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Pang Y, Bang JW, Kasi A, Li J, Parra C, Fieremans E, Wollstein G, Schuman JS, Wang M, Chan KC. Contributions of Brain Microstructures and Metabolism to Visual Field Loss Patterns in Glaucoma Using Archetypal and Information Gain Analyses. Invest Ophthalmol Vis Sci 2024; 65:15. [PMID: 38975942 PMCID: PMC11232899 DOI: 10.1167/iovs.65.8.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Purpose To investigate the contributions of the microstructural and metabolic brain environment to glaucoma and their association with visual field (VF) loss patterns by using advanced diffusion magnetic resonance imaging (dMRI), proton magnetic resonance spectroscopy (MRS), and clinical ophthalmic measures. Methods Sixty-nine glaucoma and healthy subjects underwent dMRI and/or MRS at 3 Tesla. Ophthalmic data were collected from VF perimetry and optical coherence tomography. dMRI parameters of microstructural integrity in the optic radiation and MRS-derived neurochemical levels in the visual cortex were compared among early glaucoma, advanced glaucoma, and healthy controls. Multivariate regression was used to correlate neuroimaging metrics with 16 archetypal VF loss patterns. We also ranked neuroimaging, ophthalmic, and demographic attributes in terms of their information gain to determine their importance to glaucoma. Results In dMRI, decreasing fractional anisotropy, radial kurtosis, and tortuosity and increasing radial diffusivity correlated with greater overall VF loss bilaterally. Regionally, decreasing intra-axonal space and extra-axonal space diffusivities correlated with greater VF loss in the superior-altitudinal area of the right eye and the inferior-altitudinal area of the left eye. In MRS, both early and advanced glaucoma patients had lower gamma-aminobutyric acid (GABA), glutamate, and choline levels than healthy controls. GABA appeared to associate more with superonasal VF loss, and glutamate and choline more with inferior VF loss. Choline ranked third for importance to early glaucoma, whereas radial kurtosis and GABA ranked fourth and fifth for advanced glaucoma. Conclusions Our findings highlight the importance of non-invasive neuroimaging biomarkers and analytical modeling for unveiling glaucomatous neurodegeneration and how they reflect complementary VF loss patterns.
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Affiliation(s)
- Yueyin Pang
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Ji Won Bang
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Anisha Kasi
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Jeremy Li
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Carlos Parra
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Els Fieremans
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States
| | - Gadi Wollstein
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States
- Center for Neural Science, New York University, New York, New York, United States
- Wills Eye Hospital, Philadelphia, Pennsylvania, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Joel S Schuman
- Wills Eye Hospital, Philadelphia, Pennsylvania, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Drexel University School of Biomedical Engineering, Science and Health Studies, Philadelphia, Pennsylvania, United States
| | - Mengyu Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
| | - Kevin C Chan
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
- Department of Radiology, New York University Grossman School of Medicine, New York, New York, United States
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States
- Center for Neural Science, New York University, New York, New York, United States
- Neuroscience Institute and Tech4Health Institute, New York University Grossman School of Medicine, New York, New York, United States
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Namgung E, Kwon SU, Han M, Kim G, Kim HY, Park K, Cho M, Choi H, Nah H, Lim HT, Kang D. Digital therapeutics using virtual reality-based visual perceptual learning for visual field defects in stroke: A double-blind randomized trial. Brain Behav 2024; 14:e3525. [PMID: 38773793 PMCID: PMC11109502 DOI: 10.1002/brb3.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Visual field defects (VFDs) represent a debilitating poststroke complication, characterized by unseen parts of the visual field. Visual perceptual learning (VPL), involving repetitive visual training in blind visual fields, may effectively restore visual field sensitivity in cortical blindness. This current multicenter, double-blind, randomized, controlled clinical trial investigated the efficacy and safety of VPL-based digital therapeutics (Nunap Vision [NV]) for treating poststroke VFDs. METHODS Stroke outpatients with VFDs (>6 months after stroke onset) were randomized into NV (defective field training) or Nunap Vision-Control (NV-C, central field training) groups. Both interventions provided visual perceptual training, consisting of orientation, rotation, and depth discrimination, through a virtual reality head-mounted display device 5 days a week for 12 weeks. The two groups received VFD assessments using Humphrey