Search

Unimodal sensory loss leads to structural and functional changes in both deprived and nondeprived brain circuits. This process is broadly known as cross-modal plasticity. The evidence available indicates that cross-modal changes underlie the enhanced performances of the spared sensory modalities in deprived subjects. Sensory experience is a fundamental driver of cross-modal plasticity, yet there is evidence from early–visually deprived models supporting an additional role for experience-independent factors. These experience-independent factors are expected to act early in development and constrain neuronal plasticity at later stages. Here we review the cross-modal adaptations elicited by congenital or induced visual deprivation prior to vision. In most of these studies, cross-modal adaptations have been addressed at the structural and functional levels. Here, we also appraise recent data regarding behavioral performance in early–visually deprived models. However, further research is needed to explore how circuit reorganization affects their function and what brings about enhanced behavioral performance., This work was supported by grants from the European Research Council (ERC-2014-CoG-647012) and the Spanish Ministry of Science, Innovation and Universities (PGC2018–096631-B-I00).

This study aimed to calculate the dose-response relationship and predictors of visual acuity (VA) improvement following occlusion therapy at the IWK Health Center Eye Clinic and to add to amblyopia therapy dose-response relationship literature. A retrospective chart review was performed, considering patients who reached an occlusion therapy outcome at the IWK Eye Clinic between 2012 and 2019. The treatment outcome was defined as equal VA or stable VA for three consecutive clinical visits despite reported compliance. Subjective patching hours from parental reports, not prescribed hours, were used for statistical analyses. One hundred and thirty-four patients (66 females and 68 males) ages 2-11 years were included. Results showed a dose-response relationship of 224 hours/0.1logMAR increase in VA and total dose of 1344 hours for full-time occlusion and 504 hours for part-time occlusion was required to reach outcome VA. The fastest VA improvement occurred with younger age at treatment initiation, during the first 4 weeks of treatment, and in patients with strabismic and/or severe amblyopia. Classification of amblyopia, age, VA chart, initial distance VA (amblyopic eye), and treatment dose predicted the hour dose-response relationship. Dose-response relationship was faster in younger participants, in participants with strabismic and severe amblyopia, and during the first month of occlusion. Additionally, by creating a GLM model of dose-response relationship, relationship calculations can be performed. Therefore, an estimated timeline can be developed to allow allocation of clinical resources and to prepare patients for the treatment duration required and possibly increase treatment compliance.

Purpose In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method. Methods From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics. Results Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9–8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages. Conclusion Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.

IntroductionThis study aimed to compare compliance between pediatric patients with amblyopia undergoing a smartphone virtual reality-based training method (EYEBIT) and those receiving traditional patching method training.MethodsA crossover design was adopted in this study. The enrolled children (n = 76) were randomized into the traditional patching and EYEBIT training method groups. The patients received training methods once a day for 2 h and 1 h in the patching and EYEBIT groups, respectively. Follow-up assessments involved interviews with parents regarding children's compliance and questionnaire-based interviews with children; compliance rating was compared between the methods.ResultsAll children completed the training and follow-up assessments. There were significant differences in parent and children compliance-related behavior and attitudes between the two training methods (p < 0.05). The EYEBIT method was associated with better compliance than the traditional patching method. Significant correlations were observed among compliance components in both methods. In the correlation analysis between the two groups, the research results showed that in the EYEBIT group, the correlation between children's compliance behaviors and children's compliance attitudes, the correlation between children's compliance behaviors and parents' compliance behaviors, and the correlations between children's compliance attitudes and parents' compliance attitudes were all negatively correlated, and in the traditional patching group, the above three correlation analysis results were all positive.ConclusionThe use of the EYEBIT method may improve compliance in children with amblyopia; this method appears acceptable to the parents of children with amblyopia.

Amblyopia is a cause of significant ocular morbidity in pediatric population and may lead to visual impairment in future life. It is caused due to formed visual deprivation or abnormal binocular interactions. Several risk factors in pediatric age group may lead to this disease. Author groups have tried managing different types of amblyopia, like anisometropic amblyopia, strabismic amblyopia and combined mechanism amblyopia, with optical correction, occlusion therapy, penalization, binocular therapy and surgery. We review historical and current management strategies of different types of amblyopia affecting children and outcomes in terms of visual acuity, binocularity and ocular deviation, highlighting evidence from recent studies. Literature searches were performed through Pubmed. Risk factors for amblyopia need to be identified in pediatric population as early in life as possible and managed accordingly, as visual outcomes in amblyopia are best if treated at the earliest. Although, monocular therapies like occlusion or penalization have been shown to be quite beneficial over the years, newer concepts related to binocular vision therapy are still evolving.摘要: 弱视是儿童重要的眼病之一, 并可能对今后的视力造成损害。它是由于形觉剥夺或不正常的双眼交互运动而引起的。儿童期的多种危险因素可导致本病的发生。本团队尝试了光学矫正、遮盖疗法、药物压抑疗法、双眼治疗和手术等方法, 以治疗不同类型的弱视, 如屈光参差性弱视、斜视性弱视以及斜视联合屈光参差性弱视。我们从视力、双眼协调能力和眼位偏差的结果, 回顾了影响儿童不同类型弱视的以往和当前的治疗策略, 并重点强调了近期的研究证据。我们对Pubmed进行了文献检索。儿童弱视的危险因素需要尽早察觉, 并进行相应的治疗和管理, 因为越早治疗, 弱视的视力恢复越好。尽管像遮盖疗法或药物压抑疗法这样的单眼治疗多年来被证明是非常有益的, 但与双眼治疗相关的新概念仍在不断更新。.

