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Zhang X, Liu L, Li Y, Li X, Wang K, Han S, Wang M, Zhang Y, Zheng G, Cheng J, Wen B. Integrative neurovascular coupling and neurotransmitter analyses in anisometropic and visual deprivation amblyopia children. iScience 2024; 27:109988. [PMID: 38883835 PMCID: PMC11177132 DOI: 10.1016/j.isci.2024.109988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/14/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
The association between visual abnormalities and impairments in cerebral blood flow and brain region potentially results in neural dysfunction of amblyopia. Nevertheless, the differences in the complex mechanisms of brain neural network coupling and its relationship with neurotransmitters remain unclear. Here, the neurovascular coupling mechanism and neurotransmitter activity in children with anisometropic amblyopia (AA) and visual deprivation amblyopia (VDA) was explored. The neurovascular coupling of 17 brain regions in amblyopia children was significantly abnormal than in normal controls. The classification abilities of coupling units in brain regions differed between two types of amblyopia. Correlations between different coupling effects and neurotransmitters were different. The findings of this study demonstrate a correlation between the neurovascular coupling and neurotransmitter in children with AA and VDA, implying their impaired neurovascular coupling function and potential molecular underpinnings. The neuroimaging evidence revealed herein offers potential for the development of neural therapies for amblyopia.
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Affiliation(s)
- Xiaopan Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yadong Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kejia Wang
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhu Wang
- MR Research Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guangying Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baohong Wen
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Hernández-Rodríguez CJ, Ferrer-Soldevila P, Artola-Roig A, Piñero DP. Rehabilitation of amblyopia using a digital platform for visual training combined with patching in children: a prospective study. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06475-0. [PMID: 38578335 DOI: 10.1007/s00417-024-06475-0] [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: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To assess the possible benefits of the use of perceptual learning and dichoptic therapy combined with patching in children with amblyopia over the use of only patching. METHODS Quasi-experimental multicentric study including 52 amblyopic children. Patients who improved their visual acuity (VA) by combining spectacles and patching were included in patching group (PG: 20 subjects), whereas those that did not improved with patching performed visual training (perceptual learning + dichoptic therapy) combined with patching, being assigned to the visual treatment group (VT: 32 subjects). Changes in VA, contrast sensitivity (CS), and stereopsis were monitored during a 6-month follow-up in each group. RESULTS Significant improvements in VA were found in both groups at 1 month (p < 0.01). The total improvement of VA was 0.18 ± 0.16 and 0.31 ± 0.35 logMAR in PG and VT groups, respectively (p = 0.317). The Wilcoxon effect size was slightly higher in VT (0.48 vs. 0.54) at 6 months. An enhancement in CS was observed in the amblyopic eye of the VT group for all spatial frequencies at 1 month (p < 0.001). Likewise, the binocular function score also increased significantly in VT group (p = 0.002). A prediction equation of VA improvement at 1 month in VT group was obtained by multiple linear regression analysis (p < 0.001, R2 = 0.747). CONCLUSIONS A combined treatment of visual training and patching is effective for obtaining a predictable improvement of VA, CS, and binocularity in patching-resistant amblyopic children.
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Affiliation(s)
- Carlos J Hernández-Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/N 03016, San Vicente del Raspeig, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Ribera Virgen de La Caridad Hospital, Cartagena, Spain
| | | | - Alberto Artola-Roig
- Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - David P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/N 03016, San Vicente del Raspeig, Alicante, Spain.
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain.
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Dong X, Liu L, Du X, Wang Y, Zhang P, Li Z, Bao M. Treating amblyopia using altered reality enhances the fine-scale functional correlations in early visual areas. Hum Brain Mapp 2023; 44:6499-6510. [PMID: 37929783 PMCID: PMC10681636 DOI: 10.1002/hbm.26526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/02/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023] Open
Abstract
Amblyopia is a developmental visual disorder that causes substantial visual deficits. Studies using resting-state functional magnetic resonance imaging have disclosed abnormal brain functional connectivity (FC) both across long-range cortical sites and within the visual cortex in amblyopes, which is considered to be related to impaired visual functions. However, little work has examined whether restoring the vision of amblyopes accompanies with an improvement of FC. Here in adult amblyopes and healthy participants, we compared their brain FC before and after an altered-reality adaptation training. Before the training, the voxel-wise FCs of amblyopia patients were substantially weaker than those of healthy control participants both within and across the early visual areas. After the training, visual acuities improved in amblyopes but not in the control participants. The effect kept strengthening in the subsequent month without further adaptation. Importantly, we observed enhanced voxel-wise FC both within and across the early visual areas of amblyopes. Moreover, the enhancement continued for at least 1 month. These results suggest that the effective treatment can improve both the amblyopes' vision and functional connections in the visual cortex.
