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Wygnanski-Jaffe T, Moshkovitz A, Kushner BJ, Belkin M, Yehezkel O. Binocular Home Treatment for Amblyopia: Gains Stable for One Year. Am J Ophthalmol 2024; 262:199-205. [PMID: 38360334 DOI: 10.1016/j.ajo.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE To report the long-term outcomes of a noninferiority randomized controlled trial (RCT) with a binocular eye-tracking-based home treatment (CureSight; NovaSight, Ltd.) in patients with amblyopia. DESIGN Prospective, multicenter, nonrandomized, long-term follow-up observational study of an RCT. METHODS Forty-three children 4 to <9 years of age with anisometropic, small-angle strabismic, or mixed-mechanism amblyopia were initially treated for 16 weeks (NCT05185076) with CureSight. In this planned observational follow-up study, 38 patients with no additional amblyopia treatment were evaluated at 12 weeks post-treatment, and 27 were evaluated at 1-year post-treatment. The main outcome measures were visual acuity (VA), stereoacuity, and amblyopia recurrence at 12- and 52-week post-treatment. RESULTS At 12-week post-treatment, improvement in amblyopic eye VA was maintained vs baseline (0.27 ± 0.14 logMAR, P< .0001), with no change vs the end-of-treatment visit (P > .05). At 1 year there was a partial reduction in the amblyopic eye VA gain of 0.085±0.1 logMAR compared to end-of-treatment (P = .001), but the residual gain of 0.20±0.14 logMAR compared to baseline was statistically significant (P < .0001). Gains in stereoacuity and binocular VA were maintained vs baseline at both 12-weeks and 1-year post-treatment (P < .0001), with no change vs end-of-treatment (P > .05). Amblyopia recurrence (a worsening of ≥2 logMAR levels compared with end-of-treatment) occurred in 2/38 patients at 12-weeks post-treatment (5.3%), and in 5/27 patients at 1-year post-treatment (20.4%). CONCLUSIONS VA and stereopsis gains following binocular treatment with CureSight were maintained at 1 year without additional treatment.
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Affiliation(s)
- Tamara Wygnanski-Jaffe
- Goldschleger Eye Institute, Sheba Medical Center (T.W.-J.), Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University (T.W.-J., M.B.), Tel-Aviv, Israel
| | | | - Burton J Kushner
- Department of Ophthalmology and Visual Sciences, University of Wisconsin (B.J.K.), Madison, Wisconsin, USA
| | - Michael Belkin
- Sackler Faculty of Medicine, Tel-Aviv University (T.W.-J., M.B.), Tel-Aviv, Israel; Goldschleger Eye Research Institute, Sheba Medical Center (M.B.), Tel Hashomer, Israel
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Zhou S, Zhou J. New advances in amblyopia therapy: early patching is more effective than extended optical treatment. Lancet 2024; 403:1725-1727. [PMID: 38704157 DOI: 10.1016/s0140-6736(24)00350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/19/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Shiqi Zhou
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325035, China; State Key Laboratory of Ophthalmology, Optometry, and Visual Science, Wenzhou, China; National Clinical Research Center for Ocular Disease, Wenzhou, China
| | - Jiawei Zhou
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325035, China; State Key Laboratory of Ophthalmology, Optometry, and Visual Science, Wenzhou, China; National Clinical Research Center for Ocular Disease, Wenzhou, China.
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Zou L, Zhou C, Hess RF, Zhou J, Min SH. Daily dose-response from short-term monocular deprivation in adult humans. Ophthalmic Physiol Opt 2024; 44:564-575. [PMID: 38317572 DOI: 10.1111/opo.13282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
Short-term monocular deprivation (MD) shifts sensory eye balance in favour of the previously deprived eye. The effect of MD on eye balance is significant but brief in adult humans. Recently, researchers and clinicians have attempted to implement MD in clinical settings for adults with impaired binocular vision. Although the effect of MD has been studied in detail in single-session protocols, what is not known is whether the effect of MD on eye balance deteriorates after repeated periods of MD (termed 'perceptual deterioration'). An answer to this question is relevant for two reasons. Firstly, the effect of MD (i.e., dose-response) should not decrease with repeated use if MD is to be used therapeutically (e.g., daily for weeks). Second, it bears upon the question of whether the neural basis of the effects of MD and contrast adaptation, a closely related phenomenon, is the same. The sensory change from contrast adaptation depends on recent experience. If the observer has recently experienced the same adaptation multiple times for consecutive days, then the adaptation effect will be smaller because contrast adaptation exhibits perceptual deterioration, so it is of interest to know if the effects of MD follow suit. This study measured the effect of 2-h MD for seven consecutive days on binocular balance of 15 normally sighted adults. We found that the shift in eye balance from MD stayed consistent, showing no signs of deterioration after subjects experienced multiple periods of MD. This finding shows no loss of effectiveness of repeated daily doses of MD if used therapeutically to rebalance binocular vision in otherwise normal individuals. Furthermore, ocular dominance plasticity, which is the basis of the effects of short-term MD, does not seem to share the property of 'perceptual deterioration' with contrast adaptation, suggesting different neural bases for these two related phenomena.
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Affiliation(s)
- Liying Zou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chenyan Zhou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Robert F Hess
- McGill Vision Research, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Quebec, Canada
| | - Jiawei Zhou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Seung Hyun Min
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Liu J, Huang C, Cotter SA, Chan LYL, Yu Y, Jia Y, Ye Q, Feng L, Yao Y, Jiang R, Xiao C, Xu Z, Zhuang Y, He Y, Zhou Y, Chen X, Yuan J, Wen Y, Yu W, Pang Y, Lu ZL, Thompson B, Li J. Novel Quantitative Contrast Sensitivity Function Enhances the Prediction of Treatment Outcome and Recurrence in Amblyopia. Invest Ophthalmol Vis Sci 2024; 65:31. [PMID: 38771572 PMCID: PMC11114618 DOI: 10.1167/iovs.65.5.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/20/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose Although effective amblyopia treatments are available, treatment outcome is unpredictable, and the condition recurs in up to 25% of the patients. We aimed to evaluate whether a large-scale quantitative contrast sensitivity function (CSF) data source, coupled with machine learning (ML) algorithms, can predict amblyopia treatment response and recurrence in individuals. Methods Visual function measures from traditional chart vision acuity (VA) and novel CSF assessments were used as the main predictive variables in the models. Information from 58 potential predictors was extracted to predict treatment response and recurrence. Six ML methods were applied to construct models. The SHapley Additive exPlanations was used to explain the predictions. Results A total of 2559 consecutive records of 643 patients with amblyopia were eligible for modeling. Combining variables from VA and CSF assessments gave the highest accuracy for treatment response prediction, with the area under the receiver operating characteristic curve (AUC) of 0.863 and 0.815 for outcome predictions after 3 and 6 months, respectively. Variables from the VA assessment alone predicted the treatment response, with AUC values of 0.723 and 0.675 after 3 and 6 months, respectively. Variables from the CSF assessment gave rise to an AUC of 0.909 for recurrence prediction compared to 0.539 for VA assessment alone, and adding VA variables did not improve predictive performance. The interocular differences in CSF features are significant contributors to recurrence risk. Conclusions Our models showed CSF data could enhance treatment response prediction and accurately predict amblyopia recurrence, which has the potential to guide amblyopia management by enabling patient-tailored decision making.
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Affiliation(s)
- Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Chencui Huang
- AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, China
| | - Susan A. Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, United States
| | - Lily Y. L. Chan
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yizhou Yu
- AI Lab, Beijing Deepwise & League of PHD Technology Co., Ltd, Beijing, China
- Department of Computer Science, The University of Hong Kong, Hong Kong, China
| | - Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Chutong Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
- Donald Bren School of Information and Computer Sciences, University of California Irvine, California, United States
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Junpeng Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yun Wen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Wentong Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yangfei Pang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhong-Lin Lu
- Division of Arts and Sciences, New York University Shanghai, Shanghai, China
- Department of Neural Science and Psychology, New York University, New York, New York, United States
- Institute of Brain and Cognitive Science, New York University-East China Normal University, Shanghai, China
| | - Benjamin Thompson
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Tuna AR, Pinto N, Fernandes A, Brardo FM, Vaz Pato M. Longstanding effects of continuous theta burst stimulation in adult amblyopes. Clin Exp Optom 2024; 107:457-464. [PMID: 37400360 DOI: 10.1080/08164622.2023.2228989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 07/05/2023] Open
Abstract
CLINICAL RELEVANCE Continuous theta burst stimulation may be an important tool in the therapeutic management of amblyopia, when trying to correct the established neuronal imbalance. It is important to understand whether two sessions of continuous theta burst stimulation produce greater and longstanding changes in visual acuity and suppressive imbalance than one session of continuous theta burst stimulation. BACKGROUND We hypothesise that through the usage of continuous theta burst stimulation (cTBS) it is possible to change cortical excitability in a situation where visual impairment is present. METHODS We selected 22 adult amblyopes, 18 females and 4 males, with an age range of 20-59 years. They were randomised into two groups: group A with 10 amblyopes was submitted to one session of cTBS and group B with 12 amblyopes submitted to two sessions of cTBS. Visual acuity (VA) and suppressive imbalance (SI) were evaluated immediately before and after stimulation in both groups A and B. A follow-up was done in both groups. RESULTS For both group A and B, the VA improvements were significant after cTBS (p = 0.005 and p = 0.003, respectively). Regarding SI, both group A and B had significant improvements after cTBS (p = 0.03 and p = 0.005, respectively). Comparing groups, A and B no significant differences were found with regard to the results obtained both for VA (p = 0.72) and SI (p = 0.24). However, significant differences were found between group A and B with regard to the duration of stimulation effect for VA (p = 0.049) and SI (p = 0.03). CONCLUSION We conclude that two sessions of cTBS do not produce better results than one session of stimulation. However, it seems that two sessions of cTBS produce longstanding effects in VA and SI.
