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From the Department of Clinical Neurosciences (G.A.S., D.K., H.C.), Royal Free Hospital and University College Medical School, London; MRC Clinical Sciences Centre and Division of Neuroscience (R.J.S.W), Faculty of Medicine, Imperial College, Hammersmith Hospital, London; Department of Psychology (S.A.M.), University of Edinburgh, Scotland; Department of Neuro-ophthalmology (G.T.P), Moorfields Eye Hospital, London; and National Hospital for Neurology and Neurosurgery (A.P.L.), University College London Hospitals, UK.
Address correspondence and reprint requests to Dr. Alexander Leff, Wellcome Department of Imaging Neuroscience, 12 Queen Square, London, WC1N 3BG, UK
Objective: An acquired right-sided homonymous hemianopia can result in slowed left-to-right text reading, called hemianopic alexia (HA). Patients with HA lack essential visual information to help guide ensuing reading fixations. We tested two hypotheses: first, that practice with a visual rehabilitation method that induced small-field optokinetic nystagmus (OKN) would improve reading speeds in patients with HA when compared to a sham visual rehabilitation therapy; second, that this therapy would preferentially affect reading saccades into the blind field.
Methods: Nineteen patients with HA were entered into a two-armed study with two therapy blocks in each arm: one group practiced reading moving text (MT) that scrolled from right to left daily for two 4-week blocks (Group1), while the other had sham therapy (spot the difference) for the first block and then crossed over to MT for the second.
Results: Group 1 showed significant improvements in static text reading speed over both therapy blocks (18% improvement), while Group 2 did not significantly improve over the first block (5% improvement) but did when they crossed over to the MT block (23% improvement). MT therapy was associated with a direction-specific effect on saccadic amplitude for rightward but not leftward reading saccades.
Conclusion: Optokinetic nystagmus inducing therapy preferentially affects reading saccades in the direction of the induced (involuntary) saccadic component. This is the first study to demonstrate the effectiveness of a specific eye movement based therapy in patients with hemianopic alexia (HA) in the context of a therapy-controlled trial. A free Web-based version of the therapy used in this study is available online to suitable patients with HA.
Editorial, see page 1881
Supplemental data at www.neurology.org
Funded by The Wellcome Trust (project grant no: GR063064AIA).
Disclosure: The authors report no conflicts of interest.
Received December 27, 2006. Accepted in final form February 28, 2007.
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Neurology 2007 68: 1881-1882.
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