Can human amblyopia be treated in adulthood?
Can human amblyopia be treated in adulthood?
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DOI：
10.3109/09273972.2011.600420
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发表时间：
2011-09
期刊：
影响因子：
0.9
通讯作者：
Webb BS
中科院分区：
文献类型：
--
作者：
Astle AT;McGraw PV;Webb BS
弱视是一种常见的视觉障碍，导致受影响的眼睛的空间敏锐度缺陷。正统的治疗方法是长时间遮挡未受影响的眼睛，这在很大程度上取决于诊断时视力缺陷的严重程度。尽管这种治疗方法也存在问题（依从性差，可能降低双眼功能等），但它对许多中度至重度弱视儿童有效。生命早期的诊断和开始治疗被认为是这种治疗成功的关键。对于年龄较大的儿童（10岁以上），由于其视力益处被认为是微不足道的，因此很少进行遮挡。因此，对于闭塞无效的受试者或在大规模筛查计划中遗漏的受试者，在以后的生活中没有替代治疗。最近，越来越多的证据开始揭示成人大脑中以前未被认识到的残余神经可塑性水平，科学家们已经开发出新的遗传、药理学和行为干预措施来激活这些潜在的机制，以利用它们的视觉恢复潜力。其中最突出的是感知学习的概念，即反复练习具有挑战性的视觉任务，随着时间的推移，视觉表现会得到实质性和持久的改善。在正常的视觉系统中，这种改善与训练刺激的属性高度相关。然而，在弱视的视觉系统中，习得的改善已经被证明可以推广到新的任务中。在本文中，我们询问是否可以在成年后减少弱视缺陷，并探讨学习改善的转移模式。我们还表明，制定训练方案，以立体视力的缺陷为目标，即使在成年期也可以恢复正常的立体功能。这一信息将有助于指导该临床组进一步发展基于学习的干预措施。
Amblyopia is a common visual disorder that results in a spatial acuity deficit in the affected eye. Orthodox treatment is to occlude the unaffected eye for lengthy periods, largely determined by the severity of the visual deficit at diagnosis. Although this treatment is not without its problems (poor compliance, potential to reduce binocular function etc.) it is effective in many children with moderate to severe amblyopia. Diagnosis and initiation of treatment early in life are thought to be critical to the success of this form of therapy. Occlusion is rarely undertaken in older children (over 10 years old) as the visual benefits are considered to be marginal. Therefore, in subjects where occlusion is not effective or those missed by mass screening programmes there is no alternative therapy available later in life. More recently, burgeoning evidence has begun to reveal previously unrecognised levels of residual neural plasticity in the adult brain and scientists have developed new genetic, pharmacological and behavioural interventions to activate these latent mechanisms in order to harness their potential for visual recovery. Prominent amongst these is the concept of perceptual learning - the fact that repeatedly practicing a challenging visual task leads to substantial and enduring improvements in visual performance over time. In the normal visual system the improvements are highly specific to the attributes of the trained stimulus. However, in the amblyopic visual system learned improvements have been shown to generalize to novel tasks. In this paper we ask whether amblyopic deficits can be reduced in adulthood and explore the pattern of transfer of learned improvements. We also show that developing training protocols that target the deficit in stereo acuity allows the recovery of normal stereo function even in adulthood. This information will help guide further development of learning-based interventions in this clinical group.