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Affiliation(s)
- Ana Rita Tuna
- CICS - Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Nuno Pinto
- CICS - Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Andresa Fernandes
- CICS - Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Department of Physics, University of Beira Interior, Covilhã, Portugal
| | - Francisco Miguel Brardo
- CICS - Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
- Department of Physics, University of Beira Interior, Covilhã, Portugal
| | - Maria Vaz Pato
- CICS - Health Sciences Research Centre, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
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Zhao Y, Liu J, Dosher BA, Lu ZL. Enabling identification of component processes in perceptual learning with nonparametric hierarchical Bayesian modeling. J Vis 2024; 24:8. [PMID: 38780934 PMCID: PMC11131338 DOI: 10.1167/jov.24.5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024] Open
Abstract
Perceptual learning is a multifaceted process, encompassing general learning, between-session forgetting or consolidation, and within-session fast relearning and deterioration. The learning curve constructed from threshold estimates in blocks or sessions, based on tens or hundreds of trials, may obscure component processes; high temporal resolution is necessary. We developed two nonparametric inference procedures: a Bayesian inference procedure (BIP) to estimate the posterior distribution of contrast threshold in each learning block for each learner independently and a hierarchical Bayesian model (HBM) that computes the joint posterior distribution of contrast threshold across all learning blocks at the population, subject, and test levels via the covariance of contrast thresholds across blocks. We applied the procedures to the data from two studies that investigated the interaction between feedback and training accuracy in Gabor orientation identification over 1920 trials across six sessions and estimated learning curve with block sizes L = 10, 20, 40, 80, 160, and 320 trials. The HBM generated significantly better fits to the data, smaller standard deviations, and more precise estimates, compared to the BIP across all block sizes. In addition, the HBM generated unbiased estimates, whereas the BIP only generated unbiased estimates with large block sizes but exhibited increased bias with small block sizes. With L = 10, 20, and 40, we were able to consistently identify general learning, between-session forgetting, and rapid relearning and adaptation within sessions. The nonparametric HBM provides a general framework for fine-grained assessment of the learning curve and enables identification of component processes in perceptual learning.
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Affiliation(s)
- Yukai Zhao
- Center for Neural Science, New York University, New York, NY, USA
| | - Jiajuan Liu
- Department of Cognitive Sciences and Institute of Mathematical Behavioral Sciences, University of California, Irvine, CA, USA
| | - Barbara Anne Dosher
- Department of Cognitive Sciences and Institute of Mathematical Behavioral Sciences, University of California, Irvine, CA, USA
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, USA
- NYU-ECNU Institute of Brain and Cognitive Neuroscience, Shanghai, China
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Doğan L, Özçakmakcı GB, Yılmaz ĬE. The Performance of Chatbots and the AAPOS Website as a Tool for Amblyopia Education. J Pediatr Ophthalmol Strabismus 2024:1-7. [PMID: 38661309 DOI: 10.3928/01913913-20240409-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the understandability, actionability, and readability of responses provided by the website of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), ChatGPT-3.5, Bard, and Bing Chat about amblyopia and the appropriateness of the responses generated by the chatbots. METHOD Twenty-five questions provided by the AAPOS website were directed three times to fresh ChatGPT-3.5, Bard, and Bing Chat interfaces. Two experienced pediatric ophthalmologists categorized the responses of the chatbots in terms of their appropriateness. Flesch Reading Ease (FRE), Flesch Kincaid Grade Level (FKGL), and Coleman-Liau Index (CLI) were used to evaluate the readability of the responses of the AAPOS website and chatbots. Furthermore, the understandability scores were evaluated using the Patient Education Materials Assessment Tool (PEMAT). RESULTS The appropriateness of the chatbots' responses was 84.0% for ChatGPT-3.5 and Bard and 80% for Bing Chat (P > .05). For understandability (mean PEMAT-U score AAPOS website: 81.5%, Bard: 77.6%, ChatGPT-3.5: 76.1%, and Bing Chat: 71.5%, P < .05) and actionability (mean PEMAT-A score AAPOS website: 74.6%, Bard: 69.2%, ChatGPT-3.5: 67.8%, and Bing Chat: 64.8%, P < .05), the AAPOs website scored better than the chat-bots. Three readability analyses showed that Bard had the highest mean score, followed by the AAPOS website, Bing Chat, and ChatGPT-3.5, and these scores were more challenging than the recommended level. CONCLUSIONS Chatbots have the potential to provide detailed and appropriate responses at acceptable levels. The AAPOS website has the advantage of providing information that is more understandable and actionable. The AAPOS website and chatbots, especially Chat-GPT, provided difficult-to-read data for patient education regarding amblyopia. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].
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Şengör T, Gençağa Atakan T. Management of Contact Lenses and Visual Development in Pediatric Aphakia. Turk J Ophthalmol 2024; 54:90-102. [PMID: 38645732 PMCID: PMC11034540 DOI: 10.4274/tjo.galenos.2023.56252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/28/2023] [Indexed: 04/23/2024] Open
Abstract
Congenital cataract is among the main causes of treatable vision loss in childhood. The first weeks and months of life are a critical time for the development of vision. Therefore, early cataract surgery and effective multifaceted treatment of the resulting aphakia in the early stages of life are of great value for the management of vision development. Among the treatment models, contact lenses (CL) have an important place in infancy and early childhood up to the age of 2 years. Although good visual gains were not considered very likely, especially in unilateral aphakia, important steps have been taken in the treatment of pediatric aphakia thanks to the surgical techniques developed over time and the increasing experience with optical correction systems, especially CLs. This review examines current developments in the types of CL used in pediatric aphakia, their application features, comparison with other optical systems, the features of amblyopia treatment in the presence of CL, and the results obtained with family compliance to CL wear and occlusion therapy in the light of existing studies.
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Affiliation(s)
| | - Tuğba Gençağa Atakan
- University of Health Sciences Türkiye, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Clinic of Eye Ophthalmology, İstanbul, Türkiye
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Drews-Botsch C, Cotsonis G, Celano M, Hartmann EE, Zaidi J, Lambert SR. Patching in Children With Unilateral Congenital Cataract and Child Functioning and Parenting Stress. JAMA Ophthalmol 2024:2817342. [PMID: 38635258 DOI: 10.1001/jamaophthalmol.2024.0800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Importance Parents may be concerned about the adverse outcomes of occlusion therapy in children treated for unilateral congenital cataract (UCC). Objective To determine whether occlusion therapy in children treated for UCC with poor visual outcomes is negatively associated with poorer child and/or family functioning. Design, Setting, and Participants This cohort study was conducted in 2023 using data collected between 2006 and 2016 in the Infant Aphakia Treatment Study (IATS). IATS participants with a visual acuity (VA) of 20/200 or worse were included. Statistical analysis was performed from July 2022 to October 2023. Exposure Caregivers reported the mean daily minutes of patching during the 12 months prior to the VA assessment at 4.5 years of age. Patching was categorized as minimal (<15 minutes per day), moderate (15 to <120 minutes per day), or extensive (≥120 minutes per day). Main Outcome Measures At 4.25 and 10.5 years of age, caregivers reported stress associated with the parenting role using the Parenting Stress Index and the Ocular Treatment Index and child behavior problems using the Achenbach Child Behavior Checklist. Motor skills were assessed at age 54 months using the Movement Assessment Battery for Children-Second Edition. Children completed the Harter Self-Perception Profile for Children at age 10.5 years. One-way analysis of variance and χ2 tests were used to compare outcomes by amount of patching. Results Patching data were available for 47 of 53 children (88.7%) with a VA of 20/200 or worse. Among these 47 children with patching data included in the study, 20 (42.5%) were female, 27 (57.5%) were male, 12 (25.5%) were reported to have been patched fewer than 15 minutes per day, 11 (23.4%) were patched 16 to 119 minutes per day, and 24 (51.1%) were patched at least 120 minutes per day. Parenting stress, child behavior problems, motor functioning, and child self-perception were similar in all groups. For example, after adjusting for gender and insurance status, there was a nonsignificant difference between mean stress scores of 11.0 (95% CI, -4.5 to 26.5) points for parents who reported minimal patching vs parents who reported patching at least 120 minutes per day, and there was no significant difference in children's report of their global self-worth (0.0 [95% CI, -0.4 to 0.3] points). Conclusions and Relevance Occlusion therapy was not negatively associated with family or child functioning. Although the sample size was limited, these results do not support changes to the current practice guidelines.
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Affiliation(s)
- Carolyn Drews-Botsch
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - George Cotsonis
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Marianne Celano
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - E Eugenie Hartmann
- Rebecca D. Considine Research Institute and Vision Center, Akron Children's Hospital, Akron, Ohio
| | - Jaffer Zaidi
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia
| | - Scott R Lambert
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Zhou S, Weng L, Zhou C, Zhou J, Min SH. Reduced Monocular Luminance Promotes Fusion But Not Mixed Perception in Amblyopia. Invest Ophthalmol Vis Sci 2024; 65:15. [PMID: 38587443 PMCID: PMC11008760 DOI: 10.1167/iovs.65.4.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose The purpose of this study was to understand how monocular luminance reduction affects binocular balance and examine whether it differentially influences fusion and mixed perception in amblyopia. Methods Twenty-three normally sighted observers and 12 adults with amblyopia participated in this study. A novel binocular rivalry task was used to measure the phase duration of four perceptual responses (right- and left-tilts, fusion, and mixed perception) before and after a neutral density (ND) filter was applied at various levels to the dominant eye (DE) of controls and the fellow eye (FE) of patients with amblyopia. Phase durations were analyzed to assess whether the duration of fusion or mixed perception shifted after monocular luminance reduction. Moreover, we quantified ocular dominance and adjusted monocular contrast and luminance separately to investigate the relationship between changes in ocular dominance induced by the two manipulations. Results In line with previous studies, binocular balance shifted in favor of the brighter eye in both normal adults and patients with amblyopia. As a function of the ND filter's density, the duration of fusion and mixed perception decreased in normal controls, whereas that of fusion but not mixed perception increased significantly in patients with amblyopia. In addition, changes in binocular balance from luminance reduction were more significant in more balanced amblyopes or normal observers. Furthermore, shifts in binocular balance after contrast and luminance modulation were correlated in both normal and amblyopic observers. Conclusions The duration of fusion but not mixed perception increased in amblyopia after monocular luminance reduction in the FE. Moreover, our findings demonstrate that changes in ocular dominance from contrast-modulation and luminance-modulation are correlated in both normal and amblyopic observers.
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Affiliation(s)
- Shiqi Zhou
- School of Ophthalmology and Optometry and Eye Hospital, and State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liuqing Weng
- School of Ophthalmology and Optometry and Eye Hospital, and State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chenyan Zhou
- School of Ophthalmology and Optometry and Eye Hospital, and State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiawei Zhou
- School of Ophthalmology and Optometry and Eye Hospital, and State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Seung Hyun Min
- School of Ophthalmology and Optometry and Eye Hospital, and State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Dong X, Liu L, Du X, Wang Y, Zhang P, Li Z, Bao M. Treating amblyopia using altered reality enhances the fine-scale functional correlations in early visual areas. Hum Brain Mapp 2023; 44:6499-6510. [PMID: 37929783 PMCID: PMC10681636 DOI: 10.1002/hbm.26526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
Amblyopia is a developmental visual disorder that causes substantial visual deficits. Studies using resting-state functional magnetic resonance imaging have disclosed abnormal brain functional connectivity (FC) both across long-range cortical sites and within the visual cortex in amblyopes, which is considered to be related to impaired visual functions. However, little work has examined whether restoring the vision of amblyopes accompanies with an improvement of FC. Here in adult amblyopes and healthy participants, we compared their brain FC before and after an altered-reality adaptation training. Before the training, the voxel-wise FCs of amblyopia patients were substantially weaker than those of healthy control participants both within and across the early visual areas. After the training, visual acuities improved in amblyopes but not in the control participants. The effect kept strengthening in the subsequent month without further adaptation. Importantly, we observed enhanced voxel-wise FC both within and across the early visual areas of amblyopes. Moreover, the enhancement continued for at least 1 month. These results suggest that the effective treatment can improve both the amblyopes' vision and functional connections in the visual cortex.
