Structural and functional alterations in the brains of patients with anisometropic and strabismic amblyopia: a systematic review of magnetic resonance imaging studies

Dynamic neural activity alterations and associated neurotransmitter profiles in children with monocular amblyopia

PURPOSE

To investigate the alterations in dynamic neural activity in the visual cortex in children with monocular amblyopia and its correlation with neurotransmitter profiles.

METHODS

A total of 61 participants with amblyopia (thirty right eye amblyopia, thirty-one left eye amblyopia) and 30 individuals with normal vision were recruited. The dynamic functional changes in brain areas, dynamic amplitude of low‑frequency fluctuations (dALFF) serves as the primary index. Spatial correlation between dALFF changes and neurotransmitter imaging was also examined.

RESULTS

Abnormal dALFF changes in the left and right lingual gyrus, the left and right middle occipital gyrus, the right calcarine fissure and surrounding cortex, and the left cuneus. The dALFF variation in lingual and middle occipital gyrus are negatively correlated with visual acuity and best-corrected visual acuity. Furthermore, cross-modal correlations displayed that there was a significant correlation between intergroup functional effect map and neurotransmitter densities.

CONCLUSION

The results of this study reveal dynamic alterations in neural activity within the visual brain regions, along with corresponding neurotransmitter levels, providing insights into the neural basis of monocular amblyopia.

Brain structural and functional magnetic resonance imaging alterations in individuals with convergence insufficiency

PURPOSE

Individuals with convergence insufficiency (CI) encounter challenges in turning their eyes inward during near work. It is unclear how this relates to brain structural and functional alterations. This study aimed to explore the neural mechanism underlying CI using multimodal brain magnetic resonance imaging (MRI).

METHODS

Thirty-four CI participants and 35 healthy controls (HC) were recruited, who underwent visual examinations and brain MRI scanning. Structural MRI data were analysed to calculate cortical thickness, volume and surface area. Fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity were obtained from resting-state functional MRI data. The brain structural and functional metrics were compared between the two groups followed by correlation analyses between clinical measurements and significant brain features.

RESULTS

Relative to HC, individuals with CI had lower grey matter volume (GMV) and surface area in the right frontal eye fields, parietal eye fields and left medial orbitofrontal cortex, higher GMV and surface area in the right middle frontal and inferior temporal gyri and higher fALFF of the left cerebellum and functional connection between bilateral cerebellums. GMV of the right middle frontal gyrus and fALFF in the left cerebellum were positively correlated with the near point of convergence in all participants.

CONCLUSIONS

Lower structural metrics in the visual and oculomotor cortices and higher functional activity in the cerebellum may underpin convergence dysfunction and visual fatigue, while higher structural metrics in the right middle frontal and inferior temporal gyri reflect partial compensation for the visual and oculomotor cortex defects, thereby maintaining attention and parallax information processing. This study may enhance understanding of the neural mechanism of CI by revealing the impact of abnormal visual experiences of CI on the brain with disassociated structural and functional alterations in the vergence system.

Impaired visual attention and numerical processing in children with anisometropic amblyopia and after visual acuity recovery

Amblyopia affects more than visual acuity. To compare the performances of visual selective attention and numerical processing in children with anisometropic amblyopia and children with normal vision, and investigate whether performance would be improved after visual acuity recovery, we performed 3 visual attention tasks (identifying number location task, numerical comparison task, and specific number comparison task) in children with anisometropic amblyopia, children who had recovered from anisometropic amblyopia, and children with normal vision in 6-8 and 9-11 years groups. The numerical processing ability, visual selective attention, and numerical distance effect were assessed by their reaction time of different tasks. The amblyopia group showed significantly worse visual selective attention than control group. However, the recovered amblyopic group showed worse visual selective attention compared to control group only in 9-11 years group. Children aged 6-8 had a greater numerical distance effect than 9-11 in control group, while there were no significant differences between different age groups in amblyopia and recovered amblyopic children. These findings suggest children with anisometropic amblyopia have not only defective visual selective attention but also different age-related patterns of numerical distance effect. Moreover, the improvement of visual selective attention after early stage of visual acuity recovery is better at younger age.

