Perceptual learning for treating amblyopia in children based on activation of visual signal pathway Relationship of curative effects and time

BACKGROUND: Conventional methods (such as occlusion therapy, fine manipulation, complementary, and alternative medicine) take effects slowly, are time and labor consuming, and have uncertain curative effects in the treatment of amblyopia. Perceptual learning, a new method for treating amblyopia, improves the ability to process signals from the cerebral optic nerve system by specific visual stimulation and visual learning, as well as activation of the visual signal pathway utilizing brain nervous system plasticity. OBJECTIVE: This study investigated and evaluated the curative effects of perceptual learning, which can directionally increase brain plasticity, on the treatment of amblyopia in children. The relationship between curative effect and time was also analyzed. DESIGN: A self-control experiment. SETTING: Visual Science and Optometry Center, People’s Hospital of Guangxi Zhuang Autonomous Region. PARTICIPANTS: A total of 125 amblyopic children (250 amblyopic eyes), 73 males, 52 females, averaging (6 ± 2) years of age, received treatment at the Visual Science and Optometry Center, People’s Hospital of Guangxi Zhuang Autonomous Region between September 2006 and February 2007 and were recruited for this study. All children presented with no structural disease of the eyeballs. Written informed consent for therapeutic regiments was obtained from each child’s parent. The protocol received approval from the Hospital’s Ethics Committee. METHODS: Visual function was tested with a perceptual learning system (Research Center for Human Health and Development of Sun Yat-sen University, National Engineering Technique Research Center for Medical Care Implement) for visual noise, position noise, contour discrimination, contrast sensitivity, grating stereogram, and random-dot fusion. These tests helped to evaluate the efficiency of visual information processing of these children, and to determine the degree of defects of the optic nerve cells and the connections of visual cortical neurons. According to results of visual function tests, individualized treatment was adopted for each amblyopia patient using perceptual learning system. One course of treatment lasted one month, and treatment was performed twice every day with two training procedures (each training procedure lasted for ten minutes). There was a ten-minute time interval between the two training procedures. The training treatment was performed in a quiet and dark environment. Visual acuity and recovery of visual function were tested every month. Original training procedure was continued or adjusted according to the results of visual function. MAIN OUTCOME MEASURES: Visual function change; relationship of curative effects and curative time. RESULTS: A total of 125 amblyopia children were included in the final analysis. The total efficiency of perceptual learning for treating amblyopia in children was 75.2%. Visual acuity began to greatly increase 3 months after treatment (P < 0.05). Visual acuity was best corrected from 0.60 ± 0.23 before treatment to 0.86 ± 0.26 after treatment (P < 0.05). The mean time to reach improved levels with curative effects was (2.82 ± 1.30) months, and to reach a basically cured level was (2.87 ± 1.40) months. Percentage of improved visual acuity was the highest [98% (39/40)] in children that received 3 months of treatment and the lowest [55% (31/56)] in children that received 1 month of treatment (P < 0.05). The percentage of basically cured levels with curative effects increased with length of learning time and was the greatest in children that received 4 months of treatment [67% (31/46), P < 0.05]. CONCLUSION: Perceptual learning rapidly and remarkably improves visual function of amblyopia children; however, the curative effects are first apparent two and three months after intervention.