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Affiliation(s)
- Xue Dong
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Lijuan Liu
- Beijing Institute of Ophthalmology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Xinxin Du
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Yue Wang
- State Key Laboratory of Brain and Cognitive Science, Institute of BiophysicsChinese Academy of SciencesBeijingChina
| | - Peng Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of BiophysicsChinese Academy of SciencesBeijingChina
| | - Zhihao Li
- School of PsychologyShenzhen UniversityShenzhenGuangdongChina
- Department of Psychiatry and Behavioral SciencesEmory UniversityAtlantaGeorgiaUSA
| | - Min Bao
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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12
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Benhaim-Sitbon L, Lev M, Polat U. Abnormal basic visual processing functions in binocular fusion disorders. Sci Rep 2023; 13:19301. [PMID: 37935803 PMCID: PMC10630403 DOI: 10.1038/s41598-023-46291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
Heterophoria is a common type of binocular fusion disorder that consists of a latent eye misalignment with potential consequences on daily activities such as reading or working on a computer (with CVS). Crowding, a type of contextual modulation, can also impair reading. Our recent studies found an abnormal pattern of low-level visual processing with larger perceptive fields (PF) in heterophoria. The PF is the fundamental processing unit of human vision and both masking and crowding depend on its size. We investigated how heterophoria would impact the PF's size via a lateral masking experiment and consequently affect the foveal crowding at different letter-spacings (the crowding zone). More specifically, we explored the relationship between crowding, lateral masking, the PF's size, and the amount of heterophoria. The binocular horizontal PF's size was larger with heterophoric subjects, in agreement with our previous study. We found a stronger crowding and an extended crowding zone associated with slower response times; this shows that the processing of letter identification under both crowded and uncrowded conditions requires more processing effort in heterophoric individuals. In agreement with previous studies, we found a correlation between the crowding zone and the PF's size; each was strongly correlated with the amount of phoria. These findings resemble those involving the PF size and the extended crowding found at the fovea in amblyopia and young children. We suggest that these findings could help explain the inter-observers' variability found in the masking literature, and the reading difficulties often encountered in subjects with high heterophoria.
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Affiliation(s)
- Laura Benhaim-Sitbon
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Maria Lev
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Uri Polat
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel.
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13
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Nowik M, Perna F, Dahlmann-Noor A, Stern J, Malkowski JP, Weisberger A, Webber A. Amblyopia-A novel virtual round table to explore the caregiver perspective. Ophthalmic Physiol Opt 2023; 43:1571-1580. [PMID: 37515472 DOI: 10.1111/opo.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE A survey aimed to capture the caregiver's perspective on the impact of amblyopia and its treatment on the child and family, as well as caregivers' views on the design and feasibility of clinical trials investigating dichoptic binocular therapies for amblyopia. METHODS Parents of amblyopic children, patient advocates and healthcare professionals took part in a moderated, structured discussion on a novel virtual advisory-board platform. RESULTS Seven parents of children with amblyopia, two patient organisation representatives, one ophthalmologist and one optometrist participated in the survey. A total of 645 posts were entered on the platform over a 14-day period in September 2021. There was widespread agreement that the management of amblyopia poses more of a burden on the child and family than the condition itself, with treatment burden accentuated when treatment is unsuccessful. Parents expressed uncertainty and frustration in relation to the duration of patching, success of patching and alternative treatment options, and felt there was inadequate readily available, easy-to-understand information on the condition. Parents reported that a new treatment for amblyopia, such as dichoptic binocular therapy using video games, should be safe, non-invasive and engaging compared with an eye patch. Treating at home, potentially for a shorter treatment duration, and with an entertaining game were the main reasons parents would join a clinical study with this type of novel therapy. However, due to a limited critical period treatment window, parents would feel more comfortable joining a clinical trial if traditional therapies were offered in conjunction with those under investigation. CONCLUSION Patient perspectives and the role of caregivers in the acceptance of any interventional treatments are increasingly recognised. Understanding how amblyopia and its treatment impacts a child and family should be an important premise to guide therapy and evaluate treatment value, both in clinical trials and in routine medical practice.
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Affiliation(s)
| | | | | | - Jude Stern
- c/o International Agency for the Prevention of Blindness (IAPB), Sydney, New South Wales, Australia
| | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Randhawa S, Griffiths N, O'Brien P, Panter C, Boparai K, Harrad R, Khuddus N, Webber A, Bouchet C, Felizzi F. Qualitative Exploration of the Visual Function Impairments and Health-Related Quality of Life Impacts of Amblyopia in Adult and Pediatric Populations. Ophthalmol Ther 2023; 12:2505-2528. [PMID: 37356087 PMCID: PMC10441976 DOI: 10.1007/s40123-023-00751-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION Amblyopia is a reduction in vision in one or both eyes due to impaired development of the visual pathway. This study explored the experience of amblyopia and treatment from the patient, caregiver, and clinician perspectives. METHODS A targeted literature review, including a review of social media listening (SML) studies, was conducted. Next, qualitative interviews were conducted with amblyopia patients, caregivers of children with amblyopia, and ophthalmologists with experience treating patients with amblyopia. The findings informed the development of a disease model. Amblyopia clinical experts provided input at key stages. RESULTS Twelve data sources were reviewed, including qualitative studies in the literature and SML studies. Overall, 133 patients/caregivers were interviewed (23 adults, 16 adolescents, 47 child-caregiver dyads), plus 10 ophthalmologists from the United States, France, and Germany. Reduced visual acuity, impaired depth perception, impaired peripheral vision, and double vision were the most frequently reported symptoms. Amblyopia impacted daily activities (reading, using digital devices), the ability to move around, school/work (productivity, seeing the board in class), emotional well-being (frustration, sadness), and social functioning (difficulty socializing). Treatments, including patching and corrective lens, also impacted daily activities (using digital devices, sports/leisure), mobility (bumping into things), and work/school (tasks taking longer) as well as emotional well-being (embarrassment), and social functioning (bullying/stigma). CONCLUSION The findings contribute valuable insights into the adult and pediatric experience of amblyopia from a multi-stakeholder perspective. The findings were used to critically assess existing clinical outcome assessments and supported the development of patient- and observer-reported outcome measures for use in amblyopia clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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15
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Duffy KR, Bear MF, Patel NB, Das VE, Tychsen L. Human deprivation amblyopia: treatment insights from animal models. Front Neurosci 2023; 17:1249466. [PMID: 37795183 PMCID: PMC10545969 DOI: 10.3389/fnins.2023.1249466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Amblyopia is a common visual impairment that develops during the early years of postnatal life. It emerges as a sequela to eye misalignment, an imbalanced refractive state, or obstruction to form vision. All of these conditions prevent normal vision and derail the typical development of neural connections within the visual system. Among the subtypes of amblyopia, the most debilitating and recalcitrant to treatment is deprivation amblyopia. Nevertheless, human studies focused on advancing the standard of care for amblyopia have largely avoided recruitment of patients with this rare but severe impairment subtype. In this review, we delineate characteristics of deprivation amblyopia and underscore the critical need for new and more effective therapy. Animal models offer a unique opportunity to address this unmet need by enabling the development of unconventional and potent amblyopia therapies that cannot be pioneered in humans. Insights derived from studies using animal models are discussed as potential therapeutic innovations for the remediation of deprivation amblyopia. Retinal inactivation is highlighted as an emerging therapy that exhibits efficacy against the effects of monocular deprivation at ages when conventional therapy is ineffective, and recovery occurs without apparent detriment to the treated eye.
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Affiliation(s)
- Kevin R. Duffy
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Mark F. Bear
- Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Nimesh B. Patel
- College of Optometry, University of Houston, Houston, TX, United States
| | - Vallabh E. Das
- College of Optometry, University of Houston, Houston, TX, United States
| | - Lawrence Tychsen
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, United States
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16
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Pekica D, Košič Knez N, Razboršek B, Pahor D. OCT-Angiography Findings in Children with Anisometropic Amblyopia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1519. [PMID: 37761480 PMCID: PMC10528469 DOI: 10.3390/children10091519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The purpose of this prospective study is to show findings of OCT angiography in children with anisometropic amblyopia with a statistically significant difference, regardless of the type of refractive disorder, between the amblyopic and the fellow eye. This research aimed to establish whether there is a difference in vascular density [VD] and size of the foveal avascular zone [FAZ] in the superficial capillary plexus [SCP]. METHODS All children between 9 and 18 years of age who were treated at the Outpatient Clinic for Orthoptics and Pleoptics of the Department of Ophthalmology, University Medical Centre Maribor from January 2020 to December 2022 due to unilateral anisometric amblyopia were enrolled in our study. Fourteen children met the criteria. Cirrus 5000 high-resolution OCT with AngioPlex OCT angiography was used to analyze the size of the FAZ and VD in the SCP and TCS. The paired t-test or Wilcox signed-rank test [p < 0.05] was used for statistical analysis of each parameter between the amblyopic and fellow eye. RESULTS Mean child age was 13 years ± 2.9 and ranged from 9 to 18 years. Most of the children [85.7%] were boys. The VD of the SCP did not show statistically significant differences between the visually impaired and control eyes [p = 0.328]. The comparison of the FAZ area between the two eyes was also not statistically significant [p < 0.808]. There was also no statistically significant difference in central macular thickness [TCS] [p < 0.291]. CONCLUSIONS Our research results show no statistically significant differences in the VD and the FAZ of the SCP, and in the TCS between the amblyopic and fellow eye in children with unilateral anisometropic amblyopia. Our research did not confirm the results of certain previous studies in which a lower density of the capillary network was present in the visually impaired eye. Further studies with more children are necessary to confirm our results.
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Affiliation(s)
- David Pekica
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
| | - Nina Košič Knez
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Barbara Razboršek
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Dušica Pahor
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (D.P.); (N.K.K.); (B.R.)
- Department of Ophthalmology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
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17
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Sii SSZ, Chean CS, Kuht H, Bunce C, Thomas MG, Rufai SR. Home-based screening tools for amblyopia: a systematic review. Eye (Lond) 2023; 37:2649-2658. [PMID: 36828959 PMCID: PMC9951845 DOI: 10.1038/s41433-023-02412-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 02/26/2023] Open
Abstract
Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.
