Physiotherapy for the Eyes
Submitting InstitutionUniversity of Aberdeen
Unit of AssessmentPsychology, Psychiatry and Neuroscience
Summary Impact TypeTechnological
Research Subject Area(s)
Medical and Health Sciences: Clinical Sciences, Neurosciences, Ophthalmology and Optometry
Summary of the impact
Research carried out at the University of Aberdeen has directly resulted
in a new therapy for stroke
patients who have suffered partial sight loss. The sight rehabilitation
device developed through the
research has so far been used to treat around 300 UK stroke patients, who
improvements in their quality of life. The therapy has been publicized by
the UK Stroke
Association and at national and international events. The research also
led to commercial impacts
through the creation of a spin-out company, Sight Science Ltd, which was
later acquired by its only
worldwide competitor, NovaVision Inc, protecting jobs and forging a
The specific impacts on commerce have been: substantial industrial
investment in research and
development, job creation and protection within UK industry,
commercialisation of a new product,
and long term partnership contract with industry with provisions for
commercialisation of future
Each year, around 7,500 people in the UK suffer sight loss due to a
stroke, with 56,000 affected
across the European Union and 37,000 in the US. The pattern of sight loss
most commonly seen
in stroke patients is a loss of the right or left halves of the visual
field of both eyes — meaning that
the patient cannot compensate for this partial loss by using the other
eye. Up until now, there have
been few effective treatment options.
It is on this type of sight loss and new ways of treating it that a team
led by Arash Sahraie,
Professor of Psychology (at the University of Aberdeen since 1998) has
focused a series of
research projects. Funded by a Chief Scientist Office grant, the research
interdisciplinary team at Aberdeen including Dr CT Trevethan (Psychology),
Dr MJ MacLeod
(Medicine and Dentistry), and Dr J Olson (consultant ophthalmic physician)
alongside Dr R
Coleman (NHS Grampian) and Prof L Weiskrantz (University of Oxford).
Between 2001 and 2004, Sahraie et al conducted a systematic investigation
of residual visual
abilities within the blind visual fields of a cohort of stroke patients.
The studies primarily involved
psychophysical investigations of visual performance under controlled
Initially, 15 stroke patients underwent a range of clinical investigations
to determine the extent of
their sight loss. This was followed by psychophysical tests to detect and
characterise any residual
visual sensitivity within the field defect, to find the optimum visual
stimulus parameters that can be
detected after brain injury. These tests revealed the existence of a
channel of visual processing
with well-defined spatial [3.1, 3.2] and temporal [3.4] characteristics.
Crucially, the laboratory-based
research techniques were also able to reveal evidence of neuronal
processing, even when
patients were not aware of being able to see the visual patterns they were
shown. Establishing the
type of visual patterns that could be processed — in the absence of
patient awareness — was a key
step towards devising a novel rehabilitation intervention.
A subsequent study investigated and established the impact on visual
sensitivity following daily
visual stimulation using visual targets matching the optimum channel
properties in a group of case
controlled stroke patients [3.3]. The results showed that repeated
exposure to appropriate visual
stimuli can lead to improvements in visual sensitivities in the very
depths of the field defect.
These findings led to the development of a novel patent-protected medical
Rehabilitation ProgramCE TM) aimed at rehabilitation of sight
loss, which has been shown to improve
visual sensitivity in stroke patients with impaired vision [3.5]. The
computer-based device, tailored
to each individual's specific visual field defect, can be used in the
patient's home environment.
Patients spend approximately 30 minutes daily in front of a computer
screen where specific visual
patterns are shown in the damaged areas of the patient's visual field. The
patient's task is to
indicate the presence of the patterns using button presses. The
intervention was shown to have
had a positive quality of life outcome in 76% of cases [3.6].
References to the research
[3.1] Sahraie A, Trevethan CT, Weiskrantz L, Olson J, MacLeod MJ, Murray
AD, Dijkhuizen RS,
Counsell CE & Coleman R. (2003). Spatial channels of visual processing
in cortical blindness.