Objective We explored differences in postural stability between subgroups of patients with low back pain (LBP) and varying risk levels for developing chronicity measured using the Subgroups for Targeted Treatment (STarT) Back Tool. Methods This was a cross-sectional, single-session, double-blind experimental study among 65 participants who had LBP for more than 14 days. Postural stability was assessed by measuring the center of pressure (COP) range, displacement area, and velocity in anterior–posterior and mediolateral directions under four sensory and cognitive conditions: (i) eyes open and counting forward, (ii) eyes closed and counting forward, (iii) eyes closed and counting forward in multiples of seven, and (iv) eyes closed and counting backward in multiples of seven. The participants were stratified into low-/medium- (n = 53) and high-risk (n = 9) subgroups. Results There were no significant between-group differences among patients with LBP stratified as having a low/medium or high risk of chronicity in postural stability and sensory and cognitive conditions. Conclusions Impaired postural stability is important to consider when treating patients with LBP. However, we found that these impairments were not strongly aggravated in groups with a higher risk of chronicity, as measured using the STarT Back Tool.

The recommended amount of occlusion therapy and amblyopia treatment success rates remains controversial. This study explores rates of occlusion therapy success and attempts to address limitations of previous literature.A retrospective chart review was performed on patients with occlusion therapy outcomes from 2012 to 2019. Equal visual acuity (VA) or stable VA for three consecutive clinical visits, despite reported good compliance defined outcome VA.Results showed 90.3% of subjects obtained outcome distance VA of 0.3logMAR, 76% ≥0.3logMAR, 35% ≥0.2logMAR, and 6% ≥0.1logMAR in the amblyopic eye following treatment. Sixty-nine percent of the study population obtained equal vision following occlusion therapy. Only initial VA (amblyopic eye) and initial interocular visual optotype difference at distance predicted post-treatment success.These results support the conclusion that occlusion therapy, both PTO and FTO, can be effective in treating amblyopia when good compliance is maintained based on parental reports of compliance. Additionally, as VA gain was higher than in previous literature, it is important to continue treatment until VA is equal or three consecutive cycles of stable VA are obtained to ensure maximum VA improvement.

Purpose: To compare the visual outcome of occlusion therapy with virtual reality game playing as a new therapy for children with amblyopia. Methods: This randomized clinical trial was performed on 50 children between 4 and 10 years old who had unilateral amblyopia. They were randomly divided into virtual reality and patching groups (n = 25 in each). The virtual reality group was trained binocularly using the virtual reality games through a head set for 1 hour per day 5 days a week for 4 weeks. Patients in the patching group occluded their non-amblyopic eyes 2, 4, and 6 hours for mild (best corrected visual acuity [BCVA] 0.2 to 0.3 logarithm of the minimum angle of resolution [logMAR]), moderate (0.3 to 0.6 logMAR), and severe (worse than 0.6 logMAR) amblyopia, respectively. Results: The mean BCVA based on logMAR units improved significantly in both groups ( P < .0001), but the difference between the two groups was not significant ( P = .59). BCVA based on the responded letters improved in both groups (virtual reality: P = .0001, patching: P = .001), and change in BCVA in the virtual reality group was higher than in the patching group ( P = .002). Conclusions: Virtual reality game playing was equal or superior to patching in an analysis of linear and letter BCVA, respectively. Therefore, applying this new amblyopia therapy is recommended. [ J Pediatr Ophthalmol Strabismus . 2021;58(3):154–160.]

A single-blind study to investigate the effects of noisy galvanic vestibular stimulation (nGVS) in straight walking and 2 Hz head yaw walking for healthy and bilateral vestibular hypofunction (BVH) participants in light and dark conditions. The optimal stimulation intensity for each participant was determined by calculating standing stability on a force plate while randomly applying six graded nGVS intensities (0–1000 µA). The chest–pelvic (C/P) ratio and lateral deviation of the center of mass (COM) were measured by motion capture during straight and 2 Hz head yaw walking in light and dark conditions. Participants were blinded to nGVS served randomly and imperceivably. Ten BVH patients and 16 healthy participants completed all trials. In the light condition, the COM lateral deviation significantly decreased only in straight walking (p = 0.037) with nGVS for the BVH. In the dark condition, both healthy (p = 0.026) and BVH (p = 0.017) exhibited decreased lateral deviation during nGVS. The C/P ratio decreased significantly in BVH for 2 Hz head yaw walking with nGVS (p = 0.005) in light conditions. This study demonstrated that nGVS effectively reduced walking deviations, especially in visual deprived condition for the BVH. Applying nGVS with different head rotation frequencies and light exposure levels may accelerate the rehabilitation process for patients with BVH.Clinical Trial Registration This clinical trial was prospectively registered at www.clinicaltrials.gov with the Unique identifier: NCT03554941. Date of registration: (13/06/2018).

Purpose: To determine change in visual acuity (VA) in the population of a previous amblyopia treatment study (Loudon 2006) and assess risk factors for VA decrease. Methods: Subjects treated between 2001 and 2003 were contacted between December 2015 and July 2017. Orthoptic examination was conducted under controlled circumstances and included subjective refraction, best corrected VA, reading acuity, binocular vision, retinal fixation, cover-uncover and alternating cover test. As a measure for degree of amblyopia, InterOcular VA Difference (IOD) at the end of occlusion therapy was compared with IOD at the follow-up examination using Wilcoxon’s signed-rank test. Regression analysis was conducted to determine the influence of clinical and socio-economic factors on changes in IOD. Results: Out of 303 subjects from the original study, 208 were contacted successfully, 59 refused and 15 were excluded because of non-amblyopic cause of visual impairment. Mean IOD at end of therapy (mean age 6.4 years) was 0.11 ± 0.16 logMAR, and IOD at follow-up examination (mean age 18.3 years) was 0.09 ± 0.21 logMAR; this difference was not significant (p = 0.054). Degree of anisometropia (p = 0.008; univariable analysis), increasing anisometropia (p = 0.009; multivariable), eccentric fixation (p

