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CompletedNCT06136169Updated Sep 18, 2026Results posted

Reminder-cue Scanning Training for Homonymous Visual Field Loss

An interventional study of Reminder-cue scanning training in Homonymous Hemianopia and Homonymous Quadrantanopia, sponsored by Massachusetts Eye and Ear Infirmary. Completed at 1 site in United States. Open to participants aged 16 Years and older. Per ClinicalTrials.gov, last updated 2026-09-18.

Sponsored by Massachusetts Eye and Ear Infirmary · Not applicable, Interventional, and Other

Phase
Not applicable
Study type
Interventional
Enrollment
16
Allocation
Not applicable
Ages
16 Years and older
Sex
All
01

Study summary

This study will evaluate a new approach to training people with visual field loss to scan when driving

Read the detailed description

Homonymous visual field loss is the loss of vision on the same side in both eyes. The most common types are hemianopia (the loss of one half of the field of vision) and quadrantanopia (the loss of one quarter of the field of vision). Hemianopia and quadrantanopia may cause difficulties in seeing objects on the side of the field loss. People with these types of field loss can compensate by scanning (looking) toward the side of the field loss. However, sometimes they might not scan sufficiently well resulting in delayed responses to hazards when driving. The purpose of this research study is to evaluate a new approach, "reminder-cue scanning training", to training people with homonymous visual field loss to scan when driving.

Participants will receive reminder-cue scanning training in the driving simulator.Typically there will be three training sessions within about a 2-week period. In addition, participants will complete an evaluation in the driving simulator before and after the training.

02

Conditions studied

  • Homonymous Hemianopia
  • Homonymous Quadrantanopia

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03

Who can participate

Ages eligible
16 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Homonymous hemianopia or homonymous quadrantanopia for at least 3 months
  • Binocular visual acuity of at least 20/40
  • Prior or current driving experience
  • Able to attend multiple study visits
  • Able to communicate in English sufficiently to understand the study procedures

Exclusion criteria

Exclusion Criteria:

  • Physical or general health problems that could impair the ability to operate the controls of the driving simulator or participate in the training
04

Study design

Phase
Not applicable
Primary purpose
Other
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
16 participants (actual)

Study arms

  • Experimental
    StudyArm

    Participants will receive reminder-cue scanning training in a driving simulator.

    Behavioral: Reminder-cue scanning training

Interventions

  • BehavioralReminder-cue scanning training

    Auditory reminders to scan when scanning to the side of the field loss is inadequate

05

What researchers measure

Primary outcomes

  1. Rate of Early Large Head Scans to the Side of the Field Loss

    Percentage of intersections at which an early large head scan was made to the side of the field loss

    Time frame: Pre-training, post-training (1 week)

  2. Detection Rate for Hazards on the Side of the Field Loss

    Percentage of hazards detected out of the total number of hazards on the side of the field loss

    Time frame: Pre-training, Post-training (1 week)

Secondary outcomes

  1. Number of Head Scans to the Side of the Field Loss

    Number of head scans per intersection to the side of the field loss. A validated algorithm was used to detect head scans, defined as lateral rotations of the head away from the straight ahead position toward either the left or the right, which exceeded a predefined threshold based on the participant's distance to the intersection: ≥ 4° (100 to 50 m to intersection), ≥ 6° (50 to 20m), ≥ 10° (20 to 0m). Savage SW, Zhang L, Swan G, Bowers AR (2020) The effects of age on the contributions of head and eye movements to scanning behavior at intersections. Transp Res Part F Traffic Psychol Behav. 73:128-142. Swan G, Goldstein RB, Savage SW, Zhang L, Ahmadi A, Bowers AR (2021) Automatic processing of gaze movements to quantify gaze scanning behaviors in a driving simulator. Behav Res Methods. 53(2): 487-506

    Time frame: Pre-training, Post-training (1 week)