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Affiliation(s)
- Xue Dong
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Lijuan Liu
- Beijing Institute of Ophthalmology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Xinxin Du
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
| | - Yue Wang
- State Key Laboratory of Brain and Cognitive Science, Institute of BiophysicsChinese Academy of SciencesBeijingChina
| | - Peng Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of BiophysicsChinese Academy of SciencesBeijingChina
| | - Zhihao Li
- School of PsychologyShenzhen UniversityShenzhenGuangdongChina
- Department of Psychiatry and Behavioral SciencesEmory UniversityAtlantaGeorgiaUSA
| | - Min Bao
- CAS Key Laboratory of Behavioral Science, Institute of PsychologyChinese Academy of SciencesBeijingChina
- Department of PsychologyUniversity of Chinese Academy of SciencesBeijingChina
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Meng C, Zhang Y, Wang S. Anisometropic amblyopia: A review of functional and structural changes and treatment. Eur J Ophthalmol 2023; 33:1529-1535. [PMID: 36448184 DOI: 10.1177/11206721221143164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Amblyopia is the decreased best-corrected visual acuity (BCVA) in one or both eyes caused by the abnormal processing of visual input during development. One common cause of amblyopia is anisometropia, which has attracted widespread attention. Many structural changes occur in the primary and extrastriate visual areas of the cerebral cortex, as well as in the eyes, in patients with anisometropic amblyopia. Understanding these mechanisms has provided a favorable theoretical basis for treating anisometropic amblyopia. This article reviews the functional and anatomical changes and progress toward the treatment of anisometropic amblyopia.
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Affiliation(s)
- Can Meng
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
| | - Shurong Wang
- Corneal Refraction Department, The Second Hospital of Jilin University, Changchun, China
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Wang G, Liu L. Amblyopia: progress and promise of functional magnetic resonance imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1229-1246. [PMID: 36282454 DOI: 10.1007/s00417-022-05826-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Amblyopia is a neurodevelopmental disorder characterized by functional deficits in the visual cortex. Functional magnetic resonance imaging (fMRI) is the most commonly used neuroimaging technique for investigating amblyopia. Herein, we systematically searched a PubMed database from inception to December 2021 to highlight the current progress and promises about fMRI technology in amblyopia; amblyopia's neural mechanism, the comparison of different types of amblyopia, and the evaluation of the therapeutic effect were explored. Relevant articles published in English and appropriate cross-references were considered for inclusion, including basic studies, imaging techniques, clinical diagnostic and therapeutic studies, case series, and reviews.
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Affiliation(s)
- Guiqu Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Longqian Liu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Leal Vega L, Piñero DP, Hernández Rodríguez CJ, Molina Martín A, Morales-Quezada L, Vallelado Álvarez AI, Arenillas Lara JF, Coco Martín MB. Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia. BMC Ophthalmol 2022; 22:253. [PMID: 35672688 PMCID: PMC9172013 DOI: 10.1186/s12886-022-02466-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. METHODS We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. DISCUSSION The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. TRIAL REGISTRATION This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.
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Affiliation(s)
- L Leal Vega
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
| | - D P Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - C J Hernández Rodríguez
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Clinical Optometry Unit, Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
| | - A Molina Martín
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - L Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - A I Vallelado Álvarez
- Pediatric Ophthalmology Unit, Department of Ophthalmology, University Clinical Hospital of Valladolid, Valladolid, Spain
| | - J F Arenillas Lara
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain.
- Stroke Unit and Stroke Program, Department of Neurology, University Clinical Hospital of Valladolid, Valladolid, Spain.
| | - M B Coco Martín
- Group of Applied Clinical Neurosciences and Advanced Data Analysis, Department of Medicine, Dermatology and Toxicology, University of Valladolid, Av. Ramón y Cajal, 7, 47005, Valladolid, Spain
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Chen X, Liao M, Jiang P, Sun H, Liu L, Gong Q. Abnormal effective connectivity in visual cortices underlies stereopsis defects in amblyopia. Neuroimage Clin 2022; 34:103005. [PMID: 35421811 PMCID: PMC9011166 DOI: 10.1016/j.nicl.2022.103005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 04/05/2022] [Indexed: 02/08/2023]
Abstract
Abnormal effective connectivity inherent stereopsis defects in amblyopia was studied. A weakened connection from V2v to LO2 relates to stereopsis defects in amblyopia. Higher-order visual cortices may serve as key nodes to the stereopsis defects. An independent longitudinal dataset was used to validate the obtained results.