visual field (HVF) tests at baseline and 12-week follow-up. The final analysis included those completed the study (NV, n = 40; NV-C, n = 35). Efficacy measures included improved visual area (sensitivity ≥6 dB) and changes in the HVF scores during the 12-week period. RESULTS With a high compliance rate, NV and NV-C training improved the visual areas in the defective hemifield (>72 degrees2) and the whole field (>108 degrees2), which are clinically meaningful improvements despite no significant between-group differences. According to within-group analyses, mean total deviation scores in the defective hemifield improved after NV training (p = .03) but not after NV-C training (p = .12). CONCLUSIONS The current trial suggests that VPL-based digital therapeutics may induce clinically meaningful visual improvements in patients with poststroke VFDs. Yet, between-group differences in therapeutic efficacy were not found as NV-C training exhibited unexpected improvement comparable to NV training, possibly due to learning transfer effects.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life SciencesAsan Medical CenterSeoulSouth Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Moon‐Ku Han
- Department of NeurologySeoul National University Bundang Hospital, Seoul National University College of MedicineSeongnamSouth Korea
| | - Gyeong‐Moon Kim
- Department of Neurology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hahn Young Kim
- Department of NeurologyKonkuk University Medical Center, Konkuk University College of MedicineSeoulSouth Korea
| | - Kwang‐Yeol Park
- Department of NeurologyChung‐Ang University Hospital, Chung‐Ang University College of MedicineSeoulSouth Korea
| | | | | | - Hyun‐Wook Nah
- Department of NeurologyChungnam National University Sejong Hospital, Chungnam National University College of MedicineSejongSouth Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
| | - Dong‐Wha Kang
- Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
- Nunaps Inc.SeoulSouth Korea
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Yang (杨菁艺) J, Saionz EL, Cavanaugh MR, Fahrenthold BK, Melnick MD, Tadin D, Briggs F, Carrasco M, Huxlin KR. Limited restoration of contrast sensitivity with training after V1 damage in humans. eNeuro 2024; 11:ENEURO.0020-24.2024. [PMID: 38395611 PMCID: PMC10941636 DOI: 10.1523/eneuro.0020-24.2024] [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: 01/16/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Stroke damage to the primary visual cortex (V1) causes severe visual deficits, which benefit from perceptual retraining. However, whereas training with high-contrast stimuli can locally restore orientation and motion direction discrimination abilities at trained locations, it only partially restores luminance contrast sensitivity (CS). Recent work revealed that high-contrast discrimination abilities may be preserved in the blind field of some patients early after stroke. Here, we asked if CS for orientation and direction discrimination is similarly preserved inside the blind field, to what extent, and whether it could benefit from a visual training intervention. Thirteen subacute patients (<3 months post-V1-stroke) and 12 chronic patients (>6 months post-V1-stroke) were pre-tested, then trained to discriminate either orientation or motion direction of Gabor patches of progressively lower contrasts as their performance improved. At baseline, more subacute than chronic participants could correctly discriminate the orientation of high-contrast Gabors in their blind field, but all failed to perform this task at lower contrasts, even when 10Hz flicker or motion direction were added. Training improved CS in a greater portion of subacute than chronic participants, but no-one attained normal CS, even when stimuli contained flicker or motion. We conclude that, unlike the near-complete training-induced restoration of high-contrast orientation and motion direction discrimination abilities, V1 damage in adulthood may severely limit the residual visual system's ability to regain normal CS. Our results support the notion that CS involves different neural substrates and computations than those required for orientation and direction discrimination in V1-damaged visual systems.Significance statement Stroke-induced V1 damage in adult humans induces a rapid and severe impairment of contrast sensitivity for orientation and motion direction discrimination in the affected hemifield, although discrimination of high-contrast stimuli can persist for several months. Adaptive training with Gabor patches of progressively lower contrasts improves contrast sensitivity for both orientation and motion discriminations in the blind-field of subacute (<3 months post-stroke) and chronic (>6 months post-stroke) participants; however, it fails to restore normal contrast sensitivity. Nonetheless, more subacute than chronic stroke participants benefit from such training, particularly when discriminating the orientation of static, non-flickering targets. Thus, contrast sensitivity appears critically dependent on processing within V1, with perceptual training displaying limited potential to fully restore it after V1 damage.
