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Wang Y, Wu Y, Luo L, Li F. Structural and functional alterations in the brains of patients with anisometropic and strabismic amblyopia: a systematic review of magnetic resonance imaging studies. Neural Regen Res 2023; 18:2348-2356. [PMID: 37282452 PMCID: PMC10360096 DOI: 10.4103/1673-5374.371349] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.
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Affiliation(s)
- Yuxia Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ye Wu
- Department of Ophthalmology, Laboratory of Optometry and Vision Sciences, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan Province, China
| | - Lekai Luo
- Department of Radiology, West China Second Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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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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Altered White Matter Integrity in Patients with Retinal Vein Occlusion: A Diffusion Tensor Imaging and Tract-Based Spatial Statistics Study. DISEASE MARKERS 2022; 2022:9647706. [PMID: 35251379 PMCID: PMC8894072 DOI: 10.1155/2022/9647706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/08/2021] [Accepted: 02/04/2022] [Indexed: 01/16/2023]
Abstract
Background To investigate microstructural alterations of white matter in retinal vein occlusion (RVO) patients by tract-based spatial statistics (TBSS) and diffusion tensor imaging (DTI). Material/Methods. DTI was performed on 14 RVO patients and 14 normal controls (HCs). We measured and recorded fractional anisotropy (FA) and radial diffusivity (RD) of white matter fibers and classified them through the receiver operating characteristic (ROC) curve and correlation analysis, respectively. Results The mean FA value of white matter in RVO patients is lower than the HCs, and the mean RD value in RVO patients increased, especially in the bilateral posterior thalamic, bilateral sagittal stratum, body of corpus callosum, cingulum, and fornix. The ROC curve of different brain regions showed high accuracy. Moreover, the mean FA and RD values were significantly correlated with visual and psychological disorders. Conclusion TBSS could be regarded as an important method to reveal the alterations of white matter in RVO patients, indicating the underlying neurological mechanism of the RVO.
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Kelly JP, Phillips JO, Saneto RP, Khalatbari H, Poliakov A, Tarczy-Hornoch K, Weiss AH. Cerebral Visual Impairment Characterized by Abnormal Visual Orienting Behavior With Preserved Visual Cortical Activation. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 33984120 PMCID: PMC8132015 DOI: 10.1167/iovs.62.6.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Children with cerebral visual impairment (CVI) often have abnormal visual orienting behaviors due to impaired or damaged visual cortex. Alternatively, visual-cortical function is intact but visual information is not transformed downstream into an appropriate oculomotor output (visuomotor dysfunction). We examined visual, anatomic, and oculomotor assessments to distinguish visuomotor dysfunction from CVI associated with severely reduced visual-cortical response. Methods We reviewed the medical records from children with CVI having abnormal visual orienting behaviors, normal ocular examinations, and born near term. Relevant data were visual evoked potentials (VEPs), Teller card acuity, eye movements recorded by video-oculography (VOG), and neuroimaging (magnetic resonance imaging [MRI]) including diffusion tensor imaging (DTI) tractography. Results Thirty subjects had visuomotor dysfunction based on a normal VEP; of these 33% had a normal MRI and 67% had white matter abnormalities associated with metabolic disease and/or decreased volume of brain parenchyma. VOG recordings showed smooth pursuit gains were uniformly reduced and saccades were dysmetric but followed the main sequence. Ten subjects had severe CVI based on VEPs at noise levels; visual acuities and MRI findings overlapped those of the visuomotor dysfunction group. Developmental delay, seizures, microcephaly, and hypotonia were common across all groups. All subjects with an abnormal conventional MRI had abnormal metrics on DTI tractography from the occipital lobe. Conclusions A subset of patients with CVI have abnormal visual orienting behaviors despite a normal VEP (visuomotor dysfunction). A majority have abnormal white matter metrics on tractography suggesting a downstream defect in sensorimotor transformation. Clinically, visuomotor dysfunction is indistinguishable from severe CVI.
