Binocular Vision, Amblyopia, and Refractive Development

双眼视觉、弱视和屈光发育

• 批准号: 10356044
• 负责人: Eileen Elizabeth Birch
• 金额: $ 53.38万
• 依托单位: RETINA FOUNDATION OF THE SOUTHWEST
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-05-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10356044
• 关键词: 3 year old; 4 year old; 5 year old; Address; Adoption; Adult; Affect; Age; Amblyopia; Anisometropia; Binocular Vision; Blurred vision; Caring; Child; Childhood; Clinical Trials; Collaborations; Contrast Sensitivity; Data; Development; Devices; Diagnosis; Environment; Esotropia; Eye; Eyeglasses; Foundations; Future; Goals; Grant; Impairment; Investigation; Lazy Eyes; Measurement; Measures; Methodology; Methods; Monitor; Motor; Motor Skills; Optokinetic nystagmus; Outcome Measure; Performance; Play; Reading; Recovery; Recurrence; Reflex eye movement; Research; Residual state; Retina; Risk; Self Perception; Severities; Specialist; Speed; Strabismus; Treatment Protocols; Vision; Vision Disorders; Visual; Visual Acuity; Visual impairment; clinical diagnosis; clinical outcome measures; cost; design; effectiveness evaluation; experience; improved; novel; oculomotor; portability; preference; primary outcome; relative effectiveness; response; sample fixation; self esteem; success; therapy design; treatment response; treatment trial; vision rehabilitation

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.

项目概要/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 童年时期的视觉体验，最常见的是斜视或屈光参差。斜视和 屈光参差性弱视会损害一只眼睛的视力和对比敏感度。通常，中断 双眼视力（立体视力下降或为零，眼间抑制）和眼部运动异常 也存在。这些缺陷与精细运动技能和阅读速度的降低有关，即使在 双目观察。反过来，这些相关的缺陷可能会影响儿童的学业成功和自尊。 在当前项目期间，我们发现异常双眼视觉与注视之间存在关联 不稳定，发现眼间抑制先于弱视的发生，并且弱视的严重程度 抑制与弱视深度相关，双眼弱视抑制减弱 治疗，并研究了新的双眼弱视治疗方法，旨在减少抑制并改善 视力。虽然我们的双眼治疗使视力持续改善，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而设计的，持续<4 数周，因此双眼治疗的最大改善未知，2）没有任何治疗方案 专门设计用于提高立体视力，3) 视力是所有研究中的主要结果指标 这些研究，所以我们对遮盖治疗与双眼治疗的相对有效性知之甚少 恢复精细运动能力、阅读速度和自尊，以及 4) 这些治疗仅适用于 4 岁及以上弱视儿童。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，我们将评估增强双眼弱视治疗的有效性 实现更彻底、更稳定的康复。在目标 2 中，我们将评估成功弱视的影响 对精细运动技能、阅读速度和自我感知进行治疗（修补或双眼治疗）。在目标 3 中， 我们将使用一种设备来评估一种新颖的 3 岁以下儿童视力测量方法，该设备可诱发和 测量视标消失的移动区域的反射性眼球运动 (OKN)。得出结论后，我们的 增强双眼治疗方案及弱视治疗对视力影响的研究 日常任务的表现将为设计新的、更有效的弱视治疗方法和 在临床试验中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，这将允许 我们未来将在这个年龄段进行弱视治疗试验。