Congratulations to Dr. Oechslin and Team, this year’s recipients of COVD’s Article of the Year Award! The article, Imaging of Convergence Insufficiency Treatment Effects (ICITE) Pilot Study: Design and Methods, was published in Vision Development and Rehabilitation (VDR) journal in December 2017.
The article describes the design and methods being used to investigate the neurological mechanisms of convergence insufficiency (CI) with brain imaging technology. Specifically, this research is using fMRI (functional magnetic resonance imaging) to determine what parts of the brain are activated when subjects perform vergence eye movements.
Two questions are being explored:
- Is there any difference in the extent and/or magnitude of these responses between subjects with normal binocular vision (NBV) and those with CI?
- Does anything change after treatment of CI with optometric vision therapy?
This giant leap for mankind needed much more than one small step
- Potential subjects have to be recruited for the study and given comprehensive eye examinations.
- Once identified, two groups of subjects (NBV and CI) must receive fMRI scans while viewing stereogram targets.
- Hardware must be designed to present the stimuli to subjects while in a supine position in the scanner.
- Software must be designed to present random-dot stereograms in a sequence of changing vergence demands that are appropriate to detect differences between groups and pre- and post-vision therapy.
- Then, the patients with CI need to be randomized to 12 weeks of either office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT).
- After 12 weeks, vision testing and fMRI scans must be repeated.
- All of this will generate a mountain of fMRI data that must be passed through a highly sophisticated analysis by highly trained imaging analysts to generate outcomes associated with the experimental design.
- Hopefully the fMRI data will show activation in parts of the brain that have been previously identified as specific to vision functions, but maybe some additional regions of interest (ROI) will be discovered.
- Then of course, statisticians must determine whether statistically significant differences support the answers to the two questions being explored by the experimental design.
Dr. Oechslin and team are BOLDly going where no vision scientist has gone before
The fMRI technology relies on the detection of the blood-oxygen-level-dependent (BOLD) signal associated with brain activation. This is indeed BOLD science! It is built upon 35 years of previous research along many trajectories; the clinical research associated with the diagnosis and management of CI, the neuroanatomy of eye movements, and the development of fMRI technology and its application in probing the neurology of binocular vision. It requires the collaborative effort of optometrists, vision scientists, engineers, analysts, biostatisticians and a myriad of support personnel at each step. It does take a village! It also requires a great deal of time and money, but it is time and money well spent.
Kudos to COVD for supporting this research with a BSK-COVD Research Grant, made possible by contributions from Beta Sigma Kappa. We can all look forward to Dr. Oechslin’s next publication with the results and conclusions–it is sure to open new ways of thinking and new approaches to help more of our patients. As Dr. Oechslin wote, “Once any neural mechanisms and changes have been identified, future research and therapy protocols for CI may potentially be able to be designed to target these regions and lead to new treatment strategies.”
Share the excitement with this award-winning research team at the 2018 Annual Meeting!