JP2007216051A - Eyesight training device for people - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an eyesight training device for people, easily training a part maintaining residual optical function in a zone of the visual system of people. <P>SOLUTION: This eyesight training device for people includes: a central processing means for recording, storing, processing and transmitting data from the other means of the device; at least one visual stimulation display means; a visual line fixing point means for fixing people's visual line; a means for inputting a reaction of people to the sensed visual stimulation; a means for controlling at least one visual stimulation display means; and a means for specifying a zone outside of a sound visual field, wherein a zone outside of the sound visual field includes a zone to be trained, and visual stimulation is given toward a zone inside the sound visual field and the zone outside of the sound visual field. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a human visual acuity training device. In particular, the present invention relates to an apparatus that can cause changes in the visual ability of people in need of visual improvement or recovery training by stimulating the visual system with optical stimuli.

  Possible causes of visual impairment in humans include incomplete or impaired development of the visual system in childhood, continuous and natural degradation due to aging, diseases that have a significant impact on the visual system, or sudden degradation due to accidents. There will be. For example, it has been discovered that the visual acuity of a child can be substantially restored by the practice of regular visual system training, such as in the case of strabismus. On the other hand, people with impaired vision for any reason may stop the progression of degradation or even improve vision with specific training tailored to the cause of their visual system degradation. The present invention is for all disorders where it is likely to provide optical stimuli to the visual system of a person in need of vision improvement to eliminate the cause of the disorder and / or improve the person's ability It is an object of the present invention to provide a method and apparatus for training and improving human vision.

  In recent years, computer technology has been utilized to train the mental functions of the human brain. For example, the prior art has reported a method of treating temporary processing deficits of language-learning impaired children ameliorated using computer training as a paradigm (MM Merzenich et al., Temporal processing deficits of language-learning impaired children ameliorated by training; Science 271, 77-81 (1996)). However, it is not clear whether computer-based training is useful for other sensory therapies such as visual function after brain injury.

Brain damage, such as that resulting from stroke or trauma, often impairs visual function. In general, if a patient loses vision in half of the field of view, the other half is often intact. This partial blindness is generally considered untreatable. This is because it has long been believed that proper vision requires a highly specialized neuronal organization (DH Hubel, TN Wiesel, Receptive fields, binocular interaction and functional architecture in the cat's visual cortex, J. Physiol. 106-154 (1962)). However, despite this specificity of neuronal tissue, the damaged visual system has a considerable degree of adaptability (U. Eysel, OJ Gruesser, Increased transneuronal excitation of the lateral geniculate nucleus after acute deafferentation, Brain Res 158, 107-128 (1978); JH Kaas et al., Reorganization of retinotopic cortical maps in adult mammals after lesions of the retina, Science 248, 229-231 (1990); CD Gilbert, TN Wiesel, Receptive field dynamics changes in adult cerebral cortex, Nature 356, 150-152 (1992)). Loss of visual function can be restored to a certain extent even in animals (J. Sautter, BA Sabel, Recovery of vision despite progressive loss of retrogradely labeled retinal ganglion cells after optic
nerve crush, Europ. J. Neurosci. 5, 680-690 (1993); BA Sabel, E. Kasten, MR Kreutz, Recovery of vision after partial visual system injury as a model of post-lesion neuroplasticity, Adv. Neurol. 73 , 251-276 (1997); TN Wiesel, DH Hubel, Extent of recovery from the effects of visual deprivation in kittens, J. Neurophysiol. 28, 1060-1072 (1965); KL Chow, DL Steward, Reversal of structural and functional effects of long-term visual deprivation in cats, Exp. Neurol. 34, 409-433 (1972)), as is the case with humans (H. -LL Teuber, WS Battersby, MB Bender, Visual field defects after penetrating) missile wounds of the brain, Cambridge, Mass., Harvard University Press (1960)). At least part of the natural nerve adaptation after lesions in this adult visual system is due to extensive receptive field rearrangements that occur in the post-lesion retina or cortex. (U. Eysel, O. Gruesser, partial citation .; JH Kaas et al., Partial citation).

  Prior art discloses a training method that can be used to improve the visual function of monkeys with brain damage (A. Cowey, Perimetric study of field defects in monkeys after cortical and retinal ablations, Quart. J. Exp. Psychol. 19, 232-245 (1967)), some of which target humans (J. Zihl, Zur Behandlung von Patienten mit homonymen Gesichtsfeldstorungen, Z. Neuropsychol. 2, 95-101 (1990); E. Kasten, BA Sabel, Visual field enlargement after computer traning in brain damaged patients with homonymous deficits; an open pilot trial, Restor. Neurol. Neurosci. 8, 113-127 (1995)). However, for humans, it is not generally accepted that training can improve vision. Nevertheless, there have been several observational reports that suggest that people with visual system damage may gain from visual training.

