@article{
 title = {Quantification of Oculomotor Responses and Accommodation through Instrumentation and Analysis Toolboxes},
 type = {article},
 year = {2023},
 pages = {1-21},
 websites = {https://app.jove.com/t/64808/quantification-oculomotor-responses-accommodation-through},
 id = {2ee18618-037a-3d3a-9e8e-353129104e65},
 created = {2023-05-09T17:52:07.794Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2023-05-09T17:52:07.794Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Through the purposeful stimulation and recording of eye movements, the fundamental characteristics of the underlying neural mechanisms of eye movements can be observed. VisualEyes2020 (VE2020) was developed based on the lack of customizable software-based visual stimulation available for researchers that does not rely on motors or actuators within a traditional haploscope. This new instrument and methodology have been developed for a novel haploscope configuration utilizing both eye tracking and autorefractor systems. Analysis software that enables the synchronized analysis of eye movement and accommodative responses provides vision researchers and clinicians with a reproducible environment and shareable tool. The Vision and Neural Engineering Laboratory's (VNEL) Eye Movement Analysis Program (VEMAP) was established to process recordings produced by VE2020's eye trackers, while the Accommodative Movement Analysis Program (AMAP) was created to process the recording outputs from the corresponding autorefractor system. The VNEL studies three primary stimuli: accommodation (blur-driven changes in the convexity of the intraocular lens), vergence (inward, convergent rotation and outward, divergent rotation of the eyes), and saccades (conjugate eye movements). The VEMAP and AMAP utilize similar data flow processes, manual operator interactions, and interventions where necessary; however, these analysis platforms advance the establishment of an objective software suite that minimizes operator reliance. The utility of a graphical interface and its corresponding algorithms allow for a broad range of visual experiments to be conducted with minimal required prior coding experience from its operator(s).},
 bibtype = {article},
 author = {Fine, Sebastian N. and Guo, Yi and Talasan, Henry and LeStrange, Stephen and Yaramothu, Chang and Alvarez, Tara L.},
 doi = {10.3791/64808},
 journal = {Journal of Visualized Experiments},
 number = {193}
}

Through the purposeful stimulation and recording of eye movements, the fundamental characteristics of the underlying neural mechanisms of eye movements can be observed. VisualEyes2020 (VE2020) was developed based on the lack of customizable software-based visual stimulation available for researchers that does not rely on motors or actuators within a traditional haploscope. This new instrument and methodology have been developed for a novel haploscope configuration utilizing both eye tracking and autorefractor systems. Analysis software that enables the synchronized analysis of eye movement and accommodative responses provides vision researchers and clinicians with a reproducible environment and shareable tool. The Vision and Neural Engineering Laboratory's (VNEL) Eye Movement Analysis Program (VEMAP) was established to process recordings produced by VE2020's eye trackers, while the Accommodative Movement Analysis Program (AMAP) was created to process the recording outputs from the corresponding autorefractor system. The VNEL studies three primary stimuli: accommodation (blur-driven changes in the convexity of the intraocular lens), vergence (inward, convergent rotation and outward, divergent rotation of the eyes), and saccades (conjugate eye movements). The VEMAP and AMAP utilize similar data flow processes, manual operator interactions, and interventions where necessary; however, these analysis platforms advance the establishment of an objective software suite that minimizes operator reliance. The utility of a graphical interface and its corresponding algorithms allow for a broad range of visual experiments to be conducted with minimal required prior coding experience from its operator(s).

@inproceedings{
 title = {"It's all in your head": Abnormal Visual Processing During Magnetoencephalography is Associated with Mild Traumatic Brain Injury in US Veterans},
 type = {inproceedings},
 year = {2023},
 id = {69a7e722-7807-34ef-9b73-9a77028f8684},
 created = {2023-05-09T18:01:52.417Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
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 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Quinn, Davin and Schendel, Megan and Littleton, Adam and Sterling, Marcus and Upston, Joel and Jones, Thomas and Worth, Lindsay and Wilson, Kevin and Chavez, Jude and Richardson, Jessica and Yaramothu, Chang and Alvarez, Tara and Hoffer, Michael and Harris-Carriman, Stacey and Mayer, Andrew and Stephen, Julia},
 booktitle = {Brain & Behavioral Health Research Day}
}

@article{
 title = {Vision Quality of Life with Time Survey : Normative Data and Repeatability},
 type = {article},
 year = {2023},
 keywords = {endurance,patient-reported outcome measure,quality of life,timed survey,visual symptoms},
 pages = {205-212},
 volume = {15},
 websites = {https://www.dovepress.com/articles.php?article_id=86648},
 id = {3ca0678a-5ff2-363f-b213-a73209c3554f},
 created = {2023-09-12T13:15:38.445Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2023-09-12T13:15:38.445Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Purpose: To develop a novel Vision Quality of Life (QoL) survey that emphasizes the amount of time a visual activity can be performed before symptoms occur. Methods: The Vision Quality of Life with Time (VisQuaL-T) survey was developed with 10 daily activities and a list of common visual symptoms. Participants were recruited from a university campus. Participants were not excluded based on binocular impairments to obtain a normative dataset. Participants were instructed to denote when they first experience symptoms within certain time ranges. If participants did not engage in one of the 10 activities, they were instructed to denote “N/A”. A composite score (range 0– 3) was determined by only accounting for the questions that were answered. Results: The normative data cohort had a sample size of 376 participants and the repeatability cohort had 54 participants. The normative, test, and retest datasets had a mean composite score of 2.47± 0.54, 2.69± 0.42, and 2.67± 0.49 and 95% confidence interval of 2.38– 2.71, 2.58– 2.81, 2.54– 2.80, respectively. There was good reliability and high correlation between the test and retest timepoints with an ICC of 0.825 and a Pearson correlation coefficient of 0.839 in the repeatability cohort. The normative data cohort showed good internal consistency with a Cronbach’s alpha value of 0.803. Test and retest timepoints showed no statistical significance among the individual questions (p > 0.1). Conclusion: A lower bound score of 2.4 can potentially be used to differentiate visually normal and symptomatic participants. Statistical analysis showed the survey is repeatable and reliable. Using time as a metric for assessing symptomology could be a useful method for identifying patients with QoL issues and for assessing effectiveness of binocular vision, accommodative, and eye movement treatments.},
 bibtype = {article},
 author = {Dungan, Michaela E and Scheiman, Mitchell and Yaramothu, Chang},
 doi = {https://doi.org/10.2147/OPTO.S406407},
 journal = {Clinical Optometry},
 number = {June}
}

Purpose: To develop a novel Vision Quality of Life (QoL) survey that emphasizes the amount of time a visual activity can be performed before symptoms occur. Methods: The Vision Quality of Life with Time (VisQuaL-T) survey was developed with 10 daily activities and a list of common visual symptoms. Participants were recruited from a university campus. Participants were not excluded based on binocular impairments to obtain a normative dataset. Participants were instructed to denote when they first experience symptoms within certain time ranges. If participants did not engage in one of the 10 activities, they were instructed to denote “N/A”. A composite score (range 0– 3) was determined by only accounting for the questions that were answered. Results: The normative data cohort had a sample size of 376 participants and the repeatability cohort had 54 participants. The normative, test, and retest datasets had a mean composite score of 2.47± 0.54, 2.69± 0.42, and 2.67± 0.49 and 95% confidence interval of 2.38– 2.71, 2.58– 2.81, 2.54– 2.80, respectively. There was good reliability and high correlation between the test and retest timepoints with an ICC of 0.825 and a Pearson correlation coefficient of 0.839 in the repeatability cohort. The normative data cohort showed good internal consistency with a Cronbach’s alpha value of 0.803. Test and retest timepoints showed no statistical significance among the individual questions (p > 0.1). Conclusion: A lower bound score of 2.4 can potentially be used to differentiate visually normal and symptomatic participants. Statistical analysis showed the survey is repeatable and reliable. Using time as a metric for assessing symptomology could be a useful method for identifying patients with QoL issues and for assessing effectiveness of binocular vision, accommodative, and eye movement treatments.

@inproceedings{
 title = {Presence of Accommodative Dysfunction Postconcussion in an Adult Population},
 type = {inproceedings},
 year = {2022},
 pages = {E535},
 publisher = {Lippincott Williams & Wilkins},
 city = {New York, NY},
 id = {30383c9f-a3d0-3478-b906-6b1b4b358d2e},
 created = {2023-05-09T18:01:52.456Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2023-05-09T18:01:52.456Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Theis, Jacqueline and Starzynski, Sophia and Mohan, Stuti and Yaramothu, Chang},
 booktitle = {Journal of Head Trauma Rehabilitation}
}

@inproceedings{
 title = {Oculomotor and Vestibular Endurance Screening (MoVES) Protocol and Visual Quality of Life on an Adult Population},
 type = {inproceedings},
 year = {2022},
 pages = {E534},
 publisher = {Lippincott Williams & Wilkins},
 city = {New York, NY},
 id = {7fe2b0a2-4210-32bd-92f4-b4b9559d6ff9},
 created = {2023-05-09T18:01:52.639Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2023-05-09T18:01:52.639Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Theis, Jacqueline and Starzynski, Sophia and Mohan, Stuti and Yaramothu, Chang},
 booktitle = {Journal of Head Trauma Rehabilitation}
}

@article{
 title = {Underlying neurological mechanisms associated with symptomatic convergence insufficiency},
 type = {article},
 year = {2021},
 keywords = {Cerebellum,Cortex,Neuroscience,Oculomotor system},
 pages = {6545},
 volume = {11},
 websites = {https://doi.org/10.1038/s41598-021-86171-9},
 month = {12},
 publisher = {Nature Research},
 day = {1},
 id = {0be1c44d-3c5b-33b7-817a-33b091c77db7},
 created = {2021-05-07T18:32:29.233Z},
 accessed = {2021-05-07},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-05-07T18:38:18.202Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.},
 bibtype = {article},
 author = {Alvarez, Tara L. and Scheiman, Mitchell and Morales, Cristian and Gohel, Suril and Sangoi, Ayushi and Santos, Elio M. and Yaramothu, Chang and D’Antonio-Bertagnolli, John Vito and Li, Xiaobo and Biswal, Bharat B.},
 doi = {10.1038/s41598-021-86171-9},
 journal = {Scientific Reports},
 number = {1}
}

Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.

@article{
 title = {Disparity vergence differences between typically occurring and concussion-related convergence insufficiency pediatric patients},
 type = {article},
 year = {2021},
 pages = {58-67},
 volume = {185},
 websites = {https://linkinghub.elsevier.com/retrieve/pii/S0042698921000754},
 month = {8},
 publisher = {Pergamon},
 day = {1},
 id = {aadd3c6f-a619-32a1-a883-9fd1eedc9667},
 created = {2021-05-07T18:33:10.629Z},
 accessed = {2021-05-07},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-05-07T18:38:18.215Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {false},
 hidden = {false},
 private_publication = {false},
 bibtype = {article},
 author = {Alvarez, Tara L. and Yaramothu, Chang and Scheiman, Mitchell and Goodman, Arlene and Cotter, Susan A. and Huang, Kristine and Chen, Angela M. and Grady, Matthew and Mozel, Anne E. and Podolak, Olivia E. and Koutures, Chris G. and Master, Christina L.},
 doi = {10.1016/j.visres.2021.03.014},
 journal = {Vision Research}
}

