A randomized study of network-based perception learning in the treatment of amblyopia children

INTRODUCTION

Amblyopia reduces the best-corrected visual acuity(BCVA) of one or both eyes without any organic cause.It is a common eye disease and the most common cause of vision loss among children and adults, with the pooled prevalence rate of amblyopia was about 1.44%

. Amblyopia affects vision and visual function, such as spatial resolution,contrast sensitivity, color vision, stereoscopic vision, which have different effects on all aspects of life

.

Participants that met the inclusion criteria were randomly assigned to either NBPL group (

=28) or control group (

=28) based on the random number table method.After being enrolled in the two groups, they were given corresponding treatment. All results were based on the comparison between NBPL and the control group. Because of the small sample size, we did not further stratify the analysis within the group.

For centuries the main approach to the treatment of amblyopia consisted of optical correction of any refractive error and occlusion or penalization of the “strong” eye, thus “forcing”the brain to use the input from the “weaker” amblyopic eye

.However, it does not help much in building binocular function.Furthermore, due to the lack of binocular vision, there is always a high recurrence rate, and some patients have residual amblyopia

. Research in recent years suggested that binocular cortical communication persists in subjects with amblyopia

.These findings prompted that activation of these persistent binocular neural circuits might be exploited to ‘awaken’an amblyopic eye. Therefore, binocular vision training is considered necessary to treat amblyopia, which is essential for establishing visual function

.

In the past, we used traditional visual training eyesight exercises to improve children’s stereoacuity, such as needle threading, wearing beads, and tracing. Nowadays, with the development of computer technology, many visual perception trainings have emerged

. Visual perceptual learning is the improvement in visual task performance with practice or training. It reflects learning and plasticity in the visual system and a network of other brain substrates of behavior

.Visual perceptual learning has been used to improve visual performance in different conditions, including amblyopia,presbyopia, low vision, cortical blindness, and rehabilitation after surgical interventions

.

The network-based perception learning (NBPL) system is a multimedia bio-stimulation perceptual learning software program. The program directly targets the binocular function using dichoptic presentation and presents 3D images using a complete split screen view. The program is based on visual biometric information stimulation and has various perceptual learning training games, making the training process attractive.It utilizes cloud medical technology; when the data center receives the patient’s visual function test results or medical record data uploaded by the client, the intelligent expert system in the cloud can instantly develop targeted, individualized visual training plans for amblyopia patients. With this program, all patients’ treatment information will be preserved,facilitating the doctor’s tracking and management of the patient’s treatment.

It is unclear whether visual perceptual training or traditional training is better in the treatment of amblyopia, especially in the improvement of visual acuity (VA) and stereopsis.Therefore, we evaluated the effectiveness of visual perceptual training in untreated amblyopic children between 4-12y using the NBPL system.

SUBJECTS AND METHODS

The study protocol was approved by the Ethics Committee of Tongji Hospital affiliated to Tongji University in Shanghai. Detailed signed informed consent was obtained from each subject and their guardians before the research. Trial registration: Chinese Clinical Trial Registry,ChiCTR. Trial ID: ChiCTR1800015444. Registered March 30,2018.

This study is a randomized controlled trial to assess the effectiveness of a network vision treatment for amblyopia.Between February 20, 2016, and May 20, 2018, a total of 56 amblyopic subjects (25 males, 31 females) with a mean age of 6.7y (range, 4-12y) were enrolled in this study.

Participants were recruited

ophthalmologists in Tongji Hospital affiliated to Tongji University, Shanghai. Eligible children 4 to 12 years old were diagnosed as having anisometropic and/or strabismic amblyopia. All patients underwent a baseline ophthalmological examination, including visual testing, manifest and cycloplegic refraction, cover test, Worth four dot test, anterior segment examination with the slit lamp, corneal topography, and funduscopy. The eligible children had amblyopic eye BCVA of 0.2 to 1.0 logMAR (20/32 to 20/200). Children who had prior treatment with either patching or atropine penalization were not eligible for recruitment providing.

正如習近平總書記所言，要回答“世界怎么了、我們怎么辦？”的問題，首先要弄清楚“我們從哪里來、現在在哪里、將到哪里去？”這一最基本的問題，首先需要把握人類的共同價值訴求。對此，習近平總書記認為：“和平、發展、公平、正義、民主、自由，是全人類的共同價值，也是聯合國的崇高目標。”［6］522而這些任務至今遠遠沒有完成。

None of the children had systemic disease, congenital infections, malformations, or coexisting ocular disease (previous ocular surgery, corneal irregularity,opacification of ocular media including cataracts, and active ocular disease).

我的婀娜美艷，讓身邊的樹都不敢直視。我的萬般風情，使我成了西莊山的圣樹，西莊坪人的驕傲。現在坪里胡子花白的老人，都是我看著從穿開襠褲長大的。我見證了西莊坪兩百多年的歷史，從看見三五個人來到這片荒野，到陸續發展到三五十戶人家；從男人們蓄著辮子穿著長衫，到剃成短發穿上中山裝；從農業學大寨的熱鬧鼎沸，到聯產承包的自豪激情；一直到當下人口外流，農田拋荒后的退耕還林。

高職學生相對本科學生來說，其學習力較低，對于學習沒有強大的欲望，比較重視自身的興趣發展，他們的群體意識較強，天生便擁有一種融入群體的渴望。高校社團就是有興趣愛好一致的同學組成自發的組織，社團活動也是基于學生的共同目標開展的，如他們能在社團學到許多課本上所沒有的知識，更早的積累社會實踐的寶貴經驗，不僅對自身實踐能力提升有好處，更堅定了自身目標和追求，擴大自己的交際圈的同時，更是提高自己的人際交往能力，因此其自治性也比較凸顯。

NBPL group (

=28) and the control group (

=28) got patching and corresponding training (NBPL and traditional training)for 3mo. Follow-up was performed at 1, 2, and 3mo after treatment in both groups. BCVA and visual function tests were performed, including three-level visual function examination using synoptophore and a comprehensive refractometer.Unfortunately, the total number of samples is small, so it is not enough for further subgroup analysis.

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