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Affiliation(s)
- John P Kelly
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - James O Phillips
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington School of Medicine, Department of Otolaryngology, Seattle, Washington, United States
| | - Russell P Saneto
- Seattle Children's Hospital, Department of Neurology/Division of Pediatric Neurology, Neuroscience Institute, Seattle, Washington, United States
| | - Hedieh Khalatbari
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Andrew Poliakov
- Seattle Children's Hospital, Department of Radiology, Seattle, Washington, United States
| | - Kristina Tarczy-Hornoch
- Roger H. Johnson Vision Clinic, Seattle Children's Hospital, Division of Ophthalmology, Seattle, Washington, United States.,University of Washington, Department of Ophthalmology, Seattle, Washington, United States
| | - Avery H Weiss
- University of Washington, Department of Ophthalmology, Seattle, Washington, United States
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Efficacy of Perceptual Learning-Based Vision Training as an Adjuvant to Occlusion Therapy in the Management of Amblyopia: A Pilot Study. Vision (Basel) 2021; 5:vision5010015. [PMID: 33807038 PMCID: PMC8006050 DOI: 10.3390/vision5010015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022] Open
Abstract
A retrospective study was conducted to evaluate preliminarily the efficacy of perceptual learning (PL) visual training in medium-term follow-up with a specific software (Amblyopia iNET, Home Therapy Systems Inc., Gold Canyon, AZ, USA) for visual acuity (VA) and contrast sensitivity (CS) recovering in a sample of 14 moderate to severe amblyopic subjects with a previously unsuccessful outcome or failure with patching (PL Group). This efficacy was compared with that achieved in a patching control group (13 subjects, Patching 2). At one-month follow-up, a significant VA improvement in the amblyopic eye (AE) was observed in both groups, with no significant differences between them. Additionally, CS was measured in PL Group and exhibited a significant improvement in the AE one month after the beginning of treatment for 3, 6, 12, and 18 cycles/º (p = 0.003). Both groups showed long-lasting retention of visual improvements. A combined therapy of PL-based visual training and patching seems to be effective for improving VA in children with amblyopia who did not recover vision with patching alone or had a poor patching compliance. This preliminary outcome should be confirmed in future clinical trials.
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Tong H, Hao Q, Wang Z, Wang Y, Li R, Zhao X, Sun Q, Zhang X, Chen X, Zhu H, Huang D, Liu H. The biometric parameters of aniso-astigmatism and its risk factor in Chinese preschool children: the Nanjing eye study. BMC Ophthalmol 2021; 21:67. [PMID: 33535994 PMCID: PMC7860027 DOI: 10.1186/s12886-021-01808-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022] Open
Abstract
Backgrounds Aniso-astigmatism may hinder normal visual development in preschool children. Knowing its prevalence, biometric parameters and risk factors is fundamental to children eye care. The purpose of this study was to determine the biometric components of aniso-astigmatism and associated maternal risk factors in Chinese preschool children. Methods In the population-based, prospective cohort Nanjing Eye Study, children were measured for noncycloplegic refractive error using an autorefractor and for biometric parameters using an optical low-coherent reflectometry. The difference of total astigmatism (TA) between both eyes was calculated using cylinder power (non-vectorial aniso-TA was defined as ≥1.00 Dioptre Cylinder [DC] between both eyes) and by vector analysis (vectorial aniso-TA was defined as a difference of ≥0.5 in J0 or J45 between both eyes which is equivalent to 1.00 DC). The prevalence of aniso-TA was presented. Interocular biometric parameters were compared between with vs. without aniso-astigmatism group. In addition, risk factors were determined using multivariate logistic regression model. Results Of 1131 children (66.90 ± 3.38 months, 53.31% male), the prevalence of non-vectorial aniso-TA was 1.95% (95% Confidence Interval (CI) = 1.14–2.75%), while the prevalence of vectorial aniso-TA was twice as common as non-vectorial aniso-TA, neither varying with sex or age. With aniso-TA eyes were more asymmetric in axial length and corneal curvature radius than without aniso-TA eyes. In multivariate logistic regression model, 5-min Apgar score less than 7 was significantly associated with higher risk of aniso-TA (vectorial aniso-TA: Odds Ratio (OR) = 6.42, 95%CI = 2.63–15.69, P < 0.001; non-vectorial aniso-TA: OR = 4.99, 95%CI = 1.41–17.68, P = 0.01). Being twin or triple was significantly associated with higher risk of vectorial aniso-CA (OR = 2.43, 95%CI = 1.05–5.60, P = 0.04). Pre-term delivery (OR = 2.60, 95%CI = 1.09–6.15, P = 0.03) and post-term delivery (OR = 3.61, 95%CI = 1.31–9.96, P = 0.01) were significantly associated with higher risk of vectorial aniso-CA. Conclusions Both corneal curvature radius and axial length asymmetry were correlated with aniso-TA. Children with 5-min Apgar score < 7 were more likely to have aniso-TA, while twin or triple, pre-term or post-term delivery were more likely to have vectorial aniso-CA. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01808-7.
