Potential employment of transcranial magnetic stimulation as a beneficial intervention in children with amblyopia: a brief overview


Indra Tri Mahayana(1*), Dhimas Hari Sakti(2), Natalia Christina Angsana(3)

(1) Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Department of Ophthalmology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author


Amblyopia is an early functional imbalance between each eye and the brain that may result in visual cortex inhibition. Current conservative treatments involve altering the input from the ‘good eye’, for example, using patching or biochemical penalization. Direct brain stimulation to the amblyopic cortex might improve the condition. This paper aimed to systematically review the published scientific literature regarding the use of transcranial magnetic stimulation (TMS) as a potential method for treatment in the amblyopic visual cortex. This study was a systematic review of the published scientific literature related to theTMS for the treatment of amblyopia that was performed using “TMS, amblyopia” as keywords. However, only three research papers were found and included in the literature review. A study showed that repetitive TMS of the visual cortex can temporarily improve contrast sensitivity in the amblyopic visual cortex. Another study used continuous thetaburst stimulation (cTBS) delivered to the visual cortex while patients viewed a high contrast stimulus with their non-amblyopic eye. It was found that daily theta burst TMS stimulation improved amblyopic eye contrast sensitivity in five adult volunteers. The TMS also increased median visual acuity in the patient with amblyopia after stimulation with no significant changes in the placebo group.Protocol employing repetitive administration of TMS might result in beneficial effects in amblyopia treatment. TMS works in brain dynamics and experience-dependent plasticity, all of which could be important in investigating and treating amblyopia.


amblyopia; transcranial magnetic stimulation; pediatric ophthalmology; visual cortex; refractive correction;

