这项工作是由该撒利亚爱德蒙和本杰明·罗斯柴尔德基金会的支持。

该协议遵循人类受试者的研究哈达萨希伯来大学伦理委员会的指导方针。为了避免近视或屈光不正对测试结果的影响，该协议应在患者佩戴的眼镜（矫正视力）来执行。 对象从运动（OFM）协议： 1，测试启动和指导主题<ol><li>座椅被摄体50厘米的电脑屏幕前。 </li><li>打开OFM软件。 </li><li>指示，他将看到定义的运动物体的主题。指示他回应是正确的，尽可能快地通过按下“A”键盘，然后口头命名的感知对象。 </li><li>下面的响应，屏幕显示“按空格键”会出现。指示受按空格键时，做好准备，确定下一个刺激。 </li><li>要解释这个问题的刺激可能会很困难出现在对perceivË速度或一些容易察觉的。 </li></ol> 2，学习阶段在命令行中输入“学习OFM”。主题现在将带有4例的刺激。这一阶段是进行时，主体的两个眼睛是睁开的。 3，测试阶段在一般情况下，每OFM试验包括20个刺激。所有首先提出在4个像素/秒的最低速度。那些未确认将接着介绍在5.5像素/秒的速度旁边。那些不被认可，将随后介绍7.5像素/秒的下一个速度等，经过10像素/秒，13.5像素/秒，18像素/秒，至24.5像素/秒的最快速度。基于该指数y = 3 * E 0.3的速度被定义。如果连续五年的刺激在一定的速度是不被认可，接下来的刺激将在未来更快的速度被提出，以避免挫折的患者。钍是会导致缩短测试长度一般较长，以表扬更糟糕的是（通过每个大的刺激速度的数量因此需要通过）。 <ol><li>封面主题的一只眼睛用眼罩。每一个眼罩可能就足够了，只要它提供全覆盖。 </li><li>在命令行中输入“OFM对象”。 </li><li>选择一个刺激组（软件包括4刺激套每套包括20个不同的对象选择可以是随机的但是，请确保您应用不同的刺激套每个测试的眼睛;。应用不同的刺激集以后的学习时间点案例纵向评估的）。 </li><li>一个提示，要求您输入对象的名称，被测眼和测试日期将出现。填写所需的信息。 </li><li>仔细监视对象和响应对象，而他/她完成任务如下： <ol><li>当刺激出现的主题必须按下keybo的“A”按钮ARD和命名呈现刺激的身份。 </li><li>按下鼠标左键为正确答案或鼠标右键为一个错误的答案。 </li><li>主题按下“空格键”键盘上的下一个刺激的开始。 </li><li>此过程（步骤3.5.1-3.1.5.3）继续进行，直到所有20个刺激的集合要么承认或以最快的速度呈现。 </li></ol></li><li>使用一组不同刺激的主题的第二眼重复整个过程（从步骤3.1）。 </li></ol>时间约束的立体声协议： 1，测试启动和指导主题<ol><li>座椅被摄体50厘米的电脑屏幕前。 </li><li>打开立体声软件。 </li><li>指示主题，他将看到3维（3D）的形状和将要命名的感知形状正确，越快越好。形状将执行下列操作之一：圆形，方形，三角形或星形。 </li><li>解释到刺激可能会出现在非常努力地感知状态下或在一些容易察觉的人的主题。 </li><li>指示须佩戴3D眼镜。 </li><li>关闭房间减轻。 </li></ol> 2，学习阶段在命令行中输入“学习型立体声”。主题现在将带有4个重复的每个的形状，在最长的刺激持续时间（500毫秒），并在最简单的视差（840秒弧）的条件下呈现。随着3D演示条件下，2D演讲将遵循对每一形状。在后者中，标线的形状的轮廓将被添加，以确保受试者感知所呈现的形状的尺寸。主题，谁也不会在这个简单的条件下取得成功，不会在下一阶段进行测试。 3测试阶段：感知立体视觉双目视差的功能 4个形状s将被呈现500毫秒在4个不同的条件悬殊：120，300，540，和840秒弧。 <ol><li>在命令行中输入“立体视差”。 </li><li>一个提示，要求您输入对象的名称和测试日期将会出现。填写所需的信息。 </li><li>刺激出现</li><li>主题名称所提出的形状。响应由考官在关键按钮1-4（ 即编码。按1，2，为“一圈”的主题的口头答复3或4键按钮，“方形”，“三角形”或“一明星“，分别）。由于照明条件和拍摄对象戴3D眼镜的事实，他不能由自己编写的回应）。 </li><li>主题按任意键继续到下一个刺激。刺激呈现的顺序是随机的。 </li></ol> 4，测试阶段立体视觉感知作为刺激呈现时间的函数。 4形状将提交的540和8的差距40秒弧在任40，60，或100毫秒的持续时间。 <ol><li>在命令行中输入“立体声持续时间”。 </li><li>重复步骤3.2-3.5。 </li></ol>

