Benefits of Explorative Saccade Training in Patients with Advanced Glaucomatous Visual Field Defects-A Randomized, Placebo-Controlled Study

Purpose: Patients with advanced glaucoma have visual field defects that impair mobility and quality of life (QoL). We aim to determine the effects of exploratory saccade training (EST) in such patients with bilateral overlapping scotomas that affect at least one visual field quadrant. Patients and Methods: This study was approved by the Ethics Committee of the Medical Faculty of the University of Tuebingen, Germany, and was registered in the German Clinical Trials Register (DRKS DRKS00031082, date of approval: 2 February 2023). We randomly assigned 27 patients to two groups, one of which trained with a computer-based EST (group 1). A control group (group 2) first used reading training (rapid serial visual presentation, RSVP, a single-word presentation to minimize eye movements) as placebo training (PRT) in regard to EST, which trains eye movements and, in a later phase, also used EST. Each training method required 6 weeks of home training. Main outcome variables were reaction time (RT) during the EST training sessions, RT during a natural search task (table test), reading speed (RS) during training on the screen, and during reading printed paragraphs aloud. QoL was assessed by a questionnaire. Results: Reaction times during EST and the table test improved significantly, which indicated transfer of the training effect to daily life. RS and QoL were reduced at baseline. Reading training improved RS significantly and reached normal median values. QoL improved significantly in the sub-categories regarding mobility problems in group 1. Patients with inferior field defects were more impaired and improved more than those without inferior field defects. Conclusions: As a supplement to the necessary treatment for glaucoma, EST is an effective home training method for rehabilitation by improving reaction time in daily living tasks for patients with advanced glaucoma. Reading training improved RS while reading from a screen as well as reading printed text.