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Affiliation(s)
| | - Chung Shen Chean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Helen Kuht
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Mervyn G Thomas
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK.
| | - Sohaib R Rufai
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, UK.
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK.
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18
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Min SH, Wang Z, Chen MT, Hu R, Gong L, He Z, Wang X, Hess RF, Zhou J. Metaplasticity: Dark exposure boosts local excitability and visual plasticity in adult human cortex. J Physiol 2023; 601:4105-4120. [PMID: 37573529 DOI: 10.1113/jp284040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
An interlude of dark exposure for about 1 week is known to shift excitatory/inhibitory (E/I) balance of the mammalian visual cortex, promoting plasticity and accelerating visual recovery in animals that have experienced cortical lesions during development. However, the translational impact of our understanding of dark exposure from animal studies to humans remains elusive. Here, we used magnetic resonance spectroscopy as a probe for E/I balance in the primary visual cortex (V1) to determine the effect of 60 min of dark exposure, and measured binocular combination as a behavioural assay to assess visual plasticity in 14 normally sighted human adults. To induce neuroplastic changes in the observers, we introduced 60 min of monocular deprivation, which is known to temporarily shift sensory eye balance in favour of the previously deprived eye. We report that prior dark exposure for 60 min strengthens local excitability in V1 and boosts visual plasticity in normal adults. However, we show that it does not promote plasticity in amblyopic adults. Nevertheless, our findings are surprising, given the fact that the interlude is very brief. Interestingly, we find that the increased concentration of the excitatory neurotransmitter is not strongly correlated with the enhanced functional plasticity. Instead, the absolute degree of change in its concentration is related to the boost, suggesting that the dichotomy of cortical excitation and inhibition might not explain the physiological basis of plasticity in humans. We present the first evidence that an environmental manipulation that shifts cortical E/I balance can also act as a metaplastic facilitator for visual plasticity in humans. KEY POINTS: A brief interlude (60 min) of dark exposure increased the local concentration of glutamine/glutamate but not that of GABA in the visual cortex of adult humans. After dark exposure, the degree of the shift in sensory eye dominance in favour of the previously deprived eye from short-term monocular deprivation was larger than that from only monocular deprivation. The neurochemical and behavioural measures were associated: the magnitude of the shift in the concentration of glutamine/glutamate was correlated with the boost in perceptual plasticity after dark exposure. Surprisingly, the increase in the concentration of glutamine/glutamate was not correlated with the perceptual boost after dark exposure, suggesting that the physiological mechanism of how E/I balance regulates plasticity is not deterministic. In other words, an increased excitation did not unilaterally promote plasticity.
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Affiliation(s)
- Seung Hyun Min
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zili Wang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Meng Ting Chen
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rongjie Hu
- Center for Biomedical Imaging, University of Science and Technology of China, Anhui, China
| | - Ling Gong
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhifen He
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaoxiao Wang
- Center for Biomedical Imaging, University of Science and Technology of China, Anhui, China
| | - Robert F Hess
- McGill Vision Research, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Canada
| | - Jiawei Zhou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Skerswetat J, He J, Shah JB, Aycardi N, Freeman M, Bex PJ. AIM (Angular Indication Measurement)- Visual Acuity: An adaptive, self-administered, and generalizable vision assessment method used to measure visual acuity. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.25.529586. [PMID: 36909639 PMCID: PMC10002620 DOI: 10.1101/2023.02.25.529586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
This proof-of-concept study introduces Angular Indication Measurement and applies it to VA (AIM-VA). First, we compared the ability of AIM-VA and ETDRS to detect defocus and astigmatic blur in 22 normally-sighted adults. Spherical and cylindrical lenses (±0.00D, +0.25D, +0.50D, +0.75D, +1.00D, +2.00D and +0.50D, +1.00D, +2.00D each at 0°, 90°, 135°, respectively) in the dominant eye induced blur. Second, we compared repeatability over two tests of AIM-VA and ETDRS. A 2-way-ANOVA showed a main effect for defocus-blur and test with no interaction. A 3-way-ANOVA for the astigmatism experiment revealed main effects for test type, blur, and direction and with no interactions. Planned multiple comparisons showed AIM had greater astigmatic-induced VA loss than ETDRS. Bland-Altman plots showed small bias and no systematic learning effect for either test type and improved repeatability with >2 adaptive steps for AIM-VA. AIM-VA's ability to detect defocus was comparable with that of an ETDRS letter chart and showed greater sensitivity to astigmatic blur, and AIM-VA's repeatability is comparable with ETDRS when using 2 or more adaptive steps. AIM's self-administered orientation judgment approach is generalizable to interrogate other visual functions, e.g., contrast, color, motion, stereo-vision.
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20
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Jiang SQ, Chen YR, Liu XY, Zhang JY. Contour integration deficits at high spatial frequencies in children treated for anisometropic amblyopia. Front Neurosci 2023; 17:1160853. [PMID: 37564367 PMCID: PMC10411894 DOI: 10.3389/fnins.2023.1160853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study was conducted to reexamine the question of whether children treated for anisometropic amblyopia have contour integration deficits. To do so, we used psychophysical methods that require global contour processing while minimizing the influence of low-level deficits: visibility, shape perception, and positional uncertainty. Methods Thirteen children with anisometropic amblyopia (age: 10.1 ± 1.8 years) and thirteen visually normal children (age: 10.8 ± 2.0 years) participated in this study. The stimuli were closed figures made up of Gabor patches either in noise or on a blank field. The contrast thresholds to detect a circular contour on a blank field, as well as the thresholds of aspect ratio and contour element number to discriminate a circular or elliptical contour in noise, were measured at Gabor spatial frequencies of 1.5, 3, and 6 cpd for amblyopic eyes (AEs), fellow eyes (FEs), and normal control eyes. Visual acuities and contrast sensitivity functions for AEs and FEs and the Randot stereoacuity were measured before testing. Results The AEs showed contrast deficits and degraded shape perception compared to the FEs at higher spatial frequencies (6 cpd). When the influence of abnormal contrast sensitivity and shape perception were minimized, the AEs showed contour integration deficits at spatial frequencies 3 and 6 cpd. These deficits were not related to basic losses in contrast sensitivity and acuity, stereoacuity, and visual crowding. Besides, no significant difference was found between the fellow eyes of the amblyopic children and the normal control eyes in the performance of contour integration. Conclusion After eliminating or compensating for the low-level deficits, children treated for anisometropic amblyopia still show contour integration deficits, primarily at higher spatial frequencies, which might reflect the deficits in global processing caused by amblyopia. Contour integration deficits are likely independent of spatial vision deficits. Refractive correction and/or occlusion therapies may not be sufficient to fully restore contour integration deficits, which indicates the need for the development of clinical treatments to recover these deficits.
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Affiliation(s)
- Shu-Qi Jiang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Yan-Ru Chen
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Xiang-Yun Liu
- The Affiliated Tengzhou Hospital of Xuzhou Medical University, Tengzhou, Shandong, China
| | - Jun-Yun Zhang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
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Thompson B, Concetta Morrone M, Bex P, Lozama A, Sabel BA. Harnessing brain plasticity to improve binocular vision in amblyopia: An evidence-based update. Eur J Ophthalmol 2023:11206721231187426. [PMID: 37431104 DOI: 10.1177/11206721231187426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Amblyopia is a developmental visual disorder resulting from atypical binocular experience in early childhood that leads to abnormal visual cortex development and vision impairment. Recovery from amblyopia requires significant visual cortex neuroplasticity, i.e. the ability of the central nervous system and its synaptic connections to adapt their structure and function. There is a high level of neuroplasticity in early development and, historically, neuroplastic responses to changes in visual experience were thought to be restricted to a "critical period" in early life. However, as our review now shows, the evidence is growing that plasticity of the adult visual system can also be harnessed to improve vision in amblyopia. Amblyopia treatment involves correcting refractive error to ensure clear and equal retinal image formation in both eyes, then, if necessary, promoting the use of the amblyopic eye by hindering or reducing visual input from the better eye through patching or pharmacologic therapy. Early treatment in children can lead to visual acuity gains and the development of binocular vision in some cases; however, many children do not respond to treatment, and many adults with amblyopia have historically been untreated or undertreated. Here we review the current evidence on how dichoptic training can be used as a novel binocular therapeutic approach to facilitate visual processing of input from the amblyopic eye and can simultaneously engage both eyes in a training task that requires binocular integration. It is a novel and promising treatment for amblyopia in both children and adults.
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Affiliation(s)
- Benjamin Thompson
- Department of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Centre for Eye and Vision Science, Hong Kong
| | - Maria Concetta Morrone
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Peter Bex
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Anthony Lozama
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Bernhard A Sabel
- Institute of Medical Psychology, Faculty of Medicine, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
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He Y, Feng L, Zhou Y, Zhuang Y, Xu Z, Yao Y, Chen X, Jiang R, Yuan J, Ye Q, Wen Y, Jia Y, Liu J, Li J. Characteristics and predictive factors of visual function improvements after monocular perceptual learning in amblyopia. Heliyon 2023; 9:e17281. [PMID: 37416659 PMCID: PMC10320034 DOI: 10.1016/j.heliyon.2023.e17281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023] Open
Abstract
Monocular perceptual learning has shown promising performance in restoring visual function in amblyopes beyond the critical period in the laboratory. However, the treatment outcome is variable and indeterminate in actual clinical and neuroscientific practice. We aimed to explore the efficacy of monocular perceptual learning in the clinical setting. By combining continuous monitoring of perceptual learning and clinical measurements, we evaluated the efficacy and characteristics of visual acuity and contrast sensitivity function improvement and further explored the individualized effect after perceptual learning. Amblyopes (average age:17 ± 7 years old) were trained in a monocular two-alternative forced choice identification task at the 50% contrast threshold of the amblyopic eye for 10-15 days. We found that monocular perceptual learning improves both visual acuity and contrast sensitivity function in amblyopia. The broader activation of spatial contrast sensitivity, with a significant improvement in lower spatial frequencies, contributed to improving visual acuity. Visual acuity changes in the early stage can predict the endpoint treatment outcomes. Our results confirm the efficacy of monocular perceptual learning and suggest potential predictors of training outcomes to assist in the future management of clinical intervention and vision neuroscience research in amblyopia beyond the critical period of visual plasticity.