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Affiliation(s)
- Jingyi Yang (杨菁艺)
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Elizabeth L. Saionz
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Matthew R. Cavanaugh
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Berkeley K. Fahrenthold
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Michael D. Melnick
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
| | - Duje Tadin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
| | - Farran Briggs
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, New York 10003
| | - Krystel R. Huxlin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
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Namgung E, Kim YH, Lee EJ, Sasaki Y, Watanabe T, Kang DW. Functional connectivity interacts with visual perceptual learning for visual field recovery in chronic stroke. Sci Rep 2024; 14:3247. [PMID: 38332042 PMCID: PMC10853510 DOI: 10.1038/s41598-024-52778-x] [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: 09/27/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
A reciprocal relationship between perceptual learning and functional brain changes towards perceptual learning effectiveness has been demonstrated previously; however, the underlying neural correlates remain unclear. Further, visual perceptual learning (VPL) is implicated in visual field defect (VFD) recovery following chronic stroke. We investigated resting-state functional connectivity (RSFC) in the visual cortices associated with mean total deviation (MTD) scores for VPL-induced VFD recovery in chronic stroke. Patients with VFD due to chronic ischemic stroke in the visual cortex received 24 VPL training sessions over 2 months, which is a dual discrimination task of orientation and letters. At baseline and two months later, the RSFC in the ipsilesional, interhemispheric, and contralesional visual cortices and MTD scores in the affected hemi-field were assessed. Interhemispheric visual RSFC at baseline showed the strongest correlation with MTD scores post-2-month VPL training. Notably, only the subgroup with high baseline interhemispheric visual RSFC showed significant VFD improvement following the VPL training. The interactions between the interhemispheric visual RSFC at baseline and VPL led to improvement in MTD scores and largely influenced the degree of VFD recovery. The interhemispheric visual RSFC at baseline could be a promising brain biomarker for the effectiveness of VPL-induced VFD recovery.
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Affiliation(s)
- Eun Namgung
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, South Korea
| | | | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yuka Sasaki
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA
| | - Takeo Watanabe
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, Providence, USA
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Fahrenthold BK, Cavanaugh MR, Tamhankar M, Lam BL, Feldon SE, Johnson BA, Huxlin KR. Training in cortically-blind fields confers patient-specific benefit against retinal thinning after occipital stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.19.23298260. [PMID: 38196617 PMCID: PMC10775322 DOI: 10.1101/2023.12.19.23298260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Purpose Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral hemifield, initiating a process of trans-synaptic retrograde degeneration (TRD). Here, we examined retinal correlates of TRD using a new metric to account for global changes in inner retinal thickness, and asked if perceptual training in the intact or blind field impacts its progression. Methods We performed a meta-analysis of optical coherence tomography (OCT) data in 48 participants with unilateral V1 stroke and homonymous visual defects, who completed clinical trial NCT03350919. After measuring the thickness of the macular ganglion cell and inner plexiform layers (GCL-IPL), and the peripapillary retinal nerve fiber layer (RNFL), we computed individual laterality indices (LI) at baseline and after ~6 months of daily motion discrimination training in the intact- or blind-field. Increasingly positive LI denoted greater layer thinning in retinal regions affected versus unaffected by the cortical damage. Results Pre-training, the affected GCL-IPL and RNFL were thinner than their unaffected counterparts, generating LI values positively correlated with time since stroke. Participants trained in their intact-field exhibited increased LIGCL-IPL. Those trained in their blind-field had no significant change in LIGCL-IPL. LIRNFL did not change in either group. Conclusions Relative shrinkage of the affected versus unaffected macular GCL-IPL can be reliably measured at an individual level and increases with time post-V1 stroke. Relative thinning progressed during intact-field training, but appeared to be halted by training within the blind field, suggesting a potentially neuroprotective effect of this simple behavioral intervention.