<ol>
	<li>Rovaris, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Axonal+injury+in+early+multiple+sclerosis+is+irreversible+and+independent+of+the+short-term+disease+evolution.">Axonal injury in early multiple sclerosis is irreversible and independent of the short-term disease evolution.</a> Neurology. 65 (10), 1626-1630 .</li><li>Tallantyre, E. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinico-pathological+evidence+that+axonal+loss+underlies+disability+in+progressive+multiple+sclerosis.">Clinico-pathological evidence that axonal loss underlies disability in progressive multiple sclerosis.</a> Mult. Scler. 4 (4), 406-411 .</li><li>Oberwahrenbrock, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retinal+ganglion+cell+and+inner+plexiform+layer+thinning+in+clinically+isolated+syndrome.">Retinal ganglion cell and inner plexiform layer thinning in clinically isolated syndrome.</a> Mult. Scler. 19 (14), 1887-1895 (2013).</li><li>Hickman, S. J., Dalton, C. M., Miller, D. H., Plant, G. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+acute+optic+neuritis.">Management of acute optic neuritis.</a> Lancet. 360 (9349), 1953-1962 .</li><li>Keough, M. B., Yong, V. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remyelination+therapy+for+multiple+sclerosis.">Remyelination therapy for multiple sclerosis.</a> Neurotherapeutics. 10 (1), 44-54 (2013).</li><li>Halliday, A. M., McDonald, W. I., Mushin, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delayed+pattern-evoked+responses+in+optic+neuritis+in+relation+to+visual+acuity.">Delayed pattern-evoked responses in optic neuritis in relation to visual acuity.</a> Trans. Ophthalmol. Soc. U.K. 93, 315-324 .</li><li>Jones, S. J., Brusa, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurophysiological+evidence+for+long-term+repair+of+ms+lesions:+Implications+for+axon+protection.">Neurophysiological evidence for long-term repair of ms lesions: Implications for axon protection.</a> J. Neurol. 206 (2), 193-198 .</li><li>Raz, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sustained+motion+perception+deficit+following+optic+neuritis:+Behavioral+and+cortical+evidence.">Sustained motion perception deficit following optic neuritis: Behavioral and cortical evidence.</a> Neurology. 76 (24), 2103-2111 .</li><li>Raz, N., Dotan, S., Chokron, S., Ben-Hur, T., Levin, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Demyelination+affects+temporal+aspects+of+perception:+An+optic+neuritis+study.">Demyelination affects temporal aspects of perception: An optic neuritis study.</a> Ann. Neurol. 71 (4), 531-538 (2012).</li><li>Raz, N., Chokron, S., Ben-Hur, T., Levin, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporal+reorganization+to+overcome+monocular+demyelination.">Temporal reorganization to overcome monocular demyelination.</a> Neurology. 81 (8), 702-709 (2003).</li><li>Kniestedt, C., Stamper, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+acuity+and+its+measurement.">Visual acuity and its measurement.</a> Ophthalmol. Clin. North. 16 (2), 155-170 .</li><li>Mangione, C. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+the+25-item+national+eye+institute+visual+function+questionnaire.">Development of the 25-item national eye institute visual function questionnaire.</a> Arch. Ophthalmol. 119 (7), 1050-1058 (2001).</li><li>Raphael, B. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+and+test+characteristics+of+a+10-item+neuro-ophthalmic+supplement+to+the+nei-vfq-25.">Validation and test characteristics of a 10-item neuro-ophthalmic supplement to the nei-vfq-25.</a> Am. J. Ophthalmol. 142 (6), 1026-1035 .</li><li>Halliday, A. M., McDonald, W. I., Mushin, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delayed+visual+evoked+response+in+optic+neuritis.">Delayed visual evoked response in optic neuritis.</a> Lancet. 1 (7758), 982-985 .</li><li>Costello, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantifying+axonal+loss+after+optic+neuritis+with+optical+coherence+tomography.">Quantifying axonal loss after optic neuritis with optical coherence tomography.</a> Ann. Neurol. 59 (6), 963-969 .</li><li>Albrecht, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Degeneration+of+retinal+layers+in+multiple+sclerosis+subtypes+quantified+by+optical+coherence+tomography.">Degeneration of retinal layers in multiple sclerosis subtypes quantified by optical coherence tomography.</a> Mult. Scler. 18 (10), 1422-1429 .</li><li>Bock, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Time+domain+and+spectral+domain+optical+coherence+tomography+in+multiple+sclerosis:+A+comparative+cross-sectional+study.">Time domain and spectral domain optical coherence tomography in multiple sclerosis: A comparative cross-sectional study.</a> Mult. Scler. 16 (7), 893-896 .</li><li>Dorr, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Association+of+retinal+and+macular+damage+with+brain+atrophy+in+multiple+sclerosis.+PLoS+One.">Association of retinal and macular damage with brain atrophy in multiple sclerosis. PLoS One.</a> 6 (4), 18132-18 .</li><li>Zimmermann, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Optic+neuritis+interferes+with+optical+coherence+tomography+and+magnetic+resonance+imaging+correlations.">Optic neuritis interferes with optical coherence tomography and magnetic resonance imaging correlations.</a> Mult. Scler. 19 (4), 443-450 (2013).</li><li>Saidha, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visual+dysfunction+in+multiple+sclerosis+correlates+better+with+optical+coherence+tomography+derived+estimates+of+macular+ganglion+cell+layer+thickness+than+peripapillary+retinal+nerve+fiber+layer+thickness.">Visual dysfunction in multiple sclerosis correlates better with optical coherence tomography derived estimates of macular ganglion cell layer thickness than peripapillary retinal nerve fiber layer thickness.</a> Mult. Scler. 17 (12), 1449-1463 (2011).</li><li>Costello, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracking+retinal+nerve+fiber+layer+loss+after+optic+neuritis:+A+prospective+study+using+optical+coherence+tomography.">Tracking retinal nerve fiber layer loss after optic neuritis: A prospective study using optical coherence tomography.</a> Mult. Scler. 14 (7), 893-905 (2008).</li><li>Walter, S. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cell+loss+in+relation+to+visual+disability+in+multiple+sclerosis.">Ganglion cell loss in relation to visual disability in multiple sclerosis.</a> Ophthalmology. 119 (6), 1250-1257 (2012).</li><li>Taveggia, C., Feltri, M. L., Wrabetz, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Signals+to+promote+myelin+formation+and+repair.">Signals to promote myelin formation and repair.</a> Nat. Rev. Neurol. 6 (5), 276-287 .</li></ol>