European Journal of Neuroscience, 18, 1189-1196. (21 cites)
This was the first study to move away from single case reports and
show that a group of patients
with blindness after brain injury, show similar characteristics in being
able to detect coarse rather
than fine structures presented in their field defect. This sensitivity
to what is known as low spatial
frequencies is retained and was used for developing rehabilitation
[3.2] Trevethan CT, & Sahraie A. (2003). Spatial and temporal
processing in a subject with cortical
blindness following occipital surgery. Neuoropsychologia, 41(10),
1296-1306. (5 cites)
Prior to this paper, there had been a long standing debate on what
underpins the residual visual
processing in the blindfield, with many arguing for so called islands of
surviving vision. This study
showed the existence of preferential low spatial frequency processing in
a patient with partial
surgical removal of the occipital lobe, settling the debate.
[3.3] Sahraie A, Trevethan CT, MacLeod MJ, Murray AD, Olson JA, &
Weiskrantz L. (2006).
Increased sensitivity after repeated stimulation of residual spatial
channels in blindsight.
Proceedings of the National Academy of Sciences of the USA, 103,
14971-14976. (46 cites)
This is the first study of the use of low spatial frequency targets
for repeated stimulation of
blindfield, leading to improved visual sensitivity in a cohort of
patients with brain injury.
[3.4] Sahraie A, Trevethan CT, & MacLeod MJ, et al. (2008). Temporal
properties of spatial
channels of processing in hemianopia. Neuropsychologia, 46, 879-885. (11
This paper brings in a new dimension into the debate by showing that
in addition to changes in
space (low spatial frequency) the way a visual target is presented in
the time domain also plays an
important role in whether or not it is detected. Again, a group of
patients were studied and the
findings in relation to the temporal parameters were consistent across
the patient group.
[3.5] Sahraie A, Trevethan CT, & MacLeod MJ. (2010). Improved
detection following Neuro-Eye
Therapy in patients with post-geniculate brain damage. Experimental Brain
Research, 206, 25-34.
This is a recent paper, but brings in a technique from the
well-established "learning" literature, into
the field of neuropsychology of vision. It shows the role of continuous
positive feedback throughout
a visual training session, leading to faster learning and improvements.
[3.6] Trevethan CT, Urquhart J, Ward R, Gentlemen D & Sahraie A.
(2012). Evidence for
perceptual learning with repeated stimulation after partial and total
cortical blindness. Advances in
Cognitive Psychology. 8(1), 29-37.
This latest paper demonstrates that learning and increased sensitivity
after repeated and
systematic stimulation can take place even in patients with total
cortical blindness. It also shows
that the exact location of visual stimulation and improvements in visual
fields are directly related.
Relevant grant funding:
Sahraie, A. Detection and evaluation of residual vision and visual
rehabilitation in cortically blind
patients. Chief Scientist Office. £126,793. 1/09/01 to 31/08/04
Sahraie, A. Visual rehabilitation device for cortically blind patients.
NESTech (Scottish Universities
Challenge Fund), £29,995. 1/07/05 to 31/12/05
Sahraie, A. Residual abilities of blindsight. Dr James Mearns Trust.
£48,255. 1/10/05 to 30/09/08.
Details of the impact
The therapy based on the research has led to improvements in patient
health and quality of life, as
well as commercial impacts through a spin-out company that was later taken
over by a large
competitor. Sahraie and his team have also worked to raise awareness and
understanding of sight
loss following stroke among practitioners and the general public.
Patient health and quality of life:
Since the new therapy became available in 2009, around 300 stroke patients
in Britain have
benefitted from it — all of them private patients, as the treatment is not
yet available on the NHS.
In addition to increased visual sensitivity, patients reported
improvements in their ability to cope
with daily living, including improvements in mobility and interactions
with the environment [3.3, 3.5,
3.6]. The patients also scored higher in questionnaires which measured
well-being [3.6]. Thus,
the new therapy led to a better quality of life for these patients,
indicating the considerable
significance of the therapy for them. Patient testimonials confirm these
results [5.1], with patients
reporting "a massive step forward" and feeling "almost back to my normal
self and lifestyle," as well
as being able to resume daily tasks like walking alone, crossing the road,
and even driving [5.1].