  The first observational report that visual training may be effective in humans is a study by Zihl et al. (Partial citation), which measured the incremental threshold at the same retinal position with repeated visual stimulation. I found that the boundaries of vision of people with visual field defects expanded a little. However, repeating the test in this situation requires the experimenter to perform training with the person being trained, that is, the person cannot use this method alone. Therefore, it takes a lot of time for the person and the experimenter.

  In order to overcome this approach of manually presenting visual stimuli, the prior art discloses several devices that can be automatically tested. These claims have been seen in only a few individuals, and despite the fact that no strictly planned clinical trials have been conducted, these claims will improve visual function There is. However, the use of these prior art devices is too complex and its use is too inefficient, so it is not widely accepted in clinical practice.

  Document number DE-U9305147 published by Schmielau describes, for example, a human visual system training device consisting of a large hemispherical semi-bowl. Here, a small row of light bulbs is arranged in a semicircle with a large diameter. Light stimulation is provided to stimulate the field of view of various eccentric positions from the center to be visually fixed by illuminating the array of light bulbs placed in close proximity to each other. Certainly this device allows for maximum evaluation and training of the entire field of view, but several drawbacks prevent its spread. The drawbacks are (1) its size, (2) lack of flexibility in the position to give visual stimuli, and (3) lack of instruction to direct training according to the residual visual function. Due to the lack of ingenuity in the stimulus applying method, the use of the conventional Schmielau device takes a long time. In addition, training half bowls are not practical for home use.

  The limitations of Schmielau's invention are evident from FIG. In the figure, as described in classical textbooks, the human visual system is represented by areas that are intact or missing. There is no mention of the underlying obstacles in visual field training, the residual visual function area.

  As an alternative to such a large and impractical device, a computer may be useful, but Schmielau (partial citation) is impossible.

  Thus, in the prior art, skilled workers have always refused to use computers, since it is clearly stated that computer controlled training is not beneficial for vision training purposes.

We have found that contrary to general expectations in the art, computer-controlled training procedures for human visual function can contribute significantly to improving training effectiveness. Therefore, a computer program described elsewhere has been developed (Non-Patent Document 1). The main advantage of using a computer-controlled device is that the device is much smaller and that the person's ability can be continuously recorded. However, the program described by Kasten et al. (Partial citation) displays stimuli on a computer screen in a random order and does not take into account the person's actual ability for visual function. Therefore, although this method proved effective in early pilot studies, training was time consuming and inefficient.
E. Kasten, BA Sabel, Visual field enlargement after computer training in brain damaged patients with homonymous deficits; an open pilot trial. Restor. Neurol. Neurosci. August 1, 1995, Vol. 8, No. 3, p. 113 -127

  This program is described in a research paper (1997; partial citation) published by Kasten et al. For example, “Sehtra” provides a small light stimulus with variable brightness to any part of the field of view, but does not adapt to the person's actual ability in different field sectors. Stimulus is given randomly from a predetermined sector of the monitor to the person's field of view, taking into account the actual nature of the defect and the zone of residual visual system damage or residual visual function (so-called “transition zone”) Not put in.

  For this reason, trained people must react to stimulus-specified areas that are actually intact in their field of vision. As a result, the person spends a lot of time for purposes that are not therapeutically useful. This situation often resulted in boredom and loss of motivation as it unnecessarily compelled the person's time and patience.

  In order to overcome this limitation, it was an object of the present invention to provide a human vision training method and apparatus that avoids the disadvantages known in the prior art. Furthermore, it is an object of the present invention to provide a region of the person's visual system where the residual visual function is maintained, where the natural vision is only partially degraded, or where the natural vision is high. It was to provide a human vision training method and apparatus that allows for training where to be maintained at a quality level (so-called “transition zones”). It is a further object of the present invention to train human vision to extend the person's field of view into the transition zone and further expand the transition zone into a substantially complete visual system damage zone if the person's vision is severely damaged. It was to provide a method and apparatus. Furthermore, an object of the present invention is to provide a human vision training method and apparatus that can be carried out by one person not only under the supervision of a skilled experimenter at a normal training center but also in the personal environment of the person. It was.

  Surprisingly, the above objective has been achieved by the present invention. The inventor has devised a new method of applying visual stimuli on a simple device that emits optical stimuli to the human visual system.

In a very general sense, the present invention relates to a method of training the human visual system by applying a light stimulus to a human, the stimulus being in a zone within the human intact field and outside the human intact field. The vision in the latter zone can be improved by including the zone to be trained and given to the zone. The method
-Locating and locating zones of vision degradation or residual visual function or partial visual system damage ("transition zones") in the human visual system;
-Identifying a training area within the transition zone;
-Training the human visual system by applying visual stimuli to the human visual system, provided that most of the visual stimuli are applied in or near the transition zone;
-The process of recording changes in the characteristics of the human visual system;
-Adapting the location and identification of the stimulus display to the transition zone in response to the change, and-continuously repeating the above steps to expand the human intact field of view into the transition zone, and Expanding the transition zone into a more visually impaired zone or a zone with less residual visual function or substantially complete visual system damage.