作者宣称没有竞争的财务权益。

视神经炎是视神经的脱髓鞘病变，引起急性视力丧失。虽然使用标准的可视化测试1时，认为是瞬态的病人继续认为在执行日常视觉任务的困难。我们认为，动态视力测试是足够的识别和量化这些持续的赤字。这是因为动态而不是静态的视觉功能依赖于投射率，并按照脱髓鞘可能更容易受到延迟的投影。 该OFM协议为了确定如何动态的视觉功能缺损反?...

视神经炎的一种模式跟踪组织变性和修复多发性硬化症（MS）是中枢神经系统（CNS）的一种慢性炎症性神经退行性疾病，是青壮年发达国家非创伤性神经功能障碍的主要原因。脱髓鞘被认为是MS的最有特点的组织病理学特征。最近的研究，但是，发现MS也是一种神经退行性疾病的早期neuroaxonal损伤1-3。 视神经炎（ON），视神经炎症，是呈现症状的MS患者的20％，而其寿命4中从MS经历痛苦开的至少一个情节中的至少50％。不像MS病变并不总是相关的临床表现，脱髓鞘性视神经发作的其他位置通常会导致急性视力丧失鲜明的体现。 Ğ尔文及其合并症与MS和其突出的临床特征，对提供跟踪组织变性和修复及其后果在一个单一的MS病灶的独特机会。 需要改进的方法用于跟踪组织变性和修复体内 在MS的病理研究牵连脱髓鞘轴突作为横断和随后的轴索变性的主要原因。髓鞘可能会阻止脱髓鞘轴突沦为;然而，有效的髓鞘再生可能是有限的反复发作的结果。因此，在MS的当前和进化神经保护和再生治疗策略的目的是防止新的攻击，并在中枢神经系统5促进髓鞘再生过程。 为了跟进视神经炎患者及评估其治疗的效果，精细的工具来量化在中枢神经系统改变髓鞘形成是必需的。然而，支架ARD的测量，包括常规视力测试和MRI扫描，不是为这个目的不够敏感。常规视力测试（ 即 ，视敏度，对比敏感度，视野，以及色知觉）可以揭示沿视觉通路降低输入投影案件但不敏感，以确定延迟的投射率，这是脱髓鞘的纤维6,7的作用。 T2高信号病变，这是该疾病的标志，从水肿，炎症，脱髓鞘，轴突丧失和神经胶质增生的剩余混合物产生，因此可以脱髓鞘和其他脑病理学之间没有区分。此外，标准MRI旨在揭示质组织的对比。虽然这些是足够用于识别异常组织的位置，它们都不足以定量评估组织特性。 动态视力测试可作为脱髓鞘和髓鞘再生的标志物我们认为那动感的视觉功能是比静态函数来确定和量化改变投影潜伏期沿视觉通路更合适。而静态和动态视觉功能成就需要视觉输入投影的足够量的，只有动态视觉功能取决于投射率。因此视神经脱髓鞘改变可能会影响动态的而不是静态的视觉功能，提示需要对视觉输入的快速传输才能感知运动。 我们已经开发了两种行为的任务，评估与预测延迟沿视觉通路可能密切关联单眼和双眼视觉功能。这些对象包括来自运动（OFM）的提取和时间限制的立体声协议。 在OFM试验，点阵列组成一个对象时，通过移动的点的图像向右内移动时在点外的图像向左移动，或反之亦然。点PAttern生成不能被检测时的点是静止的还是移动的整体伪装的目的。重要的是，物体识别依赖于运动知觉。使用OFM协议，我们已经表现出了持续的赤字，对患者的患眼，甚至明显的12个月内的视神经炎发作，而标准的视觉功能已恢复8。此外，受损的性能与延迟conductions相关（延迟P100，反映脱髓鞘），并改善运动知觉呈正相关的传导速率（反映髓鞘再生的缩短;线性最小二乘回归与相关系数的F计算= 27.3，P = 0.0005; R = -0.87）9。 在目前提出的OFM协议是为了适应测试用于临床使用，包括测试的缩短，调整测试软件导致自动输出文件，以产生一个更新的运动灵敏度性得分。 为了评估预测延迟的双目视觉效果，在时间有限​​的立体声协议的开发。在这个协议中，空间上不同的图像，提出了在有限的时间长度，具有挑战性的时刻双目集成。该测试的目的是测试，由于脱髓鞘在从两只眼睛受影响的神经，信息将在不同的时间点在时间削弱双目积分到达皮质的假说。测试组恢复对患者（1-2.5岁以下的攻击），我们已经表明，虽然大多数患者曾在一个标准的静态立体声任务完好的性能水平;在时间受限的立体声任务性能在大多数情况下10受损。 该OFM和时间约束的立体声协议提供了一个简单但功能强大的方法来识别和量化脱髓鞘和髓鞘再生沿视觉通路的过程。这些协议马y为有效的诊断和跟进和MS患者具有成本效益的方式利用一个易于使用的基于计算机的协议。

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			<td dir="LTR" height="167" style="height:167px;width:231px;">Personal computer, including laptops</td>