Introduction: Amblyopia always presents with monocular and binocular dysfunction. In this study, we aim to investigate the efficacy of alternative occlusion using liquid crystal glasses versus continuous occlusion therapy using traditional patches for treating amblyopia. Methods: Eligible subjects with anisometropic amblyopia were randomized into 2 groups: alternative flicker glass (AFG) or patching group. In the AFG group, subjects were instructed to wear the flicker glasses for 1 h a day. The AFG is a lightweight spectacle frame with liquid crystal lenses that provide direct square-wave alternating occlusion, which were preprogrammed at a temporal frequency of 7 Hz. In the patching group, the patients were prescribed to wear traditional patches for 2 h a day. The best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and stereoacuity were measured at the baseline and 3 and 12 weeks. Results: In this pilot study, a total of 40 children were recruited, with 20 in the AFG group. Mean BCVA improved by 0.17 ± 0.14 logMAR (95% CI = 0.10–0.23) in the AFG group and 0.18 ± 0.18 logMAR (95% CI = 0.09–0.26) in the patching group from baseline to 12 weeks. The improvement in BCVA in both groups was significant (both p < 0.01), while there was no significant difference between the groups (p = 0.82). The CSF of both low and high spatial frequencies exhibited significant improvement at 12 weeks in the AFG group (p < 0.01, respectively) and just had a significant improvement at low spatial frequency in the patching group (p < 0.01). The stereoacuity significantly improved by 504.00 ± 848.00 (95% CI = 107.12 to 900.88) arc seconds in the AFG group (p < 0.05), while it was 263.50 ± 639.55 (95% CI = –35.82 to 562.82) arc seconds in the patching group (p > 0.05). Conclusion: Alternative flicker glass was effective in improving both monocular and binocular function, which was most likely achieved by reducing suppression and promoting binocular fusion. This therapy exhibited promise as an alternative method for amblyopia treatment.

The effects of early visual deprivation on auditory spatial processing are controversial. Results from recent psychophysical studies show that people who were born blind have a spatial impairment in localizing sound sources within specific auditory settings, while previous psychophysical studies revealed enhanced auditory spatial abilities in early blind compared to sighted individuals. An explanation of why an auditory spatial deficit is sometimes observed within blind populations and its task-dependency remains to be clarified. We investigated auditory spatial perception in early blind adults and demonstrated that the deficit derives from blind individual’s reduced ability to remap sound locations using an external frame of reference. We found that performance in blind population was severely impaired when they were required to localize brief auditory stimuli with respect to external acoustic landmarks (external reference frame) or when they had to reproduce the spatial distance between two sounds. However, they performed similarly to sighted controls when had to localize sounds with respect to their own hand (body-centered reference frame), or to judge the distances of sounds from their finger. These results suggest that early visual deprivation and the lack of visual contextual cues during the critical period induce a preference for body-centered over external spatial auditory representations.

While there is evidence that the visual cortex retains a potential for plasticity in adulthood, less is known about the subcortical stages of visual processing. Here, we asked whether short-term ocular dominance plasticity affects the human visual thalamus. We addressed this question in normally sighted adult humans, using ultra-high field (7T) magnetic resonance imaging combined with the paradigm of short-term monocular deprivation. With this approach, we previously demonstrated transient shifts of perceptual eye dominance and ocular dominance in visual cortex (Binda et al., 2018). Here, we report evidence for short-term plasticity in the ventral division of the pulvinar (vPulv), where the deprived eye representation was enhanced over the nondeprived eye. This vPulv plasticity was similar as previously seen in visual cortex and it was correlated with the ocular dominance shift measured behaviorally. In contrast, there was no effect of monocular deprivation in two adjacent thalamic regions: dorsal pulvinar and Lateral Geniculate Nucleus. We conclude that the visual thalamus retains potential for short-term plasticity in adulthood; the plasticity effect differs across thalamic subregions, possibly reflecting differences in their corticofugal connectivity.

A comprehensive understanding of brain-environment interactions is elusive even at the sensory level as neural plasticity waxes and wanes across the lifespan. Temporary and permanent visual deprivations remain pivotal approaches for studying the degree of experience-dependent plasticity of sensory functions. Natural models and experimental manipulations of visual experiences have contributed to uncovering some of the guiding principles that characterize transitions of plastic potentials in the human visual system. The existing literature regarding the neural plasticity associated with visual systems has been extensively discussed by two recent reviews articles ( Roder et al., 2020 ; Castaldi et al., 2020 ) which provided an overview of different models of study and methods of investigations, gathering insights on both developing and adult brains. Here, we propose a framework of three main factors to characterize how the driving forces shaping visual circuits mutate, both quantitatively and qualitatively, between early development and adulthood.

The digital media becomes more and more common in our everyday lives. So it is not surprising that technical progress is also leaving its mark on amblyopia therapy. New media and technologies can be used both in the actual amblyopia therapy or therapy monitoring. In particular in this review shutter glasses, therapy monitoring and analysis using microsensors and newer video programs for amblyopia therapy are presented and critically discussed. Currently, these cannot yet replace classic amblyopia therapy. They represent interesting options that will occupy us even more in the future.Die digitalen Medien erhalten immer mehr Einzug in unseren Alltag. So ist es nicht verwunderlich, dass der technische Fortschritt auch in der Amblyopietherapie seine Spuren hinterlässt. Sowohl in der eigentlichen Therapie als auch in der Therapieüberwachung kommen neue Medien und Technologien zum Einsatz, auf die in diesem Review eingegangen wird. Insbesondere die Shutterbrille, die Therapieüberwachung und -analyse mittels Mikrosensoren und die neueren Videoprogramme für die Amblyopietherapie werden dargestellt und kritisch diskutiert. Aktuell können diese noch nicht die klassische Amblyopietherapie ersetzen. Sie stellen jedoch interessante Möglichkeiten dar, die uns in Zukunft noch mehr beschäftigen werden.