In a further embodiment, the present invention relates to a human visual system or visual acuity training device enabling the implementation of the above training method. This device
-Central data processing means for recording, storing, processing and transmitting data from other means of the device;
-At least one visual stimulus transmission means,
-Gaze fixing point means for fixing the person's gaze,
-Means to input the person's response to perceived visual stimuli,
Means essential to control said at least one optical stimulus display means in accordance with the person's ability to respond to the perceived light stimulus.

In one preferred embodiment of the invention, the device is
-Locating and locating zones of vision degradation or residual visual function or partial visual system damage ("transition zones") in the human visual system;
-Identifying a training area within the transition zone;
-Training the human visual system by applying visual stimuli to the human visual system, provided that most of the visual stimuli are applied in or near the transition zone;
-The process of recording changes in the characteristics of the human visual system;
-Adapting the location and identification of the stimulus display to the transition zone in response to the change, and-continuously repeating the above steps to expand the human intact field of view into the transition zone, and It is possible to perform the process of expanding the transition zone into a zone with more visual impairment, a zone with less residual visual function or a zone with substantially complete visual system damage.

  Therefore, a unique feature of the present invention is that stimulation training is mainly performed in or near the vision degradation zone, residual visual function zone or partial visual system damage zone that is the subject of training, i.e. the transition zone. In other words, the display of stimuli in the intact visual field may be reduced to a considerable extent or even gone.

  In these aspects, the present invention is different from the prior art methods and apparatus described by Kasten et al. (1997, partial citations) that do not disclose continuous monitoring of the residual ability of the trained person's visual system. Is different. Rather, the Kasten device keeps the training area of the field of view constant and repeatedly stimulates areas that have already recovered vision or are completely free of vision impairment. Thus, prior art devices provide stimulation regardless of the person's actual ability. The device still trains the recovered area after some experience of the training effect, even though it is no longer necessary. Therefore, the visual display paradigm disclosed in the prior art is time consuming and requires a lot of time, and most of the time is unnecessary. In fact, trained people report that they are too time consuming and tedious for prior art training.

  Furthermore, it is not possible with the prior art methods to locate and treat limited areas of vision degradation “only” or residual visual function or partial visual system damage. Prior art methods are time consuming training that includes training of areas or zones that show optimal results of visual ability, so the idea of an optical stimulus display paradigm with short duration and high usage efficiency has long been awaited. . Thus, in the present invention, we introduce an innovative process that continuously monitors the ability of a person in need of visual field training, so that only the areas of visual system degradation or partial damage “only” are observed. It was conceived of a visual training method and apparatus for stimulating.

  Thus, according to the present invention, we have developed a more efficient approach by concentrating visual stimuli in the field of view where more efficient rehabilitation progress can be expected.

  In order to overcome the limitations of the device in the prior art, we are now able to find, identify and characterize the location of the zone of failure, i.e. the zone of visual impairment or residual visual function or partial visual system damage first. Propose to clarify. A zone of visual impairment or visual impairment or partial visual system damage is briefly referred to as a transition zone below (see FIG. 1). Such a transition zone may be seen among older people whose vision is increasingly restricted, such as side vision. Transition zones may also be seen among people whose visual system is affected as a result of brain damage, seizures or similar events. Another example is a transition zone between a zone that fully maintains the ability to visually distinguish colors, shapes, or actions and a zone that has completely disappeared. Within the transition zone, find the location of the training area or zone defined in the next step of the procedure.

  In one preferred embodiment of the present invention, the size and location of the training area within the transition zone depends on the size, location and type of the human partial visual system degradation, residual visual function or vision deficit zone. Selected. That is, it is necessary to carefully check which part of the human visual system is most in need of further training by applying a light stimulus.

  Next, we propose to provide training stimuli for those transition zones based on the individual's ability that is continuously or intermittently identified during the training. In a preferred embodiment of the present invention, optical and preferably light stimuli are applied to the person's visual system. More preferably, light stimuli of various colors, brightness, intensity and / or shape are given to the visual system of the trained person. Such a light stimulus can be applied continuously as a stationary light stimulus or as a series of light stimuli that give the impression of a moving object.

