An interventional study of StableEyes: Incremental Vestibulo-Ocular Reflex Adaptation (IVA) in Vestibular Hypofunction, Binocular Vision Abnormalities and Reduced Vision, sponsored by Emory University. Recruiting at 2 sites in United States. Open to participants aged 18 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-04-17.
Sponsored by Emory University · Not applicable, Interventional, and Basic science
The goal of this study is to learn whether a balance-training exercise called incremental vestibulo-ocular reflex adaptation (IVA) is safe and effective for adults with vision impairments, with or without additional vestibular (inner-ear balance) problems.
The main questions it aims to answer are:
Researchers will compare adults with vision impairment only to adults who have both vision and vestibular impairments to see whether the groups respond differently to IVA.
Participants will:
Impairment of vestibular pathways can lead to deficits in balance, gait, and gaze stability. Gaze-stability exercises are a central component of vestibular rehabilitation and have been shown to improve vision during head movement as well as functional mobility in individuals with peripheral or central vestibular dysfunction. Improvements in gaze stability may occur through vestibulo-ocular reflex (VOR) adaptation or through compensatory saccadic eye movements. However, many adults with vestibular hypofunction also present with uncorrected visual acuity deficits or binocular vision abnormalities, such as low vision, convergence insufficiency, or ocular misalignment. These visual conditions are common but understudied in the context of vestibular rehabilitation, and it is not known whether they limit the capacity for VOR adaptation.
Incremental vestibulo-ocular reflex adaptation (IVA) is a non-invasive, 15-minute training method that strengthens the VOR by exposing users to a controlled visual error signal. IVA uses a moving laser target whose velocity is programmed as a function of the participant's head movement, producing immediate increases in VOR gain. The method can be customized to provide unilateral, bilateral, or asymmetric adaptation, allowing targeted training for individuals with unilateral or bilateral vestibular deficits. IVA has been studied extensively in adults with vestibular hypofunction, but its effectiveness in individuals with impaired visual acuity or binocular vision abnormalities has not been evaluated.
This study will examine whether reduced static visual acuity or binocular vision abnormalities affect the magnitude of VOR adaptation in adults with and without vestibular hypofunction. Two experiments will be conducted using a cross-over design. Experiment 1 will enroll adults with abnormal uncorrected static visual acuity, with and withoutvestibular hypofunction, to compare VOR adaptation with and without vision correction. Experiment 2 will enroll adults with binocular vision abnormalities, with and without vestibular hypofunction, to evaluate VOR adaptation in their best corrected visual state. All participants will complete IVA training during two study visits separated by a washout period.
98 studies on the registry are indexed under Vision, Low; 23 are open to participants now.
This study's planned enrollment of 100 is above the median of 60 across 78 interventional studies indexed under Vision, Low.
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For All Participants (All Groups)
Group-Specific Inclusion Criteria:
Individuals who have abnormal static visual acuity, a binocular vision abnormality (ocular misalignment, convergence insufficiency), and vestibular loss will be assigned to Group 4.
The following definitions will be used when determining group placement:
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adults with abnormal uncorrected distance visual acuity and normal vestibular function. This group will be part of Experiment 1. This experiment studies people whose main visual problem is reduced uncorrected distance visual acuity (i.e., blurry vision without glasses/contacts). Experiment 1 tests the effect of blurry vision on VOR adaptation
Device: StableEyes: Incremental Vestibulo-Ocular Reflex Adaptation (IVA)
Adults with abnormal uncorrected distance visual acuity and unilateral vestibular hypofunction. This group will be part of Experiment 1. This experiment studies people whose main visual problem is reduced uncorrected distance visual acuity (i.e., blurry vision without glasses/contacts). Experiment 1 tests the effect of blurry vision on VOR adaptation
Device: StableEyes: Incremental Vestibulo-Ocular Reflex Adaptation (IVA)
Adults with binocular vision abnormalities (e.g., convergence insufficiency, ocular misalignment) and normal vestibular function. This group will be part of Experiment 2. This experiment studies people whose main visual problem is how the two eyes work together (e.g., convergence insufficiency, ocular misalignment). Experiment 2 tests the effect of binocular vision dysfunction on VOR adaptation
Device: StableEyes: Incremental Vestibulo-Ocular Reflex Adaptation (IVA)
Adults with binocular vision abnormalities and unilateral vestibular hypofunction. This group will be part of Experiment 2. This experiment studies people whose main visual problem is how the two eyes work together (e.g., convergence insufficiency, ocular misalignment). Experiment 2 tests the effect of binocular vision dysfunction on VOR adaptation
Device: StableEyes: Incremental Vestibulo-Ocular Reflex Adaptation (IVA)
IVA is delivered using the StableEyes device, which includes a lightweight head-mounted unit with inertial sensors and a micromirror that controls the position of a low-power laser target projected onto a wall. The device adjusts the target's movement based on the participant's head velocity to create a controlled visual error signal that induces vestibulo-ocular reflex (VOR) adaptation. During each session, participants sit about one meter from a blank wall and perform rapid, self-generated head impulses while visually tracking the moving laser target. The target appears at neutral, moves at a fraction of head velocity during each impulse, and briefly disappears before reappearing at center. Each session lasts 15 minutes and includes roughly 150 head impulses in the horizontal or vertical plane. The procedure has been well-tolerated in prior studies with no reported adverse events.
Change in Vestibulo-Ocular Reflex (VOR) Gain
VOR gain will be measured using the video head impulse test (vHIT). Gain is calculated as eye velocity divided by head velocity during high-acceleration, moderate velocity, small amplitude head rotations in the plane of the semicircular canals. This outcome quantifies the strength of the vestibulo-ocular reflex, with higher gain values indicating stronger VOR responses, with normal gain = 0.8 to 1.2. The change in VOR gain from before to after training will be used to assess VOR adaptation. IVA: Incremental Vestibulo-Ocular Reflex Adaptation
Time frame: Baseline (visit 1) (before and after after IVA intervention), Visit 2 (2-10 days from baseline) (before and after IVA intervention)
Change in Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)
Participants stand under four sensory conditions (eyes open/closed on firm/foam surfaces). Outcomes include time maintained (0-120 seconds) and postural sway metrics from inertial measurement units. Higher times indicate better balance.
Time frame: Baseline (visit 1) (before and after after IVA intervention), Visit 2 (2-10 days from baseline) (before and after IVA intervention)
Change in Gait Disorientation Test (GDT)
Participants walk 20 feet with eyes open and eyes closed. The GDT score is the difference in time between the two conditions. Larger differences indicate greater gait disorientation.
Time frame: Baseline (visit 1) (before and after after IVA intervention), Visit 2 (2-10 days from baseline) (before and after IVA intervention)
Symptom Severity During IVA (Verbal Analog Scales)
Symptom tolerance during incremental VOR adaptation (IVA) will be assessed using verbal analog scales. Participants will rate the severity of blurry vision, eye strain, dizziness, and headache on 0-10 scales, where 0 indicates no symptoms and 10 indicates the worst imaginable symptoms. Ratings will be collected immediately before and after each IVA session to quantify changes in self-reported symptom severity.
Time frame: Baseline (visit 1) (before and after after IVA intervention), Visit 2 (2-10 days from baseline) (before and after IVA intervention)
Plan to share: Yes — A complete de-identified dataset will be shared.
Supporting information: Study protocol, Statistical analysis plan
Time frame: 12 months after the primary outcome is published; indefinitely
Access criteria: Mechanism: Through the Open Science Framework or Emroy Dataverse
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