Visual scanning training for loss of vision in half the visual field (hemianopia) - SEARCH trial

Plain English summary of protocol

Background and study aims
Sight is considered by many as our most important sense. After stroke a common problem is ‘hemianopia’; loss of one half of the visual field leaving people with a ‘blind’ side to their right or left side. Hemianopia occurs suddenly in 30% of stroke survivors with devastating impact on quality of life - individuals cannot drive, bump into people/objects, and can lead to loss of independence, falls and depression. Treatment to help stroke patients compensate for visual field loss is variable and not standardised in the NHS because of uncertainty about what works best and when is the best time to offer treatment. This causes an unacceptable difference in the care individuals receive. Visual scanning training involves repeated practice by the patient at locating different targets on both seeing and blind sides of their visual field. Training can be provided by many methods – some needing paper cards and others needing computers. Paper-based visual scanning training is available to ALL patients; computer training is not. A review of treatment options for hemianopia concluded that visual scanning training is potentially useful. We recently completed a pilot trial (VISION) to test a training card for visual scanning (involving repeated practice by the patient at locating different targets on both seeing and blind sides of their visual field). Our training shows promise and will be carefully investigated in this full trial. We aim to find out how effective paper-based visual scanning training is for hemianopia after stroke.

Who can participate?
Patients aged 18 or over who have recently had a stroke and are having problems with their vision known as homonymous hemianopia.

What does the study involve?
In a randomised clinical trial 71 people will undertake eye scanning training and 71 people will undertake sham training; both for 30 minutes daily, 7 days/week over 6 weeks. Everyone will be followed for 6 months. No additional visits are required. We will test peoples’ visual reactions and independence in daily activities and compare groups to see if there is more benefit from scanning treatment. For both groups, the researcher will record all vision information taken from the participants’ normal eye examination such as level of sight on the vision letter chart and amount of visual field absent with hemianopia. At routine eye clinic visits, they will be asked some additional questions by the researcher about their stroke and their vision, e.g. measures of reading ability and mobility. We will also ask them to complete three questionnaires at each visit. This will give us information about how their loss of vision impacts on day-to-day activities.

What are the possible benefits and risks of participating?
There is potential for visual scanning training to benefit stroke survivors by improving their adaptation to hemianopia. There is potential for cost-savings in NHS/social care through maximising stroke survivor’s use of their remaining vision, so lessening the impact on daily life activities. This trial is important: it addresses an area of treatment for which there is limited evidence and no standard care in the NHS. This treatment is a top priority highlighted by two national surveys involving large numbers of patients and carers. It can take some time for participants to get used to the change in their vision and the treatments to help them adapt, but we do not foresee any additional risks of being involved in this study. We cannot promise that this study will help participants. We expect that the information we get from this study will improve how we deliver treatment in the future.

Where is the study run from?
University of Liverpool (UK)

When is the study starting and how long is it expected to run for?
December 2020 to March 2024

Who is funding the study?
The study is funded by Fight for Sight and the Stroke Association

Who is the main contact?
Prof Fiona Rowe (scientific)
rowef@liverpool.ac.uk
Dr Laura Wright (public)
searcht@liverpool.ac.uk

Study website

Contact information

Prof Fiona Rowe
Scientific

Institute for Population Health
University of Liverpool
Waterhouse Building Block B
1-3 Brownlow Street
Liverpool
L69 3GL
United Kingdom

ORCID ID	0000-0001-9210-9131
Phone	+44 (0)1517944956
Email	rowef@liverpool.ac.uk

Dr Laura Wright
Public

Institute for Population Health
University of Liverpool
Waterhouse Building Block B
1-3 Brownlow Street
Liverpool
L69 3GL
United Kingdom

Phone	+44 (0)1517944956
Email	searcht@liverpool.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• England
• Scotland
• United Kingdom
• Wales

Study participating centres

Sponsor information

University of Liverpool
University/education

Clinical Directorate
Waterhouse Building Block C
3 Brownlow Street
Liverpool
L69 3GL
England
United Kingdom

Phone	+44 (0)151 7948722
Email	sponsor@liverpool.ac.uk
Website	http://www.liv.ac.uk/
"ROR"	https://ror.org/04xs57h96

Funders

Funder type

Charity

Results and Publications

Study outputs

Editorial Notes

18/03/2025: Publication reference added.
01/03/2024: The overall end date was changed from 12/02/2024 to 31/03/2024.
10/07/2023: The overall end date was changed from 31/12/2023 to 12/02/2024.
12/06/2023: The following changes have been made to the study record:
1. Sandwell and West Birmingham Hospitals NHS Trust, The Royal Wolverhampton NHS Foundation Trust and Royal United Hospitals Bath NHS Foundation Trust were removed as trial centres and Moorfields Eye Centre at St George's Hospital was added as a trial centre.
2. The recruitment end date has been changed from 18/06/2023 to 31/07/2023.
3. The target number of participants has been changed from 142 to 157.
03/11/2022: The following changes have been made:
1. Blackpool Teaching Hospitals NHS Foundation Trust, Aneurin Bevan University LHB Trust, Southport and Ormskirk Hospitals NHS Foundation Trust, and East Lancashire Hospitals NHS Foundation Trust were removed as trial centres.
2. Leighton Hospital, Whipps Cross University Hospital, The Royal London Hospital, Moorfields Eye Centre at Croydon University Hospital, Cheltenham General Hospital, Cambridgeshire Community Services NHS Trust, Milton Keynes University Hospital, Calderdale Royal Hospital, Stoke Mandeville Hospital, Torbay District General Hospital, Yeovil District Hospital, Queen Margaret Hospital, Raigmore Hospital, NHS Lanarkshire and University Hospitals Plymouth NHS Trust were added as trial centres and Scotland was added as a location accordingly.
11/10/2022: The following changes have been made:
1. The recruitment end date has been changed from 31/10/2022 to 18/06/2023.
2. The overall trial end date has been changed from 30/11/2023 to 31/12/2023 and the plain English summary updated accordingly.
3. The intention to publish date has been changed from 30/11/2024 to 31/05/2025.
13/05/2021: The ethics approval details and trial website were added.
08/01/2021: Trial’s existence confirmed by Fight for Sight.