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Molina-Martín A, Leal-Vega L, de Fez D, Martínez-Plaza E, Coco-Martín MB, Piñero DP. Amblyopia Treatment through Immersive Virtual Reality: A Preliminary Experience in Anisometropic Children. Vision (Basel) 2023; 7:vision7020042. [PMID: 37218960 DOI: 10.3390/vision7020042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
The use of digital devices provides a wide range of possibilities for measuring and improving visual function, including concepts such as perceptual learning and dichoptic therapy. Different technologies can be used to apply these concepts, including, in recent years, the introduction of virtual reality (VR) systems. A preliminary experience in treating anisometropic amblyopia through an immersive VR device and using prototype software is described. A total of 4 children were treated by performing 18 office-based sessions. Results showed that distance VA in amblyopic eyes remained constant in two subjects, whereas the younger subjects improved after the training. Near VA improved in three subjects. All subjects showed an increase in the stereopsis of at least one step, with three subjects showing a final stereopsis of a 60 s arc. A total of three subjects showed an increase of approximately 0.5 CS units for the spatial frequency of 3 cpd after the training. Results from this pilot study suggest that visual training based on perceptual learning through an immersive VR environment could be a viable treatment for improving CS, VA, and stereopsis in some children with anisometropic amblyopia. Future studies should support these preliminary results.
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Affiliation(s)
- Ainhoa Molina-Martín
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Luis Leal-Vega
- Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - Dolores de Fez
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Elena Martínez-Plaza
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicente del Raspeig, Spain
- University of Valladolid, 47003 Valladolid, Spain
| | - María Begoña Coco-Martín
- Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain
| | - David P Piñero
- Group of Optics and Visual Perception. Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicente del Raspeig, Spain
- Department of Ophthalmology, Vithas Medimar International Hospital, 03016 Alicante, Spain
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24
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Eisen-Enosh A, Farah N, Polat U, Mandel Y. Perceptual learning based on a temporal stimulus enhances visual function in adult amblyopic subjects. Sci Rep 2023; 13:7643. [PMID: 37169784 PMCID: PMC10175483 DOI: 10.1038/s41598-023-34421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/29/2023] [Indexed: 05/13/2023] Open
Abstract
Studies have shown that Perceptual Learning (PL) can lead to enhancement of spatial visual functions in amblyopic subjects. Here we aimed to determine whether a simple flickering stimulus can be utilized in PL to enhance temporal function performance and whether enhancement will transfer to spatial functions in amblyopic subjects. Six adult amblyopic and six normally sighted subjects underwent an evaluation of their performance of baseline psychophysics spatial functions (Visual acuity (VA), contrast sensitivity (CS), temporal functions (critical fusion frequency (CFF) test), as well as a static and flickering stereopsis test, and an electrophysiological evaluation (VEP). The subjects then underwent 5 training sessions (on average, a total of 150 min over 2.5 weeks), which included a task similar to the CFF test using the method of constant stimuli. After completing the training sessions, subjects repeated the initial performance evaluation tasks. All amblyopic subjects showed improved temporal visual performance (CFF) in the amblyopic eye (on average, 17%, p << 0.01) following temporal PL. Generalization to spatial, spatio-temporal, and binocular tasks was also found: VA increased by 0.12 logMAR (p = 0.004), CS in backward masking significantly increased (by up to 19%, p = 0.003), and flickering stereopsis increased by 85 arcsec (p = 0.048). These results were further electrophysiologically manifested by an increase in VEP amplitude (by 43%, p = 0.03), increased Signal-to-Noise ratio (SNR) (by 39%, p = 0.024) to levels not different from normally sighted subjects, along with an improvement in inter-ocular delay (by 5.8 ms, p = 0.003). In contrast, no significant effect of training was found in the normally sighted group. These results highlight the potential of PL based on a temporal stimulus to improve the temporal and spatial visual performance in amblyopes. Future work is needed to optimize this method for clinical applications.
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Affiliation(s)
- Auria Eisen-Enosh
- School of Optometry and Vision Science, Bar-Ilan University, Ramat Gan, Israel
| | - Nairouz Farah
- School of Optometry and Vision Science, Bar-Ilan University, Ramat Gan, Israel
| | - Uri Polat
- School of Optometry and Vision Science, Bar-Ilan University, Ramat Gan, Israel
| | - Yossi Mandel
- School of Optometry and Vision Science, Bar-Ilan University, Ramat Gan, Israel.
- Bar-Ilan Institute for Nanotechnology and Advanced Materials (BINA), Bar-Ilan University, Ramat Gan, Israel.
- The Leslie and Susan Gonda (Goldschmied) Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel.
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25
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Benhaim-Sitbon L, Lev M, Polat U. Extended perceptive field revealed in humans with binocular fusion disorders. Sci Rep 2023; 13:6584. [PMID: 37085571 PMCID: PMC10121568 DOI: 10.1038/s41598-023-33429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
Binocular vision disorders or dysfunctions have considerable impact on daily visual activities such as reading. Heterophoria (phoria) is a latent eye misalignment (with a prevalence of up to 35%) that appears in conditions that disrupt binocular vision and it may affect the quality of binocular fusion. Our recent study, which used lateral masking (LM), suggests that subjects with binocular fusion disorders (horizontal phoria) exhibit an asymmetry and an abnormal pattern of both binocular and monocular lateral interactions, but only for the horizontal meridian (HM). The perceptive field (PF) is the fundamental processing unit of human vision and both masking and crowding depend on its size. An increased PF size is found in amblyopic populations or in young children. We hypothesized that the PF's size would be asymmetric only for the phoric group (larger along the HM). We estimated the PF's size using two different methods (LM with equal-phase and opposite-phase flankers). Phoric subjects exhibited a larger binocular PF size, only for the HM, confirming our hypothesis of an asymmetric PF size. However, the monocular PF size of phoric and control subjects was similar. Phoria affects the PF's size similarly to meridional amblyopia but without being attributed to abnormal refraction. We suggest that these findings could help explain the inter-observer variability found in the masking literature and the reading difficulties often encountered in subjects with high heterophoria. Since perceptual learning can reduce the PF's size, further investigation of training may provide a novel therapy to reduce some symptoms related to heterophoria.
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Affiliation(s)
- Laura Benhaim-Sitbon
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Maria Lev
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Uri Polat
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
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26
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Chen Y, Chen Y, Tao C, Zhou S, Chen H, Huang PC, Hess RF, Zhou J. Temporal synchrony discrimination is abnormal in dichoptic but not monocular visual processing in treated anisometropic amblyopes. Ophthalmic Physiol Opt 2023; 43:263-272. [PMID: 36648010 DOI: 10.1111/opo.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate whether temporal synchrony processing deficits remain when normal visual acuity is restored in adults with unilateral anisometropic amblyopia. METHODS We recruited 14 clinically treated anisometropic amblyopes (mean age 23.17 ± 2.53 years) with best-corrected visual acuity ≤ 0.1 logMAR and 15 age-matched emmetropes (mean age 24.40 ± 1.92 years) with normal vision to participate in our experiment. We presented two pairs of flicking Gaussian dots (1 Hz) as visual stimuli: one pair of dots was synchronous (reference), and the other pair of dots was asynchronous (signal). Subjects were asked to determine the position of the asynchronous pair. We applied the constant stimuli method to measure the temporal synchrony threshold under monocular and dichoptic viewing conditions. There were eight temporal phase lags in the asynchronous pair. The minimum degree of the temporal phase at which a participant can discriminate a signal pair is defined as the temporal synchrony threshold. RESULTS Under monocular viewing conditions where both the reference and signal pairs were presented to one eye, the temporal synchrony thresholds of previous amblyopic eyes and fellow eyes were not significantly different (p = 0.15). Under dichoptic viewing conditions where both the reference and signal pairs were dichoptically presented to both eyes, the temporal synchrony threshold in the treated anisometropic amblyopes was significantly higher than that of the controls (119.34 ± 20.43 vs. 99.78 ± 16.60 ms, p = 0.009). There was no significant correlation between the monocular and dichoptic viewing conditions in the treated amblyopes (r = -0.22, p = 0.94). CONCLUSIONS Temporal synchrony discrimination is abnormal under dichoptic but not under monocular visual stimulation in treated anisometropic amblyopes with normalised visual acuity.
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Affiliation(s)
- Yao Chen
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
| | - Yiya Chen
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
| | - Chunwen Tao
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
| | - Shiqi Zhou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
| | - Hao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
| | - Pi-Chun Huang
- Department of Psychology, National Cheng Kung University, Tainan, Taiwan
| | - Robert F Hess
- McGill Vision Research, Department of Ophthalmology and Visual Sciences, McGill University, Montreal, Canada
| | - Jiawei Zhou
- State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China.,National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital Wenzhou Medical University, Wenzhou, China
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27
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Wygnanski-Jaffe T, Kushner BJ, Moshkovitz A, Belkin M, Yehezkel O. An Eye-Tracking-Based Dichoptic Home Treatment for Amblyopia: A Multicenter Randomized Clinical Trial. Ophthalmology 2023; 130:274-285. [PMID: 36306974 DOI: 10.1016/j.ophtha.2022.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Comparing visual outcomes after use of a novel binocular eye-tracking-based home treatment (CureSight; NovaSight, Ltd) with patching. DESIGN Prospective, multicenter, randomized, masked, controlled, noninferiority pivotal trial. PARTICIPANTS One hundred three children 4 to < 9 years with anisometropic, small-angle strabismic or mixed-mechanism amblyopia were randomized 1:1 to either CureSight treatment or patching. METHODS The CureSight treatment uses combined anaglyph glasses and an eye tracker to induce real-time blur around the fellow eye fovea in dichoptic streamed video content. Participants used the device for 90 minutes/day, 5 days/week for 16 weeks (120 hours). The patching group received 2 hours of patching 7 days/week (224 hours). The prespecified noninferiority margin was 1 line. MAIN OUTCOME MEASURES The primary outcome was the improvement in the amblyopic eye visual acuity (VA), modeled with a repeated measures analysis of covariance. Secondary outcomes included stereoacuity, binocular VA, and treatment adherence rates, analyzed by a 1-sample Wilcoxon test within each group and a 2-sample Wilcoxon test comparing groups. Safety outcomes included the frequency and severity of study-related adverse events (AEs). RESULTS CureSight group VA improvement was found to be noninferior to patching group improvement (0.28 ± 0.13 logarithm of the minimum angle of resolution [logMAR] [P < 0.0001] and 0.23 ± 0.14 logMAR [P < 0.0001], respectively; 90% confidence interval [CI] of difference, -0.008 to 0.076). Stereoacuity improvement of 0.40 log arcseconds (P < 0.0001) and improved binocular VA (0.13 logMAR; P < 0.0001) were observed in the binocular treatment group, with similar improvements in the patching group in stereoacuity (0.40 log arcseconds; P < 0.0001) and binocular VA (0.09 logMAR; P < 0.0001), with no significant difference between improvements in the 2 groups in either stereoacuity (difference, 0; 95% CI, -0.27 to -0.27; P = 0.76) or binocular VA (difference, 0.041; 95% CI, -0.002 to 0.085; P = 0.07). The binocular treatment group had a significantly higher adherence than the patching group (91% vs. 83%; 95% CI, -4.0% to 21%; P = 0.011). No serious AEs were found. CONCLUSIONS Binocular treatment was well tolerated and noninferior to patching in amblyopic children 4 to < 9 years of age. High adherence may provide an alternative treatment option for amblyopia. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Tamara Wygnanski-Jaffe
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Burton J Kushner
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
| | | | - Michael Belkin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Goldschleger Eye Research Institute, Sheba Medical Center, Tel Hashomer, Israel
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28
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Niechwiej-Szwedo E, Colpa L, Wong A. The role of binocular vision in the control and development of visually guided upper limb movements. Philos Trans R Soc Lond B Biol Sci 2023; 378:20210461. [PMID: 36511416 PMCID: PMC9745875 DOI: 10.1098/rstb.2021.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Vision provides a key sensory input for the performance of fine motor skills, which are fundamentally important to daily life activities, as well as skilled occupational and recreational performance. Binocular visual function is a crucial aspect of vision that requires the ability to combine inputs from both eyes into a unified percept. Summation and fusion are two aspects of binocular processing associated with performance advantages, including more efficient visuomotor control of upper limb movements. This paper uses the multiple processes model of limb control to explore how binocular viewing could facilitate the planning and execution of prehension movements in adults and typically developing children. Insight into the contribution of binocularity to visuomotor control also comes from examining motor performance in individuals with amblyopia, a condition characterized by reduced visual acuity and poor binocular function. Overall, research in this field has advanced our understanding of the role of binocular vision in the development and performance of visuomotor skills, the first step towards developing assessment tools and targeted rehabilitation for children with neurodevelopment disorders at risk of poor visuomotor outcomes. This article is part of a discussion meeting issue 'New approaches to 3D vision'.
