Primary Open-Angle Glaucoma With Improved Visual Outcomes Following Audio-Luminous Biofeedback Training: A Case...

BACKGROUND Audio-luminous biofeedback training (BT) is a non-invasive method of vision rehabilitation that uses micro-perimeter devices to improve vision by combining visual stimuli with auditory feedback. This rehabilitation method has previously been described to train patients with nystagmus, macular disease, and brain injury. This report describes the case of an 82-year-old man with bilateral primary open-angle glaucoma and improved visual outcomes following BT. CASE REPORT An 82-year-old man with bilateral primary open-angle glaucoma came to our service wearing an occlusive patch on the left eye for several months due to visual loss and discomfort. On examination, best-corrected visual acuity (BCVA) was 20/25 in the right eye and 20/100 in the left eye, as tested with ETDRS charts. Macular MAIA microperimetry revealed tunnel vision in both eyes, worse in the left, with relatively preserved sensitivity 2° inferior to the preferred retinal locus (PRL) in both eyes. The right eye underwent four 20-min sessions of BT targeting a trained retinal locus (TRL) 2° inferior to the PRL, matching the better fields in the left eye. Following training, the patient experienced symptomatic improvement and discontinued the use of the patch. Post-training BCVA improved to 20/20 (right) and 20/60 (left) ETDRS. Objective testing showed gains in contrast sensitivity, reading speed, fixation stability, and stereopsis. CONCLUSIONS Audio-luminous BT can be a valuable adjunct for advanced glaucoma, offering functional benefits without adverse effects, especially in therapy-resistant cases. Future studies should investigate long-term outcomes and underlying neurophysiological mechanisms to better define its role in glaucoma vision rehabilitation.