Ocular dominance plasticity (ODP) is a type of cortical plasticity operating in visual cortex of mammals that are endowed with binocular vision based on the competition-driven disparity. Earlier, a molecular mechanism was proposed that catecholamines play an important role in the maintenance of ODP in kittens. Having survived the initial test, the hypothesis was further advanced to identify noradrenaline (NA) as a key factor that regulates ODP in the immature cortex. Later, the ODP-promoting effect of NA is extended to the adult with age-related limitations. Following the enhanced NA availability, the chain events downstream lead to the β-adrenoreceptor-induced cAMP accumulation, which in turn activates the protein kinase A. Eventually, the protein kinase translocates to the cell nucleus to activate cAMP responsive element binding protein (CREB). CREB is a cellular transcription factor that controls the transcription of various genes, underpinning neuronal plasticity and long-term memory. In the advent of molecular genetics in that various types of new tools have become available with relative ease, ODP research has lightly adopted in the rodent model the original concepts and methodologies. Here, after briefly tracing the strategic maturation of our quest, the review moves to the later development of the field, with the emphasis placed around the following issues: (a) Are we testing ODP per se? (b) What does monocular deprivation deprive of the immature cortex? (c) The critical importance of binocular competition, (d) What is the adult plasticity? (e) Excitation-Inhibition balance in local circuits, and (f) Species differences in the animal models.

Purpose: The present study compared the expression of brain-derived neurotrophic factor (BDNF) in the lateral geniculate body between form deprivation amblyopia kittens and normal kittens to examine the significance of BDNF in the lateral geniculate body in the pathogenesis of amblyopia. Methods: Twenty kittens were divided into control group ( n = 10) and deprivation group ( n = 10). A black opaque eye mask was placed to cover the right eye of the deprivation group. Pattern visual-evoked potentials (PVEPs) were detected weekly in all kittens .After the kittens in the deprivation group developed monocular amblyopia, the lateral geniculate bodies of all kittens were removed. The expression of BDNF in the lateral geniculate body of the two groups was compared by immunohistochemistry and Western blotting. Results: The latency of the P100 wave in the right eye of the deprivation group was longer than that of the left eye and that of the right eye of the control group ( p < 0.05), and the amplitude decreased ( p < 0.05). The number and average optical density of BDNF-positive cells in the deprivation group were lower than those in the control group ( p < 0.05), and the expression of BDNF in the deprivation group was lower than that in the control group ( p < 0.05). Conclusions: The expression of BDNF in the lateral geniculate body of the amblyopic kittens decreased, and the decrease in BDNF promoted the development of amblyopia. These results demonstrate that BDNF in the lateral geniculate body plays an important role in visual development.

54 children with anisometropic amblyopia of ages 4-15 years were included in the study - 24 children in the patching and 30 children in the MFBF group. The study ran for a period of 6 months with BCVA assessed at each visit of follow up.In the patching group, visual acuity (VA) gain was 0.37 ± 0.26 log Mar over the course of 6 months with continuous improvement in vision across the three time points (0.20 log mar in the first month, 0.11 log Mar from month1 to 3 and 0.06 log Mar from months 3 to 6).In the Amb I Net group, visual acuity gain was 0.54 ± 0.38 log Mar over the same course of time. A continuous improvement in vision was also noted, with gains of 0.16 in the first month, 0.19 from month 1 to 3 and 0.19 from month 3 to 6. The difference in log Mar gains in VA was not statistically significant between the treatment arms and the final VA was similar (0.25 log Mar for patching and 0.18 log Mar for Amb I net). However, clinically the patching group showed 3 log MAR lines, whereas the MFBF group showed 5 log MAR lines of vision improvement at the end of therapy.MFBF was not superior to patching as far as efficacy is concerned in anisometropic amblyopia. However, the combination of more game options to sustain interest, a shorter duration of therapy over the course of a week and software directed compliance monitoring system favors the Amb I Net system from both patient and parental perspective. Amb I Net also negated discomfort, social stigma, and parental monitoring needed with patching regimens. It can be considered as a good alternative to patching in reluctant/non - compliant children with anisometropic amblyopia. This is the first large cohort study based on this therapy.

Purpose Congenital macular lesions attributed to toxoplasmosis may limit potential visual acuity. The appearance and location of these scars may cause physicians to overlook associated amblyopia. This study reviews the visual outcomes and benefits of amblyopia therapy in children with foveal toxoplasmosis scars. Design Retrospective observational case series. Methods S etting : Single center. P atient Population : Children with presumed foveal toxoplasmosis scars who underwent amblyopia treatment. M ain Outcome Measure : Charts were reviewed for amblyopia treatment, fundus photographs, optical coherence tomography (OCT), and visual acuity. Results Median age at presentation was 2.8 years and median follow-up was 6.2 years. Occlusion therapy was undertaken in 9 patients. Median duration of occlusion therapy was 1.7 years. Six patients improved with occlusion therapy (average 4.6 lines gained on optotype acuity). Final visual acuity ranged from 20/25 to 20/250, with 6 of 8 patients better than 20/80. OCT confirmed macular scars in 5 patients, with varying degrees of foveal architecture disruption. Conclusion Despite the striking appearance of the lesions in patients with presumed foveal toxoplasmosis, visual potential may be better than expected. The appearance of the lesions is not always predictive of visual outcome. A trial of occlusion therapy to treat amblyopia should be initiated in these patients to ensure that they reach their maximal visual potential.