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Affiliation(s)
- Ewa Niechwiej-Szwedo
- Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue, Waterloo, ON, Canada N2L 3G1
| | - Linda Colpa
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
- University of Toronto, 27 King's College Circle, Toronto, ON, Canada M5S 1A4
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29
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Sánchez-González MC, Gutiérrez-Sánchez E, Sánchez-González JM, De-Hita-Cantalejo C, Pinero-Rodríguez AM, González-Cruces T, Capote-Puente R. Complications of Small Aperture Intracorneal Inlays: A Literature Review. Life (Basel) 2023; 13:life13020312. [PMID: 36836669 PMCID: PMC9965951 DOI: 10.3390/life13020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Presbyopia can be defined as the refractive state of the eye in which, due to a physiological decrease in the ability to accommodate, it is not possible to sustain vision without fatigue in a prolonged manner, along with difficulty focusing near vision. It is estimated that its prevalence in 2030 will be approximately 2.1 billion people. Corneal inlays are an alternative in the correction of presbyopia. They are implanted beneath a laser-assisted in situ keratomileusis (LASIK) flap or in a pocket in the center of the cornea of the non-dominant eye. The purpose of this review is to provide information about intraoperative and postoperative KAMRA inlay complications in the available scientific literature. A search was conducted on PubMed, Web of Science, and Scopus with the following search strategy: ("KAMRA inlay" OR "KAMRA" OR "corneal inlay pinhole" OR "pinhole effect intracorneal" OR "SAICI" OR "small aperture intracorneal inlay") AND ("complication" OR "explantation" OR "explanted" OR "retired"). The bibliography consulted shows that the insertion of a KAMRA inlay is an effective procedure that improves near vision with a slight decrease in distance vision. However, postoperative complications such as corneal fibrosis, epithelial iron deposits, and stromal haze are described.
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Affiliation(s)
| | | | | | | | | | - Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, 14012 Cordoba, Spain
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain
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Abstract
Extended reality (XR) devices, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) devices, are immersive technologies that can swap or merge the natural environment with virtual content (e.g., videogames, movies, or other content). Although these devices are widely used for playing videogames and other applications, they have one distinct feature that makes them potentially very useful for the measurement and treatment of binocular vision anomalies-they can deliver different content to the two eyes simultaneously. Indeed, horizontally shifting the images in the two eyes (thereby creating binocular disparity) can provide the user with a compelling percept of depth through stereopsis. Because these devices are stereoscopic, they can also be used as high-tech synoptophores, in which the images to the two eyes differ in contrast, luminance, size, position, and content for measuring and treating binocular anomalies. The inclusion of eye tracking in VR adds an additional dimension to its utility in measuring and treating binocular vision anomalies, as well as other conditions. This paper describes the essential requirements for testing and treating binocular anomalies and reviews current studies in which XR devices have been used to measure and treat binocular vision anomalies.
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Affiliation(s)
- Dennis M. Levi
- Herbert Wertheim School of Optometry and Vision Science, University of California, Berkeley, Berkeley, CA, USA,
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31
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Bui Quoc E, Kulp MT, Burns JG, Thompson B. Amblyopia: A review of unmet needs, current treatment options, and emerging therapies. Surv Ophthalmol 2023; 68:507-525. [PMID: 36681277 DOI: 10.1016/j.survophthal.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/03/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023]
Abstract
Amblyopia is a global public health issue with extensive, multifaceted impacts on vision and quality of life (QoL) for both patients and families. Geographical variation exists in the management of amblyopia, with traditional mainstay treatments, optical correction, and fellow eye occlusion most successful when implemented at an early age. In recent years, however, studies demonstrating meaningful improvements in older children and adults have challenged the concept of a complete loss of visual processing plasticity beyond the critical period of visual development, with growing evidence supporting the potential efficacy of emerging, more engaging, binocular therapies in both adults and children. Binocular approaches aim to restore deficits in amblyopia that extend beyond monocular visual acuity impairment, including binocular fusion and visuomotor skills. In view of this, incorporating outcome measures that evaluate the visual performance and functional ability of individuals with amblyopia will provide a clearer understanding of the effect of amblyopia on QoL and a more comprehensive evaluation of amblyopia therapies.
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Affiliation(s)
- Emmanuel Bui Quoc
- Ophthalmology Department, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
| | | | | | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Canada; Centre for Eye and Vision Research, Hong Kong
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32
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Binocular fusion disorders impair basic visual processing. Sci Rep 2022; 12:12564. [PMID: 35869104 PMCID: PMC9307628 DOI: 10.1038/s41598-022-16458-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
In an era of increasing screen consumption, the requirement for binocular vision is demanding, leading to the emergence of syndromes such as the computer vision syndrome (CVS) or visual discomfort reported by virtual reality (VR) users. Heterophoria (phoria) is a latent eye misalignment (with a prevalence up to 35%) that appears in conditions that disrupt binocular vision and may affect the quality of binocular fusion. Collinear facilitation (CF), the mechanism for grouping contour elements, is a process that reveals lateral interactions by improving the visibility of a target by flankers placed collinearly. An abnormal pattern of CF has been observed in strabismic amblyopia. We hypothesize that phoria may affect CF in the horizontal meridian (HM) due to latent eye misalignment and its impact on binocular fusion. Fully corrected participants (phoria group and controls) completed a standard CF experiment for horizontal and vertical meridians during binocular and monocular viewing. Phoric observers exhibited (1) an asymmetry and an abnormal pattern of CF only for the HM, during both monocular and binocular viewing, (2) poor binocular summation between the monocular inputs, and (3) no binocular advantage of the CF. Phoria affects the CF in a way that is reminiscent of meridional amblyopia without being attributed to abnormal refraction. The abnormal pattern of CF in monocular viewing suggests that phoria could be a binocular developmental disorder that affects monocular spatial interactions. We suggest that the results could contribute to explain the visual discomfort experienced with VR users or symptoms when presenting CVS.
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Neural Correlates of Sensory Eye Dominance in Human Visual White Matter Tracts. eNeuro 2022; 9:ENEURO.0232-22.2022. [PMID: 36347601 PMCID: PMC9698723 DOI: 10.1523/eneuro.0232-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022] Open
Abstract
A significant proportion of the human neurotypical population exhibits some degree of sensory eye dominance (SED), referring to the brain's preferential processing of one eye's input versus another. The neural substrates underlying this functional imbalance are not well known. Here, we investigated the relationship between visual white matter tract properties and SED in the human neurotypical population. Observers' performance on two commonly used dichoptic tasks were used to index SED, along with performance on a third task to address a functional implication of binocular imbalance: stereovision. We show that diffusivity metrics of the optic radiations (ORs) well predict behavioral SED metrics. We found no relationship between SED and stereosensitivity. Our data suggest that SED is not simply reflected by gray matter structural and functional alterations, as often suggested, but relates, at least in part to the microstructural properties of thalamocortical white matter.
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Abstract
Stereopsis provides us with a vivid impression of the depth and distance of objects in our 3- dimensional world. Stereopsis is important for a number of everyday visual tasks, including (but not limited to) reaching and grasping, fine visuo-motor control, and navigating in our world. This review briefly discusses the neural substrate for normal binocular vision and stereopsis and its development in primates; outlines some of the issues and limitations of stereopsis tests and examines some of the factors that limit the typical development of stereopsis and the causes and consequences of stereo-deficiency and stereo-blindness. Finally, we review several approaches to improving or recovering stereopsis in both neurotypical individuals and those with stereo-deficiency and stereo-blindness and outline some emerging strategies for improving stereopsis.
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35
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Lu ZL, Dosher BA. Current directions in visual perceptual learning. NATURE REVIEWS PSYCHOLOGY 2022; 1:654-668. [PMID: 37274562 PMCID: PMC10237053 DOI: 10.1038/s44159-022-00107-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/06/2023]
Abstract
The visual expertise of adult humans is jointly determined by evolution, visual development, and visual perceptual learning. Perceptual learning refers to performance improvements in perceptual tasks after practice or training in the task. It occurs in almost all visual tasks, ranging from simple feature detection to complex scene analysis. In this Review, we focus on key behavioral aspects of visual perceptual learning. We begin by describing visual perceptual learning tasks and manipulations that influence the magnitude of learning, and then discuss specificity of learning. Next, we present theories and computational models of learning and specificity. We then review applications of visual perceptual learning in visual rehabilitation. Finally, we summarize the general principles of visual perceptual learning, discuss the tension between plasticity and stability, and conclude with new research directions.