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Affiliation(s)
- Berkeley K. Fahrenthold
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Madhura Tamhankar
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Steven E. Feldon
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Brent A. Johnson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, Rochester, NY, USA
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Yang J, Saionz EL, Cavanaugh MR, Fahrenthold BK, Melnick MD, Tadin D, Briggs F, Carrasco M, Huxlin KR. Contrast sensitivity: a fundamental limit to vision restoration after V1 damage. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.31.23294827. [PMID: 37693553 PMCID: PMC10491352 DOI: 10.1101/2023.08.31.23294827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Stroke damage to the primary visual cortex (V1) causes severe visual deficits, which benefit from perceptual retraining. However, whereas training with high-contrast stimuli can locally restore orientation and direction discrimination abilities at trained locations, it only partially restores luminance contrast sensitivity (CS). Recent work revealed that high-contrast discrimination abilities may be preserved in the blind field of some patients early after stroke. Here, we asked if CS for orientation and direction discrimination is similarly preserved inside the blind field, to what extent, and whether it could benefit from a visual training intervention. Thirteen subacute (<3 months post-V1-stroke) and 12 chronic (>6 months post-V1-stroke) participants were pre-tested, then trained to discriminate either orientation or motion direction of Gabor patches of progressively lower contrasts. At baseline, more subacute than chronic participants could correctly discriminate the orientation of high-contrast Gabors in their blind field, but all failed to perform this task at lower contrasts, even when 10Hz flicker or motion direction were added. Training improved CS in a greater portion of subacute than chronic participants, but no-one attained normal CS, even when stimuli contained flicker or motion. We conclude that, unlike the near-complete training-induced restoration of high-contrast orientation and direction discrimination, there is limited capacity for restoring CS after V1 damage in adulthood. Our results suggest that CS involves different neural substrates and computations than those required for orientation and direction discrimination in V1-damaged visual systems.
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Affiliation(s)
- Jingyi Yang
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Elizabeth L. Saionz
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Matthew R. Cavanaugh
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Berkeley K. Fahrenthold
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Michael D. Melnick
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Duje Tadin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Farran Briggs
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
- Center for Visual Science, University of Rochester, Rochester, New York 14627
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, NY, NY 10003
| | - Krystel R. Huxlin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, New York 14642
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York 14642
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, New York 14627
- Center for Visual Science, University of Rochester, Rochester, New York 14627
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Willis HE, Ip IB, Watt A, Campbell J, Jbabdi S, Clarke WT, Cavanaugh MR, Huxlin KR, Watkins KE, Tamietto M, Bridge H. GABA and Glutamate in hMT+ Link to Individual Differences in Residual Visual Function After Occipital Stroke. Stroke 2023; 54:2286-2295. [PMID: 37477008 PMCID: PMC10453332 DOI: 10.1161/strokeaha.123.043269] [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: 12/23/2022] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Damage to the primary visual cortex following an occipital stroke causes loss of conscious vision in the contralateral hemifield. Yet, some patients retain the ability to detect moving visual stimuli within their blind field. The present study asked whether such individual differences in blind field perception following loss of primary visual cortex could be explained by the concentration of neurotransmitters γ-aminobutyric acid (GABA) and glutamate or activity of the visual motion processing, human middle temporal complex (hMT+). METHODS We used magnetic resonance imaging in 19 patients with chronic occipital stroke to measure the concentration of neurotransmitters GABA and glutamate (proton magnetic resonance spectroscopy) and functional activity in hMT+ (functional magnetic resonance imaging). We also tested each participant on a 2-interval forced choice detection task using high-contrast, moving Gabor patches. We then measured and assessed the strength of relationships between participants' residual vision in their blind field and in vivo neurotransmitter concentrations, as well as visually evoked functional magnetic resonance imaging activity in their hMT+. Levels of GABA and glutamate were also measured in a sensorimotor region, which served as a control. RESULTS Magnetic resonance spectroscopy-derived GABA and glutamate concentrations in hMT+ (but not sensorimotor cortex) strongly predicted blind-field visual detection abilities. Performance was inversely related to levels of both inhibitory and excitatory neurotransmitters in hMT+ but, surprisingly, did not correlate with visually evoked blood oxygenation level-dependent signal change in this motion-sensitive region. CONCLUSIONS Levels of GABA and glutamate in hMT+ appear to provide superior information about motion detection capabilities inside perimetrically defined blind fields compared to blood oxygenation level-dependent signal changes-in essence, serving as biomarkers for the quality of residual visual processing in the blind-field. Whether they also reflect a potential for successful rehabilitation of visual function remains to be determined.
