Barberán-Bernardos Laura, Jiménez Natalia, Piñero David P
Department of Optics, Pharmacology and Anatomy University of Alicante, Alicante, Spain.
Department of Ophthalmology (IMQO-Oftalmar) Vithas Medimar International Hospital, Alicante, Spain.
J Ophthalmol. 2024 Jul 30;2024:5586202. doi: 10.1155/2024/5586202. eCollection 2024.
To investigate if the use of vision therapy (VT) in convergence insufficiency (CI) has a significant neural impact and how it correlates with the clinical changes occurring with this option of treatment.
A systematic review of the scientific literature was carried out in the PubMed and Scopus databases, where all the scientific literature on the neural impact of VT in CI was analyzed. A total of 17 articles were initially found and a detailed analysis was carried out. After full-text reading, only four studies met the defined inclusion criteria. The following data from them were extracted: CI cases and controls, clinical and neural parameters evaluated, the neural response to VT observed, type of study, and VT performed. The quality of the studies was assessed using the GRADE tool.
Some neural changes have been reported after VT in CI with the use of functional magnetic resonance imaging (fMRI). Specifically, a modification of the functional activity of some brain areas (especially front fields, oculomotor vermis, and cerebellum) was found. However, contradictory findings in terms of the change in functional activity (increase or decrease) were found that might be associated to differences in fMRI protocols. In the GRADE analysis, serious concerns were found in the categories of risk of bias, inconsistency, indirectness, and imprecision, so the certainty of evidence for each outcome was very low.
The research performed to this date does not allow confirming if there are neural changes occurring after vision therapy in patients with CI because the quality of the research performed on this issue is very low, with several methodological concerns.
探讨在集合不足（CI）中使用视觉疗法（VT）是否具有显著的神经影响，以及它与这种治疗方法所产生的临床变化之间的相关性。
在PubMed和Scopus数据库中对科学文献进行系统综述，分析所有关于VT对CI神经影响的科学文献。最初共找到17篇文章，并进行了详细分析。在全文阅读后，只有四项研究符合定义的纳入标准。从中提取了以下数据：CI病例和对照、评估的临床和神经参数、观察到的VT神经反应、研究类型以及所进行的VT。使用GRADE工具评估研究质量。
在CI中使用功能磁共振成像（fMRI）进行VT后，已报告了一些神经变化。具体而言，发现某些脑区（特别是额叶、动眼神经蚓部和小脑）的功能活动发生了改变。然而，在功能活动变化（增加或减少）方面发现了相互矛盾的结果，这可能与fMRI方案的差异有关。在GRADE分析中，在偏倚风险、不一致性、间接性和不精确性类别中发现了严重问题，因此每个结果的证据确定性非常低。
迄今为止所进行的研究无法证实CI患者在视觉治疗后是否会发生神经变化，因为针对该问题所进行研究的质量非常低，存在多个方法学问题。