The neural basis underlying stereopsis defects in patients with amblyopia remains unclear, which hinders the development of clinical therapy. This study aimed to investigate visual network abnormalities in patients with amblyopia and their associations with stereopsis function. Spectral dynamic causal modeling methods were employed for resting-state functional magnetic resonance imaging data to investigate the effective connectivity (EC) among 14 predefined regions of interest in the dorsal and ventral visual pathways. We adopted two independent datasets, including a cross-sectional and a longitudinal dataset. In the cross-sectional dataset, we compared group differences in EC between 31 patients with amblyopia (mean age: 26.39 years old) and 31 healthy controls (mean age: 25.71 years old) and investigated the association between EC and stereoacuity. In addition, we explored EC changes after perceptual learning in a novel longitudinal dataset including 9 patients with amblyopia (mean age: 15.78 years old). We found consistent evidence from the two datasets indicating that the aberrant EC from V2v to LO2 is crucial for the stereoscopic deficits in the patients with amblyopia: it was weaker in the patients than in the controls, showed a positive linear relationship with the stereoscopic function, and increased after perceptual learning in the patients. In addition, higher-level dorsal (V3d, V3A, and V3B) and ventral areas (LO1 and LO2) were important nodes in the network of abnormal ECs associated with stereoscopic deficits in the patients with amblyopia. Our research provides insights into the neural mechanism underlying stereopsis deficits in patients with amblyopia and provides candidate targets for focused stimulus interventions to enhance the efficacy of clinical treatment for the improvement of stereopsis deficiency.
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Affiliation(s)
- Xia Chen
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Liao
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China; Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Jiang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, China.
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Imaging Research Core Facilities, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Longqian Liu
- Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, China; Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, China
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Kim M, Lee S, Lee JE, Kim JH, Ha EK, Han M, Lew H. A nationwide cohort study on the risk of ADHD in children with amblyopia mediated by fine motor skill impairment in East Asia. Sci Rep 2022; 12:6932. [PMID: 35484195 PMCID: PMC9051132 DOI: 10.1038/s41598-022-10845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/11/2022] [Indexed: 11/09/2022] Open
Abstract
This national administrative investigation of Republic of Korea compared the risk of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders(ASD) in preschool amblyopic children and identified factors that possibly mediate this association. After propensity score (PS) matching, 7762 amblyopic children and 31,030 non-amblyopic children were included. Amblyopia was associated with ADHD (aOR:1.687; 95% CI 1.444, 1.970) but not with ASD (aOR: 0.591; 95% CI 0.341, 1.026). Fine motor skill impairment was a mediating factor in association of amblyopia with ADHD, accounting for 4.2% (95% CI 1.7, 8.0). In conclusion, amblyopic children have a greater risk of ADHD, and deficits in fine motor skills mediate this association. We suggest increased attention given to fine motor skill underdevelopment in amblyopic children to prevent the development of ADHD.
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Affiliation(s)
- Myungjin Kim
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea
| | - Seungwon Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea.,Department of Data Science, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
| | - Ju Hee Kim
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Manyong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, Republic of Korea.
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Functional connectivity density alterations in children with strabismus and amblyopia based on resting-state functional magnetic resonance imaging (fMRI). BMC Ophthalmol 2022; 22:49. [PMID: 35109804 PMCID: PMC8808980 DOI: 10.1186/s12886-021-02228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/07/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To explore functional connectivity density (FCD) values of brain areas in children with strabismus and amblyopia (SA) based on blood oxygen level-dependent (BOLD) signals. Methods This study recruited 26 children (14 male, 12 females) with SA and 26 healthy children (14 male, 12 female) as healthy controls (HCs). Both groups matched in age, gender, educational level and socioeconomic background. While resting, all participants underwent fMRI scanning and global FCD (gFCD) and local FCD (lFCD) values were calculated. Receiver operating characteristic (ROC) curves were created to investigate whether there was a significant difference between children with SA and healthy controls. Results When compared with healthy controls, children with SA had significantly lower gFCD values in the right cerebellum, left putamen, and right superior frontal gyrus; however, the same metrics showed opposite changes in the right angular gyrus, left middle cingulate gyrus, left angular gyrus, right superior parietal gyrus, and right middle frontal gyrus. In children with SA, lFCD values were found to be remarkably decreased in regions of the middle right temporal pole, right cerebellum, left putamen, left hippocampus, right hippocampus, left thalamus, left cerebellum; values were increased in the right superior parietal gyrus as compared with healthy controls. Conclusion We noted abnormal neural connectivity in some brain areas of children with SA; detailing such connectivity aberrations is useful in exploring the pathophysiology of SA and providing useful information for future clinical management.