Significance We sought to identify baseline and clinical factors that were predictive of the response to amblyopia treatment. We report that binocular amblyopia treatment may be especially effective for moderate amblyopia in orthotropic children. Purpose We previously reported results from the primary cohort (n = 28) enrolled in a randomized clinical trial (NCT02365090), which found that binocular amblyopia treatment was more effective than patching. Enrollment of an additional 20 children was pre-planned to provide the opportunity to examine factors that may be predictive of response to amblyopia treatment. Methods Forty-eight children (4 to 10 years old) were enrolled, with 24 randomized to contrast-rebalanced binocular game treatment (1 hour a day, 5 days a week) and 24 to patching treatment (2 hours a day, 7 days a week). The primary outcome was change in amblyopic eye best-corrected visual acuity at the 2-week visit. Baseline factors examined were age at enrollment, visual acuity, stereoacuity, and suppression. Clinical factors were etiology, age at diagnosis, prior treatment, and ocular alignment. Results At 2 weeks, visual acuity improvement was significantly greater with the binocular game than patching. Children with moderate amblyopia and orthotropia had more visual acuity improvement with binocular game play than did those with severe amblyopia. In addition, children who spent more time playing the binocular game had more improvement. We were not able to confidently identify any baseline or clinical factors that were associated with response to patching treatment. Conclusions Binocular amblyopia treatment was more effective among orthotropic children with moderate amblyopia than among children with microtropia or severe amblyopia.

Background We reported that in our previous study that wearing intermittent occlusion therapy glasses (IO-therapy) for 4 hours (h) was non-inferior to patching for 2 h in 3 to 8-year-old children with amblyopia. We hypothesize that an intense regimen of 12-h IO-therapy per day for 4 weeks could be as effective as the standard regimen of 4-h IO-therapy per day for 12 weeks in treating moderate amblyopia in 3 to 8-year-old children. Methods/Design A total of 56 children between 3 and 8 years of age with amblyopia in association with anisometropia and/or strabismus will be enrolled. All participants will be prescribed IO-therapy glasses (Amblyz™), set at 30-s opaque/transparent intervals (i.e., occluded 50% of wear time). They will be randomized to receive the standard regimen for 12 weeks or the intense regimen for 4 weeks. Adherence to using the IO-therapy glasses will be objectively monitored in each participant by means of a microsensor dose monitor. The primary study objective is to compare the effectiveness of an intense regimen to a standard regimen of IO-therapy in 3 to 8-year-old children with moderate amblyopia. The secondary study objectives are to determine whether adherence differs between an intense regimen and a standard regimen of IO-therapy, and to determine the dose-response relationship of IO-therapy. Discussion In addition to testing the effectiveness, this study will test for the first time the association between treatment adherence and the visual outcome of IO-therapy, which will enhance our understanding of the dose-response relationship of IO-therapy. If an intense regimen is shown to be effective, it would alter amblyopia treatment strategies and improve visual outcomes. Trial registration ClinicalTrials.gov: NCT02767856. Registered on 10 May 2016.

After years of austerity, the people of Romania rebelled against its communist government despite the oppression of the hated and feared state secret police force, the Securitate. On Christmas day ...

Introduction Long-term confinement is known to be a stressful experience with multiple psycho-physiological effects. In the MARS500 project, a real-time simulation of a space-flight to Mars conducted in a hermetically isolated habitat, effects of long-term confinement could be investigated in a unique manner. The aim of this study was to evaluate effects of long-term-confinement on brain cytoarchitecture. Material & Methods The participants of the MARS500 project underwent 3T-MR imaging including a dedicated DTI-sequence before the isolation, right after ending of confinement and 6 months after the experiment. Voxelwise statistical analysis of the DTI data was carried out using tract-based-spatial statistics, comparing an age-matched control group. Results At all three sessions, significant lower fractional anisotropy (FA) than in controls was found in the anterior parts of the callosal body of the participants. Furthermore, after ending of confinement a wide-spread FA reduction could be seen in the right hemisphere culminating in the temporo-parietal-junction-zone. All these areas with decreased FA predominantly showed an elevated radial diffusivity and mean diffusivity while axial diffusivity was less correlated. Discussion Long-term confinement does have measurable effects on the microstructure of the brain white matter. We assume effects of sensory deprivation to account for the regional FA reductions seen in the right TPJ. The differences in the Corpus callosum were interpreted as due to preliminary conditions, e.g. personality traits or training effects. FA and radial diffusivity were the predominant DTI parameters with significant changes, suggesting underlying processes of myelin plasticity.

Purpose of the study was to quantify the importance of auditory feedback for movement precision in elevated rowing task difficulty with elite athletes under normal and masked hearing conditions. It was hypothesized that rowing with masked hearing would reduce the precision of movement, particularly at the non-usual/less-preferred stroke frequencies (SF). Self-reported questionnaires helped to understand the difficulty of the task. Twenty rowers completed 2 × 1000 m-distance-blocks, each separated into 4 × 250 m, with increasing SF 18, 20, 22 24 strokes/minute once with normal and once with masked hearing. Precision was determined as the deviation between the SF target and the SF actually performed (DSF). Athletes' subjective perception was requested before and after the experiment. A 2 (hearing condition) × 4 (SF 18, 20, 22, 24) repeated measures ANOVA showed systematically larger DSF during masked hearing for all SFs compared to the DSF in the normal hearing condition (