@article{
 title = {Vergence Fusion Sustaining Oscillations},
 type = {article},
 year = {2021},
 keywords = {feedback control,fusion sustaining component,oscillations,slow component,vergence},
 pages = {4},
 volume = {14},
 websites = {http://optometry.osu.edu/research/CITT},
 month = {6},
 day = {28},
 id = {51b57bc7-e1a1-3ee3-8390-467245a9003d},
 created = {2021-07-01T19:36:04.881Z},
 accessed = {2021-07-01},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-07-01T19:37:59.479Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {false},
 hidden = {false},
 private_publication = {false},
 abstract = {Introduction: Previous studies have shown that the slow, or fusion sustaining, component of disparity vergence contains oscillatory behavior as would be expected if fusion is sustained by visual feedback. This study extends the examination of this behavior to a wider range of frequencies and a larger number of subjects. Methods: Disparity vergence responses to symmetrical 4.0 deg step changes in target position were recorded in 20 subjects. Approximately three seconds of the late component of each response were isolated using interactive graphics and the frequency spectrum calculated. Peaks in these spectra associated with oscillatory behavior were identified and examined. Results: All subjects exhibited oscillatory behavior with fundamental frequencies ranging between 0.37 and 0.55 Hz; much lower than those identified in the earlier study. All responses showed significant higher frequency components. The relationship between higher frequency components and the fundamental frequency suggest may be harmonics. A correlation was found across subjects between the amplitude of the fundamental frequency and the maximum velocity of the fusion initiating component probably due to the gain of shared neural pathways. Conclusion: Low frequency oscillatory behavior was found in all subjects adding support that the slow, or fusion sustaining, component is mediated by a feedback control.},
 bibtype = {article},
 author = {Semmlow, John and Yaramothu, Chang and Scheiman, Mitchell and Alvarez, Tara L},
 doi = {10.16910/jemr.14.1.4},
 journal = {Journal of Eye Movement Research},
 number = {1}
}

Introduction: Previous studies have shown that the slow, or fusion sustaining, component of disparity vergence contains oscillatory behavior as would be expected if fusion is sustained by visual feedback. This study extends the examination of this behavior to a wider range of frequencies and a larger number of subjects. Methods: Disparity vergence responses to symmetrical 4.0 deg step changes in target position were recorded in 20 subjects. Approximately three seconds of the late component of each response were isolated using interactive graphics and the frequency spectrum calculated. Peaks in these spectra associated with oscillatory behavior were identified and examined. Results: All subjects exhibited oscillatory behavior with fundamental frequencies ranging between 0.37 and 0.55 Hz; much lower than those identified in the earlier study. All responses showed significant higher frequency components. The relationship between higher frequency components and the fundamental frequency suggest may be harmonics. A correlation was found across subjects between the amplitude of the fundamental frequency and the maximum velocity of the fusion initiating component probably due to the gain of shared neural pathways. Conclusion: Low frequency oscillatory behavior was found in all subjects adding support that the slow, or fusion sustaining, component is mediated by a feedback control.

@article{
 title = {OculoMotor Assessment Tool Test Procedure and Normative Data},
 type = {article},
 year = {2021},
 pages = {636-643},
 volume = {98},
 websites = {https://journals.lww.com/optvissci/Fulltext/2021/06000/OculoMotor_Assessment_Tool_Test_Procedure_and.14.aspx},
 month = {6},
 publisher = {Ovid Technologies (Wolters Kluwer Health)},
 id = {e4adde5a-1b93-3f7a-9e78-c0adac9b817d},
 created = {2021-07-01T19:37:51.911Z},
 accessed = {2021-07-01},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2023-05-31T13:01:00.957Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {false},
 hidden = {false},
 private_publication = {false},
 abstract = {SIGNIFICANCE This study establishes normative data and a testing procedure for the oculomotor assessment tool. The oculomotor assessment tool standardizes visual targets for the Vestibular/OculoMotor Screening assessment and provides additional metrics that may aid in the differentiation between those with normal and those with abnormal oculomotor function potentially caused by a concussion. PURPOSE This study aimed to assess the oculomotor endurance of healthy participants with no self-reported history of concussions using the oculomotor assessment tool. METHODS Healthy participants (n = 376, average age of 20.4 years, range of 11 to 34 years, with no self-reported history of concussions) were recruited to perform the following three tasks for 60 seconds each: (1) horizontal saccades, (2) vertical saccades, and (3) vergence jumps. The participants were instructed to alternate visual fixation between two targets for each of the tasks as fast as they could without overshooting or undershooting the visual target. The differences in the number of eye movements between the initial and latter 30 seconds of the 1-minute test were analyzed. RESULTS A statistical difference (P <.001) was observed in the number of eye movements for all three tasks (horizontal saccades [70 ± 15 for initial 30 seconds, 63 ± 13 for latter 30 seconds], vertical saccades [68 ± 14, 63 ± 13], and vergence jumps [43 ± 11, 39 ± 10]) between the initial and latter 30 seconds. No significant differences were identified in the number of eye movements or the change in eye movements between the initial and latter 30 seconds based on sex. CONCLUSIONS These results establish a normative database for various eye movements. These data could potentially be used to compare different patient populations who have binocular endurance dysfunctions potentially due to traumatic brain injury, such as patients with concussion(s).},
 bibtype = {article},
 author = {Yaramothu, Chang and Morris, Christopher J. and D'Antonio-Bertagnolli, John Vito and Alvarez, Tara L.},
 doi = {10.1097/OPX.0000000000001698},
 journal = {Optometry and Vision Science},
 number = {6}
}

SIGNIFICANCE This study establishes normative data and a testing procedure for the oculomotor assessment tool. The oculomotor assessment tool standardizes visual targets for the Vestibular/OculoMotor Screening assessment and provides additional metrics that may aid in the differentiation between those with normal and those with abnormal oculomotor function potentially caused by a concussion. PURPOSE This study aimed to assess the oculomotor endurance of healthy participants with no self-reported history of concussions using the oculomotor assessment tool. METHODS Healthy participants (n = 376, average age of 20.4 years, range of 11 to 34 years, with no self-reported history of concussions) were recruited to perform the following three tasks for 60 seconds each: (1) horizontal saccades, (2) vertical saccades, and (3) vergence jumps. The participants were instructed to alternate visual fixation between two targets for each of the tasks as fast as they could without overshooting or undershooting the visual target. The differences in the number of eye movements between the initial and latter 30 seconds of the 1-minute test were analyzed. RESULTS A statistical difference (P <.001) was observed in the number of eye movements for all three tasks (horizontal saccades [70 ± 15 for initial 30 seconds, 63 ± 13 for latter 30 seconds], vertical saccades [68 ± 14, 63 ± 13], and vergence jumps [43 ± 11, 39 ± 10]) between the initial and latter 30 seconds. No significant differences were identified in the number of eye movements or the change in eye movements between the initial and latter 30 seconds based on sex. CONCLUSIONS These results establish a normative database for various eye movements. These data could potentially be used to compare different patient populations who have binocular endurance dysfunctions potentially due to traumatic brain injury, such as patients with concussion(s).

@article{
 title = {Convergence insufficiency neuro-mechanism adult population study: phoria adaptation results},
 type = {article},
 year = {2021},
 keywords = {Convergence insufficiency (CI),Office-based vergence and accommodative therapy (O,Phoria adaptation,Vergence,Vision therapy},
 volume = {62},
 id = {893284e8-9622-3056-8b27-28965c4f79c5},
 created = {2022-07-12T18:48:06.286Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2022-07-12T18:48:06.286Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {PURPOSE. The purpose of this study was to compare changes in phoria adaptation between young adult binocularly normal controls (BNCs) and participants with symptomatic convergence insufficiency (CI), who were randomized to either office-based vergence accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). METHODS. In the double-masked randomized clinical trial, 50 BNC and 50 CI participants were randomized to the following therapeutic interventions: OBVAT or OBPT with home reinforcement for 12 one-hour office sessions. A 6 base-out and 6 base-in phoria adaptation experiment at near (40 cm) was conducted using the flashed Maddox rod technique at baseline and at outcome. Measurements included the rate and the magnitude of phoria adaptation. RESULTS. At baseline, BNC and CI participants had significantly different rates and magnitudes of base-in and base-out phoria adaptation (P < 0.001). When comparing the outcome to baseline measurements, significant main effect differences in longitudinal measurements were observed for the magnitude and the rate of phoria adaptation for both base-out and base-in experiments (P < 0.05). For the magnitude and rate of phoria adaptation, post hoc analyses using paired t-tests revealed that the CI group administered the OBVAT intervention exhibited a significant increase in the magnitude and rate of phoria adaptation compared to baseline for both base-in and base-out phoria adaptation (P < 0.01) but not for those administered OBPT. CONCLUSIONS. Phoria adaptation is significantly different at baseline between those with normal binocular vision and symptomatic CI participants. OBVAT significantly improves the rate and magnitude of both base-out and base-in phoria adaptation at near compared to OBPT. Results have clinical implications for new therapeutic interventions.},
 bibtype = {article},
 author = {Sangoi, Ayushi and Scheiman, Mitchell and Yaramothu, Chang and Santos, Elio M. and Gohel, Suril and Alvarez, Tara L.},
 doi = {10.1167/IOVS.62.10.19},
 journal = {Investigative Ophthalmology and Visual Science},
 number = {10}
}

PURPOSE. The purpose of this study was to compare changes in phoria adaptation between young adult binocularly normal controls (BNCs) and participants with symptomatic convergence insufficiency (CI), who were randomized to either office-based vergence accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). METHODS. In the double-masked randomized clinical trial, 50 BNC and 50 CI participants were randomized to the following therapeutic interventions: OBVAT or OBPT with home reinforcement for 12 one-hour office sessions. A 6 base-out and 6 base-in phoria adaptation experiment at near (40 cm) was conducted using the flashed Maddox rod technique at baseline and at outcome. Measurements included the rate and the magnitude of phoria adaptation. RESULTS. At baseline, BNC and CI participants had significantly different rates and magnitudes of base-in and base-out phoria adaptation (P < 0.001). When comparing the outcome to baseline measurements, significant main effect differences in longitudinal measurements were observed for the magnitude and the rate of phoria adaptation for both base-out and base-in experiments (P < 0.05). For the magnitude and rate of phoria adaptation, post hoc analyses using paired t-tests revealed that the CI group administered the OBVAT intervention exhibited a significant increase in the magnitude and rate of phoria adaptation compared to baseline for both base-in and base-out phoria adaptation (P < 0.01) but not for those administered OBPT. CONCLUSIONS. Phoria adaptation is significantly different at baseline between those with normal binocular vision and symptomatic CI participants. OBVAT significantly improves the rate and magnitude of both base-out and base-in phoria adaptation at near compared to OBPT. Results have clinical implications for new therapeutic interventions.

@article{
 title = {The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data},
 type = {article},
 year = {2020},
 keywords = {Convergence insufficiency,eye movement,functional MRI,randomized clinical trial,vergence},
 pages = {52-72},
 volume = {27},
 publisher = {Taylor and Francis Ltd},
 id = {bb184366-0200-30da-a2b7-29385deb97d2},
 created = {2019-11-25T15:06:00.771Z},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:06:44.826Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures. Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031. Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD. Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.},
 bibtype = {article},
 author = {Alvarez, Tara L. and Scheiman, Mitchell and Santos, Elio M. and Morales, Cristian and Yaramothu, Chang and D’Antonio-Bertagnolli, John Vito and Biswal, Bharat B. and Gohel, Suril and Li, Xiaobo},
 doi = {10.1080/09286586.2019.1679192},
 journal = {Ophthalmic Epidemiology},
 number = {1}
}

Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures. Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031. Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD. Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.