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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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Jukes C, Bjerre A, Coupe J, Gibson J. Pilot Study Evaluating the Feasibility of Comparing Computer Game Play with Close Work During Occlusion in Children Aged 2-7 Years with Amblyopia. Br Ir Orthopt J 2019; 15:115-124. [PMID: 32999982 PMCID: PMC7510385 DOI: 10.22599/bioj.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background/Aims: Computer games have been used to stimulate vision in amblyopia with varying degrees of success. The aim of this pilot study was to evaluate the feasibility of conducting a randomised controlled trial to test the effectiveness of computer game play compared to close work during occlusion treatment in children. Method: Children aged 2–7 years with amblyopia and no prior amblyopia treatment were invited to participate. Participants were randomised to a computer game group or close work group and asked to complete two hours occlusion per day, incorporating one hour of their allocated activity. LogMAR visual acuity (VA) was assessed before treatment commenced and after 7(±1) weeks. The same examiner, who was unaware of the allocated treatment, assessed the participant using the same VA test. Results: Eighteen participants (mean age of 4.2 ± 1.3 years) completed the study. After seven weeks the mean VA of the amblyopic eye in the computer game group improved by 0.147 ± 0.182 logMAR, and in the close work group improved by 0.181 ± 0.124 logMAR. The difference in VA improvement between the computer game and the close work groups was not statistically significant (F(1,32) = 3.71; p = 0.06). Conclusion: No significant difference was found in visual outcomes between the two groups, but a larger sample size would be needed to draw conclusions regarding the amblyopic population. Evaluation of the study design suggests it would be feasible to conduct a randomised controlled trial comparing computer games and close work during occlusion to determine if a significant difference in visual outcome exists.
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Shao Y, Li QH, Li B, Lin Q, Su T, Shi WQ, Zhu PW, Yuan Q, Shu YQ, He Y, Liu WF, Ye L. Altered brain activity in patients with strabismus and amblyopia detected by analysis of regional homogeneity: A resting‑state functional magnetic resonance imaging study. Mol Med Rep 2019; 19:4832-4840. [PMID: 31059016 PMCID: PMC6522834 DOI: 10.3892/mmr.2019.10147] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/27/2019] [Indexed: 01/05/2023] Open
Abstract
Previous studies have demonstrated that strabismus or amblyopia can result in marked brain function and anatomical alterations. However, differences in spontaneous brain activity in strabismus and amblyopia (SA) patients as compared with control individuals remain unclear. The present study aimed to analyze the potential brain activity changes in SA patients and their association with behavioral performance. In total, 16 patients with SA (10 women and 6 men) and 16 healthy controls (HCs; 6 men and 10 women) with matched age and sex were recruited. All subjects were examined with resting-state functional magnetic resonance imaging (rs-fMRI), and changes in the spontaneous brain activity of SA patients were evaluated by the regional homogeneity (ReHo) method. The diagnostic ability of the ReHo method was assessed using receiver operating characteristic (ROC) curve analysis. In addition, the association between the mean ReHo value in different brain regions and the behavioral performance was explored by correlation analysis. It was observed that the ReHo value was significantly increased in SA patients compared with HCs in the following brain regions: left lingual gyrus, right middle occipital gyrus/precuneus, bilateral anterior cingulate, left middle occipital gyrus and bilateral precentral gyrus. By contrast, the ReHo value of the left inferior frontal gyrus was significantly lower than that in HCs. ROC curve analysis indicated that the ReHo method has certain credibility for the diagnosis of SA patients. In addition, no similar changes were detected in other brain regions. These results revealed abnormal spontaneous brain activity in certain parts of the brain in adult patients with SA, which suggests the involvement of the neuropathological or compensatory mechanism in these patients, and may be beneficial for clinical treatment.
