Project Details

Improving visuomotor and visuocognitive outcomes in deprivation amblyopia with binocular treatment

Eileen Birch, PhD

Summary

BACKGROUND: Deprivation amblyopia, due to congenital and infantile cataracts, is likely to have significant, widespread effects on developing visuomotor and visuocognitive abilities and self-perception. Recent animal models challenge the dominant theory that a cataract deprives the developing visual cortex of input during a critical period; a cataract does not only “turn off” input but also results in discordant spontaneous activity, akin to the decorrelation of monocular images experienced in strabismic and anisometropic amblyopia. Thus, as in strabismic and anisometropic amblyopia, we may expect to find widespread effects on developing visuomotor and visuocognitive abilities in deprivation amblyopia that may be responsive to the new binocular approach to amblyopia treatment. GAP: Because the etiology of deprivation amblyopia has been viewed as distinct from strabismic and anisometropic amblyopia, there is only a scant evidence base on the consequences and rehabilitation of deprivation amblyopia. HYPOTHESIS: Hypothesis 1: Deprivation amblyopia has quantifiable and significant effects on developing visuomotor and visuocognitive abilities. Hypothesis 2: Deprivation amblyopia can be treated with contrast-balanced binocular games. METHODS: Children (age 3-14 years) with a history of visually significant congenital or infantile cataracts will be enrolled. Aim 1 is a cross-sectional evaluation of visuomotor skills, visuocognitive skills, self-perception, visual acuity, binocular function, and fixation stability; Aim 2 is a randomized clinical trial of binocular treatment vs. patching in deprivation amblyopia. RESULTS: Children with deprivation amblyopia from a visually significant congenital or infantile cataract: · have impaired fine motor skills, including drawing trail, aiming, and catching compared with controls · motor skill impairment was greater among those with worse affected eye visual acuity · take longer to reach and touch a target than controls, especially in children with worse affected eye visual acuity · have intact binocular reading speed compared with controls, regardless of the severity of visual acuity deficit for the affected eye · have lower self-perception of physical competence and peer acceptance than controls · motor skill impairment was associated with lower self-perception of physical competence and peer acceptance · have significant deficits in fellow eye perception of global motion and motion-defined form · have fixation instability and vergence instability during binocular viewing · show modest improvements in visual acuity when treated with contrast rebalanced binocular games IMPACT: These data will guide the design of school accommodations and interventions to promote academic success and potentially open a new avenue for deprivation amblyopia treatment to surmount obstacles to proficient visuomotor skills, reading, and self-perception.

Publications:

Birch EE, Castañeda YS, Cheng-Patel CS, et al. Self-perception of School-aged Children With Amblyopia and Its Association With Reading Speed and Motor Skills. JAMA Ophthalmol. 2019;137(2):167-174. doi:10.1001/jamaophthalmol.2018.5527

Birch EE, Kelly KR, Giaschi DE. Fellow Eye Deficits in Amblyopia. J Binocul Vis Ocul Motil. 2019;69(3):116-125. doi:10.1080/2576117X.2019.1624440

Birch EE, Castañeda YS, Cheng-Patel CS, et al. Self-perception in Children Aged 3 to 7 Years With Amblyopia and Its Association With Deficits in Vision and Fine Motor Skills. JAMA Ophthalmol. 2019;137(5):499-506. doi:10.1001/jamaophthalmol.2018.7075

Birch EE, Jost RM, Wang YZ, Kelly KR, Giaschi DE. Impaired Fellow Eye Motion Perception and Abnormal Binocular Function. Invest Ophthalmol Vis Sci. 2019;60(10):3374-3380. doi:10.1167/iovs.19-26885

Kelly KR, Morale SE, Wang SX, Stager DR Jr, Birch EE. Impaired fine motor skills in children following extraction of a dense congenital or infantile unilateral cataract. J AAPOS. 2019;23(6):330.e1-330.e6. doi:10.1016/j.jaapos.2019.08.278

Kelly KR, Jost RM, Wang S, Stager Jr D, Birch EE. Binocular reading in children with deprivation amblyopia. Journal of AAPOS, 2020, in press.

Birch EE, Jost RM, Wang SX, Kelly KR. A pilot randomized trial of contrast rebalanced binocular treatment for deprivation amblyopia. Journal of AAPOS, 2020, in press.

Birch EE, Castañeda YS, Cheng-Patel CS, Morale SE, Kelly KR, Wang SX. Self-perception in preschool children with deprivation amblyopia and its association with deficits in vision and fine motor skills. JAMA Ophthalmology, under review.