@article{
 title = {Reliability of Frontal Eye Fields Activation and Very Low-Frequency Oscillations Observed during Vergence Eye Movements: an fNIRS Study},
 type = {article},
 year = {2020},
 pages = {1-10},
 volume = {10},
 id = {438ab45a-8a5c-32dd-be03-078ff4851c8d},
 created = {2020-02-24T01:37:34.643Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-24T01:37:34.643Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Functional near-infrared spectroscopy (fNIRS), an imaging tool that utilizes infrared light to measure changes within the concentration of oxygenated (HbO) and deoxygenated (HbR) hemoglobin, holds promise to study functional activity from motor, visual, and memory cortical regions using stimulus-induced tasks. This study investigated the reliability for fNIRS to examine cortical activations within the frontal eye fields (FEF) while initiating vergence eye movements, the inward and outward rotation of the eyes. FNIRS data were collected from twenty participants with normal binocular vision while performing vergence eye movements compared to sustained gaze fixation within a block design during two different sessions. Reliability of the experimental protocol was assessed using the intraclass correlation coefficient (ICC). The ICC values ranged from 0.6 to 0.7 for measuring the HbO activation within the vicinity of the FEF. A frequency power spectrum analysis revealed two predominant frequencies within the functional activation signals from the FEF. One high-intensity signal was present at 0.029 Hz, centering around the block design frequency. The peak-intensity signal was observed between 0.012 and 0.018 Hz where this very low-frequency oscillation (VLFO) was hypothesized to be generated by the macrovasculature present near the FEF and should be avoided as a block design frequency in future fNIRS studies to avoid false positive results.},
 bibtype = {article},
 author = {Yaramothu, Chang and Li, Xiaobo and Morales, Cristian and Alvarez, Tara L.},
 doi = {10.1038/s41598-020-57597-4},
 journal = {Scientific Reports},
 number = {1}
}

Functional near-infrared spectroscopy (fNIRS), an imaging tool that utilizes infrared light to measure changes within the concentration of oxygenated (HbO) and deoxygenated (HbR) hemoglobin, holds promise to study functional activity from motor, visual, and memory cortical regions using stimulus-induced tasks. This study investigated the reliability for fNIRS to examine cortical activations within the frontal eye fields (FEF) while initiating vergence eye movements, the inward and outward rotation of the eyes. FNIRS data were collected from twenty participants with normal binocular vision while performing vergence eye movements compared to sustained gaze fixation within a block design during two different sessions. Reliability of the experimental protocol was assessed using the intraclass correlation coefficient (ICC). The ICC values ranged from 0.6 to 0.7 for measuring the HbO activation within the vicinity of the FEF. A frequency power spectrum analysis revealed two predominant frequencies within the functional activation signals from the FEF. One high-intensity signal was present at 0.029 Hz, centering around the block design frequency. The peak-intensity signal was observed between 0.012 and 0.018 Hz where this very low-frequency oscillation (VLFO) was hypothesized to be generated by the macrovasculature present near the FEF and should be avoided as a block design frequency in future fNIRS studies to avoid false positive results.

@article{
 title = {Test–Retest Reliability of Functional Magnetic Resonance Imaging Activation for a Vergence Eye Movement Task},
 type = {article},
 year = {2020},
 keywords = {Functional MRI,Test–retest reliability,Vergence eye movement,Vergence region of interest masks},
 pages = {506-518},
 volume = {36},
 websites = {https://link.springer.com/article/10.1007/s12264-019-00455-9},
 month = {5},
 publisher = {Springer},
 day = {1},
 id = {d8ab1e55-2fec-3496-aaa6-8aa16bd83760},
 created = {2021-05-07T18:28:23.969Z},
 accessed = {2021-05-07},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-05-07T18:30:28.413Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Vergence eye movements are the inward and outward rotation of the eyes responsible for binocular coordination. While studies have mapped and investigated the neural substrates of vergence, it is not well understood whether vergence eye movements evoke the blood oxygen level-dependent signal reliably in separate experimental visits. The test–retest reliability of stimulus-induced vergence eye movement tasks during a functional magnetic resonance imaging (fMRI) experiment is important for future randomized clinical trials (RCTs). In this study, we established region of interest (ROI) masks for the vergence neural circuit. Twenty-seven binocularly normal young adults participated in two functional imaging sessions measured on different days on the same 3T Siemens scanner. The fMRI experiments used a block design of sustained visual fixation and rest blocks interleaved between task blocks that stimulated eight or four vergence eye movements. The test–retest reliability of task-activation was assessed using the intraclass correlation coefficient (ICC), and that of spatial extent was assessed using the Dice coefficient. Functional activation during the vergence eye movement task of eight movements compared to rest was repeatable within the primary visual cortex (ICC = 0.8), parietal eye fields (ICC = 0.6), supplementary eye field (ICC = 0.5), frontal eye fields (ICC = 0.5), and oculomotor vermis (ICC = 0.6). The results demonstrate significant test–retest reliability in the ROIs of the vergence neural substrates for functional activation magnitude and spatial extent using the stimulus protocol of a task block stimulating eight vergence eye movements compared to sustained fixation. These ROIs can be used in future longitudinal RCTs to study patient populations with vergence dysfunctions.},
 bibtype = {article},
 author = {Morales, Cristian and Gohel, Suril and Li, Xiaobo and Scheiman, Mitchell and Biswal, Bharat B. and Santos, Elio M. and Yaramothu, Chang and Alvarez, Tara L.},
 doi = {10.1007/s12264-019-00455-9},
 journal = {Neuroscience Bulletin},
 number = {5}
}

Vergence eye movements are the inward and outward rotation of the eyes responsible for binocular coordination. While studies have mapped and investigated the neural substrates of vergence, it is not well understood whether vergence eye movements evoke the blood oxygen level-dependent signal reliably in separate experimental visits. The test–retest reliability of stimulus-induced vergence eye movement tasks during a functional magnetic resonance imaging (fMRI) experiment is important for future randomized clinical trials (RCTs). In this study, we established region of interest (ROI) masks for the vergence neural circuit. Twenty-seven binocularly normal young adults participated in two functional imaging sessions measured on different days on the same 3T Siemens scanner. The fMRI experiments used a block design of sustained visual fixation and rest blocks interleaved between task blocks that stimulated eight or four vergence eye movements. The test–retest reliability of task-activation was assessed using the intraclass correlation coefficient (ICC), and that of spatial extent was assessed using the Dice coefficient. Functional activation during the vergence eye movement task of eight movements compared to rest was repeatable within the primary visual cortex (ICC = 0.8), parietal eye fields (ICC = 0.6), supplementary eye field (ICC = 0.5), frontal eye fields (ICC = 0.5), and oculomotor vermis (ICC = 0.6). The results demonstrate significant test–retest reliability in the ROIs of the vergence neural substrates for functional activation magnitude and spatial extent using the stimulus protocol of a task block stimulating eight vergence eye movements compared to sustained fixation. These ROIs can be used in future longitudinal RCTs to study patient populations with vergence dysfunctions.

@article{
 title = {A normative study of objective measures of disparity vergence and saccades in children 9 to 17 years old},
 type = {article},
 year = {2020},
 pages = {416-423},
 volume = {97},
 websites = {https://journals.lww.com/optvissci/Fulltext/2020/06000/A_Normative_Study_of_Objective_Measures_of.6.aspx},
 month = {6},
 publisher = {Lippincott Williams and Wilkins},
 day = {1},
 id = {7164d52f-055d-3694-b76a-2b54cabd9055},
 created = {2021-05-07T18:30:20.303Z},
 accessed = {2021-05-07},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-05-07T18:31:21.844Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {SIGNIFICANCE: This study establishes normative data for objective outcome measures of vergence and saccade eye movements for the pediatric population. These data should facilitate future clinical trial design. PURPOSE: This study was designed to establish normative data for objective measures of disparity vergence and saccades in children between the ages 9 and 17 years using an objective binocular eye movement tracking system. METHODS: Participants (aged 9 to 17 years) had a vision examination including refraction, accommodative, and binocular vision testing. Eligibility criteria included 20/25 visual acuity with best correction, normal accommodation, and binocular vision. The ISCAN RK-826PCI binocular tracking system (ISCAN, Woburn, MA) was used to objectively record horizontal, symmetrical disparity vergence, and saccadic eye movements. Parameters assessed included peak velocity, time to peak velocity, latency, and response amplitude for both disparity vergence and saccades. RESULTS: One hundred eighteen participants were recruited (54.94% female; mean age, 13.5 years), and 77.1% (91/118) of the participants completed the assessment with usable data. A sample of the normative data included peak velocity (°/s), which had a mean ± standard deviation of 25.4 ± 2.9, 22.0 ± 3.0, 225 ± 16.7, and 332.5 ± 20.5 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. The mean ± standard deviation for the latency (seconds) measures were 0.28 ± 0.1, 0.28 ± 0.16, 0.23 ± 0.05, and 0.23 ± 0.05 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. CONCLUSIONS: Normative data enable researchers to have benchmark results for comparison with patient populations with binocular dysfunction. These objective disparity vergence measures can serve as outcome measures in future clinical trials to assess the effectiveness of therapeutic interventions by determining whether post-treatment results are similar to normal data.},
 bibtype = {article},
 author = {Namaeh, Mashael and Scheiman, Mitchell M. and Yaramothu, Chang and Alvarez, Tara L.},
 doi = {10.1097/OPX.0000000000001515},
 journal = {Optometry and Vision Science},
 number = {6}
}

SIGNIFICANCE: This study establishes normative data for objective outcome measures of vergence and saccade eye movements for the pediatric population. These data should facilitate future clinical trial design. PURPOSE: This study was designed to establish normative data for objective measures of disparity vergence and saccades in children between the ages 9 and 17 years using an objective binocular eye movement tracking system. METHODS: Participants (aged 9 to 17 years) had a vision examination including refraction, accommodative, and binocular vision testing. Eligibility criteria included 20/25 visual acuity with best correction, normal accommodation, and binocular vision. The ISCAN RK-826PCI binocular tracking system (ISCAN, Woburn, MA) was used to objectively record horizontal, symmetrical disparity vergence, and saccadic eye movements. Parameters assessed included peak velocity, time to peak velocity, latency, and response amplitude for both disparity vergence and saccades. RESULTS: One hundred eighteen participants were recruited (54.94% female; mean age, 13.5 years), and 77.1% (91/118) of the participants completed the assessment with usable data. A sample of the normative data included peak velocity (°/s), which had a mean ± standard deviation of 25.4 ± 2.9, 22.0 ± 3.0, 225 ± 16.7, and 332.5 ± 20.5 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. The mean ± standard deviation for the latency (seconds) measures were 0.28 ± 0.1, 0.28 ± 0.16, 0.23 ± 0.05, and 0.23 ± 0.05 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. CONCLUSIONS: Normative data enable researchers to have benchmark results for comparison with patient populations with binocular dysfunction. These objective disparity vergence measures can serve as outcome measures in future clinical trials to assess the effectiveness of therapeutic interventions by determining whether post-treatment results are similar to normal data.

@article{
 title = {Convergence Insufficiency Neuro-mechanism in Adult Population Study Randomized Clinical Trial: Clinical Outcome Results},
 type = {article},
 year = {2020},
 pages = {1061-1069},
 volume = {97},
 websites = {https://journals.lww.com/optvissci/Fulltext/2020/12000/Convergence_Insufficiency_Neuro_mechanism_in_Adult.9.aspx},
 month = {12},
 publisher = {NLM (Medline)},
 day = {1},
 id = {ee5eb4eb-08cf-3104-9306-c5db1b297c6a},
 created = {2021-05-07T18:31:16.419Z},
 accessed = {2021-05-07},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-05-07T18:31:50.877Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {SIGNIFICANCE: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency within a double-masked longitudinal randomized clinical trial. PURPOSE: This study aimed to report changes in clinical signs and symptoms of convergence insufficiency from a randomized clinical trial evaluating the effectiveness of office-based vergence/accommodative therapy for young adults with symptomatic convergence insufficiency. METHODS: In this double-masked, randomized clinical trial, convergence insufficiency patients (n = 50; average age, 21 ± 3 years; range, 18 to 32 years) were randomized to either office-based vergence/accommodative therapy or office-based placebo therapy. Improvements in (1) near point of convergence, (2) positive fusional vergence, and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were evaluated after twelve 1-hour sessions of treatment within the office comparing the results from the vergence/accommodative therapy and the placebo therapy groups. RESULTS: The mean near point of convergence improved by 6.0 and 3.1 cm in the vergence/accommodative and placebo therapy groups, respectively (mean difference of -2.9 cm; 95% confidence interval [CI], -4.6 to -1.0 cm; P < .01). The mean positive fusional vergence increased by 17.3 and 7.4Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 9.9Δ; 95% CI, 4.9 to 16.0Δ; P < .001). The mean CISS score improved by 12.4 and 10.1 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 2.3 points; 95% CI, -8.3 to +4.6 points; P = .56). CONCLUSIONS: Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, we recommend that the CISS be revised if it is to be used as an outcome measure in future studies of convergence insufficiency.},
 bibtype = {article},
 author = {Alvarez, Tara L. and Scheiman, Mitchell and Santos, Elio M. and Yaramothu, Chang and D'Antonio-Bertagnolli, John Vito},
 doi = {10.1097/OPX.0000000000001606},
 journal = {Optometry and vision science : official publication of the American Academy of Optometry},
 number = {12}
}

