The effect of vergence vision training on binocularly normal subjects

Vergence is the disjunctive (inward or outward) movement of the eyes that is stimulated by retinal disparity (difference of where an image is projected to the retina and the fovea). A recent randomized clinical trial showed the efficacy of vision therapy for children with the binocular dysfunction known as convergence insufficiency is 73%. However, it is unknown whether binocularly normal persons will have any significant change to their vergence ocular motor system if they participate in vision training sessions. A total of ten (n = 10) binocularly normal persons participated in this study (18 to 28 years of age). A haploscope with an integrated infrared video-based eye tracking system manufactured by ISCAN presented vergence stimuli to the subject to record eye movement data before and after 12 hours of vision therapy with a custom LabVIEW program. Vision therapy entailed a random walk of 2° and 4° steps at near and far space along with ramps ranging from 1° to 20° of total vergence angular rotation. All processing and statistical analyses were conducted in MATLAB. All subjects experienced a significant decrease in time to peak velocity (p\u3c0.05). However, each subject’s peak velocity values were subject dependent and either increased, decreased, or maintained at the same level after training. The peak velocity of responses to 2° steps began to approach a more critically damped linear control system after vision training supporting an improvement in the accuracy of responses. Data support that even in binocularly normal control subjects; vision therapy improves vergence eye movements quantified as significant improvements in the time to fuse the new target and significantly more accurate responses compared to each subject’s baseline measurements

A cortical model for binocular vergence control without explicit calculation of disparity

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Dynamics of the disparity vergence fusion sustain component

The stereotypical vergence response to a step stimulus consists of two dynamic components: a high velocity fusion initiating component followed by a slower component that may mediate sustained fusion.  The initial component has been well-studied and is thought to be controlled by an open-loop mechanism. Less is known about the slow, or fusion sustaining component except that it must be feedback controlled to achieve the positional precision of sustained fusion.  Given the delays in disparity vergence control, a feedback control system is likely to exhibit oscillatory behavior.  Vergence responses to 4 deg step changes in target position were recorded in eight subjects. The slow component of each response was isolated manually using interactive graphics and the frequency spectrum determined.  The frequency spectra of all isolated slow vergence movements showed a large low frequency peak between 1.0 and 2.0 Hz and one or more higher frequency components.  The higher frequency components were found to be harmonics of the low frequency oscillation.  A feedback model of the slow component was developed consisting of a time delay, an integral/derivative controller and an oculomotor plant based on Robinson’s model.  Model simulations showed that a direction dependent asymmetry in the derivative element was primarily responsible for the higher frequency harmonic components. Simulations also showed that the base frequencies are primarily dependent on the time delay in the feedback control system. The fact that oscillatory behavior was found in all subjects provides strong support that the slow, fusion sustaining component is mediated by a feedback system

Evidence Supporting Open-Loop Control During Early Vergence

Disparity vergence eye movements were analyzed to determine if the early component of this response operates under open-loop, or preprogrammed, control. The analysis compares ratios of peak velocity to response amplitude (i.e., main sequence ratios) for the isolated early component and for the entire disparity vergence response. The stimuli were limited a 4 deg step changes in vergence so that any differences in movement dynamics (i.e., peak velocities) were due only to internal noise. Nine binocularly normal subjects were studied. A significant correlation between peak velocity and amplitude was observed during the early portion of the movement (p < 0.002), but not for the overall vergence response. Results support the widely held, but unproven assumption that the early component of symmetrical vergence is guided by open-loop, or preprogrammed, control processes while the overall response is influenced by internal and/or external feedback

Vergence eye movement parameters for pre/post-obvat and sham therapy on binocularly normal controls

Vergence is the disjunctive movement of the eyes to maintain single binocular vision. Vergence eye movements are necessary to maintain the object of interest on the fovea of each eye as an individual looks from one object to another. Recent studies show that office based vergence/accommodative therapy (OBVAT) is an effective treatment for the binocular dysfunction known as convergence insufficiency. This study was performed to investigate the changes in oculomotor parameters parameter data for pre- and post-therapy subjects who are binocularly normal controls. A haploscope was used to collect eye movement data pre- and post-therapy. The analysis of the eye movements was done in MATLAB. Fifty binocularly normal controls participated in 12 hours of office-based therapy where half participated in OBVAT and the remaining half participated in office-based placebo therapy (OBPT) therapy. The latency, time to peak velocity, peak velocity, response amplitude, final amplitude, and main sequence ratio were measured for participant’s responses to 4-degree and 6-degree ramps, 4- and 6-degree disappearing steps, 6- and 10-degree stepramps, and 5- and 10-degree saccades. Peak velocity was significantly greater post OBVAT therapy compared to baseline, most of them having a p≤.001. Clinically meaning differences were not observed post OVPT compared to baseline. Results support that OBVAT significantly changes vergence dynamics and may be used for sports enhancement