  This “stimulation based on transition zones” is an area of partial visual function where some of the neuronal structure is immune to damage, and the area where the human visual acuity is only degraded, or the vision is not intact or completely damaged Is based on the consideration that exists. As long as this surviving neuron exceeds a certain minimum number ("minimum residual structure hypothesis"), it is inferred to mediate visual recovery through training, and thus these stimuli from training are taken It should be an important means. As a result, in order to overcome the problems of already recognized inadequate visual field stimulation, we use computer-controlled stimulators to selectively stimulate these areas (“transition zones”), The method of grant was devised.

  Following the above ingenuity, a specific algorithm has been developed, which can very efficiently train areas of visual system dysfunction or dysfunction. The following are specific steps of a training procedure relating to stimulating specific areas or zones of the human visual system with light stimulation.

  During the training process, changes in the characteristics of the trained human visual system are recorded. That is, the ability of a person to be trained is recorded by the system / apparatus of the present invention from the viewpoint of visually recognizing the displayed optical stimulus and showing the person a desired response in the visual recognition process. Is done. To give just one example, the trainer's response time to the optical stimulus indicated for the transition zone of the person's visual system is measured, and the application and response of the optical stimulus (eg, pressing a button on the device); The time elapsed between is understood as the person's ability in the training area of the transition zone, depending on the average time value previously measured as the trainer's baseline value. However, this example should not be considered as limiting the present invention. Any other suitable measures may be taken in order to record changes in the characteristics of the human visual system continuously or intermittently.

  Based on the continuous recording of the characteristic change as described above, the position and identification of the transition zone are adapted to the change. This may be continuous or intermittent. That is, the transition zone is newly identified according to the ability of the trainee to process the display optical stimulus by the visual system. While not wishing to be bound by this explanation, effective training of specific transition zones, for example, to improve any of the degraded functions of the visual system (eg peripheral vision, visual acuity, different colors, shapes, By improving motion discrimination (decreasing strabismus, increasing viewing angle), or residual visual function, or removing partial visual system damage, the trainee's vision is improved within the zone. As a result, the transition zone will be an intact area of the person's visual system, another missing area will be (and identified) as the transition zone, and optical to the new transition zone of the person's visual system. It is used in another training process or series of processes for displaying stimuli (see also FIG. 1).

  By repeating the above process, the person's intact field of view was previously located in the transition zone and continuously expanded into the identified zone, and the transition zone was previously a vision impairment zone or residual It is continually extended into a zone that was a reduced visual function zone or a substantially complete visual system damage zone, i.e., a bad zone (see FIG. 1).

  Using training based on this computer program, we conducted two independent placebo-controlled clinical trials in humans suffering from central nervous system injury. This study is not considered to be limited to such severe illnesses, but our methods and devices can be used for any disease of the visual system, but those who have been trained and evaluated in this study There were people with visual cortex or optic nerve damage. For the first time, in a well-regulated clinical trial, training a person's visual system through repetitive stimulation of the visual field can significantly reduce partial blindness when stimulating residual function or “transition zone” areas. I was able to show.

Training software and training procedures Training was regularly conducted at the homes of trained people using home PCs. In the preferred embodiment of the present invention, one hour of daily training in a dark room is performed for a long period of time, for example, 6 months, as was the case in this test. However, the effectiveness of any other training period has been proven.

  Special algorithms for applying light stimuli on the monitor, such as providing repetitive visual stimuli to transition zones located between the intact and damaged visual field sectors of a trained human because the prior art devices were inefficient Was developed. In the first step, the location of the “transition zone” was found, identified, and characterized. That is, at this time, an accurate residual visual function within the transition zone was confirmed with respect to position, size, and type.

  After the first step, a training area located in the transition zone is identified. The training area is an area within the transition zone. As a result of the identification and characterization of the transition zone in the first step, the neuron structure of the person's visual system can be expected to be reproduced due to the presence of a minimum residual neuron structure, for example. By the way.

  In the next step, the dysfunctional area is stimulated based on the capabilities identified in the first and second steps. This approach is more efficient. This is because the intact area of the visual field is not stimulated, but only the area that is revealed to be dysfunctional is stimulated.

  Also, in prior art devices, the program simply stores data for later analysis, but unlike the present invention, the present invention continuously or intermittently places training algorithms in or near dysfunctional areas. Adapt to visual system ability.

  In addition, daily treatment results can be stored on a suitable storage medium such as tape or disk, so that adaptability can be monitored and a treatment strategy tailored to the person's progress can be made.

  According to the configuration of the present invention, in the human visual system zone, the residual visual function is maintained, the natural visual acuity is only partially deteriorated, or the natural visual acuity is high quality. It is possible to realize a training device that can effectively perform training where it should be maintained at a certain level (so-called “transition zone”) based on the effect of improving human brain function.