Interactions between excitatory neurons and parvalbumin interneurons in V1 underlie neural mechanisms of amblyopia and visual stimulation treatment

As the main cause of visual function deficits in children and adolescents worldwide, amblyopia causes serious impairment of monocular visual acuity and stereopsis. The recovery of visual functions from amblyopia beyond the critical period is slow and incomplete due to the limited plasticity of the mature cortex; notably, visual stimulation training seems to be an effective therapeutic strategy in clinical practice. However, the precise neural basis and cellular mechanisms that underlie amblyopia and visual stimulation treatment remain to be elucidated. Using monocular deprivation in juvenile mice to model amblyopia, we employed two-photon calcium imaging and chemogenetic techniques to investigate the visual responses of individual excitatory neurons and parvalbumin (PV+) interneurons in the primary visual cortex (V1) of amblyopic mice. We demonstrate that amblyopic mice exhibit an excitation/inhibition (E/I) imbalance. Moreover, visual stimulation decreases the response of PV+ interneurons, reactivates the ocular dominance plasticity of excitatory neurons, and promotes vision recovery in adult amblyopic mice. Our results reveal a dynamic E/I balance between excitatory neurons and PV+ interneurons that may underlie the neural mechanisms of amblyopia during cortical development and visual stimulation-mediated functional recovery from adult amblyopia, providing evidence for therapeutic applications that rely on reactivating adult cortical plasticity.

The concept of cone opponency may extend beyond accommodation, to myopiagenesis and emmetropization, for a better peripheral defocus lens

Myopia has ever-rising prevalence in the past few decades globally. Its pathogenesis is still not adequately elucidated especially at the signal transduction level. For the environmental risk factors, there is a large body of fragmented knowledge about the visual inputs for accommodation, myopiagenesis and emmetropization, with the latter two being essentially local processes. The red-green and yellow-blue chromatic pathways, together with the underlying L-M and S-(L+M) cone opponency, seem to be the common denominator amongst them. In this review, experimental and observational evidence are summarized to delineate the interplay of them. This review may establish the pivotal role of longitudinal chromatic aberration (LCA) for a mechanistic approach to future research in myopia control. This review looks into the mechanistic processes underlying myopiagenesis and emmetropization, specifically focusing on chromatic aberration and cone opponency in vision as pivotal components. The roles of longitudinal chromatic aberration (LCA) and cone contrast in myopia onset and development are intriguing. How visual input and chromatic pathways (specifically, red-green and blue-yellow cone opponency) contribute to accommodation that may trigger emmetropization mechanisms, thereby influencing eye growth patterns are explored and discussed. In brief, this manuscript delves into the physiology of visual processing and highlights a foundational aspect of visual science that may account for a "Go" or "Stop" signaling in axial eye growth. It further proposes a metric to gauge myopia-inhibiting optical devices such as the peripheral defocus lenses, for its best iteration. Future research in the above-mentioned areas is warranted.

Reconnecting Anisometropic Amblyopic Eyes to the Cortex: VEP-Based Auditory Biofeedback

OBJECTIVE

This study aimed to evaluate the effectiveness of a visual rehabilitation method for anisometropic amblyopia that uses visual evoked potential (VEP) parameters and sound biofeedback to increase objectiveness.

DESIGN

an observational, case-controlled trial.

SETTING

Ophthalmology Clinic, Emergency County Hospital, Cluj-Napoca, Romania.

PARTICIPANTS

Sixteen subjects with amblyopic anisometropia, aged 15-57, and sixteen controls, aged 24-33, were included.

INTERVENTIONS

Subjects were divided into two groups. The control group, composed of normal-vision subjects, and the amblyopic group received 10 training sessions. The rehabilitation program lasted 10 min, took place twice a week, and ran over five consecutive weeks. During each session, the subjects were asked to fixate on a target on the computer screen and were instructed to keep the fixation and maintain the sound of the biofeedback at high frequency.

MAIN MEASURES

The study assessed the main visual parameters at baseline, after 10 sessions, and 1, 3, 6, and 12 months after treatment. Performance was evaluated by measuring visual acuity, contrast sensitivity, and reading velocity (words/minute).

