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Editors Selection IGR 24-3

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Comment by Harry Quigley on:

120394 Virtual Reality Visual Perceptual Plastic Training Promotes Retinal Structure and Macular Function Recovery in Glaucoma Patients, Zhao M; Lu Y; Wiederhold M et al., Cyberpsychology, behavior and social networking, 2023; 26: 861-868

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I provide here a list of the considerable weaknesses of the study:

1. No control group.
2. Inclusion of both eye’s data without accounting interocular correlation.
3. Methods state “paired sample t test” used, but data are group mean comparisons.
4. Bonferroni correction not applied to multiple sector comparisons of OCT data.
5. If Bonferroni applied, OCT regional data are not statistically significant.
6. No comparison of areas of abnormal field to degree of change.
7. comparison of findings between eyes of each patient.
8. No presentation of degree of overall glaucoma damage in fields at baseline.
9. No presentation of statistical abnormality of OCT damage at baseline.
10. Use of mean sensitivity in dB rather than total or pattern deviation values in fields.
11. Apparent use of only one field and OCT at baseline and one at 3 months.
12. Failure to compare field data change in all points in the field.
13. No definition of what “good” eye and “poor” eye meant in field or OCT.
14. The description of the patterns shown to the patient are mixed with foregone conclusions about what the results might be.
15. Thickening of localized retinal areas is assumed to be beneficial to function, ignoring effects of visual effort on retinal and choroidal thickness known to be associated with emmetropization, which are temporary and not associated with better visual function.
16. Cited references by the same authors or using similar methods have insufficient sample sizes and a lack of controlled observations.
17. he authors fail to cite the IOP as an individual variable in analysis, in fact omitting what if any treatment the patients were undergoing and how adherence with therapy was monitored if at all.
18. Does the intense visual task for as much as one hour per day alter IOP?
19. There is no citation of methods reported to improve visual function, such as (among others) nicotinamide/pyruvate administration as means of improving short-term visual function¹

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