Visual Perceptual Learning for the Treatment of Visual Field Defect (VIVID)

This study will test the hypothesis whether visual field defect caused by chronic stroke could be improved by visual perceptual learning. The secondary hypothesis is that improvement of visual field defect would be accompanied by connectivity changes in visual networks. In addition, investigators will evaluate whether improvement of visual field defect could achieve improvement of subjective visual function.

Study design: A PROBE (Prospective, Randomized, Open-label, Blinded-endpoint) design Methods: Visual perceptual learning (VPL) group Visual perceptual learning (24 times for 2 months, 3 times per week) in visual field defect areas At baseline and post-VPL evaluations (2 months after): Structural & Functional MRIs, Visual field tests, Visual evoked potential, Visual cognitive tests, Subjective visual function questionnaires Control group At baseline and 2-months later: No VPL, Structural & Functional MRIs, Visual field tests, Visual evoked potential, Visual cognitive tests, Subjective visual function questionnaires Visual perceptual learning after 2-month follow-up evaluation (24 times for 2 months, 3 times per week) (The patients who were stratified by age (over 65 years old or not) and degree of visual field defect (quadrantanopia or complete hemianopia) will be randomly assigned into the learning and control group.) Investigations Improvement of visual field test scores between VPL group and control group Analysis of brain network changes in MRI data Correlation analysis of improvement of visual field defect and MRI data Correlation analysis of improvement of visual field defect and visual evoked potential (VEP) data Correlation analysis of improvement of visual field defect and neuropsychological data

Functional connectivity changes in resting-state functional MRI Structural connectivity changes in diffusion tensor imaging

Change in Korean version of National Eye institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) Change of subjective visual field area

Inclusion Criteria: The patient has chronic stroke more than 6 months after onset. The patient has visual field defect (Quadrantanopia or Hemianopia). The patient has corrected eyesight 0.7 or above. Exclusion Criteria: The patient has contraindication to MRI scan. The patient has cognitive impairment (Mini-Mental Status Exam score <24). The patient has ophthalmologic diseases (e.g., glaucoma, cataract).