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Affiliation(s)
- Zhong-Lin Lu
- Division of Arts and Sciences, New York University Shanghai, Shanghai, China
- Center for Neural Science, New York University, New York, NY, USA
- Department of Psychology, New York University, New York, NY, USA
- Institute of Brain and Cognitive Science, New York University - East China Normal University, Shanghai, China
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Wang G, Liu L. Amblyopia: progress and promise of functional magnetic resonance imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1229-1246. [PMID: 36282454 DOI: 10.1007/s00417-022-05826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly used neuroimaging technique for investigating amblyopia. Herein, we systematically searched a PubMed database from inception to December 2021 to highlight the current progress and promises about fMRI technology in amblyopia; amblyopia's neural mechanism, the comparison of different types of amblyopia, and the evaluation of the therapeutic effect were explored. Relevant articles published in English and appropriate cross-references were considered for inclusion, including basic studies, imaging techniques, clinical diagnostic and therapeutic studies, case series, and reviews.
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Affiliation(s)
- Guiqu Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Chen Y, Zuo J, Xiong Y, Yu X, Wei L, Luo Y, Bao J, Chen H, Zhou J. Refraction development in anisometropic amblyopia with patching therapy. Front Med (Lausanne) 2022; 9:959085. [PMID: 36330057 PMCID: PMC9623012 DOI: 10.3389/fmed.2022.959085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/26/2022] [Indexed: 09/29/2023] Open
Abstract
PURPOSE To investigate the development of refraction in anisometropic amblyopia who had been with patching therapy. METHODS We retrospectively reviewed 37,528 medical records of the amblyopes who had been treated with patching therapy between July 2003 and January 2020 at the School of Optometry and Ophthalmology and Eye Hospital of Wenzhou Medical University. We included unilateral anisometropic amblyopia with a follow-up length of not < 2 years. In total, 371 cases were enrolled and followed up for a mean of 4.76 ± 2.11 years. The subjects were then divided into different groups and periods according to their initial spherical equivalent (SE) refractive error and best-corrected visual acuity (BCVA) of the amblyopic eye. Linear mixed-effects models were fitted to calculate the annual change of SE. RESULTS The annual changes in SE were -0.32 (-0.35 to -0.30) and -0.16 (-0.19 to -0.14) D/yr for the amblyopic eye and the fellow eye, respectively. The annual changes in SE of amblyopic eyes during the treatment period and the successfully treated period were -0.36 (-0.43 to -0.29; 95% CI) and -0.27 (-0.32 to -0.23; 95% CI) D/yr, respectively; the annual SE changes of the fellow eye during the treatment period and the successfully-treated period were -0.07 (-0.14 to -0.01; 95% CI) and -0.18 (-0.22 to -0.14; 95% CI) D/yr, respectively. CONCLUSION The amblyopic eye experienced a significantly greater degree of refractive error changes than the fellow eye and underwent a continuous refractive error reduction before and after 7 years old. After the patching therapy was terminated, emmetropization in the amblyopic eye remained synchronized, whereas the refractive error change was increased in the fellow eye.
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Affiliation(s)
| | | | | | | | | | | | | | - Hao Chen
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
| | - Jiawei Zhou
- School of Ophthalmology and Optometry, Affiliated Eye Hospital, State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China
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Li L, Xue H, Lai T, Xue Y, Luo G. Comparison of compliance among patients with pediatric amblyopia undergoing virtual reality-based and traditional patching method training. Front Public Health 2022; 10:1037412. [PMID: 36311619 PMCID: PMC9614073 DOI: 10.3389/fpubh.2022.1037412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023] Open
Abstract
Introduction This study aimed to compare compliance between pediatric patients with amblyopia undergoing a smartphone virtual reality-based training method (EYEBIT) and those receiving traditional patching method training. Methods A crossover design was adopted in this study. The enrolled children (n = 76) were randomized into the traditional patching and EYEBIT training method groups. The patients received training methods once a day for 2 h and 1 h in the patching and EYEBIT groups, respectively. Follow-up assessments involved interviews with parents regarding children's compliance and questionnaire-based interviews with children; compliance rating was compared between the methods. Results All children completed the training and follow-up assessments. There were significant differences in parent and children compliance-related behavior and attitudes between the two training methods (p < 0.05). The EYEBIT method was associated with better compliance than the traditional patching method. Significant correlations were observed among compliance components in both methods. In the correlation analysis between the two groups, the research results showed that in the EYEBIT group, the correlation between children's compliance behaviors and children's compliance attitudes, the correlation between children's compliance behaviors and parents' compliance behaviors, and the correlations between children's compliance attitudes and parents' compliance attitudes were all negatively correlated, and in the traditional patching group, the above three correlation analysis results were all positive. Conclusion The use of the EYEBIT method may improve compliance in children with amblyopia; this method appears acceptable to the parents of children with amblyopia.
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Affiliation(s)
- Li Li
- Ophthalmology Department, Fujian Provincial Hospital South Branch, Fujian Provincial Hospital, Fuzhou, China
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Hailan Xue
- Ultrasound Department, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Taichen Lai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Ying Xue
- Ophthalmology Department, Fujian Provincial Hospital South Branch, Fujian Provincial Hospital, Fuzhou, China
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gang Luo
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States
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Mukerji A, Byrne KN, Yang E, Levi DM, Silver MA. Visual cortical γ-aminobutyric acid and perceptual suppression in amblyopia. Front Hum Neurosci 2022; 16:949395. [PMID: 36118971 PMCID: PMC9479630 DOI: 10.3389/fnhum.2022.949395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/17/2022] [Indexed: 01/23/2023] Open
Abstract
In amblyopia, abnormal visual experience during development leads to an enduring loss of visual acuity in adulthood. Physiological studies in animal models suggest that intracortical GABAergic inhibition may mediate visual deficits in amblyopia. To better understand the relationship between visual cortical γ-aminobutyric acid (GABA) and perceptual suppression in persons with amblyopia (PWA), we employed magnetic resonance spectroscopy (MRS) to quantify GABA levels in both PWA and normally-sighted persons (NSP). In the same individuals, we obtained psychophysical measures of perceptual suppression for a variety of ocular configurations. In PWA, we found a robust negative correlation between the depth of amblyopia (the difference in visual acuity between the amblyopic and non-amblyopic eyes) and GABA concentration that was specific to visual cortex and was not observed in a sensorimotor cortical control region. Moreover, lower levels of visual cortical GABA were associated with weaker perceptual suppression of the fellow eye by the amblyopic eye and stronger suppression of the amblyopic eye by the fellow eye. Taken together, our findings provide evidence that intracortical GABAergic inhibition is an important component of the pathology of human amblyopia and suggest possible therapeutic interventions to restore vision in the amblyopic eye through enhancement of visual cortical GABAergic signaling in PWA.
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Affiliation(s)
- Arjun Mukerji
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States,Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States
| | - Kelly N. Byrne
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States,Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA, United States,School of Optometry, University of California, Berkeley, Berkeley, CA, United States
| | - Eunice Yang
- Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States,School of Optometry, University of California, Berkeley, Berkeley, CA, United States
| | - Dennis M. Levi
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States,Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States,Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA, United States,School of Optometry, University of California, Berkeley, Berkeley, CA, United States
| | - Michael A. Silver
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA, United States,Henry H. Wheeler, Jr. Brain Imaging Center, University of California, Berkeley, Berkeley, CA, United States,Vision Science Graduate Group, University of California, Berkeley, Berkeley, CA, United States,School of Optometry, University of California, Berkeley, Berkeley, CA, United States,*Correspondence: Michael A. Silver,
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Mortazavi M, Aigner K, Antono JE, Gambacorta C, Nahum M, Levi DM, Föcker J. Intramodal cortical plastic changes after moderate visual impairment in human amblyopia. iScience 2022; 25:104871. [PMID: 36034215 PMCID: PMC9403333 DOI: 10.1016/j.isci.2022.104871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 06/08/2022] [Accepted: 07/29/2022] [Indexed: 10/28/2022] Open
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Chow A, Nallour Raveendran R, Erkelens I, Babu R, Thompson B. Increased saccadic latency in Amblyopia: Oculomotor and attentional factors. Vision Res 2022; 197:108059. [DOI: 10.1016/j.visres.2022.108059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/04/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022]
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Fixation instability, astigmatism, and lack of stereopsis as factors impeding recovery of binocular balance in amblyopia following binocular therapy. Sci Rep 2022; 12:10311. [PMID: 35725590 PMCID: PMC9209502 DOI: 10.1038/s41598-022-13947-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022] Open
Abstract
Dichoptic therapy is a promising method for improving vision in pediatric and adult patients with amblyopia. However, a systematic understanding about changes in specific visual functions and substantial variation of effect among patients is lacking. Utilizing a novel stereoscopic augmented-reality based training program, 24 pediatric and 18 adult patients were trained for 20 h along a three-month time course with a one-month post-training follow-up for pediatric patients. Changes in stereopsis, distance and near visual acuity, and contrast sensitivity for amblyopic and fellow eyes were measured, and interocular differences were analyzed. To reveal what contributes to successful dichoptic therapy, ANCOVA models were used to analyze progress, considering clinical baseline parameters as covariates that are potential requirements for amblyopic recovery. Significant and lasting improvements have been achieved in stereoacuity, interocular near visual acuity, and interocular contrast sensitivity. Importantly, astigmatism, fixation instability, and lack of stereopsis were major limiting factors for visual acuity, stereoacuity, and contrast sensitivity recovery, respectively. The results demonstrate the feasibility of treatment-efficacy prediction in certain aspects of dichoptic amblyopia therapy. Furthermore, our findings may aid in developing personalized therapeutic protocols, capable of considering individual clinical status, to help clinicians in tailoring therapy to patient profiles for better outcome.
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Hou C, Nicholas SC. Perceptual learning with dichoptic attention tasks improves attentional modulation in V1 and IPS and reduces interocular suppression in human amblyopia. Sci Rep 2022; 12:9660. [PMID: 35690626 PMCID: PMC9188564 DOI: 10.1038/s41598-022-13747-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
Long-term and chronic visual suppression to the non-preferred eye in early childhood is a key factor in developing amblyopia, as well as a critical barrier to treat amblyopia. To explore the relationship between selective visual attention and amblyopic suppression and its role in the success of amblyopic training, we used EEG source-imaging to show that training human adults with strabismic and anisometropic amblyopia with dichoptic attention tasks improved attentional modulation of neural populations in the primary visual cortex (V1) and intraparietal sulcus (IPS). We also used psychophysics to show that training reduced interocular suppression along with visual acuity and stereoacuity improvements. Importantly, our results revealed that the reduction of interocular suppression by training was significantly correlated with the improvement of selective visual attention in both training-related and -unrelated tasks in the amblyopic eye, relative to the fellow eye. These findings suggest a relation between interocular suppression and selective visual attention bias between eyes in amblyopic vision, and that dichoptic training with high-attention demand tasks in the amblyopic eye might be an effective way to treat amblyopia.