SIGNIFICANCE: These data confirm the effectiveness of office-based vergence/accommodative therapy for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency within a double-masked longitudinal randomized clinical trial. PURPOSE: This study aimed to report changes in clinical signs and symptoms of convergence insufficiency from a randomized clinical trial evaluating the effectiveness of office-based vergence/accommodative therapy for young adults with symptomatic convergence insufficiency. METHODS: In this double-masked, randomized clinical trial, convergence insufficiency patients (n = 50; average age, 21 ± 3 years; range, 18 to 32 years) were randomized to either office-based vergence/accommodative therapy or office-based placebo therapy. Improvements in (1) near point of convergence, (2) positive fusional vergence, and (3) self-reported symptoms (Convergence Insufficiency Symptom Survey [CISS] score) were evaluated after twelve 1-hour sessions of treatment within the office comparing the results from the vergence/accommodative therapy and the placebo therapy groups. RESULTS: The mean near point of convergence improved by 6.0 and 3.1 cm in the vergence/accommodative and placebo therapy groups, respectively (mean difference of -2.9 cm; 95% confidence interval [CI], -4.6 to -1.0 cm; P < .01). The mean positive fusional vergence increased by 17.3 and 7.4Δ in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 9.9Δ; 95% CI, 4.9 to 16.0Δ; P < .001). The mean CISS score improved by 12.4 and 10.1 points in the vergence/accommodative and placebo therapy groups, respectively (mean difference of 2.3 points; 95% CI, -8.3 to +4.6 points; P = .56). CONCLUSIONS: Our results demonstrate that office-based vergence/accommodative therapy is effective for improving the near point of convergence and positive fusional vergence in young adults with symptomatic convergence insufficiency. However, given that both treatment groups had a similar reduction in self-reported symptoms, we recommend that the CISS be revised if it is to be used as an outcome measure in future studies of convergence insufficiency.

@article{
 title = {Vergence endurance test: A pilot study for a concussion biomarker},
 type = {article},
 year = {2019},
 keywords = {concussion biomarker,objective concussion metric,post-concussion syndrome,vergence distractors,vergence eye movements},
 pages = {2200-2212},
 volume = {36},
 websites = {http://www.ncbi.nlm.nih.gov/pubmed/30829134,https://www.liebertpub.com/doi/10.1089/neu.2018.6075},
 month = {3},
 day = {2},
 id = {1cea2788-5756-3f99-aab9-7277b3f491dc},
 created = {2019-03-20T14:25:22.988Z},
 accessed = {2019-03-20},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2019-12-17T15:32:55.068Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {false},
 hidden = {false},
 folder_uuids = {ef724bcc-ea1a-47ba-811c-f2799f915dbd},
 private_publication = {false},
 abstract = {The Vergence Endurance Test (VET), a quantitative and objective eye movement assessment, was utilized to differentiate control from concussed subjects. Nine symptomatic concussed (2 male; 30.8 ± 11 years) and 9 asymptomatic control (6 male; 25.1 ± 1.4 years) subjects participated in the VET. Symmetrical disparity vergence step targets were presented with and without visual distractors. A masked data analyst measured vergence latency, peak velocity, response amplitude, settling time, and the percentage of trials which contained blinks. A Binocular Precision Index (BPI) and a Binocular Accuracy Index (BAI) were calculated to quantify the changes that occur in the vergence parameters over the duration of the VET. Convergence and divergence peak velocity, divergence response amplitude, the percentage of trials that contained blinks during the transient portion of the response, and the BAI were significantly (p < 0.05) different between the concussed and the control subjects. For these parameters, the BAI and divergence response amplitude yielded the greatest accuracy, 78%, in their ability to discriminate between the groups. The VET objectively measures the change in vergence performance over time and shows promise as a method to diagnose a concussion. Future studies will determine whether the VET can be used to assess the extent of natural recovery and the effectiveness of therapeutic interventions.},
 bibtype = {article},
 author = {Yaramothu, Chang and Greenspan, Lynn D. and Scheiman, Mitchell and Alvarez, Tara L.},
 doi = {10.1089/neu.2018.6075},
 journal = {Journal of Neurotrauma},
 number = {14}
}

The Vergence Endurance Test (VET), a quantitative and objective eye movement assessment, was utilized to differentiate control from concussed subjects. Nine symptomatic concussed (2 male; 30.8 ± 11 years) and 9 asymptomatic control (6 male; 25.1 ± 1.4 years) subjects participated in the VET. Symmetrical disparity vergence step targets were presented with and without visual distractors. A masked data analyst measured vergence latency, peak velocity, response amplitude, settling time, and the percentage of trials which contained blinks. A Binocular Precision Index (BPI) and a Binocular Accuracy Index (BAI) were calculated to quantify the changes that occur in the vergence parameters over the duration of the VET. Convergence and divergence peak velocity, divergence response amplitude, the percentage of trials that contained blinks during the transient portion of the response, and the BAI were significantly (p < 0.05) different between the concussed and the control subjects. For these parameters, the BAI and divergence response amplitude yielded the greatest accuracy, 78%, in their ability to discriminate between the groups. The VET objectively measures the change in vergence performance over time and shows promise as a method to diagnose a concussion. Future studies will determine whether the VET can be used to assess the extent of natural recovery and the effectiveness of therapeutic interventions.

@article{
 title = {Proceedings #37: Virtual Eye Rotation Vision Exercises (VERVE): A Virtual Reality Vision Therapy Platform with Eye Tracking},
 type = {article},
 year = {2019},
 pages = {e107-e108},
 volume = {12},
 month = {3},
 publisher = {Elsevier},
 id = {dd7f8045-e210-3ec8-b427-87c44e145a45},
 created = {2019-09-01T00:00:53.616Z},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2021-11-20T20:30:51.299Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 folder_uuids = {2a1ff542-029e-4f47-9dc1-e33eaca67bb7},
 private_publication = {false},
 abstract = {Binocular vision disorders such as convergence insufficiency (CI) impact the quality of life in patients across the entire age spectrum. While office‐based vision therapy has been found to be effective, home‐based vision therapy has been found to be no more effective than placebo therapy. It is hypothesized that this may be due to poor patient compliance and the “boring” nature of therapy. This pilot study tested VERVE (Virtual Eye Rotation Vision Exercises), a virtual reality video game that incorporates effective elements of office‐based vision therapy, on nine CI patients. A masked, licensed clinician diagnosed and re‐examined patients. Near point of convergence, positive fusional vergence, symptom surveys and vergence responses to 4 deg symmetrical step stimuli were compared pre‐ and post‐VERVE. After 12 one‐ hour sessions with VERVE, seven subjects were shown to be remediated, while the remaining subjects showed symptomatic and clinical improvement. 2 Introduction: Convergence insufficiency (CI) is a prevalent binocular vision disorder which significantly impacts the quality of life in adults and children[1]. Symptoms include double/blurred vision, eyestrain, headaches, and re‐reading of words for comprehension, so performing near work (for example, reading from a book or smart‐device) interferes with a subject's day to day activities. CI is present in 4.2% to 17.6% of the general population[2–5]. CI has also been observed in 50% of civilian [6] and 46% of military/veteran populations following a traumatic brain injury (TBI), including concussions [7]. Traditional Office‐Based Vergence and Accommodative Therapy (OBVAT) is 73% effective in remediating patient symptoms[1]; yet, home therapy has been reported to be no more effective then sham therapy. It may be that the repetitive nature of the therapy protocols and lack of engagement by a vision therapist in a home environment may in part be the reasons for the low success rates for home‐based therapy. Therefore, there is a need for a vision therapy tool that is fun, interactive, automated, and can produce quantitative metrics for the clinician and patient, in both office‐ and home‐based settings. VERVE (Virtual Eye Rotation Vision Exercises) is an interactive virtual reality experience, which incorporates eye tracking monitoring and engages patients like a traditionally fun video game. VERVE has been designed with elements of vision therapy; specifically, VERVE modifies the vergence demand, or amount of eye rotation, required to complete each exercise. VERVE alters the vergence demand within each gaming session and increases the total vergence demand every session that the subject plays the vision therapy game. 3 Methods: Nine subjects (5M, 22.6 + 4.7 years) were recruited for this pilot study. All signed informed consent documentation prior to the experiments, which were approved by the New Jersey Institute of Technology's (NJIT) Institutional Review Board (IRB) in accordance with the Declaration of Helsinki. Clinical and oculomotor quantitative assessments were performed before and after VERVE vision therapy outside the therapeutic environment. Clinical exams were performed by an optometrist who was simultaneously examining subjects from another study involving the same patient demographics, participating in both active and placebo therapies. Hence, the clinician was masked, leading to a virtually unbiased clinical exam. VERVE is played on a FOVE 0 head mounded display (HMD), a commercially available headset with integrated eye tracking. VERVE displays specific stimuli in the FOVE 0 that controls the amount of time a patient converges (inward eye rotation) in the near or far space on their visual midline. The magnitude of convergence is varied within a single session. The total magnitude of convergence demand in each session is systematically increased from session 1 to session 12. All subjects participated in 12 one‐hour sessions (1 – 2 sessions per week) of VERVE. The following clinical measures were measured from each subject pre‐ and post‐therapy: 1) Near Point of Convergence (NPC), 2) Positive Fusional Vergence (PFV), 3) near / far dissociated phoria, and 4) Convergence Insufficiency Symptom Survey (CISS). The CISS is 15 questions using a 5‐point Likert scale to assess vision symptoms where the greater the score the more symptomatic the subject. These methods were chosen because CI is diagnosed using the following criteria: 1) NPC ≥ 6cm, 2) PFV not meeting Sheard's criteria of at least twice the near phoria or a range of ≤ 15Δ, 3) exophoria at near more than 4Δ greater than at far, and 4) CISS score of ≥ 21 for those 18 years and older.[1,8] Quantitative eye movement assessments included response amplitudes, latencies, and peak velocities from vergence responses stimulated from 4 and 6 deg symmetrical convergence and divergence steps as shown by others were also collected pre‐ and post‐therapy[9]. 4 Results: Seven out of the nine subjects met success criteria for both clinical measures and symptoms, while the remaining two subjects showed clinical and symptomatic improvement. The mean NPCs improved from 10.4 ± 2.9 cm to 5.1 ± 2.1 cm; mean PFVs improved from 14.7 ± 3.0Δ to 26.5 ± 10.8Δ; and mean CISS scores improved from 35.6 ± 5.5 to 19.4 ± 5.6. Based on the definitions of a CI, seven subjects were classified as successfully remediated by VERVE. Figure 1 shows the vergence eye movements (positive position on the y axis is convergence rotation) from binocularly normal control (green traces), two CI patients before VERVE vision therapy (blue traces) and the same CI patients after VERVE vision therapy (red traces). The solid traces are the position traces, while dashes traces are the respective velocity traces. The responses are generated by the individuals from the presentation a symmetrical 4‐degree vergence step stimuli. The control's eye movements are more accurate, meaning that they can respond to and hold the eye onto a new target. The eye movements are also precise, in that the subject can consistently make similar 4‐degree vergence movements. The CIs initially (pre‐VERVE therapy) have poor accuracy, meaning the eye cannot attain the 4‐degree final position. Accuracy in the CI subjects improves post VERVE, and eye movements look more similar to the control subject. [Figure presented] 5 Discussion and Conclusion: The results from this study show the potential for an effective therapy platform that can be conducted within a virtual reality setting and can be automated to produce quantitative metrics. Future work will include more subjects and a randomized clinical trial paradigm to test the effectiveness of VERVE compared to a control group. Current vision therapy methodologies require the presence of a trained vision therapist for an effective treatment. None of the tools currently available to vision therapists provide objective, quantitative metrics of eye movements, which are available only through eye tracking. Thus, there is a need for a quantitative tool that will facilitate the treatment and track progress of vision performance in CI patients. Finally, if VERVE is shown to be successful when administered as home‐based therapy, it may reduce the cost of vision therapy making it more accessible to a broader population that was previously unable to benefit either because of financial restrictions or the lack of availability of a licensed vision therapist. References: [1] Convergence Insufficiency Treatment Trial Study Group CITTI. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol (Chicago, Ill 1960) 2008;126:1336–49. doi:10.1001/archopht.126.10.1336. [2] Rouse MW, Borsting EJ, Hyman L, Hussein M, Cotter SA, Flynn M, et al. Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group. Optom Vis Sci 1999;76:643–9. [3] Hussaindeen JR, Rakshit A, Singh NK, George R, Swaminathan M, Kapur S, et al. Prevalence of non‐ strabismic anomalies of binocular vision in Tamil Nadu: report 2 of BAND study. Clin Exp Optom 2017;100:642–8. doi:10.1111/cxo.12496. [4] Davis AL, Harvey EM, Twelker JD, Miller JM, Leonard‐Green T, Campus I. Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O'odham Students. J Ophthalmol 2016;2016:1–7. doi:10.1155/2016/6963976. [5] Wajuihian SO, Hansraj R. Anomalías de vergencia en una muestra de estudiantes de secundaria de Sudáfrica. J Optom 2016;9:246–57. doi:10.1016/j.optom.2015.10.006. [6] Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, et al. Vision Diagnoses Are Common After Concussion in Adolescents. Clin Pediatr (Phila) 2016;55:260–7. doi:10.1177/0009922815594367. [7] Goodrich GL, Kirby J, Cockerham G, Ingalla SP, Lew HL. Visual function in patients of a polytrauma rehabilitation center: A descriptive study. J Rehabil Res Dev 2007;44:929–36. [8] Rouse MW, Borsting EJ, Mitchell GL, Cotter SA, Kulp MT, Scheiman M, et al. Validity of the Convergence Insufficiency Symptom Survey: A Confirmatory Study. Optom Vis Sci 2009;86:357– 63. doi:10.1097/OPX.0b013e3181989252. [9] Scheiman MM, Talasan H, Mitchell GL, Alvarez TL. Objective Assessment of Vergence after Treatment of Concussion‐Related CI: A Pilot Study. Optom Vis Sci 2016. doi:10.1097/OPX.0000000000000936. Acknowledgement: This research was supported in part by NIH 1R01EY023261 to TLA and},
 bibtype = {article},
 author = {Yaramothu, Chang and Vito d’Antonio- Bertagnolli, John and Santos, Elio M. and Crincoli, Patrick C. and Rajah, Joel V. and Scheiman, Mitchell and Alvarez, Tara L.},
 doi = {10.1016/j.brs.2018.12.206},
 journal = {Brain Stimulation},
 number = {2}
}

