Efficacy of perceptual learning in low vision: A systematic review and meta-analysis

Abstract

BACKGROUND Visual perceptual learning (PL) shows promise for enhancing visual functions in individuals with visual impairment. OBJECTIVE This systematic review aimed to evaluate the effectiveness of PL in improving visual function. STUDY ELIGIBILITY Eligible studies were those examining the efficacy of PL in individuals with low vision. STUDY APPRAISAL AND SYNTHESIS METHODS The review protocol was registered with the international Prospective Register of Systematic Reviews (ID CRD42022327545) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screened studies were synthesized using random-effects meta-analysis and narrative synthesis following Synthesis Without Meta-analysis guidelines. The quality of the evidence was assessed using the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tool for Quasi-Experimental studies. RESULTS Fifty studies were included, covering various visual impairments and employing different PL interventions. Most studies had low risk of bias. Meta-analysis showed significant improvement in visual search for individuals with cortical blindness (Hedges' g = 0.71; 95% confidence interval, 0.48 to 0.93; p=0.002); all other analyses did not show significant improvements—reading in central vision loss and cortical blindness, and visual field in peripheral vision loss and cortical blindness. However, the narrative synthesis provided evidence showing effectiveness, particularly in individuals with central vision loss and cortical blindness, demonstrating positive effects on reading, contrast sensitivity, visual field, and motion perception. LIMITATIONS Variations in study design, PL protocols, outcome measures, and measurement methods introduced heterogeneity, limiting the analysis. CONCLUSIONS The efficacy of PL in vision rehabilitation remains uncertain. Although meta-analysis results were mostly inconclusive, the narrative synthesis indicated improved visual functions following PL, consistent with individual study findings. IMPLICATIONS OF KEY FINDINGS Future research should optimize intervention parameters, explore long-term effects, and assess generalizability across diverse populations and visual impairment etiologies. Larger randomized controlled trials using standardized outcome measures are needed to advance the field.