Modification of a visual discrimination intervention using virtual reality technology in an NHS clinical setting: development and feasibility

Background Homonymous visual field loss is a loss of peripheral vision in both eyes to the right or left side. This occurs in 30% of stroke survivors, having a sudden and significant impact on quality of life. Treatment for visual field loss is not provided as standard in the NHS, due to a limited evidence base. Some people retain the ability to detect visual information within the non-seeing field of vision; this is known as blindsight. We do not know why only some people appreciate blindsight or whether it can be improved with training. Recent evidence suggests that visual training can restore some visual functions on the non-seeing side. This training is monotonous, takes considerable time and requires complex computer set up, with head restraints. If training could be made more engaging and accessible it will improve access, providing more potential for neuroplasticity. Aims This research aims to modify a visual discrimination intervention by developing a smartphone application to be used in a cardboard virtual reality headset. Objectives: Develop a novel low-cost intervention for post-stroke visual field loss. Develop a core outcome set for measurement of outcomes important to patients, to assess improvements in visual function after training. Assess feasibility of the new intervention and core outcome set for patients in an NHS acute stroke setting. Methods Work package 1 (WP1) Interviews with participants who have undertaken previous research-based training will explore intervention modification requirements. Smartphone application development will follow, using a co-design process with app developers, researchers, clinicians, and people with lived experience of visual field loss / previous training. Finally, engagement meetings will test the intervention and change as necessary. Work package 2 (WP2) A systematic review of existing literature will determine the current evidence base for clinically relevant outcome measures used in the management of visual field loss. A Delphi survey will then gain stakeholder consensus on which of these outcome measures are deemed most important. Finally, consensus meetings will use findings to agree a core outcome set to take forward to a full clinical trial. Work package 3 (WP3) A feasibility study will be undertaken in the NHS to determine feasibility of using the new smartphone application and virtual reality system intervention and core outcome set in an NHS clinical setting. Planning will commence for a future clinical and cost effectiveness randomised controlled trial. Timelines for delivery This is a five-year research plan. WP1 and WP2 will mainly take place in the first two years. Feasibility testing will commence in year three, with a 12-month recruitment and 6-month follow-up period. Anticipated impact and dissemination This research will lead to development of an engaging and accessible intervention for post-stroke visual field loss, to be taken forward to a full clinical and cost effectiveness RCT in the NHS. Ultimately, this has potential to change clinical practice in the management of visual field loss and improved outcomes for patients, their families and society. Research findings will be shared widely through relevant conferences and peer-reviewed publications.