  Hereinafter, the present invention will be described in detail with reference to the drawings. Although the specification of the present invention primarily deals with training people with severely damaged visual systems, all the details, methods and devices of the present invention are for people whose visual systems are progressively degraded due to aging. It can also be applied to those who need to train normal vision to maintain a high level of visual acuity, with changes as needed by skilled workers. To that extent, the description of training procedures for people with severe visual impairments is not to be construed as a limitation of the present invention.

In the drawing,
-Figure 1 shows the assumed field of view of a person suffering from partial blindness. The field of view is a sector or zone in which the person has no visual impairment (“intact area”), a sector or zone of partial visual system damage (“transition zone”), and a sector or zone of substantially complete visual system damage (“ It is divided into “bad areas”).

  FIG. 2 shows a computer-based high-resolution peripheral vision measurement method (“HRP”). In FIG. 2A, the assumed field of view of the person is represented by a circle, the defective area is seen on the left (half shaded circle), and the central square represents the area assessed by computer-based HRP. . FIG. 2B is an enlarged view of the central square of FIG. 2A, the white area on the right is the intact visual function zone, the gray area is the area that reacts inconsistently to light stimulation (light gray is “hit”) The black area represents a zone of poor visual function. FIG. 2C is an enlarged view of the left portion of FIG. 2B, showing an island of residual visual function. FIG. 2D shows the same region as FIG. 2C, but after recovery training. Further, FIG. 2E shows the difference between FIG. 2D and FIG. 2C to show the increase or decrease in visual ability. Note that the visual stimulus is given based on the shape and position of the “gray” zone, ie the transition zone where the visual ability is recognized. Most of the visual stimulus is given in the transition zone, not in the intact visual field sector. In contrast to prior art devices that randomly stimulate the entire field of view or move the stimulus from line to line, the present invention provides stimulation only in the “transition zone”.

  FIG. 3 shows the visual function before (white bar) and after (black bar) recovery training or placebo (fixed gaze training) for people with optic nerve or post-chiasma injury (mean ± SE). The HRP data is displayed as the detected stimulus, ie the number per hit (top graph). The lower graph shows the position of the visual field boundary from the zero vertical meridian in degrees of viewing angle.

  FIG. 4 shows the distance of the black square from the zero vertical meridian (i.e. the unhit position, see legend in FIG. 1), + 20 °, + 10 °, 0 °, −10 ° and −20 ° of viewing angle. By measuring at the vertical position, the data in which the boundary at HRP or TAP is determined is shown. The extent of the visual field expansion was confirmed by calculating the difference between before and after obtaining the average value of these measured values. Note that the HRP boundary and the boundary obtained by the TAP peripheral visual field measurement method are different.

  The present invention will be described in more detail with reference to the drawings and preferred embodiments, but the present invention is not limited to these embodiments.

  In the computer algorithm for the step of applying visual stimulus to the human visual system, the monitor displays the fixed point of gaze, but may be displayed on any part of the monitor. The line-of-sight fixing point plays a role of fixing the person's line of sight to a certain point in order to adjust the angle of the person's line of sight. Subsequently, additional visual stimuli are provided in or immediately adjacent to the transition zone that has been located in the previous step and modified according to the person's ability. The prior art devices announced by Kasten et al. Are inefficient and time consuming because they are given visual stimuli regardless of their actual progress. In contrast, the present invention provides visual stimulation primarily in or adjacent to the transition zone, i.e., only in areas of partial visual system damage or vision degradation.

  In the present invention as in the prior art, the person responds to each optical stimulus to the transition zone of the visual system by pressing the appropriate key on the computer keyboard. However, in contrast to the prior art device disclosed by Kasten et al. (1997), here to increase the possibility of therapeutic effect and fitness of training by avoiding the level of unmotivated training, Personalized training procedures are used. At the same time, the same effect can be achieved by reducing the total number of visual stimuli.

  As is apparent from this disclosure, it is beneficial to limit the portion of the field of view that is only partially damaged or degraded as the training area. Of course, the stimuli that are actually applied may vary in size, brightness, shape or color, and other means such as projection screens, simple computer monitors or other visuals such as virtual reality goggles or helmets. Can be displayed using an optical projection device. As long as it is certain that the stimulus display position is adapted to the individual's individual defect, the type of stimulus and the method for displaying the stimulus are further largely the “transition zone”, ie, the area of visual function damage. As long as it is given, it is not limited.

  The theory behind this visual field stimulation algorithm is the assumption that iterative activation of neurons restores functions that would otherwise be lost, compromised or wasted. The present invention is superior to prior art devices by focusing the person's attention on the area of visual field damage, along the line from the missing part of the person's visual field to the intact part in the prior art. The activation of neurons is higher than when attention must be directed to moving small light stimuli. As evidenced by this argument, concentrating attention on a partially damaged sector of the field of vision will direct the person's attention to the very area where residual visual function can still be detected even if damaged, Neuron activity will become relatively active. It would not be beneficial to give a large number of stimuli to the intact vision sector as well.

