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Functional Mechanism of Neural Control in Post-Concussion Convergence Insufficiency

Award Number: R01EY023261
ORGANIZATION: NATIONAL EYE INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 04/01/2014
PERIOD OF PERFORMANCE END DATE: 08/31/2026

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Functional Mechanism of Neural Control in Post-Concussion Convergence Insufficiency - Project Summary/Abstract: During the past 6 years, our study team investigated the neural mechanism of typically-occurring convergence insufficiency (TYP-CI), the most common binocular vision disorder in children and young adults (3.4% to 12.7%5–11) leading to 20 publications12–31 with 4 more in review and 6 in preparation. We conducted the only randomized clinical trial (RCT) integrating objective eye movement and fMRI outcome measures, achieving 100% planned enrollment and retention of 100 young adults.28 Our results localized the reduction in functional activity for TYP-CI compared to controls within the oculomotor vermis (OVM) and the cuneus. Functional activity in the OVM and cuneus was significantly correlated to convergence peak velocity providing the first mechanistic identification of these deficits that create significant burden to those afflicted. 23 Our longitudinal results discovered that the neural mechanistic change stimulated by office-based vergence /accommodative therapy (OBVAT) is an increase in the frontal eye field (FEF) and thalamus functional activity. Increased functional activity from the FEF and thalamus significantly correlates to convergence peak velocity. 23,32,33 Results are leading to personalized point-of-care therapies remediating the debilitating symptoms for TYP-CI patients. While our research and results of other RCTs show that OBVAT is the most effective treatment for remediating symptoms and improving vision function in both TYP-CI children 34–36 and adults, 37,38 none of these participants had a history of head injury, a pathology that has been linked to CI. Our research team has demonstrated that the prevalence of CI is higher (38% to 49%) in children 39,40 and adults 41,42 with persistent post-concussive symptoms (PPCS-CI), than in the non-concussed population. Currently, there is no validated treatment for PPCS-CI. This difference in prevalence, mode of onset (longstanding versus sudden onset), and severity of the condition has led to a debate about whether the diagnostic and management procedures effective for TYP-CI should be utilized for PPCS-CI, and strongly suggests that new research is needed to optimize PPCS-CI management. We are uniquely positioned to provide answers to these questions by building on our work establishing the neurofunctional mechanism of TYP-CI and OBVAT administered to TYP-CI. Such research is of great importance because PPCS-CI is associated with debilitating visual symptoms impacting the return to school/sports, 43–47 work, 48–51 or driving. 52 We have identified three significant gaps for the treatment of PPCS-CI that must be addressed to determine its most effective management. First, given the obvious differences in etiology, are there significant differences between TYP-CI and PPCS-CI related to objective eye movement measures (peak velocity, final amplitude, and repeatability) due to underlying neural mechanistic differences? Second, what is the underlying neural mechanism of OBVAT for PPCS-CI compared to TYP-CI? Third, how effective is OBVAT for PPCS-CI and is the dosage of administration different than TYP-CI? This renewal addresses these gaps in clinical science.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $552,933 )
2024	2024	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	001	9	8/15/2024	NON-COMPETING CONTINUATION	$552,933
2024	2023	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	8	10/16/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $552,933

Issue Date FY: 2023 ( Subtotal = $632,958 )
2023	2023	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	8	8/18/2023	NON-COMPETING CONTINUATION	$632,958
														Subtotal = $632,958

Issue Date FY: 2022 ( Subtotal = $628,421 )
2022	2022	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	7	9/9/2022	NON-COMPETING CONTINUATION	$628,421
														Subtotal = $628,421

Issue Date FY: 2021 ( Subtotal = $615,535 )
2021	2021	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	001	6	8/26/2021	COMPETING CONTINUATION	$615,539
2021	2018	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	5	6/29/2021	SUPPLEMENT FOR EXPANSION	-$4
														Subtotal = $615,535

Issue Date FY: 2020 ( Subtotal = $0 )
2020	2018	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 DR MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	5	2/21/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2018 ( Subtotal = $505,035 )
2018	2018	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	001	5	9/21/2018	SUPPLEMENT FOR EXPANSION	$122,977
2018	2018	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	5	4/9/2018	NON-COMPETING CONTINUATION	$382,058
														Subtotal = $505,035

Issue Date FY: 2017 ( Subtotal = $382,086 )
2017	2017	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	001	4	6/29/2017	NON-COMPETING CONTINUATION	$38,209
2017	2017	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING JR BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	4	3/20/2017	NON-COMPETING CONTINUATION	$343,877
														Subtotal = $382,086

Issue Date FY: 2016 ( Subtotal = $373,103 )
2016	2016	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	3	3/11/2016	NON-COMPETING CONTINUATION	$373,103
														Subtotal = $373,103

Issue Date FY: 2015 ( Subtotal = $371,837 )
2015	2015	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	2	4/16/2015	NON-COMPETING CONTINUATION	$371,837
														Subtotal = $371,837

Issue Date FY: 2014 ( Subtotal = $380,919 )
2014	2014	NEW JERSEY INSTITUTE OF TECHNOLOGY	323 MARTIN LUTHER KING BLVD	NEWARK	NJ	07102	ESSEX	USA	Vision Research	000	1	3/25/2014	NEW	$380,919
														Subtotal = $380,919

Grand Total All Awards = $4,442,827

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Functional Mechanism of Neural Control in Post-Concussion Convergence Insufficiency

Award Number: R01EY023261

ORGANIZATION: NATIONAL EYE INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 04/01/2014

PERIOD OF PERFORMANCE END DATE: 08/31/2026

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