  2. Magnitude of Head Scans to the Side of the Field Loss

    Mean magnitude (in degrees) of head scans to the side of the field loss. A validated algorithm was used to detect head scans, defined as lateral rotations of the head away from the straight ahead position toward either the left or the right, which exceeded a predefined threshold based on the participant's distance to the intersection: ≥ 4° (100 to 50 m to intersection), ≥ 6° (50 to 20m), ≥ 10° (20 to 0m). The magnitude is the lateral angular extent of the scan measured from the straight-ahead position to the furthest lateral position to the left or right. Savage SW, Zhang L, Swan G, Bowers AR (2020) The effects of age on the contributions of head and eye movements to scanning behavior at intersections. Transp Res Part F Traffic Psychol Behav. 73:128-142. Swan G, Goldstein RB, Savage SW, Zhang L, Ahmadi A, Bowers AR (2021) Automatic processing of gaze movements to quantify gaze scanning behaviors in a driving simulator. Behav Res Methods. 53(2): 487-506

    Time frame: Pre-training, Post-training (1 week)

  3. Response Times to Hazards on the Side of the Field Loss

    Mean time (in seconds) between the hazard appearing and the horn-press response

    Time frame: Pre-training, Post-training (1 week)

06

Results

Posted May 12, 2026

Participant flow

Participants were recruited from local ophthalmology outpatient clinics

Intervention
Participant flow — Intervention
MilestoneIntervention
Started16
Completed16
Not completed0
Follow up
Participant flow — Follow up
MilestoneIntervention
Started16
Completed16
Not completed0

Outcome measures

PrimaryRate of Early Large Head Scans to the Side of the Field Loss

Percentage of intersections at which an early large head scan was made to the side of the field loss

Time frame:
Pre-training, post-training (1 week)
Reported as:
Number · Percentage of intersections
Rate of Early Large Head Scans to the Side of the Field Loss
Percentage of intersectionsIntervention
Pre-training18 (9 to 26)
1-week post-training84 (77 to 91)
Statistical analysis
  • Intervention · Mixed Models Analysis · p = <0.0001 (The p-value is from a planned contrast from the GLMM comparing 1-week post-training to pre-training)
PrimaryDetection Rate for Hazards on the Side of the Field Loss

Percentage of hazards detected out of the total number of hazards on the side of the field loss

Time frame:
Pre-training, Post-training (1 week)
Reported as:
Number · Percentage of hazards
Detection Rate for Hazards on the Side of the Field Loss
Percentage of hazardsIntervention
Pre-training56 (41 to 70)
1-week post-training86 (76 to 95)
Statistical analysis
  • Intervention · Mixed Models Analysis · p = <0.0001 (The p-value is from a planned contrast from the GLMM comparing 1-week post-training to pre-training)
SecondaryNumber of Head Scans to the Side of the Field Loss

Number of head scans per intersection to the side of the field loss. A validated algorithm was used to detect head scans, defined as lateral rotations of the head away from the straight ahead position toward either the left or the right, which exceeded a predefined threshold based on the participant's distance to the intersection: ≥ 4° (100 to 50 m to intersection), ≥ 6° (50 to 20m), ≥ 10° (20 to 0m). Savage SW, Zhang L, Swan G, Bowers AR (2020) The effects of age on the contributions of head and eye movements to scanning behavior at intersections. Transp Res Part F Traffic Psychol Behav. 73:128-142. Swan G, Goldstein RB, Savage SW, Zhang L, Ahmadi A, Bowers AR (2021) Automatic processing of gaze movements to quantify gaze scanning behaviors in a driving simulator. Behav Res Methods. 53(2): 487-506

Time frame:
Pre-training, Post-training (1 week)
Reported as:
Mean · Number of head scans per intersection
Number of Head Scans to the Side of the Field Loss
Number of head scans per intersectionIntervention
Pre-training2.2 (1.8 to 2.7)
1-week post-training3.5 (3.1 to 4.0)
Statistical analysis
  • Intervention · Mixed Models Analysis · p = <0.0001 (The p-value is from a planned contrast from the LMM comparing 1-week post-training to pre-training)
SecondaryMagnitude of Head Scans to the Side of the Field Loss