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Affiliation(s)
- Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Qing-Hai Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Qi Lin
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Ting Su
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361000, P.R. China
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Yong-Qiang Shu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi 330006, P.R. China
| | - Ying He
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Wen-Feng Liu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi 330006, P.R. China
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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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14
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The treatment of amblyopia: current practice and emerging trends. Graefes Arch Clin Exp Ophthalmol 2019; 257:1061-1078. [DOI: 10.1007/s00417-019-04254-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/22/2018] [Accepted: 01/17/2019] [Indexed: 02/04/2023] Open
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Abstract
PURPOSE OF REVIEW This review article is an update on the current treatments for amblyopia. In particular, the authors focus on the concepts of brain plasticity and their implications for novel treatment strategies for both children and adults affected by amblyopia. RECENT FINDINGS A variety of strategies has been developed to treat amblyopia in children and adults. New evidence on the pathogenesis of amblyopia has been obtained both in animal models and in clinical trials. Mainly, these studies have challenged the classical concept that amblyopia becomes untreatable after the 'end' of the sensitive or critical period of visual development, because of a lack of sufficient plasticity in the adult brain. SUMMARY New treatments for amblyopia in children and adults are desirable and should be encouraged. However, further studies should be completed before such therapies are widely accepted into clinical practice.
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Advanced Perceptual Learning Techniques Induce Neuroplasticity to Enable Improved Visual Functions. CURRENT OPHTHALMOLOGY REPORTS 2016. [DOI: 10.1007/s40135-016-0086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Yan FF, Zhou J, Zhao W, Li M, Xi J, Lu ZL, Huang CB. Perceptual learning improves neural processing in myopic vision. J Vis 2016; 15:12. [PMID: 26501404 DOI: 10.1167/15.10.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Visual performance is jointly determined by the quality of optical transmission of the eye and neural processing in the visual system. An open question is: Can effects of optical defects be compensated by perceptual learning in neural processing? To address this question, we conducted a perceptual learning study on 23 observers with myopic vision, targeting high frequency deficits by training them in a monocular grating detection task in the non-dominant eye near their individual cutoff spatial frequencies. The contrast sensitivity function and visual acuity in both eyes (without optical correction) were assessed for all the observers in the training group before and after training, and for all the observers in the control group twice with a 10-day interval between the tests. In addition, the threshold versus external noise contrast function was measured for five observers in the training group before and after training. We found that (a) training significantly improved contrast sensitivity at the trained spatial frequency, visual acuity, and contrast sensitivity over a wide range of spatial frequencies in both eyes; (b) training did not lead to any significant refractive changes; (c) the mechanism of improvements was a combination of internal additive noise reduction and external noise exclusion; and (d) the improvements in visual acuity and contrast sensitivity were almost fully retained for at least four months in the three observers tested. These results suggest that perceptual learning may provide a potential noninvasive procedure to compensate for optical defects in mild to modest myopia.
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18
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Li Q, Zhai L, Jiang Q, Qin W, Li Q, Yin X, Guo M. Tract-based spatial statistics analysis of white matter changes in children with anisometropic amblyopia. Neurosci Lett 2015; 597:7-12. [PMID: 25899779 DOI: 10.1016/j.neulet.2015.04.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Amblyopia is a neurological disorder of vision that follows abnormal binocular interaction or visual deprivation during early life. Previous studies have reported multiple functional or structural cortical alterations. Although white matter was also studied, it still cannot be clarified clearly which fasciculus was affected by amblyopia. In the present study, tract-based spatial statistics analysis was applied to diffusion tensor imaging (DTI) to investigate potential diffusion changes of neural tracts in anisometropic amblyopia. Fractional anisotropy (FA) value was calculated and compared between 20 amblyopic children and 18 healthy age-matched controls. In contrast to the controls, significant decreases in FA values were found in right optic radiation (OR), left inferior longitudinal fasciculus/inferior fronto-occipital fasciculus (ILF/IFO) and right superior longitudinal fasciculus (SLF) in the amblyopia. Furthermore, FA values of these identified tracts showed positive correlation with visual acuity. It can be inferred that abnormal visual input not only hinders OR from well developed, but also impairs fasciculi associated with dorsal and ventral visual pathways, which may be responsible for the amblyopic deficiency in object discrimination and stereopsis. Increased FA was detected in right posterior part of corpus callosum (CC) with a medium effect size, which may be due to compensation effect. DTI with subsequent measurement of FA is a useful tool for investigating neuronal tract involvement in amblyopia.