  The above argument does not imply that function can never be restored in blindness or in substantially completely poor fields, i.e. in zones that have not previously responded to visual stimuli. Rather, training will restore visual function, even in areas that have completely lost visual function, as our clinical trials show. 2C to 2E show an example. Note that the areas that were not visible before (black squares in FIG. 2C) are flipped to be visible again after several months of training (white squares in FIG. 2D).

  The timing of training also does not predict how quickly the visual field defect recovers. Some people need weeks or months to restore functionality, while others improve quickly. Thus, the present invention does not suggest that a certain period of training is required.

  Another advantage of the present invention is that it can particularly train areas that are found to be defective by training. Note the areas of reduced ability due to training in FIGS. 2C-2E. Prior art devices do not take into account the possibility of functional degradation due to training. As a result, an adaptive procedure is also beneficial in this fact. Again, the stimulation will be concentrated on the area of the visual field that shows the defect.

  This raises the question of how to identify areas of visual deficit. There are many ways to identify a partially damaged brain area. Theoretically, if there is a lack of response to a visual stimulus, a long response time to the stimulus, or a problem in identifying the stimulus, it is identified as a visual defect region. As described in the prior art, visual deficiencies, regardless of whether or not they are conscious, (a) changes in threshold during testing of the visual contrast sensitivity function, (b) reduced reaction time, or (c) the person. This is evidenced as the absence of a response to the stimulus. Again, the present invention makes no assumptions about how the deficits in visual function are identified as long as the majority of the training stimulus is given to the region of the visual field corresponding to the partially damaged function (“transition zone”). Not performed.

Examination of the effectiveness of the program in clinical trials The following trials and the characteristics of the people were chosen to demonstrate that this invention can in principle reduce visual field defects. The example chosen does not imply that visual training is effective only for these people and not for any other people or people with different visual impairments. In a preferred embodiment, the subject is one with a nervous system lesion, but the present invention is also used by those skilled in the art to treat other diseases of the eye or visual system that do not affect the nervous system. It will be used effectively.

  To demonstrate the effectiveness of this invention, we conducted two clinical trials. The people who participated in the study were selected from among 130 large personnel with optic nerve damage or damage to the primary visual cortex. They were screened according to pre-determined criteria for participation and exclusion and a baseline assessment was performed. The selection criteria for inclusion and exclusion criteria were chosen only for the purpose of reducing capacity variation within groups of people. It was not chosen to suggest that people who do not meet these criteria cannot be treated. In fact, the present invention is useful for any disease of the visual system.

  The data reported here are from two independent clinical trials, each consisting of an experimental group and a review group. In the first study, two groups of people with optic nerve damage, the experimental and review groups, combined people according to age (blindness, n = 19). In the second study, people with post-chiasma injuries were randomly assigned (double blind, n = 19). The people were then instructed to train at home with visual tasks on the monitor.

  The following detailed description is only one preferred example of the invention. It is not limited by the type of stimulation given, or the amount of training required or the type of visual system disease. It is only intended as an illustration.

  In HRP, 500 stimuli with a brightness clearly above the detection threshold were displayed on a 17-inch computer monitor (see FIG. 2). The person was instructed to constantly stare at the gaze fixation point (center star) and press the key within 750 milliseconds. To ensure proper gaze fixation during home training, the gaze fixation point (4 mm diameter star) is random from bright green (95 cd / m 2) to bright yellow (100 cd / m 2). The person was then instructed to press any key within 500 milliseconds.

  A white bright stimulus was applied continuously at 500 different positions, each with a duration of 150 milliseconds (25 × 20 grid, dark monitor screen, stimulus size (SS) 0.15 °, stimulus Brightness (SL) 95 cd / m 2, background brightness (BL) <1 cd / m 2). Peripheral vision measurement tasks and training were performed 30 cm away from the monitor, using a chin support to ensure a stable head position. The overall resolution of HRP was about 4 times greater than that of TAP (E. Kasten, S. Wuest & B. A. Sabel, J. Clin. Exp. Neurophysiol., In press).

  TAP is a fixed peripheral perimeter used in daily clinical practice, and a field of view up to 30 ° eccentricity is confirmed using 191 stimuli with brightness close to the threshold (R. Fendrich, CM Wessinger, MS Gazzaniga, Residual vision in a scotoma: Implications for blindsight, Science 258, 1489-1491 (1992)). Proper eye fixation was monitored using a video camera. However, TAP has methodological limitations. This is because (a) the person's subjective evaluation criteria may change over time when responding to stimuli near the threshold, and (b) the resolution is relatively low. Therefore, the ability of TAP was chosen as a secondary outcome measure. All peripheral visual field analysis included only the values obtained in the training area (treatment group) or the corresponding area in the placebo group. Visual acuity was measured with Landolt's numerical value, and the minimum resolution angle was calculated from the numerical value. In addition, a history interview after standard illness was conducted to confirm whether treatment resulted in a subjective improvement in visual acuity in daily life.