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Affiliation(s)
- Haohai Tong
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qingfeng Hao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Zijin Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yue Wang
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Rui Li
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xiaoyan Zhao
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Qigang Sun
- Department of Ophthalmology, Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, China
| | - Xiaohan Zhang
- Department of Ophthalmology, Wuxi Children's Hospital, Wuxi, China
| | - Xuejuan Chen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Dan Huang
- Department of Child Healthcare, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Miller NP, Aldred B, Schmitt MA, Rokers B. Impact of Amblyopia on the Central Nervous System. J Binocul Vis Ocul Motil 2020; 70:182-192. [PMID: 33206009 DOI: 10.1080/2576117x.2020.1841710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Amblyopia is a common perceptual disorder resulting from abnormal visual input during development. The clinical presentation and visual deficits associated with amblyopia are well characterized. Less is known however, about amblyopia's impact on the central nervous system (CNS). While early insights into the neuropathophysiology of amblyopia have been based on findings from animal models and postmortem human studies, recent advances in noninvasive magnetic resonance imaging (MRI) techniques have enabled the study of amblyopia's effects in vivo. We review recent retinal and neuroimaging research documenting amblyopia's structural and functional impact on the CNS. Clinical imaging provides some evidence for retinal and optic nerve abnormalities in amblyopic eyes, although the overall picture remains inconclusive. Neuroimaging studies report clearer changes in both structure and function of the visual pathways. In the optic nerves, optic tracts, and optic radiations of individuals with amblyopia, white-matter integrity is decreased. In the lateral geniculate nuclei, gray matter volume is decreased and neural activity is reduced. Reduced responses are also seen in the amblyopic primary visual cortex and extrastriate areas. Overall, amblyopia impacts structure and function at multiple sites along the visual processing hierarchy. Moreover, there is some evidence that amblyopia's impact on the CNS depends on its etiology, with different patterns of results for strabismic and anisometropic amblyopia. To clarify the impact of amblyopia on the CNS, simultaneous collection of retinal, neural, and perceptual measures should be employed. Such an approach will help (1) distinguish cause and effect of amblyopic impairments, (2) separate the impact of amblyopia from other superimposed conditions, and (3) identify the importance of amblyopic etiology to specific neural and perceptual deficits.
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Affiliation(s)
- Nathaniel P Miller
- Department of Psychology, University of Wisconsin-Madison , Madison, Wisconsin.,Psychology, New York University Abu Dhabi , Abu Dhabi, UAE
| | - Breanna Aldred
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison , Madison, Wisconsin
| | - Melanie A Schmitt
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison , Madison, Wisconsin
| | - Bas Rokers
- Psychology, New York University Abu Dhabi , Abu Dhabi, UAE
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Active Vision Therapy for Anisometropic Amblyopia in Children: A Systematic Review. J Ophthalmol 2020; 2020:4282316. [PMID: 32733699 PMCID: PMC7376429 DOI: 10.1155/2020/4282316] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/30/2020] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose The aim of the study was evaluation of the scientific evidence about the efficacy of vision therapy in children and teenagers with anisometropic amblyopia by performing a systematic literature review. Methods A search was performed using 3 searching strategies in 4 different databases (PubMed, Web of Science, Scopus, and PruQuest). The quality of the included articles was evaluated using two tools for the risk of bias assessment, ROBINS-I for nonrandomized studies of intervention (NRSI), and ROB 2.0 for randomized clinical trials. Results The search showed 1274 references, but only 8 of them passed the inclusion criteria after the complete text review. The articles that were finally included comprised 2 randomized control trials and 6 nonrandomized studies of intervention. These articles provided evidence supporting the efficacy of vision therapy for the treatment of anisometropic amblyopia in children and teenagers. Assessment of the risk of bias showed an appropriate risk of bias for the randomized control trials, but a high risk of bias for nonrandomized studies of intervention (NRSI). A main source of risk of bias for NRSI was the domain related to the measurements of the outcomes, due to a lack of double-blind studies. Conclusion Vision therapy is a promising option for the treatment of anisometropic amblyopia in children and teenagers. However, the level of scientific evidence provided by the studies revised is still limited, and further randomized clinical trials are necessary to confirm the results provided to date and to optimize the vision therapy techniques by knowing the specific neural mechanisms involved.