Binocular vision disorders such as convergence insufficiency (CI) impact the quality of life in patients across the entire age spectrum. While office‐based vision therapy has been found to be effective, home‐based vision therapy has been found to be no more effective than placebo therapy. It is hypothesized that this may be due to poor patient compliance and the “boring” nature of therapy. This pilot study tested VERVE (Virtual Eye Rotation Vision Exercises), a virtual reality video game that incorporates effective elements of office‐based vision therapy, on nine CI patients. A masked, licensed clinician diagnosed and re‐examined patients. Near point of convergence, positive fusional vergence, symptom surveys and vergence responses to 4 deg symmetrical step stimuli were compared pre‐ and post‐VERVE. After 12 one‐ hour sessions with VERVE, seven subjects were shown to be remediated, while the remaining subjects showed symptomatic and clinical improvement. 2 Introduction: Convergence insufficiency (CI) is a prevalent binocular vision disorder which significantly impacts the quality of life in adults and children[1]. Symptoms include double/blurred vision, eyestrain, headaches, and re‐reading of words for comprehension, so performing near work (for example, reading from a book or smart‐device) interferes with a subject's day to day activities. CI is present in 4.2% to 17.6% of the general population[2–5]. CI has also been observed in 50% of civilian [6] and 46% of military/veteran populations following a traumatic brain injury (TBI), including concussions [7]. Traditional Office‐Based Vergence and Accommodative Therapy (OBVAT) is 73% effective in remediating patient symptoms[1]; yet, home therapy has been reported to be no more effective then sham therapy. It may be that the repetitive nature of the therapy protocols and lack of engagement by a vision therapist in a home environment may in part be the reasons for the low success rates for home‐based therapy. Therefore, there is a need for a vision therapy tool that is fun, interactive, automated, and can produce quantitative metrics for the clinician and patient, in both office‐ and home‐based settings. VERVE (Virtual Eye Rotation Vision Exercises) is an interactive virtual reality experience, which incorporates eye tracking monitoring and engages patients like a traditionally fun video game. VERVE has been designed with elements of vision therapy; specifically, VERVE modifies the vergence demand, or amount of eye rotation, required to complete each exercise. VERVE alters the vergence demand within each gaming session and increases the total vergence demand every session that the subject plays the vision therapy game. 3 Methods: Nine subjects (5M, 22.6 + 4.7 years) were recruited for this pilot study. All signed informed consent documentation prior to the experiments, which were approved by the New Jersey Institute of Technology's (NJIT) Institutional Review Board (IRB) in accordance with the Declaration of Helsinki. Clinical and oculomotor quantitative assessments were performed before and after VERVE vision therapy outside the therapeutic environment. Clinical exams were performed by an optometrist who was simultaneously examining subjects from another study involving the same patient demographics, participating in both active and placebo therapies. Hence, the clinician was masked, leading to a virtually unbiased clinical exam. VERVE is played on a FOVE 0 head mounded display (HMD), a commercially available headset with integrated eye tracking. VERVE displays specific stimuli in the FOVE 0 that controls the amount of time a patient converges (inward eye rotation) in the near or far space on their visual midline. The magnitude of convergence is varied within a single session. The total magnitude of convergence demand in each session is systematically increased from session 1 to session 12. All subjects participated in 12 one‐hour sessions (1 – 2 sessions per week) of VERVE. The following clinical measures were measured from each subject pre‐ and post‐therapy: 1) Near Point of Convergence (NPC), 2) Positive Fusional Vergence (PFV), 3) near / far dissociated phoria, and 4) Convergence Insufficiency Symptom Survey (CISS). The CISS is 15 questions using a 5‐point Likert scale to assess vision symptoms where the greater the score the more symptomatic the subject. These methods were chosen because CI is diagnosed using the following criteria: 1) NPC ≥ 6cm, 2) PFV not meeting Sheard's criteria of at least twice the near phoria or a range of ≤ 15Δ, 3) exophoria at near more than 4Δ greater than at far, and 4) CISS score of ≥ 21 for those 18 years and older.[1,8] Quantitative eye movement assessments included response amplitudes, latencies, and peak velocities from vergence responses stimulated from 4 and 6 deg symmetrical convergence and divergence steps as shown by others were also collected pre‐ and post‐therapy[9]. 4 Results: Seven out of the nine subjects met success criteria for both clinical measures and symptoms, while the remaining two subjects showed clinical and symptomatic improvement. The mean NPCs improved from 10.4 ± 2.9 cm to 5.1 ± 2.1 cm; mean PFVs improved from 14.7 ± 3.0Δ to 26.5 ± 10.8Δ; and mean CISS scores improved from 35.6 ± 5.5 to 19.4 ± 5.6. Based on the definitions of a CI, seven subjects were classified as successfully remediated by VERVE. Figure 1 shows the vergence eye movements (positive position on the y axis is convergence rotation) from binocularly normal control (green traces), two CI patients before VERVE vision therapy (blue traces) and the same CI patients after VERVE vision therapy (red traces). The solid traces are the position traces, while dashes traces are the respective velocity traces. The responses are generated by the individuals from the presentation a symmetrical 4‐degree vergence step stimuli. The control's eye movements are more accurate, meaning that they can respond to and hold the eye onto a new target. The eye movements are also precise, in that the subject can consistently make similar 4‐degree vergence movements. The CIs initially (pre‐VERVE therapy) have poor accuracy, meaning the eye cannot attain the 4‐degree final position. Accuracy in the CI subjects improves post VERVE, and eye movements look more similar to the control subject. [Figure presented] 5 Discussion and Conclusion: The results from this study show the potential for an effective therapy platform that can be conducted within a virtual reality setting and can be automated to produce quantitative metrics. Future work will include more subjects and a randomized clinical trial paradigm to test the effectiveness of VERVE compared to a control group. Current vision therapy methodologies require the presence of a trained vision therapist for an effective treatment. None of the tools currently available to vision therapists provide objective, quantitative metrics of eye movements, which are available only through eye tracking. Thus, there is a need for a quantitative tool that will facilitate the treatment and track progress of vision performance in CI patients. Finally, if VERVE is shown to be successful when administered as home‐based therapy, it may reduce the cost of vision therapy making it more accessible to a broader population that was previously unable to benefit either because of financial restrictions or the lack of availability of a licensed vision therapist. References: [1] Convergence Insufficiency Treatment Trial Study Group CITTI. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol (Chicago, Ill 1960) 2008;126:1336–49. doi:10.1001/archopht.126.10.1336. [2] Rouse MW, Borsting EJ, Hyman L, Hussein M, Cotter SA, Flynn M, et al. Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group. Optom Vis Sci 1999;76:643–9. [3] Hussaindeen JR, Rakshit A, Singh NK, George R, Swaminathan M, Kapur S, et al. Prevalence of non‐ strabismic anomalies of binocular vision in Tamil Nadu: report 2 of BAND study. Clin Exp Optom 2017;100:642–8. doi:10.1111/cxo.12496. [4] Davis AL, Harvey EM, Twelker JD, Miller JM, Leonard‐Green T, Campus I. Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O'odham Students. J Ophthalmol 2016;2016:1–7. doi:10.1155/2016/6963976. [5] Wajuihian SO, Hansraj R. Anomalías de vergencia en una muestra de estudiantes de secundaria de Sudáfrica. J Optom 2016;9:246–57. doi:10.1016/j.optom.2015.10.006. [6] Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, et al. Vision Diagnoses Are Common After Concussion in Adolescents. Clin Pediatr (Phila) 2016;55:260–7. doi:10.1177/0009922815594367. [7] Goodrich GL, Kirby J, Cockerham G, Ingalla SP, Lew HL. Visual function in patients of a polytrauma rehabilitation center: A descriptive study. J Rehabil Res Dev 2007;44:929–36. [8] Rouse MW, Borsting EJ, Mitchell GL, Cotter SA, Kulp MT, Scheiman M, et al. Validity of the Convergence Insufficiency Symptom Survey: A Confirmatory Study. Optom Vis Sci 2009;86:357– 63. doi:10.1097/OPX.0b013e3181989252. [9] Scheiman MM, Talasan H, Mitchell GL, Alvarez TL. Objective Assessment of Vergence after Treatment of Concussion‐Related CI: A Pilot Study. Optom Vis Sci 2016. doi:10.1097/OPX.0000000000000936. Acknowledgement: This research was supported in part by NIH 1R01EY023261 to TLA and

@article{
 title = {Epidemiology and incidence of pediatric concussions in general aspects of life},
 type = {article},
 year = {2019},
 keywords = {Adolescent concussions,Concussion epidemiology,Concussions,Physical education},
 volume = {9},
 id = {7763d53c-b21e-388a-b17a-79ce27a15cfc},
 created = {2019-12-17T15:32:47.187Z},
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 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
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 abstract = {Background: Concussions are one of the most common head injuries acquired within the pediatric population. While sport-related concussions are well documented, concussions within other aspects of a child’s life are not as well researched. The purpose of this study is to examine the incidence of a large pediatric concussion population in a broad range of daily activities. Methods: Patients’ gender and nature of injury were extracted from 1408 medical records of patients who were diagnosed with a concussion at Saint Peter’s Sports Medicine Institute. Statistical analyses were conducted for activities and environmental settings using chi-squared tests. Results: Concussions were most prevalent in organized sports (53.3%), followed by injuries within the following settings: school (16.5%), recreational (6.7%), motor vehicle collisions (6.6%), home (5.5%), and other (11.3%). Specifically, soccer (12.9%), school physical education (PE) class (10.6%), and football (9.8%) subcategories recorded the most incidences of concussion. For the PE class cohort (n = 149), significantly more females were diagnosed with a concussion compared to males (p < 0.001). Conclusions: PE-related concussions had the second highest incidence rate after organized sports. A significant gender difference was observed in PE class. Awareness about concussions and methods to reduce the risk of concussion is suggested for PE classes.},
 bibtype = {article},
 author = {Yaramothu, Chang and Goodman, Arlene M. and Alvarez, Tara L.},
 doi = {10.3390/brainsci9100257},
 journal = {Brain Sciences},
 number = {10}
}

Background: Concussions are one of the most common head injuries acquired within the pediatric population. While sport-related concussions are well documented, concussions within other aspects of a child’s life are not as well researched. The purpose of this study is to examine the incidence of a large pediatric concussion population in a broad range of daily activities. Methods: Patients’ gender and nature of injury were extracted from 1408 medical records of patients who were diagnosed with a concussion at Saint Peter’s Sports Medicine Institute. Statistical analyses were conducted for activities and environmental settings using chi-squared tests. Results: Concussions were most prevalent in organized sports (53.3%), followed by injuries within the following settings: school (16.5%), recreational (6.7%), motor vehicle collisions (6.6%), home (5.5%), and other (11.3%). Specifically, soccer (12.9%), school physical education (PE) class (10.6%), and football (9.8%) subcategories recorded the most incidences of concussion. For the PE class cohort (n = 149), significantly more females were diagnosed with a concussion compared to males (p < 0.001). Conclusions: PE-related concussions had the second highest incidence rate after organized sports. A significant gender difference was observed in PE class. Awareness about concussions and methods to reduce the risk of concussion is suggested for PE classes.