			<td style="width:117px;"></td>
			<td style="width:119px;"></td>
			<td dir="LTR" style="width:171px;">The OFM software runs best on Mac or on Windows 7 (or higher) PC. The Stereo software runs on every personal computer.&#160;</td>
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			<td height="42" style="height:42px;">Monitor&#160; specification</td>
			<td style="width:117px;"></td>
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			<td dir="LTR" style="width:171px;">Size: at least 15inch,&#160; Color: at least 16 bit</td>
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		<tr height="109">
			<td height="109" style="height:109px;width:231px;">The OFM and the Stereo softwares</td>
			<td dir="LTR" style="width:117px;">These are self-developed softwares</td>
			<td style="width:119px;"></td>
			<td dir="LTR" style="width:171px;">Researchers &#38; physicians who are interested in these softwares may contact us at: fmri-hadassah.org</td>
		</tr>
		<tr height="209">
			<td dir="LTR" height="209" style="height:209px;width:231px;">Red/Cyan 3D glasses (We had tested the Stereo software on the two following 3D glasses):</td>
			<td style="width:117px;">Nvidia &#38; American Paper Optics</td>
			<td dir="LTR" style="width:119px;">3D Vision Ultimate Anaglyph 3D Glasses &#38; Pro X Style Red/Cyan 3D Glasses for Movies and Games on Flat Screens&#160;&#160;</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="63">
			<td dir="LTR" height="63" style="height:63px;width:231px;">Performance on our stereo task was compared to performance on the standard Randot stereo test</td>
			<td dir="LTR" style="width:117px;">Stereo Optical Co.</td>
			<td dir="LTR" style="width:119px;">Randot SO-002&#160;</td>
			<td></td>
		</tr>
	</tbody>
</table>

dynamic visual tests to identify and quantify visual damage and repair following demyelination in optic neuritis patients

