Impacto da estimulação cerebral não-invasiva combinada com terapia dicóptica baseada na realidade aumentada no tratamento de ambliopes adultos

Amblyopia is generally considered a neurodevelopmental disorder. Its hallmark is a reduced VA in one or both eyes that cannot be immediately corrected through optical refraction, along with compromised binocular vision. Amblyopia is the leading cause of monocular vision loss in children, and because of the failure of early detection and/or treatment, amblyopia remains a significant cause of vision loss in adults. Amblyopic individuals face a substantially increased risk of blindness compared to the general population. The current gold-standard treatment for amblyopia involves occlusion therapy, which is known to have several limitations. Recent findings have prompted a shifted in treatment focus from monocular interventions to strategies directly addressing binocular visual function. Dichoptic treatment, for instance, aims to stimulate both eyes simultaneously, thereby fostering the potential improvement of monocular VA in the amblyopic eye while also addressing suppression and promoting the normalization of binocular interactions to facilitate the recovery of binocular vision. Traditionally, it has been accepted that amblyopia is untreatable in adulthood due to a lack of sufficient brain plasticity. However, emerging forms of noninvasive brain stimulation, such as tDCS, have opened new possibilities for treating several developmental disorders previously deemed untreatable in adulthood, including amblyopia. Over the years, there have been attempts to understand the mechanisms underlying the visual rehabilitation of amblyopic adults. However, an effective rehabilitation model enabling the recovery of visual functions in this population has yet to be firmly established. Several studies have explored videogame-based dichoptic treatment. Nevertheless, it is recognized that modern-day busy schedules and demanding daily routines make it impracticable for adults to commit to daily engagement with the treatment plan. Consequently, the risk of dropout is significantly elevated. There is a pressing need to develop an innovative therapy model specifically tailored to adults, offering a heightened probability of success. Thus, the primary objective of this project is to explore a novel therapeutic approach for the visual rehabilitation of adults with anisometropic amblyopia by integrating dichoptic therapy with AR technology. Using AR technology, individuals will be able to interact with the real world in real-time during the visual stimulation, enabling them to perform everyday tasks. Additionally, HD-tDCS will be employed to facilitate neuroplasticity in these individuals. We aim to assess the potential of HD-tDCS in enhancing the effectiveness of dichoptic therapy. The HD-tDCS represents a significant advancement in the field of noninvasive brain stimulation, offering enhanced spatial precision and the potential for more precise modulation of brain activity compared to traditional tDCS. We pretend to investigate the impact of this novel combined approach on VA and stereopsis. The secondary aims are 1) to assess the effect of treatment combining AR-based dichoptic therapy with HD-tDCS on macular neuronal layers thickness, retinal ganglion cell function, and cortical population receptive fields size in amblyopic adults; 2) to measure and compare low-level and high-level achromatic contrast sensitivity function in amblyopic adults across treatment; 3) to identify potential retinal and cortical biomarkers that predict amblyopia treatment response.