Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review

Tsirlin, Inna; Colpa, Linda; Goltz, Herbert C.; Wong, Agnes M. F.

doi:10.1167/iovs.15-16583

Cited by 105 publications

(122 citation statements)

References 112 publications

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“…Recent approaches to visual training include dichoptic visual stimulation (in humans and cats) to normalize the quality of visual input across the strong and weak eye, and the use of action video games, to recruit neuromodulatory pathways that engage attention and motivation (Stryker & Löwel, this volume; Mitchell & Duffy, 2014; Hess & Thompson, 2015; Murphy et al, 2015; Levi et al, 2015). However, the improvements in visual acuity achieved with these methods in humans have been relatively modest to date (Tsirlin et al, 2015, but see; Hess & Thompson, 2015). …”

Section: Reactivating Plasticity To Enhance Recoverymentioning

confidence: 99%

Critical periods in amblyopia

2018

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The shift in ocular dominance (OD) of binocular neurons induced by monocular deprivation is the canonical model of synaptic plasticity confined to a postnatal critical period. Developmental constraints on this plasticity not only lend stability to the mature visual cortical circuitry but also impede the ability to recover from amblyopia beyond an early window. Advances with mouse models utilizing the power of molecular, genetic, and imaging tools are beginning to unravel the circuit, cellular, and molecular mechanisms controlling the onset and closure of the critical periods of plasticity in the primary visual cortex (V1). Emerging evidence suggests that mechanisms enabling plasticity in juveniles are not simply lost with age but rather that plasticity is actively constrained by the developmental up-regulation of molecular ‘brakes’. Lifting these brakes enhances plasticity in the adult visual cortex, and can be harnessed to promote recovery from amblyopia. The reactivation of plasticity by experimental manipulations has revised the idea that robust OD plasticity is limited to early postnatal development. Here, we discuss recent insights into the neurobiology of the initiation and termination of critical periods and how our increasingly mechanistic understanding of these processes can be leveraged toward improved clinical treatment of adult amblyopia.

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Section: Reactivating Plasticity To Enhance Recoverymentioning

confidence: 99%

Critical periods in amblyopia

2018

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“…We believe that there are several reasons why the natural environment is not sufficient. First, under normal binocular viewing, stimuli in the two eyes do not have equal perceived contrast, leading to suppression of the weak eye by the strong eye [18,33,34]. Moreover, for strabismic subjects, the two eyes' images fall on non-corresponding retinal areas, precluding normal fusion and triggering suppression.…”

Section: (B) Real-life Impactmentioning

confidence: 99%

Recovering stereo vision by squashing virtual bugs in a virtual reality environment

Vedamurthy

Knill

Huang

et al. 2016

Phil. Trans. R. Soc. B

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One contribution of 15 to a theme issue 'Vision in our three-dimensional world'. Stereopsis is the rich impression of three-dimensionality, based on binocular disparity-the differences between the two retinal images of the same world. However, a substantial proportion of the population is stereo-deficient, and relies mostly on monocular cues to judge the relative depth or distance of objects in the environment. Here we trained adults who were stereo blind or stereodeficient owing to strabismus and/or amblyopia in a natural visuomotor task-a 'bug squashing' game-in a virtual reality environment. The subjects' task was to squash a virtual dichoptic bug on a slanted surface, by hitting it with a physical cylinder they held in their hand. The perceived surface slant was determined by monocular texture and stereoscopic cues, with these cues being either consistent or in conflict, allowing us to track the relative weighting of monocular versus stereoscopic cues as training in the task progressed. Following training most participants showed greater reliance on stereoscopic cues, reduced suppression and improved stereoacuity. Importantly, the traininginduced changes in relative stereo weights were significant predictors of the improvements in stereoacuity. We conclude that some adults deprived of normal binocular vision and insensitive to the disparity information can, with appropriate experience, recover access to more reliable stereoscopic information.This article is part of the themed issue 'Vision in our three-dimensional world'.

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“…There is increasing interest in the feasibility of treating amblyopia in older children and adults, either with occlusion therapy (Erdem, Cinar et al 2011, Kishimoto, Fujii et al 2014 or other 475 monocular (Evans, Yu et al 2011) and/or binocular methodologies, such as dichoptic training and videogame play (Tsirlin, Colpa et al 2015). Based on the idea that interocular suppression is a cause not a symptom of amblyopia it has been proposed that binocular treatments achieve their results by reducing interocular suppression.…”

Section: Sed and Amblyopiamentioning

confidence: 99%

A comparison of tests for quantifying sensory eye dominance

Bossi

Hamm

Dahlmann‐Noor

et al. 2017

Preprint

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Purpose Clinicians rely heavily on stereoacuity to measure binocular visual function, but stereovision represents only one aspect of binocularity. Lab-based tests of sensory eye dominance (SED) are commonplace, but have not been translated to wider clinical practice. Here we compare several 15 methods of quantifying SED in a format suitable for clinical use. Methods We tested 30 participants with ostensibly normal vision on 8 tests. Seven tests (#1-7) were designed to quantify SED in the form of an interocular balance-point (BP). In tests #1-6, we estimated a contrast-BP, the interocular difference in contrast required for observers to be equally likely to base their judgement on either eye, whereas in test #7 we measured binocular rivalry (interocular ratio of sensory dominance 20 duration). We compare test-retest reliability (intra-observer consistency) and test-validity (interobserver discriminatory power) and compare BP to stereoacuity (test #8). Results The test that best preserved inter-observer differences in contrast balance while maintaining good test-retest reliability was a polarity judgement using superimposed opposite-contrast polarity same-identity optotypes. Conclusions A reliable and valid measure of SED can be obtained rapidly (20 trials) using 25 a simple contrast-polarity judgement. Tests that use polarity-rivalrous stimuli elicit more reliable judgments than those that do not. Significance StatementAlthough sensory eye dominance is central to understanding normal and disordered binocular vision, there is currently no consensus as to the best way to measure it. Here we compare several 30 candidate measures of sensory eye dominance and conclude that a reliable measure of SED can be achieved rapidly using a judgement of stimulus contrast-polarity.

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Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review

Cited by 105 publications

References 112 publications

Critical periods in amblyopia

Critical periods in amblyopia

Recovering stereo vision by squashing virtual bugs in a virtual reality environment

A comparison of tests for quantifying sensory eye dominance

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