A New Approach to Restoring Visual Acuity and Stereopsis in Adults with Amblyopia

弱视是由于生命早期的异常视觉体验而引起的缺陷，最常见的是 两只眼睛没有对准（斜视）或具有不等的屈光不正（屈光参差）。人们早就 被认为是发展成为一个永久性的缺陷，除非在生命的早期得到适当的治疗;然而，最近的研究呼吁， 这是一个问题[1-8]。成人弱视可恢复部分视功能。因此，弱视提供了一个有用的 了解如何解锁成人神经可塑性的模型。我们的主要目标是开发新的干预措施， 通过在主动和被动视觉训练中嵌入视觉训练， 奖励需要立体视觉的视觉任务。我们在当前赠款期间的工作表明， 玩动感十足的视频游戏可以增强弱视成年人视力的几个方面。培训也 单眼或双眼分光条件下的治疗可提高成人的视敏度并减少抑制 弱视然而，现在很明显，知觉学习（PL）和视频游戏（VGP）， 无论是单眼还是双眼视物，仅导致视敏度的适度改善（一到两行），以及 立体视觉仅有有限的改善[1，3 -8]。 最近的许多工作都集中在双眼抑制的作用，作为恢复视觉的关键 在弱视中的作用。具体来说，有人建议治疗应该是分型的，目的是 消除抑制-而不是单眼[5-8]。然而，我们的试点研究将这种方法称为 问题，并提出了一个更直接的方法来提高视力和立体视觉：3D下的训练 条件通过迫使两只眼睛协调和整合它们的信号以服务于共同的输出， 立体视觉为两只眼睛提供了一个独特的共同教学信号， 弱视我们强调立体视觉是新颖的，但它是基于：（1）我们的试点数据，表明在成年人中， 弱视患者的立体视训练不仅直接改善了立体视， 敏锐度和对比敏感度，以及减少的眼间抑制和（2）立体视觉的丧失， 对日常活动产生明显的负面影响，可能会严重影响个人的生活质量， 限制他们的职业选择和活动。最明显的质量缺陷与 弱视是立体深度知觉受损或完全丧失。因此，本提案的目的是： 1)为成人弱视患者开发一个综合的、身临其境的3D视频游戏训练计划; 2）开发 一套成果衡量标准，以评估培训的有效性、机制和“真实的世界”影响 3)直接立体视训练对成人弱视患者视力恢复的效果评价。

Amblyopia is a deficit that arises from abnormal visual experience early in life, most commonly when the two eyes are not aligned (strabismus) or have unequal refractive error (anisometropia). It has long been thought to develop into a permanent deficit unless properly treated early in life; however, recent studies call this into question [1-8]. Adult amblyopes can recover some visual functions. Thus, amblyopia provides a useful model for understanding how to unlock adult neural plasticity. Our main aim is to develop new interventions for restoring visual acuity and stereopsis in adults with amblyopia by embedding visual training in active and rewarding visuomotor tasks that require stereopsis. Our work during the current grant period indicates that playing action-packed video games enhances several aspects of vision in amblyopic adults. Training either monocularly or under dichoptic conditions results in improved visual acuity and reduced suppression in adults with amblyopia. However, it is now clear that both perceptual learning (PL) and videogame play (VGP), whether monocular or dichoptic, result in only a modest improvement in visual acuity (by one to two lines), and only limited improvement in stereopsis [1,3-8]. Much recent work has focused on the role of binocular suppression, as the key to recovering visual functions in amblyopia. Specifically, it has been suggested that treatment should be dichoptic – and aimed at eliminating suppression - rather than monocular [5-8]. However, our pilot studies call this approach into question, and suggest a more direct approach to improving both visual acuity and stereopsis: training under 3D conditions. By forcing the two eyes to coordinate and integrate their signal in the service of a common output, stereopsis provides a unique common teaching signal to the two eyes that may be central to overcoming amblyopia. Our emphasis on stereopsis is novel, but it is based on: (1) our pilot data, showing that in adults with amblyopia, training stereopsis directly resulted not only in improved stereopsis, but also in improved visual acuity and contrast sensitivity, as well as reduced inter-ocular suppression and (2) the loss of stereopsis has demonstrable negative effects on everyday activities that can significantly impact individual's quality of life as well as limit their career choices and activities. The most noticeable qualitative deficit associated with amblyopia is impaired or complete loss of stereoscopic depth perception. Thus, the Aims of this proposal are: 1) To develop an integrated, immersive 3D videogame training program for adults with amblyopia; 2) Develop a battery of outcome measures to evaluate the effectiveness, mechanisms and “real world” impact of training 3) Evaluate the effectiveness of direct training of stereopsis on vision recovery in adult amblyopes.