Assessment of Dual-Mode and Switched-Channel Models with Experimental Vergence Responses

Controversy exists in the literature regarding the basic neural control structure that mediates convergence responses. This study constructed and simulated two models, the switched-channel feedback model and the dual-mode model consisting of preprogrammed with feedback control. Models were constructed and compared to experimental data. The stimuli consisted of 2 deg and 4 deg vergence steps. Both closed- and open-loop settings were utilized. After parameter adjustment, both models could accurately simulate step responses from subjects having a range of response dynamics. The model with a preprogrammed element required less parameter modification when stimulus amplitude changed. Both models could accurately simulate some attributes of vergence; however, neither model could represent the modifications commonly observed within the transient portion of the vergence response

Changes in the disparity vergence main sequence after treatment of symptomatic convergence insufficiency in children

This study investigates the underlying physiological mechanisms that may lead to improved outcomes for symptomatic convergence insufficiency (CI) patients after 12 weeks of office-based vergence/accommodation therapy (OBVAT) by evaluating the change in the main sequence of vergence and saccadic eye movements. In this prospective trial, 12 participants with symptomatic CI were recruited and treated with 12 weeks of OBVAT. Outcome measures included the objective assessment of the following: peak velocity, time to peak velocity, latency, response amplitude, and clinical changes in the near point of convergence (NPC), positive fusional vergence (PFV) and symptoms via the Convergence Insufficiency Symptom Survey (CISS). Ten of the twelve participants (83%) were categorized as “successful” and two were “improved” based on pre-determined published criteria (CISS, NPC, PFV). There were statistically significant changes in peak velocity, time to peak velocity, and response amplitude for both 4° and 6° symmetrical convergence and divergence eye movements. There was a significant change in the main sequence ratio for convergence post-OBVAT compared to baseline measurements (P=0.007) but not for divergence or saccadic responses. Phasic/step vergence movements adjust the underlying neural control of convergence and are critical within a vision therapy program for CI patients

Short term modification of vergence ramp eye movements in the convergent direction

Prior oculomotor studies have investigated the various effects of short-term modification on vergence, saccadic and smooth pursuit eye movements. Previous vergence studies have concentrated on step modification stimuli. Few have investigated the effects of short-term modification on vergence ramp movements. Thus, this study explores the trends observed within a short-term modification experiment studying smoothly tracking vergence eye movements responses elicited from convergent ramp stimuli. A short-term modification experiment is composed of three phases: baseline, modification and recovery. Baseline and recovery phases contain only test stimuli; whereas, during modification, the subject is presented test and conditioning stimuli in a ratio of 1:5 test to conditioning. The test stimulus is a 0.5 deg/sec vergence ramp presented from a 3 deg vergence angle to a 5 deg vergence angle. The conditioning stimulus is a 2 deg/sec ramp presented over the same visual range. The root mean square error (RMSE) is calculated on all slower (0.5 deg/ sec) ramp responses and compared over the three phases. A significant statistical change is observed between the three stages on day one, but not on day two. A trend that can be attributed to motor memory. This study additionally explores for potential differences between the left and right eye movements. No statistical significant difference of the RMSE is observed between the left and right eye movements. Data supports that the preprogrammed portion of vergence is significantly influenced by the short-term modification experiment described here

Target eccentricity and form influences disparity vergence eye movements responses: A temporal and dynamic analysis

This study sought to investigate whether stimulation to the fovea or the parafovea with different color combinations influenced the temporal and dynamic features of 4° disparity vergence step responses. Twelve unique types of stimuli were displayed within a haploscope presented along the participant’s midsagittal plane. Vergence eye movement responses from fifteen naive participants were recorded using video-based infrared eye tracking instrumentation. Latency and peak velocity from left and right eye movement responses were quantified. Results show that the type of stimulus projection (foveal versus parafoveal) significantly (p&lt;0.001) influences the vergence response latency but did not impact peak velocity. Vergence responses to eccentric circles with 6° eccentricity targeting the parafovea resulted in a significantly faster response latency compared to vergence responses to a cross with 2° eccentricity stimuli targeting the fovea. Results have implications for the stimulus design of a variety of applications from virtual reality to vision therapy interventions