School of Optometry & Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, United States.
Handb Clin Neurol. 2021;178:13-30. doi: 10.1016/B978-0-12-821377-3.00002-7.
Amblyopia is a neurodevelopmental abnormality that results in physiological alterations in the visual pathways and impaired vision in one eye, less commonly in both. It reflects a broad range of neural, perceptual, oculomotor, and clinical abnormalities that can occur when normal visual development is disrupted early in life. Aside from refractive error, amblyopia is the most common cause of vision loss in infants and young children. It causes a constellation of perceptual deficits in the vision of the amblyopic eye, including a loss of visual acuity, position acuity, and contrast sensitivity, particularly at high spatial frequencies, as well as increased internal noise and prolonged manual and saccadic reaction times. There are also perceptual deficits in the strong eye, such as certain types of motion perception, reflecting altered neural responses and functional connectivity in visual cortex (Ho et al., 2005). Treatment in young children consists of correction of any refractive error and patching of the strong eye. Compliance with patching is challenging and a substantial proportion of amblyopic children fail to achieve normal acuity or stereopsis even after extended periods of treatment. There are a number of promising experimental treatments that may improve compliance and outcomes, such as the playing of action video games with the strong eye patched. Although there may be a sensitive period for optimal effects of treatment, there is evidence that amblyopic adults may still show some benefit of treatment. However, there is as yet no consensus on the treatment of adults with amblyopia.
弱视是一种神经发育异常，导致视觉通路的生理改变和一只眼（较少见的是双眼）视力受损。它反映了广泛的神经、感知、眼球运动和临床异常，这些异常可能在生命早期正常视觉发育受到干扰时发生。除了屈光不正外，弱视是婴儿和幼儿视力丧失的最常见原因。它导致弱视眼中出现一系列感知缺陷，包括视力、位置视力和对比敏感度下降，特别是在高空间频率下，以及内部噪声增加和手动和扫视反应时间延长。强眼中也存在感知缺陷，例如某些类型的运动感知，反映了视觉皮层中神经反应和功能连接的改变（Ho 等人，2005 年）。在幼儿中，治疗包括矫正任何屈光不正和遮盖强眼。遮盖的依从性具有挑战性，很大一部分弱视儿童即使经过长时间的治疗也无法达到正常的视力或立体视。有一些有前途的实验性治疗方法可能会提高依从性和治疗效果，例如用强眼遮盖玩动作视频游戏。尽管治疗的最佳效果可能存在敏感时期，但有证据表明弱视成年人仍可能从中受益。然而，目前对于弱视成年人的治疗尚无共识。
