Functional Mechanisms of Neural Control in Convergence Insufficiency

收敛不足的神经控制功能机制

• 批准号: 9728083
• 负责人: Tara Lynn Alvarez
• 金额: $ 12.3万
• 依托单位: NEW JERSEY INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9728083
• 关键词: Activities of Daily Living; Address; Adult; Aftercare; Age; Asthenopia; Behavioral; Binocular Vision Disorder; Blurred vision; Brain Injuries; Cerebellar vermis structure; Cerebellum; Child; Convergence Insufficiency; Cues; Custom; Data; Effectiveness; Enrollment; Exophoria; Eye Movements; Frequencies; Functional Imaging; Functional Magnetic Resonance Imaging; Functional disorder; Headache; Health Care Costs; Home environment; Knowledge; Lead; Longitudinal Studies; Masks; Metabolic; Methods; Modeling; Motor; Movement; Optometry; Parietal Lobe; Patients; Phase; Placebos; Population; Psychological reinforcement; Publishing; Randomized Clinical Trials; Reading; Recovery; Reporting; Research; Resources; Rest; Shapes; Signal Transduction; Site; Stimulus; Strabismus; Symptoms; System; Testing; Therapeutic Intervention; Time; United States National Institutes of Health; Vision; Vision Disparity; Visual; Work; base; clinically significant; cost; design; disparity reduction; experimental study; frontal eye fields; improved; individualized medicine; instrumentation; neuromechanism; neuroregulation; oculomotor; public health relevance; relating to nervous system; remediation; sample fixation; statistics; success; targeted treatment; treatment trial; vision science

DESCRIPTION (provided by applicant): Convergence insufficiency (CI), a prevalent binocular vision disorder in adults and children, is characterized by greater exophoria at near than at distance, reduced fusional convergence amplitude, receded near point of convergence, and a reduced accommodative convergence over accommodation ratio (AC/A). CI is associated with symptoms that include double/blurred vision, eyestrain, and headaches when engaged in reading or other near work, thus interfering with activities of daily living. The recent NEI/NIH multi-center randomized clinical trial, the Convergence Insufficiency Treatment Trial (CITT), demonstrated the effectiveness of Office-Based Vergence and Accommodative Therapy with home reinforcement (OBVAT) for CI, reporting 73% of patients have sustained improvements of vision function and symptoms. Our team published the first fMRI neural substrate data evoked using convergence eye movements in CI patients before and then post- OBVAT. Our results support that with the reduction of visual symptoms, the following were observed: 1) an increase in the percent signal change of functional activity in the frontal eye fields, posterior parietal cortex and the cerebellar vermis, 2) an increase in convergence peak velocity, 3) a decrease in the near point of convergence, 4) an increase in positive fusional amplitude, and 5) a reduction in the amount of exophoria at near.5 The aims of our current proposal are to test the following two hypotheses as potential underlying mechanisms of CI that may be improved post OBVAT: 1) a reduced ability to adapt vergence in near and far space via the 'slow' component of vergence and 2) a reduced ability to quickly diminish disparity error via the 'fast' component of vergence. Not only will our quantitative methods integrated with established CITT standards address important questions about potential mechanisms causing CI, our proposal seeks to identify how a validated vergence therapy may remediate symptoms. Our proposal will determine whether either of these two potential mechanisms are causing CI by quantifying the following: 1) rate and magnitude of phoria adaptation, 2) forced vergence fixation disparity curves, 3) peak velocity of convergence eye movements (studying visual cues such as disparity, accommodation and proximal stimuli in isolation and combination), and 4) the functional activity of the fast and slow vergence neural substrates prior to, and then after, OBVAT. The assembled study team is particularly knowledgeable in terms of OBVAT, convergence insufficiency, optometry, vision science, oculomotor research, functional imaging, modeling and statistics with the necessary resources to successfully complete both aims of this study. Results from our project's aims can lead to targeted treatments with improved success rates, potentially reducing the time to remediate symptoms, and ultimately reducing health care costs.

描述（由申请人提供）：会聚不足（CI）是一种成人和儿童中普遍存在的双眼视觉障碍，其特征是近距离外隐斜比远距离更大、融合会聚幅度减小、近会聚点后退以及调节会聚减少超适应率（AC/A）。 CI 与阅读或其他近距离工作时出现复视/视力模糊、眼睛疲劳和头痛等症状相关，从而干扰日常生活活动。最近的 NEI/NIH 多中心随机临床试验，即收敛不足治疗试验 (CITT)，证明了基于办公室的辐辏和家庭强化调节疗法 (OBVAT) 对 CI 的有效性，报告称 73% 的患者的收敛功能持续改善视觉功能和症状。我们的团队发表了第一个使用 CI 患者在 OBVAT 前后会聚眼球运动诱发的功能磁共振成像神经基质数据。我们的结果支持，随着视觉症状的减少，观察到以下结果：1）额眼区、后顶叶皮层和小脑蚓部功能活动的信号变化百分比增加，2）收敛峰值速度增加，3）近点会聚点的减少，4）正融合幅度的增加，以及 5）近处外隐斜量的减少。5我们当前提案的目的是测试以下两个假设作为 CI 的潜在潜在机制，在 OBVAT 后可能会得到改进：1）通过聚散的“慢”部分适应近处和远空间的聚散能力降低，2）通过“快”部分快速消除视差误差的能力降低聚散度的组成部分。我们的定量方法不仅与既定的 CITT 标准相结合，解决了有关导致 CI​​ 的潜在机制的重要问题，我们的提案还旨在确定经过验证的聚散疗法如何缓解症状。我们的建议将通过量化以下内容来确定这两种潜在机制是否会导致 CI​​：1）隐斜适应的速率和幅度，2）强制聚散注视视差曲线，3）会聚眼球运动的峰值速度（研究视觉线索，例如差异、调节和近端刺激的隔离和组合），以及 4） OBVAT 之前和之后的快和慢聚散神经基质的功能活动。组建的研究团队在 OBVAT、会聚不足、验光、视觉科学、动眼神经研究、功能成像、建模和统计方面知识渊博，拥有成功完成本研究的两个目标所需的资源。我们项目目标的结果可以带来有针对性的治疗，提高成功率，有可能减少缓解症状的时间，并最终降低医疗保健成本。