为了遵循视神经炎患者及评估其治疗效果，一个方便，准确，量化的工具是必需的，以评估在中枢神经系统（CNS）的变化在髓鞘形成。然而，标准的测量，包括常规视力测试和MRI扫描，不是为这个目的不够敏感。我们提出两个视力测试解决可能密切髓鞘形成沿视觉通路的程度相关联的动态单眼和双眼的功能。这些对象包括来自运动（OFM）的提取和时间限制的立体声协议。在OFM试验，点阵列组成一个对象时，通过移动的点的图像向右内移动时在点外的图像向左移动，或反之亦然。点阵图形生成不能被检测时的点是静止的还是移动的整体伪装的目的。重要的是，物体识别严重依赖于运动知觉。在时间限制的立体声协议，在空间上不同的图像，提出了在有限的时间长度，具有挑战性的双眼在时间的三维整合。这两项测试适合于临床应用，并提供了一​​个简单但功能强大的方法来识别和量化脱髓鞘和髓鞘再生沿视觉通路的过程。这些协议可能是有效的诊断和后续视神经炎与多发性硬化症患者。 在诊断过程中，这些协议可能表明，不能通过目前的标准视觉测量确定的视觉缺陷。此外，这些协议灵敏地确定下列视力恢复的患者目前原因不明续视觉申诉的基础。在纵向随访过程中，协议可以被用来作为脱髓鞘和remyelinating流程沿着时间的敏感标记物。这些协议可能因此被用来评估当前及未来的治疗性S的功效trategies，针对中枢神经系统髓鞘化。

OFM协议该协议将导致在一个文本文件，自动汇总科目的回应。结果可以用两种方法进行分析： 总得分：呈现每个刺激被分配有一个刺激的重量，并且所有已鉴定的刺激权重的总和被设置为被检者的响应得分。特定刺激的重量是基于刺激的速度设置，具有较高的权重，以较低的速度。身份不明的刺激被分配一个权重为零。通常，令N是不同的速度V 1，V 2，...

Watch this Scientific Journal Video about Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients at JoVE.com

Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

对象从运动（OFM）和时间限制的立体声协议是敏感的工具，以确定单眼和双眼动态视觉功能缺损，这是唯一受影响的视神经炎患者。此外，这些测试可以用作定量的非侵入性工具，以评估髓鞘形成沿视觉通路的程度。

动态视觉测试，以确定和量化视觉损伤与修复继脱髓鞘视神经炎患者

In order to follow optic neuritis patients and evaluate the effectiveness of their treatment, a handy, accurate and quantifiable tool is required to ...

dynamic-visual-tests-to-identify-quantify-visual-damage-repair

Research

JoVE Journal

Medicine

14.0K 次观看.  Hadassah Hebrew-University Medical Center. 对象从运动（OFM）和时间限制的立体声协议是敏感的工具，以确定单眼和双眼动态视觉功能缺损，这是唯一受影响的视神经炎患者。此外，这些测试可以用作定量的非侵入性工具，以评估髓鞘形成沿视觉通路的程度。 

视频: Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.

This paper illustrates an innovative visual approach (photovoice or photo-elicitation) to achieve fair process in clinical care for patients living with chronic health conditions, illuminate gaps in clinical knowledge, forge better therapeutic relationships, and identify patient-centered goals and possibilities for healing.

利用视觉和叙事方法，以实现公平的进程中，在临床护理

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

科研

医学

Dissection of Human Vitreous Body Elements for Proteomic Analysis

The vitreous is an optically clear, collagenous extracellular matrix that fills the inside of the eye and overlies the retina. 1,2 Abnormal interactions between vitreous substructures and the retina underlie several vitreoretinal diseases, including retinal tear and detachment, macular pucker, macular hole, age-related macular degeneration, vitreomacular traction, proliferative vitreoretinopathy, proliferative diabetic retinopathy, and inherited vitreoretinopathies. 1,2 The molecular composition of the vitreous substructures is not known. Since the vitreous body is transparent with limited surgical access, it has been difficult to study its substructures at the molecular level. We developed a method to separate and preserve these tissues for proteomic and biochemical analysis. The dissection technique in this experimental video shows how to isolate vitreous base, anterior hyaloid, vitreous core, and vitreous cortex from postmortem human eyes. One-dimensional SDS-PAGE analyses of each vitreous component showed that our dissection technique resulted in four unique protein profiles corresponding to each substructure of the human vitreous body. Identification of differentially compartmentalized proteins will reveal candidate molecules underlying various vitreoretinal diseases.