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Affiliation(s)
- Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Liying Zhai
- School of Medical Imaging, Tianjin Medical University, Tianjin, China
| | - Qinying Jiang
- School of Medical Imaging, Tianjin Medical University, Tianjin, China; Institute of Neuroscience, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingji Li
- Department of Pediatric Strabismus and Amblyopia, Tianjin Aier Ophthalmology Hospital, Tianjin, China
| | - Xiaohui Yin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Mingxia Guo
- School of Medical Imaging, Tianjin Medical University, Tianjin, China.
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19
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Camilleri R, Pavan A, Ghin F, Battaglini L, Campana G. Improvement of uncorrected visual acuity and contrast sensitivity with perceptual learning and transcranial random noise stimulation in individuals with mild myopia. Front Psychol 2014; 5:1234. [PMID: 25400610 PMCID: PMC4212604 DOI: 10.3389/fpsyg.2014.01234] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/10/2014] [Indexed: 11/13/2022] Open
Abstract
Perceptual learning has been shown to produce an improvement of visual acuity (VA) and contrast sensitivity (CS) both in subjects with amblyopia and refractive defects such as myopia or presbyopia. Transcranial random noise stimulation (tRNS) has proven to be efficacious in accelerating neural plasticity and boosting perceptual learning in healthy participants. In this study, we investigated whether a short behavioral training regime using a contrast detection task combined with online tRNS was as effective in improving visual functions in participants with mild myopia compared to a 2-month behavioral training regime without tRNS (Camilleri et al., 2014). After 2 weeks of perceptual training in combination with tRNS, participants showed an improvement of 0.15 LogMAR in uncorrected VA (UCVA) that was comparable with that obtained after 8 weeks of training with no tRNS, and an improvement in uncorrected CS (UCCS) at various spatial frequencies (whereas no UCCS improvement was seen after 8 weeks of training with no tRNS). On the other hand, a control group that trained for 2 weeks without stimulation did not show any significant UCVA or UCCS improvement. These results suggest that the combination of behavioral and neuromodulatory techniques can be fast and efficacious in improving sight in individuals with mild myopia.
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Affiliation(s)
- Rebecca Camilleri
- Department of General Psychology, University of Padova , Padova, Italy
| | - Andrea Pavan
- School of Psychology, University of Lincoln , Lincoln, UK
| | - Filippo Ghin
- Department of General Psychology, University of Padova , Padova, Italy
| | - Luca Battaglini
- Department of General Psychology, University of Padova , Padova, Italy
| | - Gianluca Campana
- Department of General Psychology, University of Padova , Padova, Italy ; Human Inspired Technologies Research Center, University of Padova , Padova, Italy
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Joly O, Frankó E. Neuroimaging of amblyopia and binocular vision: a review. Front Integr Neurosci 2014; 8:62. [PMID: 25147511 PMCID: PMC4123726 DOI: 10.3389/fnint.2014.00062] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/12/2014] [Indexed: 11/13/2022] Open
Abstract
Amblyopia is a cerebral visual impairment considered to derive from abnormal visual experience (e.g., strabismus, anisometropia). Amblyopia, first considered as a monocular disorder, is now often seen as a primarily binocular disorder resulting in more and more studies examining the binocular deficits in the patients. The neural mechanisms of amblyopia are not completely understood even though they have been investigated with electrophysiological recordings in animal models and more recently with neuroimaging techniques in humans. In this review, we summarize the current knowledge about the brain regions that underlie the visual deficits associated with amblyopia with a focus on binocular vision using functional magnetic resonance imaging. The first studies focused on abnormal responses in the primary and secondary visual areas whereas recent evidence shows that there are also deficits at higher levels of the visual pathways within the parieto-occipital and temporal cortices. These higher level areas are part of the cortical network involved in 3D vision from binocular cues. Therefore, reduced responses in these areas could be related to the impaired binocular vision in amblyopic patients. Promising new binocular treatments might at least partially correct the activation in these areas. Future neuroimaging experiments could help to characterize the brain response changes associated with these treatments and help devise them.
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Affiliation(s)
- Olivier Joly
- MRC Cognition and Brain Sciences Unit Cambridge, UK ; Department of Experimental Psychology, University of Oxford Oxford, UK
| | - Edit Frankó
- Department of Neurodegenerative Disease, Institute of Neurology, University College London London, UK ; National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals London, UK
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21
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Kulp MT, Cotter SA, Connor AJ, Clarke MP. Should amblyopia be treated? Ophthalmic Physiol Opt 2014; 34:226-32. [PMID: 24588534 DOI: 10.1111/opo.12124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Marjean T Kulp
- The Ohio State University College of Optometry, Columbus, USA.
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