Rehabilitación neurovisual en glaucoma avanzado: impacto funcional y calidad de vida en pacientes con discapacidad visual / Neurovisual rehabilitation in advanced glaucoma: functional impact and quality of life in patients with visual disability

Abstract

Introduction: Advanced glaucoma causes irreversible loss of the visual field, leading to functional disability and limiting personal autonomy. In rehabilitation medicine, the clinical approach to severe optic nerve damage must transcend tonometric control to focus on visual functionality. Neurovisual rehabilitation harnesses neuroplasticity to optimize functional remnants through sensory stimulation and low vision aids. Given the heterogeneity of interventions and clinical variability of patients, a structured synthesis of evidence is necessary to guide therapeutic decision-making. Objective: To synthesize scientific evidence regarding the impact of neurovisual rehabilitation, specifically microperimetric biofeedback and low vision aids, on the functional performance and quality of life of patients with advanced glaucoma. Methodology: A structured narrative review was conducted, selected due to the clinical and technological heterogeneity of neurovisual interventions, which precludes a homogeneous quantitative synthesis. A literature search was performed in PubMed/MEDLINE using MeSH terms (Glaucoma, Visual Rehabilitation, Biofeedback, Low Vision Aids, and Quality of Life) to identify literature published between 2012 and 2025. Explicit selection criteria were established, prioritizing clinical, observational, and case series studies focused on functional rehabilitation of severe glaucoma. To reduce selection bias, studies with defined clinical-functional outcomes measured using validated instruments were included, including reading speed, retinal sensitivity, fixation stability, and quality of life via NEI-VFQ-25. Primary surgical interventions were excluded. Results: Synthesized evidence shows that low vision training with acoustic biofeedback via microperimetry favors stabilization of the Preferred Retinal Locus. Included studies report clinically relevant improvements in reading speed, central retinal sensitivity, and fixation stability following neurovisual training. Furthermore, a favorable association is described between retinal fixation stability and subjective perception of well-being evaluated using the NEI-VFQ-25 questionnaire. Regarding complementary optical aids, the use of selective filters is associated with improvement in contrast sensitivity and greater functional safety under glare conditions. Conclusions: Neurovisual rehabilitation via microperimetric biofeedback and low vision aids is associated with clinically relevant improvements in visual functionality and perceived quality of life in patients with advanced glaucoma. Despite the methodological variability of available studies, current evidence supports its incorporation as a complementary alternative within comprehensive rehabilitation programs.