, they'll be able to tailor treatment to the needs and preferences of patients and poten- tially design a treatment program because they can dial in the higher- order aberration profile that suits the needs to balance depth of focus and quality of vision." Overall, Dr. Waring is very opti- mistic. "With adaptive optics, visual simulators, and the devices that help us to better define placement and line of sight, in conjunction with vi- sual rehabilitation and cortical train- ing, we're going to be able to deliver superb results in a much more pre- dictable manner," he said. EW Editors' note: Dr. Waring has financial interests with RevitalVision. Dr. Goldberg has no financial interests related to his comments. Contact information Goldberg: 212-541-6412, egoldb7407@aol.com Waring: 614-781-0499, georgewaringiv@gmail.com February 2011 Ethics of IOLs August 2011 Maximum Portability Superior Versatility Simple Integration Introducing Pictor - a new, truly portable and versatile approach to ophthalmic imaging. ® schedule a free trial today Imaging Unlimited ersa v oducing P tr n I a Im t o oph oach t tile appr a , t or - a new w, truly por t ic oducing P n g U n agi . ing thalmic imag table and , truly por limited axim Ma x or e f t Ligh a M vi o r P im S on on o e w t and a Exam p Su with x or e f Premium continued from page 41

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