Randomised Placebo-Controlled Clinical Trial Evaluating The Impact Of A New Visual Rehabilitation Program On Neuroadaptation In Patients Implanted With Trifocal Intraocular Lenses

The aim of the current randomised placebo-controlled clinical trial was to evaluate the efficacy of this new visual training program for improving the visual function and minimising the perception of visual disturbances in a relevant sample of patients undergoing bilateral cataract surgery with the implantation of trifocal diffractive intraocular lenses (IOLs). Furthermore, we aimed to assess functional and structural brain changes induced by therapy in these patients by performing a rs-fMRI substudy in a small subsample of patients to confirm that the visual training program generated a differential impact on brain activity compared to the use of the placebo software. 

Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain

Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain

Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Spain

Clínica Baviera, Valladolid, Spain

Department of Medicine, Dermatology and Toxicology, Universidad de Valladolid, Spain

Department of Neurology, University Clinical Hospital, Universidad de Valladolid, Spain

Randomised placebo-controlled clinical trial enrolling 60 subjects (age, 47-75 years) undergoing cataract surgery with implantation of trifocal diffractive IOL. Home-based active visual training was prescribed immediately after surgery to all of them (20 sessions, 30 min): 31 subjects using a serious game based on Gabor patches (study group) and 29 using a placebo software (placebo group). Visual acuity, contrast sensitivity (CS), and perception of visual disturbances (QoV questionnaire) were evaluated before and after training. Likewise, in a small subgroup, resting-state functional magnetic resonance imaging (rs-fMRI) analysis was performed.

No significant differences were found between groups in compliance time (p=0.70). After training, only significant improvements in monocular uncorrected intermediate visual acuity were found in the study group (p≤0.01), although differences between groups did not reach statistical significance (p≥0.11). Likewise, significantly better binocular far CS values were found in the study group for the spatial frequencies of 6 (p=0.01) and 12 cpd (p=0.03). More visual symptoms of the QoV questionnaire experienced a significant change in the level of bothersomeness in the study group. Rs-fMRI revealed the presence significant changes reflecting higher functional connectivity after the training with the serious game.

A 3-week visual training program based on the use of Gabor patches after bilateral implantation of trifocal diffractive IOLs is beneficial for optimizing the visual function, with neural changes associated suggesting an acceleration of neuroadaptation.