Mean magnitude (in degrees) of head scans to the side of the field loss. A validated algorithm was used to detect head scans, defined as lateral rotations of the head away from the straight ahead position toward either the left or the right, which exceeded a predefined threshold based on the participant's distance to the intersection: ≥ 4° (100 to 50 m to intersection), ≥ 6° (50 to 20m), ≥ 10° (20 to 0m). The magnitude is the lateral angular extent of the scan measured from the straight-ahead position to the furthest lateral position to the left or right. Savage SW, Zhang L, Swan G, Bowers AR (2020) The effects of age on the contributions of head and eye movements to scanning behavior at intersections. Transp Res Part F Traffic Psychol Behav. 73:128-142. Swan G, Goldstein RB, Savage SW, Zhang L, Ahmadi A, Bowers AR (2021) Automatic processing of gaze movements to quantify gaze scanning behaviors in a driving simulator. Behav Res Methods. 53(2): 487-506

Time frame:
Pre-training, Post-training (1 week)
Reported as:
Mean · Degrees
Magnitude of Head Scans to the Side of the Field Loss
DegreesIntervention
Pre-training23.9 (20.3 to 27.5)
1-week post-training27.5 (23.8 to 31.2)
Statistical analysis
  • Intervention · Mixed Models Analysis · p = <0.0001 (The p-value is from a planned contrast from the LMM comparing 1-week post-training to pre-training)
SecondaryResponse Times to Hazards on the Side of the Field Loss

Mean time (in seconds) between the hazard appearing and the horn-press response

Time frame:
Pre-training, Post-training (1 week)
Reported as:
Mean · Seconds
Response Times to Hazards on the Side of the Field Loss
SecondsIntervention
Pre-training2.7 (2.4 to 3.0)
1-week post-training1.9 (1.6 to 2.1)
Statistical analysis
  • Intervention · Mixed Models Analysis · p = <0.0001 (The p-value is from a planned contrast from the LMM comparing 1-week post-training to pre-training)

Adverse events

Collected over From start of training until end of follow-up, up to 4 weeks. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Intervention0/16 (0%)0/16 (0%)0/16 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)Intervention
Median52.5 (17 to 75)
Sex: Female, Male
Sex: Female, Male(Participants)Intervention
Female7
Male9
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Intervention
American Indian or Alaska Native0
Asian1
Native Hawaiian or Other Pacific Islander0
Black or African American0
White15
More than one race0
Unknown or Not Reported0
07

Study locations

1 site
  • Schepens Eye Research Institute of Mass Eye and Ear
    Boston, Massachusetts 02114, United States
08

References and documents

Publications

  • Toh YN, Xu J, Baker P, Bowers AR. Reinforcement-Based Head Scan Training for Drivers With Homonymous Visual Field Loss: Improves Blind-Side Detection. Arch Phys Med Rehabil. 2026 May 14:S0003-9993(26)00709-4. doi: 10.1016/j.apmr.2026.04.038. Online ahead of print. PubMed 42140549 ↗

Study documents

  • Protocol, analysis plan and consent form · Sep 3, 2025

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

09

Registry details

Key details

Study ID
NCT06136169
Lead sponsor
Massachusetts Eye and Ear Infirmary
Collaborators
National Eye Institute (NEI)
Responsible party
Alexandra Bowers (Associate Scientist, Massachusetts Eye and Ear Infirmary) — Principal investigator
First posted
Nov 18, 2023
Start date
May 14, 2024
Primary completion
May 11, 2025
Completion
Aug 1, 2026
Results posted
May 12, 2026
Last update
Sep 18, 2026

Study contacts

Alex Bowers, PhD
principal investigator · Schepens Eye Research Institute of Mass Eye and Ear

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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