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Su CC, Tsai CY, Tsai TH, Tsai IJ. Incidence and risk of attention-deficit hyperactivity disorder in children with amblyopia: A nationwide cohort study. Clin Exp Ophthalmol 2019; 47:259-264. [PMID: 30663207 PMCID: PMC6594075 DOI: 10.1111/ceo.13465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 12/03/2022]
Abstract
Importance The association between visual deficits and attention disorders has been reported but remains unproven. Background The objective of this study was to evaluate the risk of attention‐deficit hyperactivity disorder (ADHD) in children with amblyopia. Design Population‐based, cohort study. Participants The dataset from the Taiwan National Health Insurance Research Database in 2000 to 2010. Methods A total of 6817 patients aged <18 years with newly diagnosed amblyopia were identified. Four age‐ and sex‐matched controls without amblyopia were included for each patient, that is, 27268 controls. Main Outcome Measures The primary outcome was the risk of ADHD. The secondary outcomes were age at ADHD onset and use of ADHD medication. Results During a mean observation period of 7.18 years, the incidence of ADHD per 1000 person‐years was 7.02 in the amblyopia group and 4.61 in the control group (P < 0.0001). The ADHD risk in the amblyopia group was 1.81 times that in the control group (hazard ratio 1.81; 95% confidence interval 1.59‐2.06). After stratification by amblyopia subtype, the greatest risk was in the deprivation type (hazard ratio 2.14; 95% confidence interval 1.56‐2.92) followed by the strabismic (hazard ratio 2.09; 95% confidence interval 1.15‐3.79) and refractive (hazard ratio 1.76; 95% confidence interval 1.54‐2.02) types. Age at ADHD onset was younger in the amblyopia group (median 8.14 vs 8.45 years; P = 0.0096). The average duration of neuropsychiatric medication use was comparable between groups (P = 0.98). Conclusions and Relevance The ADHD risk is higher in children with amblyopia.
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Affiliation(s)
- Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ying Tsai
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - I-Ju Tsai
- Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Tsai TH, Su HT, Hsu YC, Shih YC, Chen CC, Hu FR, Tseng WYI. White matter microstructural alterations in amblyopic adults revealed by diffusion spectrum imaging with systematic tract-based automatic analysis. Br J Ophthalmol 2018; 103:511-516. [PMID: 29844086 PMCID: PMC6691873 DOI: 10.1136/bjophthalmol-2017-311733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Background/aim We investigated the microstructural changes in white matter of adults with amblyopia using diffusion spectrum imaging with systematic tract-based automatic analysis of the whole brain. Methods Ten adults with amblyopia (six women and four men, 33.6±10.6 years old on average) and 20 age- and sex-matched normal-sighted controls were enrolled. The mean generalised fractional anisotropy (GFA) was measured in 76 white matter tracts and compared between the experimental and control groups using a threshold-free cluster-weighted method and t-test. A 2-percentile cut-off was used to identify segments with the greatest differences between the two groups. Results Participants with amblyopia had significantly lower GFA values than the controls in 11 segments located in nine white matter tracts, which included the following: left arcuate fasciculus, left frontal aslant tract, left fornix and left inferior fronto-occipital fasciculus of the association fibres; left thalamic radiations of the auditory nerve and bilateral optic radiations of the projection fibres; and genu and middle temporal gyrus of the callosal fibres. Amblyopic participants had statistically higher GFA values in the bilateral uncinate fasciculus than those of the controls. Conclusion This preliminary study using whole-brain tractographic analysis of white matter reveals association between abnormal early visual processing and alterations in brain architecture, which may be related to various higher-level deficits, such as audiovisual integration and hand−eye coordination in patients with amblyopia.