This video shows an effective technique for differentiating and dissecting the various semi-transparent structures of the human vitreous body in post mortem eyes.

人类蛋白质组分析玻璃体元素剖析

The vitreous is an optically clear, collagenous extracellular matrix that fills the inside of the eye and overlies the retina. 1,2 Abnormal interactions ...

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily life, despite similar visual deficits. We assume this could be due to variable development of compensatory strategies such as altered visual scanning behavior. Scanning compensatory therapy (SCT) is studied as part of the visual training after infarction next to vision restoration therapy. SCT consists of learning to make larger eye movements into the blind field enlarging the visual field of search, which has been proven to be the most useful strategy1, not only in natural search tasks but also in mastering daily life activities2. Nevertheless, in clinical routine it is difficult to identify individual levels and training effects of compensatory behavior, since it requires measurement of eye movements in a head unrestrained condition. Studies demonstrated that unrestrained head movements alter the visual exploratory behavior compared to a head-restrained laboratory condition3. Martin et al.4 and Hayhoe et al.5 showed that behavior demonstrated in a laboratory setting cannot be assigned easily to a natural condition. Hence, our goal was to develop a study set-up which uncovers different compensatory oculomotor strategies quickly in a realistic testing situation: Patients are tested in the clinical environment in a driving simulator. SILAB software (Wuerzburg Institute for Traffic Sciences GmbH (WIVW)) was used to program driving scenarios of varying complexity and recording the driver's performance. The software was combined with a head mounted infrared video pupil tracker, recording head- and eye-movements (EyeSeeCam, University of Munich Hospital, Clinical Neurosciences).
The positioning of the patient in the driving simulator and the positioning, adjustment and calibration of the camera is demonstrated. Typical performances of a patient with and without compensatory strategy and a healthy control are illustrated in this pilot study. Different oculomotor behaviors (frequency and amplitude of eye- and head-movements) are evaluated very quickly during the drive itself by dynamic overlay pictures indicating where the subjects gaze is located on the screen, and by analyzing the data. Compensatory gaze behavior in a patient leads to a driving performance comparable to a healthy control, while the performance of a patient without compensatory behavior is significantly worse. The data of eye- and head-movement-behavior as well as driving performance are discussed with respect to different oculomotor strategies and in a broader context with respect to possible training effects throughout the testing session and implications on rehabilitation potential.

Patients with visual deficits after stroke report about different constraints in daily life most likely due to variable compensatory strategies, which are difficult to differentiate in clinical routine. We present a clinical set-up which allows measurement of different compensatory head- and eye-movement-strategies and evaluating their effects on driving performance.

驾驶模拟诊所：测试视觉与视野缺损的患者在日常活动中的探索行为

Patients suffering from homonymous hemianopia after infarction of the posterior cerebral artery (PCA) report different degrees of constraint in daily ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

基于音频的虚拟游戏环境的发展，以帮助盲人的导航技巧

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

DTI of the Visual Pathway - White Matter Tracts and Cerebral Lesions

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to visual pathways (VP), WMT are not visible with classical MRI or intra-operatively with microscope. DTI will help neurosurgeons to prevent destruction of the VP while removing lesions adjacent to this WMT. We have performed DTI on fifty patients before and after surgery between March 2012 to January 2014. To navigate we used a 3DT1-weighted sequence. Additionally, we performed a T2-weighted and DTI-sequences. The parameters used were, FOV: 200 x 200 mm, slice thickness: 2 mm, and acquisition matrix: 96 x 96 yielding nearly isotropic voxels of 2 x 2 x 2 mm. Axial MRI was carried out using a 32 gradient direction and one b0-image. We used Echo-Planar-Imaging (EPI) and ASSET parallel imaging with an acceleration factor of 2 and b-value of 800 s/mm&#178;. The scanning time was less than 9 min.
The DTI-data obtained were processed using a FDA approved surgical navigation system program which uses a straightforward fiber-tracking approach known as fiber assignment by continuous tracking (FACT). This is based on the propagation of lines between regions of interest (ROI) which is defined by a physician. A maximum angle of 50, FA start value of 0.10 and ADC stop value of 0.20 mm&#178;/s were the parameters used for tractography.
There are some limitations to this technique. The limited acquisition time frame enforces trade-offs in the image quality. Another important point not to be neglected is the brain shift during surgery. As for the latter intra-operative MRI might be helpful. Furthermore the risk of false positive or false negative tracts needs to be taken into account which might compromise the final results.

