Binocular Vision, Amblyopia, and Refractive Development

双眼视觉、弱视和屈光发育

• 批准号: 10766505
• 负责人: Eileen Elizabeth Birch
• 金额: $ 20.22万
• 依托单位: RETINA FOUNDATION OF THE SOUTHWEST
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-02-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10766505
• 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; Contrast Sensitivity; Data; Development; Devices; Diagnosis; Early Diagnosis; Environment; Esotropia; Eye; Eye Movements; Foundations; Future; Goals; Grant; Impairment; Investigation; Lazy Eyes; Measurement; Measures; Methodology; Methods; Monitor; Motor Skills; Optokinetic nystagmus; Outcome Measure; Performance; Play; Qualifying; Reading; Recovery; Recurrence; Research; Residual state; Retina; Risk; Saccades; Self Perception; Severities; Specialist; Speed; Strabismus; Treatment Protocols; Treatment outcome; Vision; Vision Disorders; Visual; Visual Acuity; Visual impairment; clinical diagnosis; clinical outcome measures; cost; design; effective therapy; effectiveness evaluation; experience; improved; novel; oculomotor; portability; preference; primary outcome; relative effectiveness; remediation; response; sample fixation; self esteem; success; therapy design; 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.

项目摘要/摘要 弱视是一种神经发育视力障碍，影响3％的儿童。这是由于不和谐的 童年时期的视觉体验，通常来自斜视或肛门图。斜视和 Anisometropic amblyopia会损害一只眼睛的视力和对比度灵敏度。通常，破坏了 双眼视力（降低或零立体稳定和眼内抑制），眼运动异常是 也存在。这些赤字与降低的运动技能和阅读速度有关 双眼观察。反过来，这些相关的赤字可能会影响儿童的学术成就和自尊。 在当前的项目期间，我们确定了异常双眼视力与固定之间的关联 不稳定性，发现眼内抑制在弱视的发作之前 抑制与弱视的深度相关，该抑制作用降低了双眼弱视 治疗，并研究了旨在减少抑制和改善的新的双眼弱视治疗 视力。尽管我们的双眼治疗导致视力持续改善，但这些早期研究 在四个方面受到限制：1）治疗方案是为短期治疗试验而设计的，持续<4 几周因此，双眼治疗的最大改善尚不清楚，2）没有任何治疗方案 专门设计以提高立体性，3）视力是所有的主要结果度量 研究，因此我们对补丁与双眼治疗的相对有效性一无所知 修复精细的运动杀手，阅读速度和自尊心，以及4）治疗仅应用于 弱视儿童4岁及以上。我们的合作研究小组现在准备解决这些问题 关键问题。在AIM 1中，我们将评估增强双眼弱视治疗的有效性 实现更完整和稳定的恢复。在AIM 2中，我们将评估成功的弱视的影响 治疗（修补或双眼治疗）对精细运动技能，阅读速度和自我感知。在AIM 3中， 我们将使用诱导和 将反身眼运动（OKN）测量到消失的光学型的移动场。结论是我们的 研究增强的双眼治疗方案以及弱视治疗对 日常任务的执行将为新的，更有效的弱视治疗的设计提供信息 采用新的结果指标（阅读，精细运动技能和自尊心）进行临床试验。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 美国在此年龄范围内进行未来的弱视治疗试验。