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Affiliation(s)
- Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Te Su
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yung-Chin Hsu
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yao-Chia Shih
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Chung Chen
- Department of Psychology, National Taiwan University College of Science, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan .,Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan .,Molecular Imaging Center, National Taiwan University, Taipei, Taiwan
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Wong NA, Rafique SA, Kelly KR, Moro SS, Gallie BL, Steeves JKE. Altered white matter structure in the visual system following early monocular enucleation. Hum Brain Mapp 2017; 39:133-144. [PMID: 28963811 DOI: 10.1002/hbm.23831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 09/19/2017] [Indexed: 01/01/2023] Open
Abstract
Partial visual deprivation from early monocular enucleation (the surgical removal of one eye within the first few years of life) results in a number of long-term morphological adaptations in adult cortical and subcortical visual, auditory, and multisensory brain regions. In this study, we investigated whether early monocular enucleation also results in the altered development of white matter structure. Diffusion tensor imaging and probabilistic tractography were performed to assess potential differences in visual system white matter in adult participants who had undergone early monocular enucleation compared to binocularly intact controls. To examine the microstructural properties of these tracts, mean diffusion parameters including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted bilaterally. Asymmetries opposite to those observed in controls were found for FA, MD, and RD in the optic radiations, the projections from primary visual cortex (V1) to the lateral geniculate nucleus (LGN), and the interhemispheric V1 projections of early monocular enucleation participants. Early monocular enucleation was also associated with significantly lower FA bidirectionally in the interhemispheric V1 projections. These differences were consistently greater for the tracts contralateral to the enucleated eye, and are consistent with the asymmetric LGN volumes and optic tract diameters previously demonstrated in this group of participants. Overall, these results indicate that early monocular enucleation has long-term effects on white matter structure in the visual pathway that results in reduced fiber organization in tracts contralateral to the enucleated eye. Hum Brain Mapp 39:133-144, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Nikita A Wong
- Department of Psychology, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada
| | - Sara A Rafique
- Department of Psychology, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada
| | | | - Stefania S Moro
- Department of Psychology, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda L Gallie
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer K E Steeves
- Department of Psychology, York University, Toronto, Ontario, Canada.,Centre for Vision Research, York University, Toronto, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Braddick O, Atkinson J, Akshoomoff N, Newman E, Curley LB, Gonzalez MR, Brown T, Dale A, Jernigan T. Individual differences in children's global motion sensitivity correlate with TBSS-based measures of the superior longitudinal fasciculus. Vision Res 2016; 141:145-156. [PMID: 27793590 DOI: 10.1016/j.visres.2016.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/12/2023]
Abstract
Reduced global motion sensitivity, relative to global static form sensitivity, has been found in children with many neurodevelopmental disorders, leading to the "dorsal stream vulnerability" hypothesis (Braddick et al., 2003). Individual differences in typically developing children's global motion thresholds have been shown to be associated with variations in specific parietal cortical areas (Braddick et al., 2016). Here, in 125 children aged 5-12years, we relate individual differences in global motion and form coherence thresholds to fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF), a major fibre tract communicating between parietal lobe and anterior cortical areas. We find a positive correlation between FA of the right SLF and individual children's sensitivity to global motion coherence, while FA of the left SLF shows a negative correlation. Further analysis of parietal cortical area data shows that this is also asymmetrical, showing a stronger association with global motion sensitivity in the left hemisphere. None of these associations hold for an analogous measure of global form sensitivity. We conclude that a complex pattern of structural asymmetry, including the parietal lobe and the superior longitudinal fasciculus, is specifically linked to the development of sensitivity to global visual motion. This pattern suggests that individual differences in motion sensitivity are primarily linked to parietal brain areas interacting with frontal systems in making decisions on integrated motion signals, rather than in the extra-striate visual areas that perform the initial integration. The basis of motion processing deficits in neurodevelopmental disorders may depend on these same structures.
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Affiliation(s)
- Oliver Braddick
- Department of Experimental Psychology, University of Oxford, UK.
| | - Janette Atkinson
- Department of Experimental Psychology, University of Oxford, UK; Faculty of Brain Sciences, University College London, UK
| | - Natacha Akshoomoff
- Center for Human Development, University of California San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Erik Newman
- Center for Human Development, University of California San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Lauren B Curley
- Center for Human Development, University of California San Diego, CA, USA; Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Marybel Robledo Gonzalez
- Center for Human Development, University of California San Diego, CA, USA; Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Timothy Brown
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; Department of Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA
| | - Anders Dale
- Department of Radiology, University of California San Diego, La Jolla, CA, USA; Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA; Department of Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA
| | - Terry Jernigan
- Center for Human Development, University of California San Diego, CA, USA; Department of Psychiatry, University of California San Diego, La Jolla, CA, USA; Department of Radiology, University of California San Diego, La Jolla, CA, USA; Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
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