Diffusion tensor imaging (DTI) was performed to try to depict the major parts of the visual pathway. The goal was to use an FDA approved standard commercial workstation which could be used for everyday routine in order to try to reduce postoperative damage of the visual pathway in the patients.

贸工部视觉通路的 - 白质及脑病变

DTI is a technique that identifies white matter tracts (WMT) non-invasively in healthy and non-healthy patients using diffusion measurements. Similar to ...

In Vivo Dynamics of Retinal Microglial Activation During Neurodegeneration: Confocal Ophthalmoscopic Imaging and Cell Morphometry in Mouse Glaucoma

Microglia, which are CNS-resident neuroimmune cells, transform their morphology and size in response to CNS damage, switching to an activated state with distinct functions and gene expression profiles. The roles of microglial activation in health, injury and disease remain incompletely understood due to their dynamic and complex regulation in response to changes in their microenvironment. Thus, it is critical to non-invasively monitor and analyze changes in microglial activation over time in the intact organism. In vivo studies of microglial activation have been delayed by technical limitations to tracking microglial behavior without altering the CNS environment. This has been particularly challenging during chronic neurodegeneration, where long-term changes must be tracked. The retina, a CNS organ amenable to non-invasive live imaging, offers a powerful system to visualize and characterize the dynamics of microglia activation during chronic disorders.
This protocol outlines methods for long-term, in vivo imaging of retinal microglia, using confocal ophthalmoscopy (cSLO) and CX3CR1GFP/+ reporter mice, to visualize microglia with cellular resolution. Also, we describe methods to quantify monthly changes in cell activation and density in large cell subsets (200-300 cells per retina). We confirm the use of somal area as a useful metric for live tracking of microglial activation in the retina by applying automated threshold-based morphometric analysis of in vivo images. We use these live image acquisition and analyses strategies to monitor the dynamic changes in microglial activation and microgliosis during early stages of retinal neurodegeneration in a mouse model of chronic glaucoma. This approach should be useful to investigate the contributions of microglia to neuronal and axonal decline in chronic CNS disorders that affect the retina and optic nerve.

In Vivo Dynamics of Retinal Microglial Activation During Neurodegeneration: Confocal Ophthalmoscopic Imaging and Cell Morphometry in Mouse Glaucoma

Microglia activation and microgliosis are key responses to chronic neurodegeneration. Here, we present methods for in vivo, long-term visualization of retinal CX3CR1-GFP+ microglial cells by confocal ophthalmoscopy, and for threshold and morphometric analyses to identify and quantify their activation. We monitor microglial changes during early stages of age-related glaucoma.

视网膜胶质细胞活化的体内动力学在神经退行性疾病：共聚焦成像眼底及细胞形态计量小鼠青光眼

Microglia, which are CNS-resident neuroimmune cells, transform their morphology and size in response to CNS damage, switching to an activated state with ...

The Rodent Model of Nonarteritic Anterior Ischemic Optic Neuropathy (rNAION)

Nonarteritic anterior ischemic optic neuropathy (NAION) is a focal ischemic lesion of the optic nerve that affects 1/700 individuals throughout their lifetime. NAION results in optic nerve edema, selective loss of the retinal ganglion cell neurons (RGCs) and atrophy of the optic nerve. A rodent model of NAION that expresses most NAION features and sequelae has been developed, which is applicable to both rats and mice. This model utilizes a focal laser application of 532 nm wavelength to illuminate a photoactive dye, Rose Bengal (RB), to cause capillary damage and leakage at the targeted anterior optic nerve (the laminar region). After rNAION induction, there is an early optic nerve ischemia, optic nerve edema, and intraneural inflammation, followed by selective RGC and axonal loss. Since the optic nerve is a CNS white matter tract, the rNAION model is applicable to mechanistic studies of selective white matter ischemia, as well as neuroprotective analyses and short and long-term mechanisms of glial and neuronal response to ischemia.

The Rodent Model of Nonarteritic Anterior Ischemic Optic Neuropathy rNAION

The following report describes how to replicate the rodent model of nonarteritic anterior ischemic optic neuropathy (rNAION), using the appropriate dye, contact lens and laser parameters. We also reveal the appropriate steps for evaluating the rNAION lesion in vivo.

非动脉炎性前部缺血性视神经病变的啮齿动物模型（rNAION）

Nonarteritic anterior ischemic optic neuropathy (NAION) is a focal ischemic lesion of the optic nerve that affects 1/700 individuals throughout their ...

