Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA.
Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania, USA.
CNS Neurosci Ther. 2024 Aug;30(8):e70007. doi: 10.1111/cns.70007.
Convergence Insufficiency (CI) is the most prevalent oculomotor dysfunction of binocular vision that negatively impacts quality of life when performing visual near tasks. Decreased resting-state functional connectivity (RSFC) is reported in the CI participants compared to binocularly normal control participants. Studies report that therapeutic interventions such as office-based vergence and accommodative therapy (OBVAT) can improve CI participants' clinical signs, visual symptoms, and task-related functional activity. However, longitudinal studies investigating the RSFC changes after such treatments in participants with CI have not been conducted. This study aimed to investigate the neural basis of OBVAT using RSFC in CI participants compared to the placebo treatment to understand how OBVAT improves visual function and symptoms.
A total of 51 CI participants between 18 and 35 years of age were included in the study and randomly allocated to receive either 12 one-hour sessions of OBVAT or placebo treatment for 6 to 8 weeks (1 to 2 sessions per week). Resting-state functional magnetic resonance imaging and clinical assessments were evaluated at baseline and outcome for each treatment group. Region of interest (ROI) analysis was conducted in nine ROIs of the oculomotor vergence network, including the following: cerebellar vermis (CV), frontal eye fields (FEF), supplementary eye fields (SEF), parietal eye fields (PEF), and primary visual cortices (V1). Paired t-tests assessed RSFC changes in each group. A linear regression analysis was conducted for significant ROI pairs in the group-level analysis for correlations with clinical measures.
Paired t-test results showed increased RSFC in 10 ROI pairs after the OBVAT but not placebo treatment (p < 0.05, false discovery rate corrected). These ROI pairs included the following: Left (L)-SEF-Right (R)-V1, L-SEF-CV, R-SEF-R-PEF, R-SEF-L-V1, R-SEF-R-V1, R-SEF-CV, R-PEF-CV, L-V1-CV, R-V1-CV, and L-V1-R-V1. Significant correlations were observed between the RSFC strength of the R-SEF-R-PEF ROI pair and the following clinical visual function parameters: positive fusional vergence and near point of convergence (p < 0.05).
OBVAT, but not placebo treatment, increased the RSFC in the ROIs of the oculomotor vergence network, which was correlated with the improvements in the clinical measures of the CI participants.
集合不足（CI）是最常见的双眼视觉动眼功能障碍，当进行视觉近距任务时，会对生活质量产生负面影响。与双眼正常对照组相比，CI 参与者的静息态功能连接（RSFC）降低。研究报告称，治疗干预，如基于办公室的聚散和调节治疗（OBVAT）可以改善 CI 参与者的临床体征、视觉症状和与任务相关的功能活动。然而，对于接受 CI 治疗的参与者，尚未进行研究治疗后 RSFC 变化的纵向研究。本研究旨在通过 RSFC 比较 CI 参与者接受 OBVAT 与安慰剂治疗，以了解 OBVAT 如何改善视觉功能和症状，从而探讨 OBVAT 的神经基础。
本研究共纳入 51 名 18 至 35 岁的 CI 参与者，并将其随机分配接受 12 次 1 小时的 OBVAT 或安慰剂治疗，为期 6 至 8 周（每周 1 至 2 次）。在每个治疗组的基线和结果时，均进行静息态功能磁共振成像和临床评估。在眼球运动汇聚网络的 9 个 ROI 中进行了感兴趣区（ROI）分析，包括：小脑蚓部（CV）、额眼区（FEF）、辅助眼区（SEF）、顶眼区（PEF）和初级视觉皮质（V1）。配对 t 检验评估了每个组的 RSFC 变化。对组水平分析中具有显著相关性的 ROI 对进行线性回归分析，以与临床测量值相关。
配对 t 检验结果显示，OBVAT 治疗后 10 个 ROI 对的 RSFC 增加，但安慰剂治疗后没有增加（p < 0.05，经假发现率校正）。这些 ROI 对包括：左（L）-SEF-右（R）-V1、L-SEF-CV、R-SEF-R-PEF、R-SEF-L-V1、R-SEF-R-V1、R-SEF-CV、R-PEF-CV、L-V1-CV、R-V1-CV 和 L-V1-R-V1。R-SEF-R-PEF ROI 对的 RSFC 强度与以下临床视觉功能参数呈显著相关性：正融像性集合和近点集合（p < 0.05）。
OBVAT 而非安慰剂治疗增加了眼球运动汇聚网络 ROI 的 RSFC，与 CI 参与者的临床测量值改善相关。