After final results measurements and 150 hours of statistical material (about 6 months) training, the final results were evaluated using the same procedure as for baseline evaluation. Subsequent post-hoc comparisons along with two-way analysis of variance were calculated for each study for statistical analysis of parameter data. Student t-tests were used for individual group comparisons.

The selection test was approved by the local medical ethics committee. People included in the study had to be those with both visual field defects and post-chiasma or optic nerve damage, with CT, MRI, surgical records or ophthalmoscopic evidence of optic atrophy. Of the following exclusions, those with at least one applicable item were not included (indicating the number of cases excluded in parentheses).

-Lack of gaze fixing ability (n = 11)
-Neglect (n = 1)
-Non-visual nerve anomalous visual field defect (n = 7)
-Eye disease (n = 9)
-No residual vision (n = 2)
-No visual loss (n = 1)
-Age> 75 years (n = 4)
-Age <18 years (n = 1)
-Death (n = 2)
-Age of lesion <12 months (n = 3)
-Epilepsy or photosensitivity (n = 2)
-Lack of recognition (n = 12)
-Refusal to participate in the study (n = 27), and-not appearing after the first review (n = 10)
After examining a total of 130 people, only 38 people were enrolled in the study.

There were no differences in baseline characteristics between baseline assessment groups with respect to age, gender, injury classification or injury magnitude (see Table 1). After the first screening, we got informed consent. People use the diagnostic program “PeriMa” (see E. Kasten, H. Strasburger, BA Sabel, Programs for diagnosis and therapy of visual deficits in vision rehabilitation, Spatial Vis. 10, 499-503 (1997), FIG. 2) and standards. In order to get used to the Molecular Tubingen Automatic Peripheral Perimeter (TAP) under conditions of ambient brightness, I participated in one training session.

  Next, baseline evaluation using HRP was performed individually 2-4 times. The integrated value of these repeated measurements was taken as the baseline value. The people were then designated as either treatment or placebo groups.

The results are shown in Table 2 as mean values ± SE. Data were analyzed by post-hoc design comparison with a two-way analysis of variance using the LSD test. The F value was extracted from a two-way analysis of variance with the training type as the independent element A and the time before and after (training) as the dependent element B. Large differences are shown as comparisons between baseline # or groups at individual time points (§).
* p <0.05; ** p <0.025; *** p <0.01
(*) Trend of p <0.10. It should be noted that both groups had a large difference in the number of hits in TAP at both time points (+ p <0.01). § These values include only the ability from the damaged half of the field of view.
The change in viewing angle baseline data from the zero vertical meridian was analyzed by student t-tests.

Evaluating the first visual outcome: Both recovery groups, except the review group, showed a significant improvement in the ability to recognize small visual stimuli well beyond the detection threshold (HRP test) after training (Table 2) . In the trained vision sector, people undergoing recovery training responded more frequently to stimuli than the review group (per hit) (post Chiasma people: 29.4% increase in baseline, optic nerve people: 73.6%, p <0.05). In addition, the review group did not show any improvement (post-chiasma people: 7.7%) or much smaller improvements (optic nerve people: 14.4%, Table 1). . Thus, people with optic nerves gained the most from training (FIGS. 2 and 3).

  Before and after treatment, the position of the visual field boundary was also assessed (Figure 4). In some optic nerve people, the lesion was located on both sides of the field of view, so the border was set on both sides of the zero vertical meridian here. Border movement was seen in both the optic nerve (5.8 ° ± 1.2) and post-chiasma people (4.9 ° ± 1.7), compared to the placebo group, which is smaller Change (4.3 ° ± 0.69, n.s.) or no change (post-chiasma: −0.9 ° ± 0.8). Most people (18 of 19) gained from recovery training, as the first outcome assessment proves. With HRP, recovery rates above baseline were less than 20% (n = 5), up to 50% (n = 5), 100% (n = 4), or 4 people were greater than 100% ( Maximum of one person: 200%).

  Evaluation of second outcome: For people with optic nerve, the total defect area as measured by TAP was significantly reduced in the recovery group but not in the review group. In the case of the later Kiasma people, there was no such difference in the ability of TAP. When the field size is calculated by determining the field boundary with the degree of viewing angle using the TAP data, the recovery training shows that the boundary movement, that is, the field size increase is 0.43 ° ± 0. Whereas it was only 34 led, it decreased by -0.51 ° ± 0.34 in the placebo group of later Chiasma people. For optic nerve people, the boundary movement was 2.1 ° ± 0.5 and 1.4 ° ± 0.5, respectively.