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Affiliation(s)
- Hanna E. Willis
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - I. Betina Ip
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - Archie Watt
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - Jon Campbell
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - William T. Clarke
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
| | - Matthew R. Cavanaugh
- Flaum Eye Institute and Center for Visual Science, University of Rochester, NY (M.R.C., K.R.H.)
| | - Krystel R. Huxlin
- Flaum Eye Institute and Center for Visual Science, University of Rochester, NY (M.R.C., K.R.H.)
| | - Kate E. Watkins
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology (K.E.W.), University of Oxford, United Kingdom
| | - Marco Tamietto
- Department of Psychology, University of Torino, Italy (M.T.)
- Department of Medical and Clinical Psychology, and CoRPS—Center of Research on Psychology in Somatic Diseases—Tilburg University, the Netherlands (M.T.)
| | - Holly Bridge
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences (H.E.W., I.B.I., A.W., J.C., S.J., W.T.C., H.B.), University of Oxford, United Kingdom
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Wang J, Zou L, Jiang X, Wang D, Mao L, Yang X. Visual stimulation rehabilitation for cortical blindness after vertebral artery interventional surgery: A case report and literature review. Int J Surg Case Rep 2023; 110:108753. [PMID: 37651808 PMCID: PMC10509878 DOI: 10.1016/j.ijscr.2023.108753] [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: 07/28/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Cortical blindness (CB) after vertebral artery interventional surgery is not a frequently reported complication. In this study, the efficacy of visual stimulation rehabilitation consisting of visual recovery training and repetitive transcranial magnetic stimulation (rTMS) for cortical blindness was investigated by clinical evaluation, ophthalmologic examination, and electroencephalography (EEG). CASE PRESENTATION This study reports on a 55-year-old male who showed partial bilateral posterior cerebral artery cortical branch occlusion after timely embolectomy due to thrombus dislodgement during right vertebral artery opening, stenting resulting in basilar artery tip occlusion. The lesions were mainly located in the right cerebellar hemisphere and bilateral occipital lobes, and the patient suffered from bilateral loss of vision, with only light perception preserved. The patient began to receive visual recovery training and 15 sessions of right occipital high-frequency transcranial magnetic stimulation 5 days after the onset. CLINICAL DISCUSSION After treatment, the patient's capacity to identify things improved, allowing him to watch television, as did the precision and fluency of random hand movements, walking, and self-care. CONCLUSION Visual stimulation rehabilitation composed of visual recovery training and rTMS is a promising therapy option for cortical blindness, and our case report provides clinical experience with vision recovery for patients with cortical blindness.