To evaluate the acceptability of a novel occlusion dose monitor (ODM) for glasses wearers with amblyopia. The novel ODM consists of a patch worn over the glasses, a logger affixed to the glasses frame, and a system that processes the logged data for interpretation by an algorithm.In this pilot study, pediatric amblyopes (ages 2-8) were recruited for a cosmesis test of a sham logger for a 1-week period. Patients were then recruited to test a functional ODM for a 2-week period and their parents were asked to document patch wear in a diary. Feedback was solicited using a modified Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Index (ATI).Five children tested the sham logger and eight children tested the functional ODM. Early feedback recommended esthetic modifications including the use of colored shrink wrap to affix the logger to the glasses' frame. The modified patch did not reduce patients' willingness to wear the patch as compared to a standard patch. ODM-recorded wear correlated with diary-recorded wear. The specific timestamps for wear were identical for patients with good ODM-diary concordance.The novel ODM is acceptable for parents and children and correlates with diary records of patch wear.

Binocular treatment for unilateral amblyopia is an emerging treatment that requires evaluation through a randomized clinical trial.This study aimed to compare change in amblyopic-eye visual acuity (VA) in children aged 4 to 6 years treated with the dichoptic binocular iPad (Apple, Cupertino, CA) game, Dig Rush (not yet commercially available; Ubisoft, Montreal, Canada), plus continued spectacle correction versus continued spectacle correction alone.Children (mean age, 5.7 years) were randomly assigned to home treatment for 8 weeks with the iPad game (prescribed 1 h/d, 5 d/wk [n = 92], or continued spectacle correction alone [n = 90]) in a multicenter randomized clinical trial. Before enrollment, children wearing spectacles were required to have at least 16 weeks of wear or no improvement in amblyopic-eye VA (0.1 logMAR) for at least 8 weeks. Outcome was change in amblyopic-eye VA from baseline to 4 weeks (primary) and 8 weeks (secondary) assessed by masked examiner.A total of 182 children with anisometropic (63%), strabismic (16%;5∆ near, simultaneous prism and cover test), or combined-mechanism (20%) amblyopia (20/40 to 20/200; mean, 20/63) were enrolled. After 4 weeks, mean amblyopic VA improved by 1.1 logMAR lines with binocular treatment and 0.6 logMAR lines with spectacles alone (adjusted difference, 0.5 lines; 95.1% confidence interval [CI], 0.1 to 0.9). After 8 weeks, results (binocular treatment: mean amblyopic-eye VA improvement, 1.3 vs. 1.0 logMAR lines with spectacles alone; adjusted difference, 0.3 lines; 98.4% CI, -0.2 to 0.8 lines) were inconclusive because the CI included both zero and the pre-defined difference in mean VA change of 0.75 logMAR lines.In 4- to 6-year-old children with amblyopia, binocular Dig Rush treatment resulted in greater improvement in amblyopic-eye VA for 4 weeks but not 8 weeks. Future work is required to determine if modifications to the contrast increment algorithm or other aspects of the game or its implementation could enhance the treatment effect.

Neural plasticity 2019, 1-21 (2019). doi:10.1155/2019/9603469, Published by Hindawi, New York, NY

To compare uncorrected distance visual acuity (UDVA) and patient-reported outcomes with a new silicone corneal shield and a conventional bandage contact lens (BCL) after photorefractive keratectomy (PRK).Stanford Eye Laser Center (Palo Alto, California) and SladeBaker Vision (Houston, Texas).Prospective randomized cohort study.Standardized bilateral wavefront-guided or wavefront-optimized PRK was performed in 25 patients with myopia. Each patient's dominant eye was randomized to either a silicone corneal shield or a conventional BCL, which was placed at the conclusion of surgery. The contralateral eye was assigned the other intervention. The UDVA and patient-reported outcomes were measured preoperatively, 1 hour after surgery, and at 1, 2, 3, 4, and 7 days postoperatively.At 1 day postoperatively, the mean logarithm of the minimum angle of resolution (logMAR) UDVA was 0.04 ± 0.16 (SD) in the silicone corneal shield group and 0.29 ± 0.22 in the BCL group (P 0.01). At 7 days postoperatively, the mean logMAR UDVA was 0.09 ± 0.17 in the silicone corneal shield group and 0.23 ± 0.24 in the BCL group (P = .01). At 1 day through 3 days postoperatively, the patients reported greater pain, discomfort, foreign body sensation, and heavy eyelid in the eye with the silicone corneal shield. There was no statistically significant difference in the survey outcomes between the two groups at 4 days and 7 days postoperatively.The new silicone corneal shield was safe and effective, with faster visual recovery and a trend toward quicker epithelialization; however, it might be less comfortable than a conventional BCL.

Brief periods of monocular deprivation significantly modify binocular visual processing. For example, patching one eye for a few hours alters the inter-ocular balance, with the previously patched eye becoming dominant once the patch is removed (Lunghi, Burr, & Morrone, 2011; Lunghi, Burr, & Morrone, 2013). However, the contribution of higher-level visual processing to this phenomenon is still unclear. Here, we compared changes in sensory eye dominance produced by three types of monocular manipulations in adult participants with normal binocular vision. One eye was covered for 150 minutes using either an opaque patch, a diffusing lens, or a prism that inverted the image. All three manipulations altered dominance duration and predominance during binocular rivalry (BR) in favour of the treated eye and the time courses of the changes were similar. These results indicate that modifications of luminance or contrast are not strictly necessary to drive shifts in eye dominance, as both were unaltered in the prism condition. Next, we found that shifts in eye dominance were dependent on attentional demands during the monocular treatment period, providing support for the role of attentional eye selection in modulating eye dominance. Finally, we found relatively rapid build-up of the ocular dominance shift after the onset of monocular treatment. Taken together, our results suggest that modifications to monocular input alter inter-ocular balance via selective attentional mechanisms that bias output towards the deprived eye. Eye-based attention may play an important role in conditions where normal input to one eye is disrupted, such as childhood amblyopia.

