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The use of Biofeedback in Clinical Virtual Reality: The INTREPID Project
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Virtual Reality-Based Dichoptic Therapy in Acquired Brain Injury: Functional and Symptom Outcomes.

Carla Otero-Currás1, Francisco J Povedano-Montero1,2, Ricardo Bernárdez-Vilaboa1

  • 1Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain.

Journal of Clinical Medicine
|February 13, 2026
PubMed
Summary

Virtual reality vision therapy for acquired brain injury (ABI) did not improve visual field measures but did reduce vision-related symptoms. Traumatic brain injury patients showed better functional gains than stroke patients.

Keywords:
acquired brain injurybinocular visiondichoptic therapyoculomotor rehabilitationvirtual realityvisual field

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Rehabilitation Medicine

Background:

  • Acquired brain injury (ABI) frequently causes binocular vision deficits, including cover test deviations and reduced stereopsis, impacting functional vision.
  • Investigating novel therapeutic approaches for visual impairments post-ABI is crucial for improving patient quality of life.

Purpose of the Study:

  • To evaluate the efficacy of a dichoptic virtual reality (VR) vision therapy protocol in adults with ABI.
  • To assess the impact of VR therapy on visual field parameters, oculomotor reaction times, and self-reported visual symptoms.

Main Methods:

  • A controlled parallel-group study involving adult ABI patients (median age 51 years).
  • Participants were assigned to either a dichoptic VR therapy group or a control group, undergoing six therapy sessions.
  • Primary outcomes included perimetric visual field indices and oculomotor reaction times; the Brain Injury Vision Symptom Survey (BIVSS) was the secondary outcome.

Main Results:

  • No significant improvements in perimetric visual field indices were observed, with a minor exception in the top-right quadrant for the experimental group.
  • Oculomotor reaction times showed no significant differences between the groups.
  • The dichoptic VR therapy group reported a greater reduction in visual symptoms (BIVSS scores), and traumatic brain injury patients showed better functional improvement.

Conclusions:

  • Dichoptic VR therapy for ABI patients did not restore visual field losses but effectively reduced subjective visual symptoms.
  • The therapy may promote functional adaptation of residual vision rather than structural recovery.
  • Therapeutic response differed by etiology, with traumatic brain injury patients benefiting more; further research with larger trials is recommended.