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  1. Maurer D, Lewis TL, Mondloch, CJ. Missing sights: consequences for visual cognitive development. Trends Cogn Sci 2005; 9(3):144-51. https://doi.org/10.1016/j.tics.2005.01.006
  2. Gunton KB. Advances in amblyopia: what have we learned from PEDIG trials? Pediatrics 2013; 131(3):540-7. https://doi.org/10.1542/peds.2012-1622
  3. Pescosolido N, Stefanucci A, Buomprisco G, Fazio S. Amblyopia treatment strategies and new drug therapies. J PediatOphthStrab 2014; 51(2):78-86. https://doi.org/10.3928/01913913-20130107-01
  4. Cotter SA, Group P.E.D.I. Treatment of anisometropic amblyopia in children with refractive correction. Ophthalmology 2006; 113(6):895-903. https://doi.org/10.1016/j.ophtha.2006.01.068
  5. Simon JW. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Evidence-Based Ophthalmology 2004; 5(1):40-1. https://doi.org/10.1097/00132578-200401000-00018
  6. Repka M, Wallace D, Beck R, Kraker R, Birch E, Cotter S, Holmes J. Pediatric eye disease investigator group two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 2005; 123(2):149-57.
  7. Repka MX, Kraker RT, Beck RW, Birch E, Cotter SA, Holmes JM, Marsh-Tootle W. Treatment of severe amblyopia with weekend atropine: results from 2 randomized clinical trials. JAAPOS 2009; 13(3):258-63. https://doi.org/10.1016/j.jaapos.2009.03.002
  8. Pawar PV, Mumbare SS, Patil MS, Ramakrishnan S. Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: A randomized controlled trial. Indian J Ophthalmol 2014; 62(2):124. https://doi.org/10.4103/0301-4738.128586
  9. Hess RF, Thompson B, Baker DH. Binocular vision in amblyopia: structure, suppression and plasticity. Ophthalmic PhysiolOpt 2014; 34(2):146-62. https://doi.org/10.1111/opo.12123
  10. Ilmoniemi RJ, Virtanen CJ, Ruohonen J, Karhu J, Aronen HJ, Näätänen R, et al. Neuronal responses to magnetic stimulation reveal cortical reactivity and connectivity. Neuroreport 1997; 8(16):3537-40. https://doi.org/10.1097/00001756-199711100-00024
  11. Cowey A. The Ferrier Lecture 2004 what can transcranial magnetic stimulation tell us about how the brain works? Philos Trans R Soc Lond B Biol Sci 2005; 360(1458): 1185-205. https://doi.org/10.1098/rstb.2005.1658
  12. Juan CH. Walsh V. Feedback to V1: a reverse hierarchy in vision. Exp Brain Res 2003; 150(2):259-63. https://doi.org/10.1007/s00221-003-1478-5
  13. Kalla R, Muggleton NG, Juan CH, Cowey A, Walsh V. The timing of the involvement of the frontal eye fields and posterior parietal cortex in visual search. Neuroreport 2008; 19(10):1067-71. https://doi.org/10.1097/WNR.0b013e328304d9c4
  14. Mahayana IT, Liu CL, Chang CF, Hung DL, Tzeng OJ, Juan CH, Muggleton NG. Far-space neglect in conjunction but not feature search following transcranial magnetic stimulation over right posterior parietal cortex. J Neurophysiol 2014; 111(4):705-14. https://doi.org/10.1152/jn.00492.2013
  15. Mahayana IT, Tcheang L, Chen CY, Juan CH, Muggleton NG. The precuneus and visuospatial attention in near and far space: a transcranial magnetic stimulation study. Brain Stimul 2014; 7(5):673-9. https://doi.org/10.1016/j.brs.2014.06.012
  16. Muggleton NG, Juan CH, Cowey A, Walsh V. Human frontal eye fields and visual search. J Neurophysiol 2003; 89(6):3340-3. https://doi.org/10.1152/jn.01086.2002
  17. Muggleton NG, Kalla R, Juan CH, Walsh V. Dissociating the contributions of human frontal eye fields and posterior parietal cortex to visual search. J Neurophysiol 2011; 105(6):2891-6. https://doi.org/10.1152/jn.01149.2009
  18. Muggleton NG, Postma P, Moutsopoulou K, Nimmo-Smith I, Marcel A, Walsh V. TMS over right posterior parietal cortex induces neglect in a scene-based frame of reference. Neuropsychologia 2006; 44(7):1222-9. https://doi.org/10.1016/j.neuropsychologia.2005.10.004
  19. Walsh V, Rushworth M. A primer of magnetic stimulation as a tool for neuropsychology. Neuropsychologia1999; 37:125-35.
  20. Sack AT. Using non-invasive brain interference as a tool for mimicking spatial neglect in healthy volunteers. Restor Neurol Neurosci 2010; 28:485-97. https://doi.org/10.3233/RNN-2010-0568
  21. Thompson B, Mansouri B, Koski L, Hess RF. Brain plasticity in the adult: modulation of function in amblyopia with rTMS. Curr Biol 2008; 18(14):1067-71. https://doi.org/10.1016/j.cub.2008.06.052
  22. Clavagnier S, Thompson B, Hess RF. Long lasting effects of daily theta burst rTMS sessions in the human amblyopic cortex. Brain Stimul 2013; 6(6): 860-7. https://doi.org/10.1016/j.brs.2013.04.002
  23. Tuna AR, Pinto N, Brardo FM, Fernandes A, Nunes AF, Pato MV. Transcranial magnetic stimulation in adults with amblyopia. J Neuro Ophthalmol 2019; 00:1-8. https://doi.org/10.1097/WNO.0000000000000828
  24. Coubard O, Kapoula Z, Muri R, Rivaud-Péchoux S. Effects of TMS over the right prefrontal cortex on latency of saccades and convergence. Invest Ophthalmol Vis Sci 2003; 44(2):600-9. https://doi.org/10.1167/iovs.02-0188
  25. Silvanto J, Lavie N, Walsh V. Double dissociation of V1 and V5/MT activity in visual awareness. Cereb Cortex 2005; 15(11):1736-41. https://doi.org/10.1093/cercor/bhi050
  26. Silvanto J, Muggleton NG, Cowey A, Walsh V. Neural adaptation reveals state-dependent effects of transcranial magnetic stimulation. Eur J Neurosci 2007; 25(6):1874-81. https://doi.org/10.1111/j.1460-9568.2007.05440.x
  27. WalshV, Ashbridge E, Cowey A. Cortical plasticity in perceptual learning demonstrated by transcranial magnetic stimulation. Neuropsychologia 1998; 36(4):363-7. https://doi.org/10.1016/S0028-3932(97)00113-9
  28. Robertson EM, Theoret H, Pascual-Leone A. Studies in cognition: The problems solved and created by transcranial magnetic stimulation. J CognNeurosci 2003; 15(7):948-60. https://doi.org/10.1162/089892-903770007344
  29. Frye RE, Rotenberg A, Ousley M, Pascual-Leone A. Transcranial magnetic stimulation in child neurology: current and future directions. J Child Neurol 2008; 23(1):79-96. https://doi.org/10.1177/088307-3807307972
  30. Walter G, Tormos JM, Israel JA, Pascual-Leone A. Transcranial magnetic stimulation in young persons: a review of known cases. J Child AdolPsychop 2001; 11(1):69-75. https://doi.org/10.1089/10445460-1750143483
  31. Garvey MA, Mall V. Transcranial magnetic stimulation in children. Clin Neurophysiol 2008; 119(5):973-84. https://doi.org/10.1016/j.clinph.2007.11.048
  32. Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009; 120(12):2008-39. https://doi.org/10.1016/j.clinph.2009.08.016
  33. Pascual-Leone A, Cohen L, Shotland L, Dang N, Pikus A, Wassermann E, Hallett M. No evidence of hearing loss in humans due to transcranial magnetic stimulation. Neurology 1992; 42(3):647-7. https://doi.org/10.1212/WNL.42.3.647
  34. Rossi S, Hallett M, Rossini PM, Pascual-Leone A. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neuophysiology 2009; 120(12):2008-39. https://doi.org/10.1016/j.clinph.2009.08.016

DOI: https://doi.org/10.19106/JMedSci005204202009

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Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Based on a work at http://jurnal.ugm.ac.id/bik/.