Purpose Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.

Recent evidence suggests that the primary deficit in amblyopia is loss of binocular vision and that the loss of monocular acuity is a secondary consequence. This new understanding derived from recent laboratory studies questions the present therapy and its primary acuity-based endpoint, which have been the gold standard in the treatment of this condition for the past 200 years.

Early visual deprivation is known to have profound consequences on the subsequent development of spatial visual processing. However, its impact on temporal processing is not well characterized. We have examined spatial and temporal contrast sensitivity functions following treatment for early and extended bilateral visual deprivation in fifteen children born with congenital cataracts in rural India. The results reveal a marked difference in post-treatment spatial and temporal sensitivities. Whereas spatial processing in newly sighted children is significantly impaired relative to age-matched controls, temporal processing exhibits remarkable resilience and is comparable to that in the control group. This difference in spatial and temporal outcomes is especially surprising given our computational analyses of video sequences which indicate a strong linkage between the spatial and temporal spectral content of natural visual inputs. We consider possible explanations for this discrepancy.

Individuals typically exhibit better cross-sensory perception following unisensory loss, demonstrating improved perception of information available from the remaining senses and increased cross-sensory use of neural resources. Even individuals with no sensory loss will exhibit such changes in cross-sensory processing following temporary sensory deprivation, suggesting that the brain's capacity for recruiting cross-sensory sources to compensate for degraded unisensory input is a general characteristic of the perceptual process. Many studies have investigated how auditory and visual neural structures respond to within- and cross-sensory input. However, little attention has been given to how general auditory and visual neural processing relates to within and cross-sensory perception. The current investigation examines the extent to which individual differences in general auditory neural processing accounts for variability in auditory, visual, and audiovisual speech perception in a sample of young healthy adults. Auditory neural processing was assessed using a simple click stimulus. We found that individuals with a smaller P1 peak amplitude in their auditory-evoked potential (AEP) had more difficulty identifying speech sounds in difficult listening conditions, but were better lipreaders. The results suggest that individual differences in the auditory neural processing of healthy adults can account for variability in the perception of information available from the auditory and visual modalities, similar to the cross-sensory perceptual compensation observed in individuals with sensory loss.

The coronavirus (COVID-19) global pandemic has been a poignant reminder of the value of telehealth services to deliver care, especially as a means of reducing the risk of infectious disease transmission caused by close personal contact, decreasing unnecessary travel for medical consultations, and limiting the number of individuals in waiting rooms. The role of telehealth in ophthalmology has historically been limited to store-and-forwarding of images, much like what is used in radiology.Remote evaluation using two-way audio-video communications over the initial 10-week period of clinic shutdowns. Visual acuity (VA) measurement was attempted using a printed single surrounded HOTV or Snellen chart. The VA measurement of fellow eyes was compared to the prior in person clinical visit. External and strabismus examinations were also conducted.Fifty-eight patients were evaluated with a mean age 12.5 years (range 5 months to 82 years). Twenty of 58 (34%) were younger than 5 years of age. Reasons for evaluation were strabismus in 26 patients (45%), refractive error in 25 (43%), and amblyopia in 10 patients (19%). Recognition visual acuity was obtained in 69% (40 of 58), including every patient older than 5 years of age. Nine children from 2 to 5 years of age (mean 3 years) were unable to perform HOTV VA testing. Of nine children unable to do complete VA testing, five had been premature and seven had developmental delay. There was a mean bias of -0.12 logMAR in favor of the prior in office test in the right eyes of 21 non-amblyopic patients. The 95% limits of agreement between the in-person visit and the subsequent telehealth video visit logMAR VA were +0.20 logMAR upper limit, -0.44 logMAR lower limit.Telehealth video visits provided basic ophthalmic information in patients who are physically incapable to come to the office, leading to improved triage. Vision could be tested remotely in young children, but we found substantial variability in the measurement of clinically normal eyes. Improvements in the reliability of at-home visual acuity testing are needed.

Patient compliance with amblyopia therapies, including eye patching and atropine drops, is crucial for optimal visual acuity outcomes. Studies utilizing objective measures of compliance measurement have consistently shown that a majority of patients receive significantly less treatment than prescribed. We review the subjective and objective compliance rates reported in the literature, assess possible explanations for poor compliance, and describe studies of interventions to improve compliance. Additionally, we report our experience implementing Inside Out Care, a novel online platform designed to improve monitoring of amblyopia patient compliance, in our clinics. We have found that this platform, which is accessible via both computer and smartphone, has improved monitoring of amblyopia patient patching compliance, as well as allowed for enhanced doctor-patient communication.