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Affiliation(s)
- Juehan Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liliang Zou
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaorui Jiang
- Department of Rehabilitation Medicine, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Daming Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Xiaofeng Yang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Aguirre Maqueda M, Zavala Romero L, Monroy Córdoba R, Meraz Soto JM, Torres-Ríos JA, Ballesteros Herrera D, Rodríguez Camacho A, Moreno Jiménez S. Effects and Assessment of the Optic Pathway After Management with Stereotactic Radiosurgery for Intracranial Tumors: A Comprehensive Literature Review. Cureus 2023; 15:e43538. [PMID: 37719564 PMCID: PMC10501811 DOI: 10.7759/cureus.43538] [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] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Intracranial tumors are treated through a minimally invasive procedure called stereotactic radiosurgery (SRS), which uses precisely targeted radiation beams. When SRS is used to treat tumors in or near the optic pathway, which is responsible for transmitting visual information from the eyes to the brain, it is essential to assess the effects of treatment on visual function. The optic pathway is considered relatively radiation-sensitive, and high doses of radiation can lead to visual impairment or loss. Various methods can be used to assess the effects of SRS on the optic pathway, including visual acuity testing, visual field testing, and imaging studies. These assessments can be performed before and after treatment to track changes in visual function and detect potential complications or side effects. Assessing the optic pathway after management with SRS for intracranial tumors is essential to the treatment process to ensure that patients receive the best possible outcomes while minimizing the risk of complications. Close collaboration between the multidisciplinary team is often necessary to optimize treatment planning and monitoring of treatment response. In this review, we conducted an extensive analysis of the effects of radiation in patients with intracranial tumors after receiving radiotherapy.
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Affiliation(s)
- Monica Aguirre Maqueda
- Neuro Radiosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Lilian Zavala Romero
- Neuro Radiosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | - Juan Marcos Meraz Soto
- Neuro Radiosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | | | | | - Sergio Moreno Jiménez
- Neuro Radiosurgery Department, National Institute of Neurology and Neurosurgery, Mexico City, MEX
- Neuro Radiosurgery Department, American British Cowdray Medical Center, Mexico City, MEX
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Leitner MC, Ladek AM, Hutzler F, Reitsamer H, Hawelka S. Placebo effect after visual restitution training: no eye-tracking controlled perimetric improvement after visual border stimulation in late subacute and chronic visual field defects after stroke. Front Neurol 2023; 14:1114718. [PMID: 37456634 PMCID: PMC10339290 DOI: 10.3389/fneur.2023.1114718] [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: 12/02/2022] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction A significant number of Restitution Training (RT) paradigms claim to ameliorate visual field loss after stroke by re-activating neuronal connections in the residual visual cortex due to repeated bright light-stimulation at the border of the blind and intact fields. However, the effectiveness of RT has been considered controversial both in science and clinical practice for years. The main points of the controversy are (1) the reliability of perimetric results which may be affected by compensatory eye movements and (2) heterogeneous samples consisting of patients with visual field defects and/or visuospatial neglect. Methods By means of our newly developed and validated Virtual Reality goggles Salzburg Visual Field Trainer (SVFT) 16 stroke patients performed RT on a regular basis for 5 months. By means of our newly developed and validated Eye Tracking Based Visual Field Analysis (EFA), we conducted a first-time full eye-movement-controlled perimetric pre-post intervention study. Additionally, patients subjectively rated the size of their intact visual field. Results Analysis showed that patients' mean self-assessment of their subjective visual field size indicated statistically significant improvement while, in contrast, objective eye tracking controlled perimetric results revealed no statistically significant effect. Discussion Bright-light detection RT at the blind-field border solely induced a placebo effect and did not lead to training-induced neuroplasticity in the visual cortex of the type needed to ameliorate the visual field size of stroke patients.
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Affiliation(s)
- Michael Christian Leitner
- Salzburg University of Applied Sciences, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Anja-Maria Ladek
- Research Program for Experimental Ophthalmology and Glaucoma Research, Department of Ophthalmology and Optometry, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Ophthalmology and Optometry, SALK, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Florian Hutzler
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Herbert Reitsamer
- Research Program for Experimental Ophthalmology and Glaucoma Research, Department of Ophthalmology and Optometry, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
- Department of Ophthalmology and Optometry, SALK, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hawelka
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
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