Different effects of double-pulse TMS of the posterior parietal cortex on reflexive and voluntary saccades

Objective Evaluation of Vergence Disorders and a Research-Based Novel Method for Vergence Rehabilitation

Purpose

We performed video-oculography to evaluate vergence eye movement abnormalities in students diagnosed clinically with vergence disorders. We tested the efficiency of a novel rehabilitation method and evaluated its benefits with video-oculography cross-correlated with clinical tests and symptomatology.

Methods

A total of 19 students (20–27 years old) underwent ophthalmologic, orthoptic examination, and a vergence test coupled with video-oculography. Eight patients were diagnosed with vergence disorders with a high symptomatology score (CISS) and performed a 5-week session of vergence rehabilitation. Vergence and rehabilitation tasks were performed with a trapezoid surface of light emitting diodes (LEDs) and adjacent buzzers (US 8851669). We used a novel Vergence double-step (Vd-s) protocol: the target stepped to a second position before the vergence movement completion. Afterward the vergence test was repeated 1 week and 1 month later.

Results

Abnormally increased intertrial variability was observed for many vergence parameters (gain, duration, and speed) for the subjects with vergence disorders. High CISS scores were correlated with variability and increased latency. After the Vd-s, variability of all parameters dropped to normal or better levels. Moreover, the convergence and divergence latency diminished significantly to levels better than normal; benefits were maintained 1 month after completion of Vd-s. CISS scores dropped to normal level, which was maintained up to 1 year.

Conclusions and Translational Relevance:

Intertrial variability is the major marker of vergence disorders. The Vd-s research-based method leads to normalization of vergence properties and lasting removal of symptoms. The efficiency of the method is due to the spatiotemporal parameters of repetitive trials that stimulate neural plasticity.

Saccade-vergence properties remain more stable over short-time repetition under overlap than under gap task: a preliminary study

Under natural circumstances, saccade-vergence eye movements are among the most frequently occurring. This study examines the properties of such movements focusing on short-term repetition effects. Are such movements robust over time or are they subject to tiredness? 12 healthy adults performed convergent and divergent combined eye movements either in a gap task (i.e., 200 ms between the end of the fixation stimulus and the beginning of the target stimulus) or in an overlap task (i.e., the peripheral target begins 200 ms before the end of the fixation stimulus). Latencies were shorter in the gap task than in the overlap task for both saccade and vergence components. Repetition had no effect on latency, which is a novel result. In both tasks, saccades were initiated later and executed faster (mean and peak velocities) than the vergence component. The mean and peak velocities of both components decreased over trials in the gap task but remained constant in the overlap task. This result is also novel and has some clinical implications. Another novel result concerns the accuracy of the saccade component that was better in the gap than in the overlap task. The accuracy also decreased over trials in the gap task but remained constant in the overlap task. The major result of this study is that under a controlled mode of initiation (overlap task) properties of combined eye movements are more stable than under automatic triggering (gap task). These results are discussed in terms of saccade-vergence interactions, convergence-divergence specificities and repetition versus adaptation protocols.