  Of the 38 people who participated in the clinical trial, 30 responded to a post-trial questionnaire to check subjective improvement. 72.2% (n = 18) of those trained in recovery report a subjective recovery in visual acuity (chi-square = 8.89, p <0.003), but only 16 in the review group 0.6% (n = 12). There were no noticeable differences between groups by age or gender of people, size or side of visual field loss (right / left) and age of injury.

Functional significance of computer-controlled training We have shown for the first time that vision recovery training on a computer monitor significantly broadens the field of view both after optic nerve and visual cortex injury. Gaze-fixing point training (placebo) did not broaden the vision of people in the later Chiasma, although some improvements were seen in people with optic nerves. Approximately 95% of all subjects in the recovery group had a light field detection of only 56.4% ± 12.3 increase in baseline, an average of 4.9 ° or 5.8 for the viewing angle of people with post-chiasma or optic nerve. Each experienced an increase in °. The magnitude of this change is significant in terms of function.

  First, a 5 ° increase in field of view corresponds to a half-page of the magazine at a distance that is roughly extended, and a central view of only 2-3 ° is generally sufficient for reading (E. Aufhorn , Soziale Integration in Abhaangigkeit von der Probnose, in W. Hammerstein, W. Lisch (eds.), Ophthalmologische Genetik, Stuttgart (1985), pages 368-373).

  Second, the vast majority (about 72.2%) of people undergoing recovery training report subjective improvements.

  The neurobiological mechanism involved in vision recovery is currently unknown, but collecting animal and human findings provides some initial clues. We propose that training activates the partially damaged structure itself, that is, the neuronal elements that survive as the boundary areas of residual vision ("transition zones") or island areas present in some people with visual cortical damage (R. Fendrich, CM Wessinger, MS Gazzaniga, Residual vision in a scotoma: Implications for blindsight, Science 258, 1489-1491 (1992)). A transition zone (see the gray area in FIGS. 2 and 4) located between the intact and damaged areas of the normal field of vision has been proposed to be representative of the function of residual neurons in the partially damaged tissue (BA Sabel Et al. (1997), partial citation; E. Kasten et al. (In press), partial citation). According to the hypothesis of "minimal residual structure" (B. A. Sabel (1997), partial citation), if only 10-15% of neurons remain, it is sufficient to restore vision. That is, if there are only a few remaining neurons in these areas, it will be enough to reactivate the visual function (J. Sautter et al. (1993), partial citation). This will also explain why people with optic nerve damage gained more from recovery training in our trial. This is because their transition zones are particularly large (ie, areas of diffuse damage, no data display). We have therefore proposed that residual neurons in the partially damaged visual system that are only insufficiently able to activate the visual target, possibly due to non-use, are activated by repeated visual stimulation during recovery training.

  It is thought that an expansion of the receptive field similar to that shown by Carth (J. H. Kaas et al. (1990), partial citation) is occurring. He found that the monkey cortex after retinal lesions naturally expanded 5 ° over the course of several months. This figure is almost the same as the 4.9 ° -5.8 ° field expansion seen in our subjects. With recovery training, applying regular visual stimuli to damaged border areas can greatly expand the field of view, so the adaptive potential of the adult visual system can be exploited for human therapeutic purposes. Using a computerized training program at home is both cost effective and convenient, with no obvious side effects.

  In conclusion, our study extends the results of previous animal studies to humans and shows that people with partial blindness can benefit from recovery training and regain some of their lost vision. A common implication of our discovery is that computer-based training programs can significantly improve human brain function.

  According to the present invention, it is possible to obtain a human visual acuity training device that can improve the effect of recovery training for people suffering from partial blindness.

A diagram showing the assumed field of view of a person suffering from partial blindness Diagram showing a computer-based high-resolution peripheral vision measurement method ("HRP") Diagram showing the visual function of the front (white bar) and back (black bar) of recovery training or placebo (fixed gaze training) for people with optic nerve or post-chiasma injury (mean ± SE) By measuring the distance of the black square from the zero vertical meridian at vertical positions of + 20 °, + 10 °, 0 °, −10 ° and −20 ° of the viewing angle, the data bounded by HRP or TAP is obtained. Illustration

Claims (1)

Central data processing means for recording, storing, processing and transmitting data from other means of the device;
At least one visual stimulus display means;
Gaze fixing point means for fixing the gaze of a person,
A means for inputting a person's response to a perceived visual stimulus;
Means for controlling said at least one visual stimulus display means in accordance with the state of human reaction to the perceived visual stimulus;
Means for identifying a zone outside the intact field of view,
The zone outside the intact field includes the zone to be trained;
An apparatus for training a human visual system or vision configured to provide a visual stimulus to a person toward a zone inside the intact field and a zone outside the intact field.

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