Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes.

BACKGROUND: Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus. METHODS: Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus. RESULTS: Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training. CONCLUSIONS: Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Effective connectivity anomalies in human amblyopia.

We investigate the effective connectivity in the lateral geniculate nucleus and visual cortex of humans with amblyopia. Six amblyopes participated in this study. Standard retinotopic mapping stimuli were used to define the boundaries of early visual cortical areas. We obtained fMRI time series from thalamic, striate and extrastriate cortical regions for the connectivity study. Thalamo-striate and striate-extrastriate networks were constructed based on known anatomical connections and the effective connectivities of these networks were assessed by means of a nonlinear system identification method. The effective connectivity of all networks studied was reduced when driven by the amblyopic eye, suggesting contrary to the current single-cell model of localized signal reduction, that a significant part of the amblyopic deficit is due to anomalous interactions between cells in disparate brain regions. The effective connectivity loss was unrelated to the fMRI loss but correlated with the degree of amblyopia (ipsilateral LGN to V1 connection), suggesting that it may be a more relevant measure. Feedforward and feedback connectivities were similarly affected. A hemispheric dependence was found for the thalamo-striate feedforward input that was not present for the feedback connection, suggesting that the reduced function of the LGN recently found in amblyopic humans may not be solely determined by the feedback influence from the cortex. Both ventral and dorsal connectivities were reduced.