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Affiliation(s)
- Chuan Hou
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, 94115, USA.
| | - Spero C Nicholas
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA, 94115, USA
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Leal Vega L, Piñero DP, Hernández Rodríguez CJ, Molina Martín A, Morales-Quezada L, Vallelado Álvarez AI, Arenillas Lara JF, Coco Martín MB. Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia. BMC Ophthalmol 2022; 22:253. [PMID: 35672688 PMCID: PMC9172013 DOI: 10.1186/s12886-022-02466-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. METHODS We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. DISCUSSION The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. TRIAL REGISTRATION This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.
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Affiliation(s)
- L Leal Vega
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - D P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - C J Hernández Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - A Molina Martín
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - L Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - A I Vallelado Álvarez
- Pediatric Ophthalmology Unit, Department of Ophthalmology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - J F Arenillas Lara
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain.
- Stroke Unit and Stroke Program, Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain.
| | - M B Coco Martín
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
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Chen X, Liao M, Jiang P, Sun H, Liu L, Gong Q. Abnormal effective connectivity in visual cortices underlies stereopsis defects in amblyopia. Neuroimage Clin 2022; 34:103005. [PMID: 35421811 PMCID: PMC9011166 DOI: 10.1016/j.nicl.2022.103005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 02/08/2023]
Abstract
Abnormal effective connectivity inherent stereopsis defects in amblyopia was studied. A weakened connection from V2v to LO2 relates to stereopsis defects in amblyopia. Higher-order visual cortices may serve as key nodes to the stereopsis defects. An independent longitudinal dataset was used to validate the obtained results.
The neural basis underlying stereopsis defects in patients with amblyopia remains unclear, which hinders the development of clinical therapy. This study aimed to investigate visual network abnormalities in patients with amblyopia and their associations with stereopsis function. Spectral dynamic causal modeling methods were employed for resting-state functional magnetic resonance imaging data to investigate the effective connectivity (EC) among 14 predefined regions of interest in the dorsal and ventral visual pathways. We adopted two independent datasets, including a cross-sectional and a longitudinal dataset. In the cross-sectional dataset, we compared group differences in EC between 31 patients with amblyopia (mean age: 26.39 years old) and 31 healthy controls (mean age: 25.71 years old) and investigated the association between EC and stereoacuity. In addition, we explored EC changes after perceptual learning in a novel longitudinal dataset including 9 patients with amblyopia (mean age: 15.78 years old). We found consistent evidence from the two datasets indicating that the aberrant EC from V2v to LO2 is crucial for the stereoscopic deficits in the patients with amblyopia: it was weaker in the patients than in the controls, showed a positive linear relationship with the stereoscopic function, and increased after perceptual learning in the patients. In addition, higher-level dorsal (V3d, V3A, and V3B) and ventral areas (LO1 and LO2) were important nodes in the network of abnormal ECs associated with stereoscopic deficits in the patients with amblyopia. Our research provides insights into the neural mechanism underlying stereopsis deficits in patients with amblyopia and provides candidate targets for focused stimulus interventions to enhance the efficacy of clinical treatment for the improvement of stereopsis deficiency.
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Affiliation(s)
- Xia Chen
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Liao
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China; Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Jiang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, China.
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Imaging Research Core Facilities, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China; Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, China
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Wan J, Zhang Z, Tian Y. Examination of Macular Retina and Choroidal Thickness in High Myopic Amblyopia Using Spectral-Domain Optical Coherence Tomography. Front Med (Lausanne) 2022; 9:808409. [PMID: 35419378 PMCID: PMC8996077 DOI: 10.3389/fmed.2022.808409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The aim of this study was to investigate changes in the retinal and choroidal thickness between high myopic amblyopia (HMA), low myopia (LM), moderate myopia (MM), high myopia (HM), and normal group (NG) using a spectral-domain optical coherence tomography (SD-OCT). Materials and Methods A total of 75 Chinese children (128 eyes; mean age 10.5 years) were recruited. Retinal thickness (RT) and choroidal thickness (CT) were measured at different locations including subfoveal (SF), and at 0.5 mm/1.0 mm/1.5 mm/2.0 mm/2.5 mm/3.0 mm to the fovea in superior, nasal, inferior, and temporal sectors using enhanced depth imaging (EDI) system of SD-OCT. Axial length (AL), best-corrected visual acuity (BCVA), and refraction errors were also collected. Results No significant differences were found in subfoveal retinal thickness (SFRT). Moreover, a significantly thinner subfoveal choroidal thickness (SFCT) was found in HMA compared to NG, LM, and MM, but not compared to HM. RT at 0.5 mm to fovea, HMA was significantly thinner compared to LM and MM in the three sectors (superior, inferior, and temporal). Nevertheless, no significant differences were found compared to NG and HM. CT at 0.5 mm to fovea, HMA was the significantly thinnest in all four sectors compared to NG, LM, and MM. RT at 1.0 mm/1.5 mm/2.0 mm/2.5 mm/3.0 mm to fovea, HMA was thinner compared to NG, LM, and MM. CT at 1.0 mm/1.5 mm/2.0 mm/2.5 mm/3.0 mm to fovea, HMA was thinner compared to NG, LM, and MM. At the superior and inferior sectors, HMA showed to be statistically thinner compared with HM. Moreover, SFCT in the HMA, HM, and NG were negatively correlated with AL. Conclusions Thinner retina and choroidal tissue appear to be related to HMA, and thus can be used as useful parameters for discovering the underlying mechanisms of the disease.
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Affiliation(s)
- Juan Wan
- Department of Ophthalmology, Guangzhou Hospital of Integrated Traditional and Western Medicine, Guangzhou, China
| | - Zhengwei Zhang
- Department of Ophthalmology, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China.,Department of Ophthalmology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yu Tian
- Department of Ophthalmology, Hunan Children's Hospital, Changsha, China
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Abstract
For four decades, investigations of the biological basis of critical periods in the developing mammalian visual cortex were dominated by study of the consequences of altered early visual experience in cats and nonhuman primates. The neural deficits thus revealed also provided insight into the origin and neural basis of human amblyopia that in turn motivated additional studies of humans with abnormal early visual input. Recent human studies point to deficits arising from alterations in all visual cortical areas and even in nonvisual cortical regions. As the new human data accumulated in parallel with a near-complete shift toward the use of rodent animal models for the study of neural mechanisms, it is now essential to review the human data and the earlier animal data obtained from cats and monkeys to infer general conclusions and to optimize future choice of the most appropriate animal model. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Donald E Mitchell
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada;
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada;
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Sesma G, AlMairi T, Khashoggi H, Aljohar F, Khandekar R, Awad A. Treatment Outcome of Occlusion for Unilateral Amblyopia in Saudi Children 6-12 Years Old. Middle East Afr J Ophthalmol 2022; 29:85-90. [PMID: 37123423 PMCID: PMC10138135 DOI: 10.4103/meajo.meajo_205_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 01/10/2023] [Indexed: 05/02/2023] Open
Abstract
PURPOSE The purpose of this study was to estimate the rate and review determinants of successful therapy for unilateral amblyopia in children. METHODS This prospective cohort consisted of Saudi children aged 6-12 who received amblyopia therapy between 2020 and 2022. Best-corrected visual acuity (BCVA) in the amblyopic eye improved to reach the BCVA of the fellow eye at follow-up visits, or BCVA in the amblyopic eye improved and remained stable over three follow-up visits. Demographic and ocular characteristics were associated with the outcome. RESULTS In 30 children, the median BCVA at presentation and the last follow-up was 0.8 logMAR (interquartile range [IQR]: 0.6; 1.0) and 0.45 logMAR (IQR: 0.3; 0.6), respectively. The success rate of amblyopia therapy was 80% (95% confidence interval: 65.7; 94.3). It was 100%, 76.5%, and 77.8% in eyes with anisometropic, strabismic, and mixed types of amblyopia, respectively. Amblyopia grade (P = 0.177), type of amblyopia (P = 0.96), and spectacles as therapy in the past (P = 0.09) were not significantly associated with the successful out. The duration of follow-up was significantly longer in those with unsuccessful outcomes (P = 0.05). Excellent compliance for occlusion was observed in 62.5% of children with successful outcomes. In 14 (46.7%) children, BCVA was ≤0.3 logMAR BCVA at the last follow-up. Two-line improvement in amblyopic eyes was in 26 (86.7%) children at the last follow-up compared to BCVA at presentation. CONCLUSION Occlusion therapy complemented using glasses in older children also significantly improved visual recovery in amblyopic eyes.
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Affiliation(s)
- Gorka Sesma
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Gorka Sesma, King Khaled Eye Specialist Hospital, Al Urubah Rd, West Building 2 Floor, Riyadh 11462, Saudi Arabia. E-mail:
| | - Tasnim AlMairi
- Department of Emergency, Almoosa Specialist Hospital, Al Mubarraz, Saudi Arabia
| | - Heba Khashoggi
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Fahad Aljohar
- Department of Diagnostic and Imaging, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Vision Science, University of British Columbia Vancouver, Canada
| | - Abdulaziz Awad
- Division of Pediatric Ophthalmology and Strabismus, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Sabel BA, Levi DM. Movie therapy for children with amblyopia: restoring binocular vision with brain plasticity. SCIENCE CHINA. LIFE SCIENCES 2022; 65:654-656. [PMID: 35060073 DOI: 10.1007/s11427-021-2050-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 05/26/2023]
Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-v.-Guericke University of Magdeburg, Magdeburg, 39120, Germany.
| | - Dennis M Levi
- Herbert Wertheim School of Optometry & Vision Science and Helen Wills Neuroscience Institute, University of California, Berkeley, CA, 94720, USA
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Manny RE, Holmes JM, Kraker RT, Li Z, Waters AL, Kelly KR, Kong L, Crouch ER, Lorenzana IJ, Alkharashi MS, Galvin JA, Rice ML, Melia BM, Cotter SA. A Randomized Trial of Binocular Dig Rush Game Treatment for Amblyopia in Children Aged 4 to 6 Years. Optom Vis Sci 2022; 99:213-227. [PMID: 35086119 PMCID: PMC8919092 DOI: 10.1097/opx.0000000000001867] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
SIGNIFICANCE Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial. PURPOSE This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone. METHODS Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (<0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner. RESULTS A total of 182 children with anisometropic (63%), strabismic (16%; <5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines. CONCLUSIONS In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.
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Affiliation(s)
| | - Jonathan M Holmes
- Department of Ophthalmology and Vision Science, University of Arizona-Tucson, Tucson, Arizona
| | | | - Zhuokai Li
- Jaeb Center for Health Research, Tampa, Florida
| | - Amy L Waters
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | - Lingkun Kong
- Texas Tech University Health Science Center, Lubbock, Texas
| | - Earl R Crouch
- Virginia Pediatric Eye Center, Virginia Beach, Virginia
| | | | | | | | | | | | - Susan A Cotter
- Southern California College of Optometry at Marshall B Ketchum University, Fullerton, California
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