Binocular Vision, Amblyopia, and Refractive Development in Esotropia

双眼视觉、弱视和内斜视的屈光发育

• 批准号: 8461548
• 负责人: Eileen Elizabeth Birch
• 金额: $ 47.83万
• 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 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8461548
• 关键词: Address; Adult; Affect; Age; Amblyopia; Atropine; Benefits and Risks; Binocular Vision; Child; Congenital Abnormality; Consensus; Data; Development; Early Diagnosis; Early Intervention; Effectiveness; Esotropia; Evaluation; Eye; Eyeglasses; Financial cost; Genetic; Glass; Goals; Growth; Hyperopia; Impairment; Infant; Intervention; Lead; Life; Methods; Modeling; Natural History; Nursery Schools; Operative Surgical Procedures; Pattern; Perinatal; Peripheral; Prevention strategy; Primates; Recurrence; Refractive Errors; Rehabilitation therapy; Reporting; Research; Residual state; Resistance; Resolution; Risk; Role; School-Age Population; Sensory; Series; Shapes; Signal Transduction; Testing; Time; Visual; Visual Accommodation; Visual Acuity; Visual evoked cortical potential; Visual impairment; Weaning; Work; base; central visual field; cohort; critical period; emmetropization; emotional distress; experience; infancy; monocular; novel; preference; prenatal; prevent; prospective; research clinical testing; sample fixation; treatment strategy; young adult

DESCRIPTION (provided by applicant): Infantile and accommodative esotropia (ET) affect 2-3% of children in the U.S. Infantile and accommodative ET disrupt binocular visual experience during the first years of life and may cause amblyopia and severe and permanent impairment of stereoacuity. Amblyopia can be treated but, due to recurrence and persistence of residual amblyopia, it remains the most common form of monocular visual impairment in young adults. Our collaborative research group is now poised to address three critical issues. Aim 1: Current consensus on infantile and accommodative ET is that that early detection and prompt intervention to realign the visual axes can preserve normal stereoacuity. However, our recent work challenges the accepted paradigm and has led us to hypothesize that a congenital deficit in disparity sensitivity is present in the central visual field. We propose to use stereo VEPs, disparity vergence, and accommodative disparity vergence to examine an alternative hypothesis for the first time - that there is a congenital defect in disparity sensitivity in the central 4¿ i infants with infantile ET and in a large subset of children with accommodative ET. These studies will give us a new, broad understanding of binocular deficits infantile and accommodative ET and have a direct translational impact on the clinical evaluation of the risk/benefits of very earl intervention. Aim 2: It is unknown why some children with ET alternate fixation and avoid amblyopia while others develop a preference for one eye and amblyopia. Based on data from primate models of amblyopia and visual evoked potential data on suppression in amblyopic infants and adults, our hypothesis is that asymmetry in suppressive binocular cortical interactions may predispose some esotropic infants and children to develop amblyopia. In addition, we hypothesize that persistent residual amblyopia despite prolonged or repeated treatment is due to the presence of strong asymmetry in suppressive binocular interactions that fails to diminish with occlusion therapy. We propose to use a novel method that allows us to quantify suppressive interactions to determine whether asymmetries in suppression precede amblyopia, whether these asymmetries resolve when treatment is effective, and whether persistent and recurrent amblyopia result from persistent asymmetric suppression. Aim 3: In a unique approach to determining the visual signal that guides emmetropization, we will utilize an infant cohort that shares the distribution of initial refractive errors of normal infants but failsto undergo emmetropization during the first year of life; i.e., infants with infantile esotropia. This approach will be used to identify the missing visually guided mechanism that normally stimulates axial growth to reduce infantile hyperopia. In a prospective evaluation of a preschool/school-age infantile ET cohort, we will, for the first time, examine the influence of axil and peripheral refractive error, accommodation, and ocular shape on the onset and progression of myopic axial growth in school-age children whose emmetropization had previously been inhibited.

描述（由适用提供）：婴儿和可容纳的粘着核（ET）影响美国婴儿和适应性ET的2-3％的儿童在生命的头几年中破坏了双眼的视觉体验，并可能导致弱视，严重且永久性的立体障碍。可以治疗弱视，但由于残留弱视的复发和持续性，它仍然是年轻人中最常见的单眼视觉障碍形式。现在，我们的合作研究小组已中毒，以解决三个关键问题。目的1：目前在基础设施和同意书上的共识是，早期的检测和及时干预以重新调整视觉轴可以保持正常的立体定位。但是，我们最近的工作挑战了公认的范式，并导致我们假设中央视野存在于差异敏感性的先天性赤字。我们建议使用立体声VEP，差距和适应性的差异范围，以首次检查替代假设 - 中央4的婴儿在患有婴儿ET和大量儿童附件ET的儿童中存在差异敏感性的先天性缺陷。这些研究将使我们对双眼防御能力的婴儿和可容纳ET的全新了解，并对早期干预的风险/好处的临床评估产生直接翻译影响。目标2：尚不清楚为什么有些患有ET替代固定的孩子并避免弱视，而另一些孩子则偏爱一只眼睛和弱视。基于弱视的灵长类动物模型以及弱视婴儿和成年人抑制的潜在数据的数据，我们的假设是，抑制性双眼皮质相互作用的不对称性可能会使某些尤其是婴儿和儿童诱发弱视。此外，我们假设持续的残留弱视延长或重复治疗是由于在抑制性双眼相互作用中存在强不对称性，而闭塞治疗无法减少。我们提出目标3：在确定指导弹性化的视觉信号的独特方法中，我们将利用一个婴儿队列，共享正常婴儿的初始折射误差的分布，但在生命的第一年中，Failsto会经历弹性化；即，婴儿息肉的婴儿。这 方法将用于确定通常会刺激轴向生长以减少基础设施远视的视觉引导机制。在对学龄前/学龄的基础设施和同类群体的前瞻性评估中，我们将首次研究轴突和周围屈光度误差，适应性和眼形形状对近视轴向生长的发作和进展，而这些儿童的近视轴向生长和进展均以先前抑制了其富有症状的孩子的影响。