Visual Neuroscience Group, School of Psychology, The University of Nottingham, Nottingham, UK.
Ophthalmic Physiol Opt. 2011 Nov;31(6):564-73. doi: 10.1111/j.1475-1313.2011.00873.x.
Amblyopia presents early in childhood and affects approximately 3% of western populations. The monocular visual acuity loss is conventionally treated during the 'critical periods' of visual development by occluding or penalising the fellow eye to encourage use of the amblyopic eye. Despite the measurable success of this approach in many children, substantial numbers of people still suffer with amblyopia later in life because either they were never diagnosed in childhood, did not respond to the original treatment, the amblyopia was only partially remediated, or their acuity loss returned after cessation of treatment.
In this review, we consider whether the visual deficits of this largely overlooked amblyopic group are amenable to conventional and innovative therapeutic interventions later in life, well beyond the age at which treatment is thought to be effective.
There is a considerable body of evidence that residual plasticity is present in the adult visual brain and this can be harnessed to improve function in adults with amblyopia. Perceptual training protocols have been developed to optimise visual gains in this clinical population. Results thus far are extremely encouraging; marked visual improvements have been demonstrated, the perceptual benefits transfer to new visual tasks and appear to be relatively enduring. The essential ingredients of perceptual training protocols are being incorporated into video game formats, facilitating home-based interventions.
Many studies support perceptual training as a tool for improving vision in amblyopes beyond the critical period. Should this novel form of treatment stand up to the scrutiny of a randomised controlled trial, clinicians may need to re-evaluate their therapeutic approach to adults with amblyopia.
弱视在儿童早期出现，影响大约 3%的西方人群。传统上，通过遮盖或惩罚对侧眼来促进弱视眼的使用，以治疗单眼视力丧失，这种方法在儿童视觉发育期的“关键期”内取得了可观的效果。然而，尽管许多孩子都取得了可衡量的成功，但仍有相当数量的人在以后的生活中仍患有弱视，原因可能是他们在儿童时期从未被诊断出患有弱视，对最初的治疗没有反应，弱视只是部分得到纠正，或者在治疗停止后视力丧失又复发。
在这篇综述中，我们考虑了这一大部分被忽视的弱视群体的视觉缺陷是否可以通过传统和创新的治疗干预来治疗，这些治疗干预的时间远远超过了治疗被认为有效的年龄。
大量证据表明，成人视觉大脑中存在相当大的可塑性，这可以被利用来改善弱视成年人的功能。已经开发出了感知训练方案来优化这一临床人群的视觉效果。迄今为止，结果令人非常鼓舞；已经证明了显著的视觉改善，感知益处可以转移到新的视觉任务上，并且似乎相对持久。感知训练方案的基本要素正在被整合到视频游戏格式中，促进了家庭干预。
许多研究支持在关键期后通过感知训练来改善弱视患者的视力，这种新的治疗方法如果经得起随机对照试验的严格审查，临床医生可能需要重新评估他们对弱视成年人的治疗方法。