RESULTS

In the experimental group, mean BCVA improved with two rows, which means an improvement in the LogMARLogMAR scale with an average of nine letters. These values tended to be maintained over time. Both groups showed better reading velocities after training, but this parameter has undergone large variability during follow-ups. Contrast sensitivity was also improved and stable.

CONCLUSIONS

Visual rehabilitation with the Retimax Vision Trainer can improve visual performance in patients with amblyopia after the critical period, an improvement that is maintained in most cases for at least one year after treatment.

The relationship between visual acuity loss and GABAergic inhibition in amblyopia

Early childhood experience alters visual development, a process exemplified by amblyopia, a common neurodevelopmental condition resulting in cortically reduced vision in one eye. Visual deficits in amblyopia may be a consequence of abnormal suppressive interactions in the primary visual cortex by inhibitory neurotransmitter γ-aminobutyric acid (GABA). We examined the relationship between visual acuity loss and GABA+ in adult human participants with amblyopia. Single-voxel proton magnetic resonance spectroscopy (MRS) data were collected from the early visual cortex (EVC) and posterior cingulate cortex (control region) of 28 male and female adults with current or past amblyopia while they viewed flashing checkerboards monocularly, binocularly, or while they had their eyes closed. First, we compared GABA+ concentrations between conditions to evaluate suppressive binocular interactions. Then, we correlated the degree of visual acuity loss with GABA+ levels to test whether GABAergic inhibition could explain visual acuity deficits. Visual cortex GABA+ was not modulated by viewing condition, and we found weak evidence for a negative correlation between visual acuity deficits and GABA+. These findings suggest that reduced vision in one eye due to amblyopia is not strongly linked to GABAergic inhibition in the visual cortex. We advanced our understanding of early experience dependent plasticity in the human brain by testing the association between visual acuity deficits and visual cortex GABA in amblyopes of the most common subtypes. Our study shows that the relationship was not as clear as expected and provides avenues for future investigation.

Resting-State Functional Connectivity of the Primary Visual Cortex in Children with Anisometropia Amblyopia

INTRODUCTION

This study aimed to explore the functional connectivity of the primary visual cortex (V1) in children with anisometropic amblyopia by using the resting-state functional connectivity analysis method and determine whether anisometropic amblyopia is associated with changes in brain function.

METHODS

Functional magnetic resonance imaging (fMRI) data were obtained from 16 children with anisometropia amblyopia (CAA group) and 12 healthy children (HC group) during the resting state. The Brodmann area 17 (BA17) was used as the region of interest, and the functional connection (FC) of V1 was analyzed in both groups. A two-sample t test was used to analyze the FC value between the two groups. Pearson's correlation was used to analyze the correlation between the mean FC value in the brain function change area of the CAA group and the best corrected visual acuity (BCVA) of amblyopia. p < 0.05 was considered statistically significant.

RESULTS

There were no significant differences in age and sex between the CAA and HC groups (p > 0.05). Compared to the HC group, the CAA group showed lower FC values in BA17 and the left medial frontal gyrus, as well as BA17 and the left triangle inferior frontal gyrus. Conversely, the CAA group showed higher FC values in BA17 and the left central posterior gyrus. Notably, BCVA in amblyopia did not correlate with the area of change in mean FC in the brain function of the CAA group.

CONCLUSION

Resting-state fMRI-based functional connectivity analysis indicates a significant alteration in V1 of children with anisometropic amblyopia. These findings contribute additional insights into the neuropathological mechanisms underlying visual impairment in anisometropic amblyopia.

Common and distinct cortical thickness alterations in youth with autism spectrum disorder and attention-deficit/hyperactivity disorder

BACKGROUND

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. While brain cortical thickness (CTh) alterations have been reported in ASD and ADHD separately, the degree to which ASD and ADHD are associated with common and distinct patterns of CTh changes is unclear.

METHODS

We searched PubMed, Web of Science, Embase, and Science Direct from inception to 8 December 2023 and included studies of cortical thickness comparing youth (age less than 18) with ASD or ADHD with typically developing controls (TDC). We conducted a comparative meta-analysis of vertex-based studies to identify common and distinct CTh alterations in ASD and ADHD.