Following these successful treatments, in 2010 the UK Stroke Association,
which supports stroke
survivors and their families, began to include information on how to
access the new therapy in its
annual factsheet [5.2].
In 2009, Sight Science Ltd was spun out of the University of Aberdeen to
take the new therapy to
the marketplace. In 2012 the company was acquired by its only worldwide
Inc, which is part of a US Stock Exchange-registered medical device
company, Vycor Inc. The
acquisition has resulted in job protection and formalised a partnership
with the University of
Aberdeen for commercialisation of all future vision-related products.
Sahraie is funded by the
Vycor group for a minimum of five years, taking the role of Chief
Scientific Officer in NovaVision
with the aim of further developing new techniques and building on the
science base in order to
work towards the next generation of vision therapies. [5.3].
The commercial aspects of the technology are protected by UK priority
patent Sahraie (No.
0513603.1; 30/06/2005), subsequently granted in the UK, Germany, France,
1906907; 17/11/2010) Singapore (No. 138426 14/01/2010) and pending in the
US and Canada.
Raising awareness and understanding:
Sahraie and his team have introduced health practitioners and the general
public to this particular
type of vision loss seen in stroke patients, and the new way of treating
it, through active public
engagement both in the UK and abroad. UK events where they presented their
- the UK Stroke Forum 2009 in Glasgow, organised by the Stroke
Association and attended
by rehab workers, stroke physicians and similar health practitioners
- the Moray Vision Awareness Day at Elgin in 2010, staged by NHS
Grampian and involving
a number of local sight loss charities;
- the Scottish Vision Strategy Spring Conference 2011 in Stirling, again
an event mainly
attended by health practitioners [5.6];
- Café Scientifique in Aberdeen, where around 60 members of the public
talk in March 2013.
Internationally, Sahraie et al presented their findings at:—
- the University hospital in Geneva, Switzerland, where Sahraie
addressed an audience of
neuropsychologists and ophthalmologists in 2009;
- the Hanse-Wissenschaftskolleg, an independent research
foundation and debate forum in
Delmenhorst, Germany, where he presented his findings in 2010 and again
- the 2012 conference of the Association for Research in Vision and
in Florida, whose members include clinical practitioners [5.7].
Feedback from these events has included enquiries from centres in
Cambridge and Ireland who
expressed an interest in using the new therapy.
In February 2010, the University of Aberdeen publicised the launch of
Sight Science and the new
therapy. Media coverage achieved during that month included stories on STV
News (featuring a
stroke patient benefitting from the new therapy) [5.8]; a large feature in
The Sun, Britain's biggest
selling newspaper [5.9]; and reports in other local and regional print and
broadcast media. The
media coverage stimulated public debate and generated increased numbers of
members of the public. The acquisition of Sight Science by NovaVision was
covered by the
Ophthalmology Times, a specialist clinical magazine, in January
Therefore the impact, as defined by REF, was that the invention has
impacted on health and
welfare as a new therapy has been developed. The invention has had
impact on commerce as
new products have been successfully commercialised by the University of
leading to its acquisition by a major international company.
Sources to corroborate the impact
Association leaflet mentioning Sight Science and the treatment available
there on pages 3 and 7.
[5.3] Chairman, Vycor Medical Inc. (parent company of NovaVision Inc)
[5.4] UK priority patent Sahraie (No. 0513603.1; 30/06/2005). Patents
granted in the UK, Germany,
France, Switzerland (No 1906907; 17/11/2010) and Singapore (No. 138426
UK Stroke Forum 2009 programme; Sahraie's
contribution on page 11.
Form.pdf Scottish Vision Strategy Spring Conference 2011
programme; Sahraie's contribution on page 3.
[5.7] http://www.abstractsonline.com/Plan/ViewSession.aspx?mID=1668&sKey=10ff1e9f-b539-42cd-a554-6915505924ef&mKey=%7BF0FCE029-9BF8-4E7C-B48E-9FF7711D4A0E%7D ARVO
2012 abstracts including Sahraie's contribution.
STV coverage of the new
therapy, February 2010.
can-see-again.html Coverage of the new therapy in The Sun, 12th