@article{
 title = {Target Eccentricity and Form Influences Disparity Vergence Eye Movements Responses : A Temporal and Dynamic Analysis},
 type = {article},
 year = {2019},
 keywords = {eye movement,target color,target eccentricity,target form,vergence},
 pages = {1-12},
 volume = {12},
 id = {af3c2b94-0982-3bce-b43a-2bd07510adfc},
 created = {2019-12-17T15:32:47.336Z},
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 author = {Yaramothu, Chang and Jaswal, Rajbir S and Alvarez, Tara L},
 journal = {Journal of Eye Movement Research},
 number = {4}
}

@article{
 title = {Changes in the Disparity Vergence Main Sequence after Treatment of Symptomatic Convergence Insufficiency in Children},
 type = {article},
 year = {2019},
 volume = {12},
 id = {f0bf8e15-649a-3e99-99e3-103e0e960d88},
 created = {2020-02-24T01:37:34.346Z},
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 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-24T01:37:34.346Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {This study investigates the underlying physiological mechanisms that may lead to improved outcomes for symptomatic convergence insufficiency (CI) patients after 12 weeks of officebased 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.},
 bibtype = {article},
 author = {Scheiman, Mitchell and Yaramothu, Chang and Alvarez, Tara L},
 journal = {Journal of Eye Movement Research},
 number = {4}
}

This study investigates the underlying physiological mechanisms that may lead to improved outcomes for symptomatic convergence insufficiency (CI) patients after 12 weeks of officebased 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.

@article{
 title = {Clinical and Functional Imaging Changes Induced from Vision Therapy in Patients with Convergence Insufficiency},
 type = {article},
 year = {2019},
 keywords = {Brain functional imaging - fMRI,Neurological disorders - Treatment methodologies,Neurorehabilitation},
 pages = {104-109},
 id = {f3716ae9-30d2-32e4-8cc9-97b9dd8e605b},
 created = {2020-02-24T01:37:34.647Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-24T01:37:34.647Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Office-Based Vergence/Accommodative Therapy (OBVAT) is an effective treatment for convergence insufficiency (CI) and remediates symptoms in about 75% of patients. Hence, the study of CI patients can serve as a systems-level model to understand the neural mechanisms evoked from rehabilitation. Symptomatic young adult CI patients (N=25) participated in 12 hours of OBVAT and were compared to 25 binocularly normal controls (BNC) using unpaired t-tests. CI patients have significantly lower near point of convergence and positive fusional vergence and were more symptomatic compared to BNC (p<0.0001). Using paired t-tests, significant differences (p<0.0001) were observed between CI patients' baseline and post-OBVAT measurements where the near point of convergence decreased, positive fusional vergence increased, and the results from the Convergence Insufficiency Symptom Survey (CISS) decreased. Using paired t-tests, the mean beta weights of the functional activity significantly increased for the frontal eye fields (p<0.01) and the oculomotor vermis (p<0.05) for CI patients post-OBVAT compared to baseline measurements. These data demonstrate that OBVAT increases functional activity within the brain and improves clinical function and visual symptoms in CI patients.},
 bibtype = {article},
 author = {Alvarez, Tara L. and Scheiman, Mitchell and Santos, Elio M. and Morales, Cristian and Yaramothu, Chang and D'Antonio-Bertagnolli, John Vito and Gohel, Suril and Biswal, Bharat B. and Li, Xiaobo},
 doi = {10.1109/EMBC.2019.8857163},
 journal = {Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS}
}

Office-Based Vergence/Accommodative Therapy (OBVAT) is an effective treatment for convergence insufficiency (CI) and remediates symptoms in about 75% of patients. Hence, the study of CI patients can serve as a systems-level model to understand the neural mechanisms evoked from rehabilitation. Symptomatic young adult CI patients (N=25) participated in 12 hours of OBVAT and were compared to 25 binocularly normal controls (BNC) using unpaired t-tests. CI patients have significantly lower near point of convergence and positive fusional vergence and were more symptomatic compared to BNC (p<0.0001). Using paired t-tests, significant differences (p<0.0001) were observed between CI patients' baseline and post-OBVAT measurements where the near point of convergence decreased, positive fusional vergence increased, and the results from the Convergence Insufficiency Symptom Survey (CISS) decreased. Using paired t-tests, the mean beta weights of the functional activity significantly increased for the frontal eye fields (p<0.01) and the oculomotor vermis (p<0.05) for CI patients post-OBVAT compared to baseline measurements. These data demonstrate that OBVAT increases functional activity within the brain and improves clinical function and visual symptoms in CI patients.

@article{
 title = {Test–Retest Reliability of Functional Magnetic Resonance Imaging Activation for a Vergence Eye Movement Task},
 type = {article},
 year = {2019},
 keywords = {Functional MRI,Test–retest reliability,Vergence eye movement,Vergence region of interest masks},
 pages = {1-13},
 month = {12},
 publisher = {Springer},
 day = {23},
 id = {57f69665-ef64-30e8-bf8a-b899c87ee4ca},
 created = {2020-02-29T19:01:03.992Z},
 accessed = {2020-02-29},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:03:11.763Z},
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 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Vergence eye movements are the inward and outward rotation of the eyes responsible for binocular coordination. While studies have mapped and investigated the neural substrates of vergence, it is not well understood whether vergence eye movements evoke the blood oxygen level-dependent signal reliably in separate experimental visits. The test–retest reliability of stimulus-induced vergence eye movement tasks during a functional magnetic resonance imaging (fMRI) experiment is important for future randomized clinical trials (RCTs). In this study, we established region of interest (ROI) masks for the vergence neural circuit. Twenty-seven binocularly normal young adults participated in two functional imaging sessions measured on different days on the same 3T Siemens scanner. The fMRI experiments used a block design of sustained visual fixation and rest blocks interleaved between task blocks that stimulated eight or four vergence eye movements. The test–retest reliability of task-activation was assessed using the intraclass correlation coefficient (ICC), and that of spatial extent was assessed using the Dice coefficient. Functional activation during the vergence eye movement task of eight movements compared to rest was repeatable within the primary visual cortex (ICC = 0.8), parietal eye fields (ICC = 0.6), supplementary eye field (ICC = 0.5), frontal eye fields (ICC = 0.5), and oculomotor vermis (ICC = 0.6). The results demonstrate significant test–retest reliability in the ROIs of the vergence neural substrates for functional activation magnitude and spatial extent using the stimulus protocol of a task block stimulating eight vergence eye movements compared to sustained fixation. These ROIs can be used in future longitudinal RCTs to study patient populations with vergence dysfunctions.},
 bibtype = {article},
 author = {Morales, Cristian and Gohel, Suril and Li, Xiaobo and Scheiman, Mitchell and Biswal, Bharat B. and Santos, Elio M. and Yaramothu, Chang and Alvarez, Tara L.},
 doi = {10.1007/s12264-019-00455-9},
 journal = {Neuroscience Bulletin}
}

Vergence eye movements are the inward and outward rotation of the eyes responsible for binocular coordination. While studies have mapped and investigated the neural substrates of vergence, it is not well understood whether vergence eye movements evoke the blood oxygen level-dependent signal reliably in separate experimental visits. The test–retest reliability of stimulus-induced vergence eye movement tasks during a functional magnetic resonance imaging (fMRI) experiment is important for future randomized clinical trials (RCTs). In this study, we established region of interest (ROI) masks for the vergence neural circuit. Twenty-seven binocularly normal young adults participated in two functional imaging sessions measured on different days on the same 3T Siemens scanner. The fMRI experiments used a block design of sustained visual fixation and rest blocks interleaved between task blocks that stimulated eight or four vergence eye movements. The test–retest reliability of task-activation was assessed using the intraclass correlation coefficient (ICC), and that of spatial extent was assessed using the Dice coefficient. Functional activation during the vergence eye movement task of eight movements compared to rest was repeatable within the primary visual cortex (ICC = 0.8), parietal eye fields (ICC = 0.6), supplementary eye field (ICC = 0.5), frontal eye fields (ICC = 0.5), and oculomotor vermis (ICC = 0.6). The results demonstrate significant test–retest reliability in the ROIs of the vergence neural substrates for functional activation magnitude and spatial extent using the stimulus protocol of a task block stimulating eight vergence eye movements compared to sustained fixation. These ROIs can be used in future longitudinal RCTs to study patient populations with vergence dysfunctions.

@inproceedings{
 title = {The Automation of the OculoMotor Assessment Tool (OMAT)},
 type = {inproceedings},
 year = {2019},
 city = {New Brunswick, NJ},
 id = {690bf77b-8fce-3bf6-9da0-deb80f5090d0},
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 author = {Armout, N. and Morris, C. and Akiyama, T. and Chirayath, A. and D'Antonio-Bertagnolli, J. V. and Yaramothu, C. and Alvarez, T. L.},
 booktitle = {Proceedings of the Northeast Bioengineering Conference (NEBEC)}
}

@inproceedings{
 title = {Abstract# 1: Individualizing HD-tDCS With fMRI and E-Field Modeling: Pilot Data from the NAVIGATE-TBI Study},
 type = {inproceedings},
 year = {2019},
 pages = {e1},
 publisher = {Elsevier},
 city = {New York, NY},
 id = {d8a6f8f5-fbf0-3991-833c-e5c9e4cc801e},
 created = {2020-02-29T19:22:48.914Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:22:48.914Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {Individualizing HD-tDCS With fMRI and E-Field Modeling: Pilot Data from the NAVIGATE-TBI Study},
 bibtype = {inproceedings},
 author = {Quinn, Davin and Upston, Joel and Jones, Thomas and Richardson, Jesicca and Worth, Lindsay and Fratzke, Violet and Stephen, Julia and Hoffer, Michael and Alvarez, Tara L. and Yaramothu, Chang and Harris-Carriman, Stacey and Bikson, Marom and Mayer, Andrew},
 booktitle = {Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation}
}

Individualizing HD-tDCS With fMRI and E-Field Modeling: Pilot Data from the NAVIGATE-TBI Study

