Binocular Vision, Amblyopia, and Refractive Development

项目摘要/摘要 弱视是一种神经发育性视力障碍，影响3%的儿童。这是不和谐的结果 儿童时期的视觉体验，通常来自斜视或屈光参差。斜视和斜视 屈光参差性弱视损害单眼的视力和对比敏感度。通常情况下，中断 双眼视力(立体视力降低或为零和眼间抑制)，以及眼运动异常 也在现场。这些缺陷与精细运动技能和阅读速度降低有关，即使在 双目观察。反过来，这些相关的缺陷可能会影响孩子的学业成功和自尊。 在目前的项目期间，我们确定了异常双眼视觉和注视之间的关联。 不稳定，发现眼间抑制在弱视发病之前，弱视的严重程度 抑制与弱视的深度相关，双眼弱视的抑制程度降低 治疗，并研究了新的双眼弱视治疗方法，旨在减少抑制和改善 视觉敏锐度。虽然我们的双眼治疗导致了视力的持续改善，但这些早期研究 在4个方面受到限制：1)治疗方案是为短期治疗试验设计的，持久；4 因此双眼治疗的最大改善是未知的，2)没有治疗方案 都是专门为提高立体视力而设计的，3)视力是所有 这些研究，所以我们对修补和双眼治疗的相对有效性知之甚少。 恢复良好的运动技能、阅读速度和自尊，以及4)治疗仅应用于 4岁及以上的弱视儿童。我们的合作研究小组现在准备解决这些问题 关键问题。在目标1中，我们将评估增强型双眼弱视治疗的效果 实现更加全面稳定的复苏。在目标2中，我们将评估成功治疗弱视的效果。 治疗(修补或双眼治疗)对精细运动技能、阅读速度和自我知觉的影响。在《目标3》中， 我们将使用一种设备来评估一种针对3岁儿童的新型视力测量，该设备可以感应和 测量自反性眼球运动(OKN)对消失的视标移动场的影响。最后，我们的 增强型双眼治疗方案及弱视治疗对视力影响的研究 日常任务的执行将为设计新的、更有效的弱视治疗方法和 临床试验采用新的结果衡量标准(阅读、精细运动技能和自尊)。此外, 我们将有一种准确的方法来诊断和监测1至3岁儿童的弱视，这将使 美国将在这个年龄段进行未来的弱视治疗试验。

Project Summary/Abstract Amblyopia is a neurodevelopmental vision disorder that affects 3% of children. It results from discordant visual experience during childhood, most often from strabismus or anisometropia. Strabismic and anisometropic amblyopia impair the visual acuity and contrast sensitivity of one eye. Typically, disrupted binocular vision (reduced or nil stereoacuity and interocular suppression), and ocular motor abnormalities are also present. These deficits are associated with reduced fine motor skills and reading speed even during binocular viewing. In turn, these associated deficits may affect academic success and self-esteem in children. During the current project period, we identified an association between abnormal binocular vision and fixation instability, discovered that interocular suppression precedes the onset of amblyopia, that the severity of suppression is correlated with the depth of amblyopia, that suppression is reduced with binocular amblyopia treatment, and investigated new binocular amblyopia treatments designed to reduce suppression and improve visual acuity. While our binocular treatment led to sustained improvement in visual acuity, these early studies were limited in 4 respects: 1) the treatment protocols were designed for short-term treatment trials, lasting <4 weeks so the maximum improvement with binocular treatment is unknown, 2) none of the treatment protocols were specifically designed to improve stereoacuity, 3) visual acuity was the primary outcome measure in all of the studies, so we know little about the relative effectiveness of patching versus binocular treatment in rehabilitating fine motor kills, reading speed, and self-esteem, and 4) the treatments have only been applied to amblyopic children age 4 years and older. Our collaborative research group is now poised to address these critical issues. In Aim 1, we will evaluate the effectiveness of enhanced binocular amblyopia treatments in achieving a more complete and stable recovery. In Aim 2, we will evaluate the effects of successful amblyopia treatment (patching or binocular treatment) on fine motor skills, reading speed, and self-perception. In Aim 3, we will evaluate a novel visual acuity measurement for <3-year-old children using a device that induces and measures reflexive eye movements (OKN) to moving fields of vanishing optotypes. Upon conclusion, our investigation of enhanced binocular treatment protocols and the effects of amblyopia treatment on the performance of everyday tasks will inform the design of new, more effective amblyopia treatments and the adoption of new outcome measures (reading, fine motor skills, and self-esteem) for clinical trials. In addition, we will have an accurate method to diagnose and monitor amblyopia in 1- to 3-year old children that will allow us to conduct future amblyopia treatment trials in this age range.