Importance Patching is often less effective for severe amblyopia because of poor adherence. For the treatment of severe amblyopia, although combined atropine and patching therapy (CAPT) has been found to be efficacious, it is currently unknown whether CAPT is more efficacious than patching alone. Objective To compare the efficacy of CAPT vs patching alone in children aged 3 to 12 years with severe amblyopia. Design, setting, and participants This single-center randomized clinical trial was conducted from November 2018 to May 2020. The visual acuity (VA) examiner was masked to the treatment groups. The follow-up visits were at 3 months and 6 months. Participants aged 3 to 12 years with severe amblyopia (20/100 to 20/500) resulting from strabismus, anisometropia, or both were randomly assigned to CAPT or patching therapy. Interventions CAPT or patching alone for 6 months. Main outcomes and measures Change of the amblyopic eye VA from baseline to 6 months. Results Among 108 participants, the mean (SD) age was 5.2 (1.8) years, and 54 (50%) were female. Overall, 53 participants (49%) were randomized to CAPT and 55 (51%) were randomized to patching therapy. At baseline, the mean (SD) amblyopic eye VA was 0.95 (0.22) logMAR (approximately 20/200 [2.2 lines]). At 6 months, the CAPT group's mean improvement in amblyopic eye VA was 0.72 logMAR (7.2 lines) compared with 0.58 logMAR (5.8 lines) in the patching alone group (difference, 0.14 logMAR [1.4 lines] greater in the CAPT group; 95% CI, 0.05-0.22 logMAR [0.5-2.2 lines]; P = .002). The amblyopic eye VA improvement in the CAPT group also was greater than that in the patching alone group at 3 months (difference in the means, 0.13 logMAR [1.3 lines]; 95% CI, 0.04-0.22 logMAR [0.4-2.2 lines]; P = .004). No participants were withdrawn because of adverse effects. Conclusions and relevance CAPT resulted in more mean improvement of amblyopic eye VA than patching alone among participants enrolled in this trial, although the clinical relevance of this relatively small VA difference cannot be determined from this trial. Trial registration Chinese Clinical Trial Registry Identifier: ChiCTR1800018663.

Reduced structural and functional interhemispheric connectivity correlates with the severity of Autism Spectrum Disorder (ASD) behaviors in humans. Little is known of how ASD-risk genes regulate callosal connectivity. Here we show that Fmr1, whose loss-of-function leads to Fragile X Syndrome (FXS), cell autonomously promotes maturation of callosal excitatory synapses between somatosensory barrel cortices in mice. Postnatal, cell-autonomous deletion of Fmr1 in postsynaptic Layer (L) 2/3 or L5 neurons results in a selective weakening of AMPA receptor- (R), but not NMDA receptor-, mediated callosal synaptic function, indicative of immature synapses. Sensory deprivation by contralateral whisker trimming normalizes callosal input strength, suggesting that experience-driven activity of postsynaptic Fmr1 KO L2/3 neurons weakens callosal synapses. In contrast to callosal inputs, synapses originating from local L4 and L2/3 circuits are normal, revealing an input-specific role for postsynaptic Fmr1 in regulation of synaptic connectivity within local and callosal neocortical circuits. These results suggest direct cell autonomous and postnatal roles for FMRP in development of specific cortical circuits and suggest a synaptic basis for long-range functional underconnectivity observed in FXS patients.

This study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances.Retrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances.The proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01-4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99-7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29-10.07, p 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49-4.66, p 0.001) than those from better home circumstances.Orthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes.

Purpose: Charles Bonnet syndrome (CBS) is a syndrome characterised by complex visual hallucinations in individuals who are cognitively normal, though often elderly and visually impaired. Although first described over 250 years ago, the condition remains poorly understood and difficult to treat. Recent findings: Our understanding of CBS pathogenesis has advanced little since it was first described, and much of the recent literature consists of case studies strikingly similar to the first published account of CBS. However, imaging studies have provided some indication as to the cortical areas implicated in the genesis of complex visual hallucinations, and the existence of similar hallucinatory syndromes in other sensory modalities suggests a common underlying mechanism. Summary: This review begins by describing what is currently known about CBS, focusing on epidemiology, clinical presentation and diagnosis. It then explores potential starting points for better understanding the pathogenesis of CBS, namely the existence of similar conditions in other sensory modalities and the reproduction of complex visual hallucinations in sensory deprivation scenarios. Finally, it discusses how CBS should be approached in clinical practice.

To describe the course of intermittent exotropia (IXT) in children followed up without treatment for 3 years.Observation arm from randomized trial of short-term occlusion versus observation.One hundred eighty-three children 3 to 10 years of age with previously untreated IXT and 400 seconds of arc (arcsec) or better near stereoacuity.Participants were to receive no treatment unless deterioration criteria were met at a follow-up visit occurring at 3 months, 6 months, or 6-month intervals thereafter for 3 years.The primary outcome was deterioration by 3 years, defined as meeting motor criterion (constant exotropia ≥10 prism diopters [Δ] at distance and near) or near stereoacuity criterion (≥2-octave decrease from best previous measure). For the primary analysis, participants also were considered to have deteriorated if treatment was prescribed without meeting either deterioration criterion.The cumulative probability of protocol-specified deterioration by 3 years was 15% (95% confidence interval, 10%-22%), but that was likely an overestimate, partly because of misclassification. Among 25 deteriorations, 2 met motor deterioration, 11 met stereoacuity deterioration, and 12 started treatment without meeting either criteria (7 for social concern, 1 for diplopia, 4 for other reasons). Among the 132 participants who completed the 3-year visit and had not been treated during the study, only 1 (1%) met motor or stereoacuity deterioration criteria at 3 years. Of the 4 participants completing the 3-year visit who met deterioration criteria previously and had not started treatment, none still met deterioration criteria. Between the baseline and 3-year examination for these 132 patients, improvement occurred in distance and near stereoacuity (mean improvement, 0.14 and 0.14 logarithm of arcsec; P ≤ 0.001 and P ≤ 0.001, respectively), distance exotropia control (mean improvement, 0.6 points; P ≤ 0.001), and distance exodeviation magnitude (mean improvement, 2.2 Δ; P = 0.002).Among children 3 to 10 years of age with IXT for whom surgery was not considered to be the immediately necessary treatment, stereoacuity deterioration or progression to constant exotropia over 3 years was uncommon, and exotropia control, stereoacuity, and magnitude of deviation remained stable or improved slightly.