@inproceedings{
 title = {Proceedings #37: Virtual Eye Rotation Vision Exercises (VERVE): A Virtual Reality Vision Therapy Platform with Eye Tracking},
 type = {inproceedings},
 year = {2019},
 pages = {e107-e108},
 volume = {12},
 issue = {2},
 month = {3},
 publisher = {Elsevier},
 city = {New York, NY},
 id = {50fd56b5-9618-3e04-aacf-c9ea8c115890},
 created = {2020-02-29T19:29:09.306Z},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:29:12.632Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 folder_uuids = {2a1ff542-029e-4f47-9dc1-e33eaca67bb7},
 private_publication = {false},
 abstract = {Binocular vision disorders such as convergence insufficiency (CI) impact the quality of life in patients across the entire age spectrum. While office-based vision therapy has been found to be effective, home-based vision therapy has been found to be no more effective than placebo therapy. It is hypothesized that this may be due to poor patient compliance and the “boring” nature of therapy. This pilot study tested VERVE (Virtual Eye Rotation Vision Exercises), a virtual reality video game that incorporates effective elements of office-based vision therapy, on nine CI patients. A masked, licensed clinician diagnosed and re-examined patients. Near point of convergence, positive fusional vergence, symptom surveys and vergence responses to 4 deg symmetrical step stimuli were compared pre- and post-VERVE. After 12 one- hour sessions with VERVE, seven subjects were shown to be remediated, while the remaining subjects showed symptomatic and clinical improvement.},
 bibtype = {inproceedings},
 author = {Yaramothu, Chang and Vito d’Antonio- Bertagnolli, John and Santos, Elio M. and Crincoli, Patrick C. and Rajah, Joel V. and Scheiman, Mitchell and Alvarez, Tara L. and D’Antonio-Bertagnolli, John Vito and Santos, Elio M. and Crincoli, Patrick C. and Rajah, Joel V. and Scheiman, Mitchell and Alvarez, Tara L.},
 doi = {10.1016/j.brs.2018.12.206},
 booktitle = {Brain Stimulation: Basic Translational, and Clinical Research in Neuromodulation}
}

Binocular vision disorders such as convergence insufficiency (CI) impact the quality of life in patients across the entire age spectrum. While office-based vision therapy has been found to be effective, home-based vision therapy has been found to be no more effective than placebo therapy. It is hypothesized that this may be due to poor patient compliance and the “boring” nature of therapy. This pilot study tested VERVE (Virtual Eye Rotation Vision Exercises), a virtual reality video game that incorporates effective elements of office-based vision therapy, on nine CI patients. A masked, licensed clinician diagnosed and re-examined patients. Near point of convergence, positive fusional vergence, symptom surveys and vergence responses to 4 deg symmetrical step stimuli were compared pre- and post-VERVE. After 12 one- hour sessions with VERVE, seven subjects were shown to be remediated, while the remaining subjects showed symptomatic and clinical improvement.

@inproceedings{
 title = {OculoMotor Assessment Tool (OMAT) Normative Data},
 type = {inproceedings},
 year = {2019},
 city = {Orlando, FL},
 id = {ade9e0a4-4598-30d2-9d54-2d0ea1685321},
 created = {2020-02-29T19:42:09.408Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:42:09.408Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Yaramothu, C. and Tawdros, L. and Botas, Y. and Masadeh, F. and Rajah, J. V. and D’Antonio-Bertagnolli, J. V. and Alvarez, T. L},
 booktitle = {American Academy of Optometry Annual Meeting}
}

@inproceedings{
 title = {CINAPS - Convergence Insufficiency Neuro-Mechanism in Adult Population Study: Effect of Vision Therapy on Clinical, Objective Eye Movement, and Functional MRI Measures},
 type = {inproceedings},
 year = {2019},
 city = {Orlando, FL},
 id = {e43511e4-a65c-35d2-9f5c-11fc21ee643f},
 created = {2020-02-29T19:42:09.786Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:42:09.786Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Alvarez, T. L and Scheiman, M. and Morales, C. and Yaramothu, C. and D’Antonio-Bertagnolli, J. V. and Santos, E. M. and Gohel, S. and Biswal, B. B. and Li, X.},
 booktitle = {American Academy of Optometry Annual Meeting}
}

@inproceedings{
 title = {Repeatability Assessment of a functional MRI task stimulating the Vergence Neural System in Binocularly Normal Controls},
 type = {inproceedings},
 year = {2019},
 city = {Philadelphia, PA},
 id = {feb828c9-7fee-3d8e-a621-0f99d65cd666},
 created = {2020-02-29T19:51:40.782Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:51:40.782Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Morales, C. and Santos, E. M. and Scheiman, M. and Gohel, S. and Li, X. and Biswal, B. B. and Yaramothu, C. and D’Antonio-Bertagnolli, J. V. and Alvarez, T. L.},
 booktitle = {Biomedical Engineering Society Annual Meeting}
}

@misc{
 title = {Method, system, and apparatus for treatment of binocular dysfunctions},
 type = {misc},
 year = {2019},
 publisher = {US Patent Office},
 revision = {10335342},
 id = {1799125f-3f40-3909-ab52-51c6f98eecaa},
 created = {2020-02-29T20:01:35.845Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T20:01:35.845Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 country = {United States},
 patent_owner = {New Jersey Institute of Technology},
 private_publication = {false},
 abstract = {Exemplary embodiments of the present disclosure relate to systems, methods, and apparatus for vision therapy. In exemplary embodiments a visual therapy game can be rendered on one or more displays and the visual therapy game can be controlled by eye movements of the user. Visual stimuli incorporated in the visual therapy game can be rendered to facilitate vergence eye movements for the treatment of binocular dysfunctions},
 bibtype = {misc},
 author = {Alvarez, Tara L. and D'antonio-bertagnolli, John Vito and Gioia, Robert and Scheiman, Mitchell and Yaramothu, Chang}
}

Exemplary embodiments of the present disclosure relate to systems, methods, and apparatus for vision therapy. In exemplary embodiments a visual therapy game can be rendered on one or more displays and the visual therapy game can be controlled by eye movements of the user. Visual stimuli incorporated in the visual therapy game can be rendered to facilitate vergence eye movements for the treatment of binocular dysfunctions

@article{
 title = {Dynamics of the Disparity Vergence Fusion Sustain Component},
 type = {article},
 year = {2019},
 keywords = {control,fusion sustaining component,slow component,vergence,vergence feedback,vergence oscillations},
 volume = {12},
 websites = {https://bop.unibe.ch/JEMR/article/view/JEMR.12.4.11},
 id = {ff405054-e94d-3f3c-bbe8-1539d544ba52},
 created = {2020-03-22T11:22:23.607Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-03-22T11:22:23.607Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {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.},
 bibtype = {article},
 author = {Semmlow, John L and Yaramothu, Chang and Alvarez, Tara L},
 doi = {https://doi.org/10.16910/jemr.12.4.11},
 number = {4}
}

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.

@article{
 title = {Comparison of symmetrical prism adaptation to asymmetrical prism adaptation in those with normal binocular vision},
 type = {article},
 year = {2018},
 keywords = {Heterophoria,Phoria adaptation,Prism adaptation,Vergence adaptation},
 pages = {59-65},
 volume = {149},
 id = {b7db3b75-6128-3952-8dd8-7b4f059fa6ac},
 created = {2018-07-06T19:24:56.728Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2019-12-17T15:32:47.619Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {false},
 hidden = {false},
 private_publication = {false},
 abstract = {This study sought to determine whether symmetrical compared to asymmetrical horizontal prisms (base-out or base-in) evoked different rates of phoria adaptation. Sixteen young adults with normal binocular vision participated in a symmetrical phoria adaptation experiment using a 3Δ base-out or 3Δ base-in binocular prism flipper and an asymmetrical phoria adaptation experiment using a 6Δ base-out or 6Δ base-in monocular wedge prism. The experiments were randomized and counterbalanced to reduce the influence of the prism stimulation order. Asymmetrical base-out prism adaptation was significantly faster than symmetrical prism adaptation for subjects with normal binocular vision. Asymmetrical phoria adaptation with base-in prism was not significantly different from symmetrical phoria adaptation implying that there are directional asymmetries (convergent versus divergent eye movements) in the slow fusional component of vergence. Data suggest that a potential interaction between the version system and the slow fusional vergence system may exist. Results have clinical relevance because patients with convergence or divergence insufficiency/excess may potentially show more pronounced differences between symmetrical and asymmetrical phoria adaptation compared to binocularly normal controls. These differences might also be relevant to clinical measurements such as vergence fusional range, which can be measured symmetrically (with Risley prisms in a phoroptor) or asymmetrically (with prism bar).},
 bibtype = {article},
 author = {Santos, Elio M. and Yaramothu, Chang and Alvarez, Tara L.},
 doi = {10.1016/j.visres.2018.06.004},
 journal = {Vision Research}
}

This study sought to determine whether symmetrical compared to asymmetrical horizontal prisms (base-out or base-in) evoked different rates of phoria adaptation. Sixteen young adults with normal binocular vision participated in a symmetrical phoria adaptation experiment using a 3Δ base-out or 3Δ base-in binocular prism flipper and an asymmetrical phoria adaptation experiment using a 6Δ base-out or 6Δ base-in monocular wedge prism. The experiments were randomized and counterbalanced to reduce the influence of the prism stimulation order. Asymmetrical base-out prism adaptation was significantly faster than symmetrical prism adaptation for subjects with normal binocular vision. Asymmetrical phoria adaptation with base-in prism was not significantly different from symmetrical phoria adaptation implying that there are directional asymmetries (convergent versus divergent eye movements) in the slow fusional component of vergence. Data suggest that a potential interaction between the version system and the slow fusional vergence system may exist. Results have clinical relevance because patients with convergence or divergence insufficiency/excess may potentially show more pronounced differences between symmetrical and asymmetrical phoria adaptation compared to binocularly normal controls. These differences might also be relevant to clinical measurements such as vergence fusional range, which can be measured symmetrically (with Risley prisms in a phoroptor) or asymmetrically (with prism bar).

@article{
 title = {Altered cortical activation and connectivity patterns for visual attention processing in young adults post-traumatic brain injury: A functional near infrared spectroscopy study},
 type = {article},
 year = {2018},
 keywords = {TBI induced inattention,functional near-infrared spectroscopy (fNIRS),sports-related concussion (SRC),traumatic brain injury (TBI),visual sustained attention},
 volume = {24},
 websites = {http://www.ncbi.nlm.nih.gov/pubmed/29359534,http://doi.wiley.com/10.1111/cns.12811},
 month = {1},
 day = {22},
 id = {2faee5d5-5170-392a-8dfa-066c9472c30a},
 created = {2019-08-28T13:34:43.261Z},
 accessed = {2018-03-14},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2019-12-17T15:32:47.639Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 abstract = {© 2018 John Wiley & Sons Ltd Aims: This study aimed at understanding the neurobiological mechanisms associated with inattention induced by traumatic brain injury (TBI). To eliminate the potential confounding caused by the heterogeneity of TBI, we focused on young adults postsports-related concussion (SRC). Methods: Functional near-infrared spectroscopy (fNIRS) data were collected from 27 young adults post-SRC and 27 group-matched normal controls (NCs), while performing a visual sustained attention task. Task responsive cortical activation maps and pairwise functional connectivity among six regions of interest were constructed for each subject. Correlations among the brain imaging measures and clinical measures of attention were calculated in each group. Results: Compared to the NCs, the SRC group showed significantly increased brain activation in left middle frontal gyrus (MFG) and increased functional connectivity between right inferior occipital cortex (IOC) bilateral calcarine gyri (CG). The left MFG activation magnitude was significantly negatively correlated with the hyperactive/impulsive symptom severity measure in the NCs, but not in the patients. The right hemisphere CG-IOC functional connectivity showed a significant positive correlation with the hyperactive/impulsive symptom severity measure in patients, but not in NCs. Conclusion: The current data suggest that abnormal left MFG activation and hyper-communications between right IOC and bilateral CG during visual attention processing may significantly contribute to behavioral manifestations of attention deficits in patients with TBI.},
 bibtype = {article},
 author = {Wu, Z. and Mazzola, C. A. and Catania, L. and Owoeye, O. and Yaramothu, C. and Alvarez, T. L. and Gao, Y. and Li, X.},
 doi = {10.1111/cns.12811},
 journal = {CNS Neuroscience and Therapeutics},
 number = {6}
}

© 2018 John Wiley & Sons Ltd Aims: This study aimed at understanding the neurobiological mechanisms associated with inattention induced by traumatic brain injury (TBI). To eliminate the potential confounding caused by the heterogeneity of TBI, we focused on young adults postsports-related concussion (SRC). Methods: Functional near-infrared spectroscopy (fNIRS) data were collected from 27 young adults post-SRC and 27 group-matched normal controls (NCs), while performing a visual sustained attention task. Task responsive cortical activation maps and pairwise functional connectivity among six regions of interest were constructed for each subject. Correlations among the brain imaging measures and clinical measures of attention were calculated in each group. Results: Compared to the NCs, the SRC group showed significantly increased brain activation in left middle frontal gyrus (MFG) and increased functional connectivity between right inferior occipital cortex (IOC) bilateral calcarine gyri (CG). The left MFG activation magnitude was significantly negatively correlated with the hyperactive/impulsive symptom severity measure in the NCs, but not in the patients. The right hemisphere CG-IOC functional connectivity showed a significant positive correlation with the hyperactive/impulsive symptom severity measure in patients, but not in NCs. Conclusion: The current data suggest that abnormal left MFG activation and hyper-communications between right IOC and bilateral CG during visual attention processing may significantly contribute to behavioral manifestations of attention deficits in patients with TBI.