RESULTS

Twelve ASD datasets involving 458 individuals with ASD and 10 ADHD datasets involving 383 individuals with ADHD were included in the analysis. Compared to TDC, ASD showed increased CTh in bilateral superior frontal gyrus, left middle temporal gyrus, and right superior parietal lobule (SPL) and decreased CTh in right temporoparietal junction (TPJ). ADHD showed decreased CTh in bilateral precentral gyri, right postcentral gyrus, and right TPJ relative to TDC. Conjunction analysis showed both disorders shared reduced TPJ CTh located in default mode network (DMN). Comparative analyses indicated ASD had greater CTh in right SPL and TPJ located in dorsal attention network and thinner CTh in right TPJ located in ventral attention network than ADHD.

CONCLUSIONS

These results suggest shared thinner TPJ located in DMN is an overlapping neurobiological feature of ASD and ADHD. This alteration together with SPL alterations might be related to altered biological motion processing in ASD, while abnormalities in sensorimotor systems may contribute to behavioral control problems in ADHD. The disorder-specific thinner TPJ located in disparate attention networks provides novel insight into distinct symptoms of attentional deficits associated with the two neurodevelopmental disorders.

TRIAL REGISTRATION

PROSPERO CRD42022370620. Registered on November 9, 2022.

Shared and differing functional connectivity abnormalities of the default mode network in mild cognitive impairment and Alzheimer's disease

Alzheimer's disease (AD) and mild cognitive impairment (MCI) both show abnormal resting-state functional connectivity (rsFC) of default mode network (DMN), but it is unclear to what extent these abnormalities are shared. Therefore, we performed a comprehensive meta-analysis, including 31 MCI studies and 20 AD studies. MCI patients, compared to controls, showed decreased within-DMN rsFC in bilateral medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC), precuneus/posterior cingulate cortex (PCC), right temporal lobes, and left angular gyrus and increased rsFC between DMN and left inferior temporal gyrus. AD patients, compared to controls, showed decreased rsFC within DMN in bilateral mPFC/ACC and precuneus/PCC and between DMN and left inferior occipital gyrus and increased rsFC between DMN and right dorsolateral prefrontal cortex. Conjunction analysis showed shared decreased rsFC in mPFC/ACC and precuneus/PCC. Compared to MCI, AD had decreased rsFC in left precuneus/PCC and between DMN and left inferior occipital gyrus and increased rsFC in right temporal lobes. MCI and AD share a decreased within-DMN rsFC likely underpinning episodic memory deficits and neuropsychiatric symptoms, but differ in DMN rsFC alterations likely related to impairments in other cognitive domains such as language, vision, and execution. This may throw light on neuropathological mechanisms in these two stages of dementia.

Differential cortical gray matter changes in early- and late-onset patients with amyotrophic lateral sclerosis

Age at onset may be an important feature associated with distinct subtypes of amyotrophic lateral sclerosis (ALS). Little is known about the neuropathological mechanism of early-onset ALS (EO-ALS) and late-onset ALS (LO-ALS). Ninety ALS patients were divided into EO-ALS and LO-ALS group, and 128 healthy controls were matched into young controls(YCs) and old controls (OCs). A voxel-based morphometry approach was employed to investigate differences in gray matter volume (GMV). Significant age at onset-by-diagnosis interactions were found in the left parietal operculum, left precentral gyrus, bilateral postcentral gyrus, right occipital gyrus, and right orbitofrontal cortex. Post hoc analysis revealed a significant decrease in GMV in all affected regions of EO-ALS patients compared with YCs, with increased GMV in 5 of the 6 brain regions, except for the right orbitofrontal cortex, in LO-ALS patients compared with OCs. LO-ALS patients had a significantly increased GMV than EO-ALS patients after removing the aging effect. Correspondingly, GMV of the left postcentral gyrus correlated with disease severity in the 2 ALS groups. Our findings suggested that the pathological mechanisms in ALS patients with different ages at onset might differ. These findings provide unique insight into the clinical and biological heterogeneity of the 2 ALS subtypes.