Vision Therapy in Adults with Convergence Insufficiency: Clinical and Functional Magnetic Resonance Imaging Measures
Vision Therapy in Adults with Convergence Insufficiency: Clinical and Functional Magnetic Resonance Imaging Measures
复制标题
DOI：
10.1097/opx.0b013e3181fef1aa
复制
发表时间：
2010-12-01
影响因子：
1.4
通讯作者：
Biswal, Bharat B.
中科院分区：
文献类型：
--
作者：
Alvarez, Tara L.;Vicci, Vincent R.;Biswal, Bharat B.
目的。这项研究量化了收敛不足 (CI) 受试者与视觉治疗相关的临床测量和功能性神经变化。方法。对 13 名具有正常双眼视力的对照成人受试者和 4 名 CI 成人受试者之间的收敛和发散 4 度阶跃反应进行了比较。所有 CI 受试者都参加了 18 小时的视觉治疗。整个治疗过程中量化的临床参数包括：会聚近点、会聚恢复点、近处正融合聚散度、近分离性隐斜以及使用峰值速度量化的眼球运动。 CI 受试者的神经相关性通过功能性磁共振成像扫描进行量化，使用块设计在视觉治疗前后比较随机与可预测的聚散运动。通过测量激活的空间范围和五个感兴趣区域 (ROI) 内的平均相关性来量化图像。 ROI 是背外侧前额皮质、部分额叶、部分顶叶、小脑和脑干。所有测量均在三名 CI 受试者治疗后 4 个月至 1 年后重复进行。结果。与对照组相比，CI 受试者对步进刺激的收敛平均峰值速度明显较慢 (p = 0.016)；然而，对于发散阶跃响应，未观察到平均峰值速度的显着差异 (p = 0.30)。对参与视觉治疗的 CI 受试者的调查表明，近会聚点、会聚恢复点和近分离性隐斜视显着下降。此外，正融合聚散度、4 度会聚步骤的平均峰值速度以及额叶区域、小脑和脑干内的功能活动量显着增加。一些临床和皮质参数显着相关。结论。与对照组相比，CI 受试者的收敛峰值速度明显较慢，这可能会导致 CI 受试者报告疲劳症状。视觉治疗与临床和皮层活动变化相关，并可能引起临床和皮层活动变化。 （光学可见科学 2010 年；87：E985-E1002）
Purpose. This research quantified clinical measurements and functional neural changes associated with vision therapy in subjects with convergence insufficiency (CI).Methods. Convergence and divergence 4 degrees step responses were compared between 13 control adult subjects with normal binocular vision and four CI adult subjects. All CI subjects participated in 18 h of vision therapy. Clinical parameters quantified throughout the therapy included: nearpoint of convergence, recovery point of convergence, positive fusional vergence at near, near dissociated phoria, and eye movements that were quantified using peak velocity. Neural correlates of the CI subjects were quantified with functional magnetic resonance imaging scans comparing random vs. predictable vergence movements using a block design before and after vision therapy. Images were quantified by measuring the spatial extent of activation and the average correlation within five regions of interests (ROI). The ROIs were the dorsolateral prefrontal cortex, a portion of the frontal lobe, part of the parietal lobe, the cerebellum, and the brain stem. All measurements were repeated 4 months to 1 year post-therapy in three of the CI subjects.Results. Convergence average peak velocities to step stimuli were significantly slower (p = 0.016) in CI subjects compared with controls; however, significant differences in average peak velocities were not observed for divergence step responses (p = 0.30). The investigation of CI subjects participating in vision therapy showed that the nearpoint of convergence, recovery point of convergence, and near dissociated phoria significantly decreased. Furthermore, the positive fusional vergence, average peak velocity from 4 degrees convergence steps, and the amount of functional activity within the frontal areas, cerebellum, and brain stem significantly increased. Several clinical and cortical parameters were significantly correlated.Conclusions. Convergence peak velocity was significantly slower in CI subjects compared with controls, which may result in asthenopic complaints reported by the CI subjects. Vision therapy was associated with and may have evoked clinical and cortical activity changes. (Optom Vis Sci 2010;87:E985-E1002)