@article{
 title = {Effects of visual distractors on vergence eye movements},
 type = {article},
 year = {2018},
 pages = {1-17},
 volume = {18},
 websites = {https://jov.arvojournals.org/article.aspx?articleid=2683935,http://www.ncbi.nlm.nih.gov/pubmed/30029212,http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5987826,http://jov.arvojournals.org/article.aspx?doi=10.1167/18.6.2},
 month = {6},
 day = {4},
 id = {6642c76d-2c2d-3ac2-ab73-7e48604a5427},
 created = {2019-08-28T13:34:43.601Z},
 accessed = {2019-03-20},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2019-12-17T15:33:01.189Z},
 read = {false},
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 hidden = {false},
 folder_uuids = {35e9cc95-7d99-4280-b323-26ce3162ba07,78ee0065-be3b-4bc8-86f7-1af7ce888e3e},
 private_publication = {false},
 abstract = {Visual attention is an important aspect of everyday life, which can be incorporated in the assessment of many diagnoses. Another important characteristic of visual attention is that it can be improved via therapeutic interventions. Fifteen subjects with normal binocular vision were presented with visual distractor stimuli at various spatial locations while initiating disparity vergence eye movements (inward or outward rotation of eyes) within a haploscope system. First, a stationary distractor stimulus was presented in either the far, middle, or near visual spaces while the subjects were instructed to follow a target stimulus that was either stationary, converging (moving toward subject), or diverging (moving away from subject). For the second experiment, a dynamic distractor stimulus within the far, middle, or near visual space that was converging or diverging was presented while the target stimulus was also converging or diverging. The subjects were instructed to visually follow the target stimulus and ignore the distractor stimulus. The vergence responses had a final vergence angle between the target and distractor stimuli which has been termed a center of gravity (CoG) effect. Statistically significant differences were observed between the convergence peak velocities (p < 0.001) and response amplitudes (p < 0.001) comparing responses without distractors to responses with the presence of a vergence distractor. The results support that vergence eye movements are influenced by visual distractors, which is similar to how distractors influence saccadic eye movements. The influence of visual distractors within vergence eye movements may be useful to assess binocular dysfunction and visual distraction which are common post brain injury.},
 bibtype = {article},
 author = {Yaramothu, C. and Santos, E. M. and Alvarez, T. L.},
 doi = {10.1167/18.6.2},
 journal = {Journal of Vision},
 number = {6}
}

Visual attention is an important aspect of everyday life, which can be incorporated in the assessment of many diagnoses. Another important characteristic of visual attention is that it can be improved via therapeutic interventions. Fifteen subjects with normal binocular vision were presented with visual distractor stimuli at various spatial locations while initiating disparity vergence eye movements (inward or outward rotation of eyes) within a haploscope system. First, a stationary distractor stimulus was presented in either the far, middle, or near visual spaces while the subjects were instructed to follow a target stimulus that was either stationary, converging (moving toward subject), or diverging (moving away from subject). For the second experiment, a dynamic distractor stimulus within the far, middle, or near visual space that was converging or diverging was presented while the target stimulus was also converging or diverging. The subjects were instructed to visually follow the target stimulus and ignore the distractor stimulus. The vergence responses had a final vergence angle between the target and distractor stimuli which has been termed a center of gravity (CoG) effect. Statistically significant differences were observed between the convergence peak velocities (p < 0.001) and response amplitudes (p < 0.001) comparing responses without distractors to responses with the presence of a vergence distractor. The results support that vergence eye movements are influenced by visual distractors, which is similar to how distractors influence saccadic eye movements. The influence of visual distractors within vergence eye movements may be useful to assess binocular dysfunction and visual distraction which are common post brain injury.

@inproceedings{
 title = {Functional Cortical Differences between Convergence Insufficiency Patients and Binocularly Normal Controls},
 type = {inproceedings},
 year = {2018},
 city = {San Antonio, TX},
 id = {340ed857-6535-3c2e-bcb7-b19f54e621b2},
 created = {2020-02-29T19:51:40.496Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:51:40.496Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Alvarez, T. L. and Scheiman, M. and Santos, E. M. and Morales, C. and Karunakaran, K. and Jaswal, R. S. and Yaramothu, C. and D’Antonio-Bertagnolli, J. V. and Biswal, B. B. and Li, X.},
 booktitle = {American Academy of Optometry Annual Meeting}
}

@inproceedings{
 title = {Treatment Results for Convergence Insufficiency using VERVE: Virtual Eye Rotation Vision Exercises: A Pilot Study},
 type = {inproceedings},
 year = {2018},
 city = {San Antonio, TX},
 id = {b60b5660-6253-375f-8d00-52e0871bdf54},
 created = {2020-02-29T19:51:41.077Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:51:41.077Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Alvarez, T. L. and M., Scheiman and Yaramothu, C. and D'Antonio-Bertagnolli, J. V. and M., Santos E.},
 booktitle = {American Academy of Optometry Annual Meeting}
}

@inproceedings{
 title = {Objective Quantitative Concussion Assessment Through Vergence Eye Movements},
 type = {inproceedings},
 year = {2018},
 city = {Washington D.C.},
 id = {f026361a-f6fe-32e8-9b49-c5d9386456d1},
 created = {2020-02-29T19:51:41.212Z},
 file_attached = {false},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2020-02-29T19:51:41.212Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 private_publication = {false},
 bibtype = {inproceedings},
 author = {Yaramothu, C. and Alvarez, T. L.},
 booktitle = {4th Annual Interagency Conference on Traumatic Brain Injury}
}

@article{
 title = {The influence of age on adaptation of disparity vergence and phoria},
 type = {article},
 year = {2017},
 keywords = {Adaptation,Age,Eye movements,Phoria,Vergence},
 pages = {1-11},
 volume = {133},
 month = {4},
 id = {9b934b2b-2fb9-3c79-bc53-9d730af7e963},
 created = {2019-08-28T13:34:43.258Z},
 file_attached = {true},
 profile_id = {1ae04d4c-5061-39bf-a766-47993400267a},
 last_modified = {2019-12-17T15:32:58.107Z},
 read = {false},
 starred = {false},
 authored = {true},
 confirmed = {true},
 hidden = {false},
 folder_uuids = {0b8908ee-7b2e-49f5-a060-3986eaf85a14},
 private_publication = {false},
 abstract = {© 2017 A paucity of research exists to investigate whether the normal aging process influences the ability to adapt disparity vergence and phoria. Vergence eye movements and dissociated phoria were recorded from 49 healthy subjects (ages 20–70 years) using an objective eye movement tracking system. Four-degree vergence responses were modified using a double-step protocol. Dynamics of vergence were quantified via peak velocity. The phoria adaptation experiment measured the magnitude (net change in phoria level) and rate (magnitude divided by the time constant) of phoria adaption during 5 min of sustained fixation on a binocular target (40 cm/8.44° from midline). The magnitude of phoria adaptation decreased as a function of age (r = −0.33; p = 0.04). The ability to adapt vergence peak velocity and the rate of phoria adaptation showed no significant age-related influence (p > 0.05). The data suggest that the ability to modify the disparity vergence system and the rate of phoria adaptation are not dependent on age; whereas, the magnitude of phoria adaptation decreases as part of the normal adult aging process. These results have clinical and basic science implications because one should consider age when assessing the changes in the magnitude of phoria adaptation which can be abnormal in those with oculomotor dysfunctions.},
 bibtype = {article},
 author = {Alvarez, T. L. and Kim, E. H. and Yaramothu, C. and Granger-Donetti, B.},
 doi = {10.1016/j.visres.2017.01.002},
 journal = {Vision Research}
}

© 2017 A paucity of research exists to investigate whether the normal aging process influences the ability to adapt disparity vergence and phoria. Vergence eye movements and dissociated phoria were recorded from 49 healthy subjects (ages 20–70 years) using an objective eye movement tracking system. Four-degree vergence responses were modified using a double-step protocol. Dynamics of vergence were quantified via peak velocity. The phoria adaptation experiment measured the magnitude (net change in phoria level) and rate (magnitude divided by the time constant) of phoria adaption during 5 min of sustained fixation on a binocular target (40 cm/8.44° from midline). The magnitude of phoria adaptation decreased as a function of age (r = −0.33; p = 0.04). The ability to adapt vergence peak velocity and the rate of phoria adaptation showed no significant age-related influence (p > 0.05). The data suggest that the ability to modify the disparity vergence system and the rate of phoria adaptation are not dependent on age; whereas, the magnitude of phoria adaptation decreases as part of the normal adult aging process. These results have clinical and basic science implications because one should consider age when assessing the changes in the magnitude of phoria adaptation which can be abnormal in those with oculomotor dysfunctions.

@inproceedings{
 title = {You, Me, and Debris},
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 year = {2017},
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 author = {Yaramothu, C. and D'Antonio-Bertagnolli, J. V. and Alvarez, T. L.},
 booktitle = {Proceedings of the Northeast Bioengineering Conference (NEBEC)}
}

@inproceedings{
 title = {Low-frequency oscillations in the outermost cortical regions – An fNIRS Study},
 type = {inproceedings},
 year = {2016},
 city = {Binghamton, NY},
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 author = {Yaramothu, C. and Jaswal, R. S. and Bharat, B. and Alvarez, T. L.},
 booktitle = {Proceedings of the Northeast Bioengineering Conference (NEBEC)}
}

@inproceedings{
 title = {Optimal fNIRS optode cap design},
 type = {inproceedings},
 year = {2016},
 city = {Binghamton, NY},
 id = {76dd0722-93e6-3a00-880b-8cd6e102a76d},
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 booktitle = {Proceedings of the Northeast Bioengineering Conference (NEBEC)}
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@inproceedings{
 title = {Short-Term Modification of Vergence Ramp Eye Movements in the Convergent Direction},
 type = {inproceedings},
 year = {2014},
 pages = {1-2},
 volume = {2014-Decem},
 publisher = {IEEE},
 city = {Boston, MA},
 id = {aa0fbad6-4e06-33c3-9965-d312576f0c10},
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 abstract = {© 2014 IEEE. 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 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 was a 0.5 deg/sec vergence ramp presented from a 3 deg vergence angle to a 5 deg vergence angle. The conditioning stimulus was a 2.0 deg/sec ramp presented over the same visual range. The root mean square error (RMSE) was calculated on all slower (0.5 deg/ sec) ramp responses and compared over the three phases. Preliminary data from one subject shows a trend where the RMSE increases within the recovery phase compared to responses recorded from the baseline phase.},
 bibtype = {inproceedings},
 author = {Yaramothu, C. and Alvarez, T. L.},
 doi = {10.1109/NEBEC.2014.6972984},
 booktitle = {Proceedings of the IEEE Annual Northeast Bioengineering Conference, NEBEC}
}

© 2014 IEEE. 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 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 was a 0.5 deg/sec vergence ramp presented from a 3 deg vergence angle to a 5 deg vergence angle. The conditioning stimulus was a 2.0 deg/sec ramp presented over the same visual range. The root mean square error (RMSE) was calculated on all slower (0.5 deg/ sec) ramp responses and compared over the three phases. Preliminary data from one subject shows a trend where the RMSE increases within the recovery phase compared to responses recorded from the baseline phase.