Binocular Approaches to Perceptual Learning in Adult Amblyopia

描述(由申请人提供)：拟议计划的目标是将Cristina Llerena Law博士培训为临床科学家和以患者为基础的独立研究人员，并开发和评估理论上有动力的双眼疗法在成人弱视治疗中的价值。出生后早期眼睛视觉输入的不对称会导致弱视，这是人类单眼视力损害的最常见基础。如果不矫正，弱视会导致未受影响的眼睛控制双眼视觉皮质，而受影响眼睛刺激皮质神经元的能力可能会减弱到功能性失明的程度。以前试图恢复成人弱视视力的成功有限，最近的数据表明，双眼训练技术可以使双眼的神经元反应正常化，可能会增强学习效果(Hess等人，2010；Ding等人，2006)。使用混合对比度刺激的知觉学习程序可能非常适合成人弱视的视觉训练，在这种情况下，视觉皮质突触可塑性的限制可能会阻碍传统的单眼训练技术的有效。最近的工作建立了测量双眼视觉期间双眼之间平衡输入的眼间对比度(ICR)的新方法(Mansouri等人，2008；Huang等人，2009)。我们将评估这些已建立的方法的有效性，并设计我们自己的协议来测量这个参数。然后，我们将在成人弱视的双眼训练中利用这种对称的感觉输入，使用新的和现有的知觉学习程序。我们相信，利用双眼的双目视觉和相等的感觉输入的技术可以促进成人弱视患者视觉功能的恢复，这将有望成为成人弱视的新的非侵入性治疗方法。这项拟议的工作将利用脑磁图(MEG)来测量弱视眼睛的反应，并首次使用类似于先前使用的VEP/EEG的分视混合时间-频率刺激来测量双眼相互作用。Llerena Law博士组建了一个由导师、合作者和顾问组成的团队，为她提供过渡到独立患者研究的最佳工具。这个团队的组建也很理想，可以为劳博士提供资源和技能，通过对包括心理物理学和生理学在内的视觉功能的全面分析来检验这一假设，并在实验期间跟踪关键里程碑的视觉功能变化。如果成功，这项工作将改变成人弱视的治疗方法，并将注意力集中在纳入减少抑制的方法的重要性上。此外，从这项工作中获得的洞察力可以扩展到斜视、眼动控制障碍以及创伤性脑损伤后最佳神经功能的恢复。

DESCRIPTION (provided by applicant): The goals of the proposed plan are to train Dr. Cristina Llerena Law as a clinician scientist and independent patient based researcher and to develop and assess the value of theoretically motivated binocular treatments for amblyopia in adult humans. An asymmetry in the visual input across the eyes early in postnatal life causes amblyopia, the most common basis of monocular visual impairment in humans. If uncorrected, amblyopia results in the unaffected eye controlling the binocular visual cortex, while the ability f the affected eye to stimulate cortical neurons may weaken to the point of functional blindness. Previous attempts to recover vision in adult amblyopes have had limited success, and recent data suggest that binocular training techniques, which normalize neuronal responses across the two eyes, may enhance learning effects (Hess et al, 2010; Ding et al, 2006). The use of perceptual learning procedures with mixed-contrast stimuli may be ideally suited for vision training in adult amblyopes, where limitations in synaptic plasticity in visual cortex may prevent conventional monocular training techniques from being effective. Recent work has established new methods for measuring inter-ocular contrast ratios (ICR) that provide balanced inputs, between the two eyes, during binocular vision (Mansouri et al, 2008; Huang et al, 2009). We will assess the validity of these established methods and design our own protocols for measuring this parameter. We will then exploit this symmetric sensory input during binocular training in adult amblyopes using both new and established perceptual learning procedures. We believe that techniques which harness the use of binocularity and equal sensory input between the two eyes may provide enhanced recovery of visual function in adult amblyopes, which would promise new non-invasive treatments of adult amblyopia. The proposed work will make use of magnetoencephalography (MEG) both to measure responses from the amblyopic eye, and for the first time, to measure binocular interactions using dichoptic mixed temporal-frequency stimuli similar to stimuli used previously with VEP/EEG. Dr. Llerena Law has assembled a team of mentors, collaborators, and consultants to provide her with the best tools to make a transition into independent patient based research. This team has also been ideally assembled to provide Dr. Law with the resources and skills to test this hypothesis, using a comprehensive analysis of visual functions, including psychophysics and physiology, and to track changes in visual function at key milestones during the experiment. If successful, this work would transform therapy for adult amblyopia, and focus attention on the importance of incorporating methods to reduce suppression. In addition, the insight gained from this work could be extended to strabismus, eye movement control disorders, and the restoration of optimal neural function after damage from traumatic brain injury.