背景:收敛功能不全(CI)是最普遍的双眼视觉动眼功能障碍,在执行视觉近距离任务时会对生活质量产生负面影响。与双眼正常对照参与者相比,CI参与者的静息状态功能连通性(RSFC)降低。研究报告说,治疗性干预措施,如基于办公室的聚散度和调节疗法(OBVAT)可以改善CI参与者的临床症状,视觉症状,和任务相关的功能活动。然而,尚未进行纵向研究调查CI参与者接受此类治疗后RSFC的变化.这项研究旨在研究使用RSFCinCI参与者与安慰剂治疗相比OBVAT的神经基础,以了解OBVAT如何改善视觉功能和症状。
方法:共有18至35岁的51CI参与者被纳入研究,并随机分配接受12次1小时OBVAT治疗或6至8周的安慰剂治疗(每周1至2次)。在基线和结果评估每个治疗组的静息状态功能磁共振成像和临床评估。在动眼聚散度网络的9个ROI中进行了感兴趣区域(ROI)分析,包括:小脑疣(CV),正面眼场(FEF),补充眼场(SEF),顶叶视野(PEF),和初级视觉皮层(V1)。配对t检验评估每组的RSFC变化。在与临床测量的相关性的组水平分析中,对显著的ROI对进行线性回归分析。
结果:配对t检验结果显示OBVAT治疗后10对ROI中RSFC增加,但安慰剂治疗无效(p<0.05,错误发现率校正)。这些ROI对包括以下内容: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。在R-SEF-R-PEFROI对的RSFC强度与以下临床视觉功能参数之间观察到显着相关性:正融合聚散度和近收敛点(p<0.05)。
结论:OBVAT,但不是安慰剂治疗,增加了动眼聚散度网络ROI中的RSFC,这与CI参与者临床指标的改善相关。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.