A Simple Mechanical Procedure to Create Limbal Stem Cell Deficiency in Mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with conjunctiva. Patients suffer from recurrent corneal defects, pain, inflammation, and loss of vision.
Previously, a murine model of LSCD was described and compared to two other models. The goal was to produce a consistent mouse model of LSCD that both mimics the phenotype in humans and lasts long enough to make it possible to study the disease pathophysiology and to evaluate new treatments. Here, the technique is described in more detail.
A motorized tool with a rotating burr has been designed to remove the rust rings from the corneal surface or to smooth the pterygium bed in patients. It is a suitable device to create the desired LSCD model. It is a readily available, easy-to-use tool with a fine tip that makes it appropriate for working on small eyes, as in mice. Its application prevents unnecessary trauma to the eye and it does not result in unwanted injuries, as often is the case with chemical injury models. As opposed to a blunt scraper, it removes the epithelium with the basement membrane. In this protocol, the limbal area was abraded two times, and then the whole corneal epithelium was shaved from limbus to limbus. To avoid stroma injury, care was taken not to brush the corneal surface once the epithelium was already removed.

The following article provides an easy, reproducible technique to effectively create a sustainable mouse model of limbal stem cell deficiency (LSCD). This animal model is useful in testing and comparing the efficacy of treatments for limbal stem cell diseases.

一个简单的机械过程来创建在小鼠角膜缘干细胞缺乏症

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with ...

Bioluminescence and Near-infrared Imaging of Optic Neuritis and Brain Inflammation in the EAE Model of Multiple Sclerosis in Mice

Experimental autoimmune encephalomyelitis (EAE) in SJL/J mice is a model for relapsing-remitting multiple sclerosis (RRMS). Clinical EAE scores describing motor function deficits are basic readouts of the immune-mediated inflammation of the spinal cord. However, scores and body weight do not allow for an in vivo assessment of brain inflammation and optic neuritis. The latter is an early and frequent manifestation in about 2/3 of MS patients. Here, we show methods for bioluminescence and near-infrared live imaging to assess EAE evoked optic neuritis, brain inflammation, and blood-brain barrier (BBB) disruption in living mice using an in vivo imaging system. A bioluminescent substrate activated by oxidases primarily showed optic neuritis. The signal was specific and allowed the visualization of medication effects and disease time courses, which paralleled the clinical scores. Pegylated fluorescent nanoparticles that remained within the vasculature for extended periods of time were used to assess the BBB integrity. Near-infrared imaging revealed a BBB leak at the peak of the disease. The signal was the strongest around the eyes. A near-infrared substrate for matrix metalloproteinases was used to assess EAE-evoked inflammation. Auto-fluorescence interfered with the signal, requiring spectral unmixing for quantification. Overall, bioluminescence imaging was a reliable method to assess EAE-associated optic neuritis and medication effects and was superior to the near-infrared techniques in terms of signal specificity, robustness, ease of quantification, and cost.

We show a technique for in vivo live bioluminescence and near-infrared imaging of optic neuritis and encephalitis in the experimental autoimmune encephalomyelitis (EAE) model for multiple sclerosis in SJL/J mice.

多发性硬化症的小鼠模型EAE视神经炎及脑部炎症的生物发光和近红外成像

Experimental autoimmune encephalomyelitis (EAE) in SJL/J mice is a model for relapsing-remitting multiple sclerosis (RRMS). Clinical EAE scores describing ...

Smartphone Fundus Photography

Smartphone fundus photography is a simple technique to obtain ocular fundus pictures using a smartphone camera and a conventional handheld indirect ophthalmoscopy lens. This technique is indispensable when picture documentation of optic nerve, retina, and retinal vessels is necessary but a fundus camera is not available. The main advantage of this technique is the widespread&#160;availability of smartphones that allows documentation of macula and optic nerve changes in many settings that was not previously possible. Following the well-defined steps detailed here, such as proper alignment of the phone camera, handheld lens, and the patient&#39;s pupil, is the key for obtaining a clear retina picture with no interfering light reflections and aberrations. In this paper, the optical principles of indirect ophthalmoscopy and fundus photography will be reviewed first. Then, the step-by-step method to record a good quality retinal image using a smartphone will be explained.

Fundus photography normally requires specialized fundus cameras that are not always available in all clinical settings.&#160;Here, a simple method to record ocular fundus images using a smartphone camera and a conventional high-plus handheld indirect ophthalmoscopy lens is described.

智能手机眼底摄影

Smartphone fundus photography is a simple technique to obtain ocular fundus pictures using a smartphone camera and a conventional handheld indirect ...