helmholtzeyeinstituteРоссийский офтальмологический журналRussian Ophthalmological Journal2072-00762587-5760Real time Publishers10.21516/2072-0076-2026-19-3-129-136helmholtzeyeinstitute-2237Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWSШум нейронной активности зрительной системы как характерная особенность и мишень для лечения амблиопииNeural noise as a characteristic feature and target for amblyopia treatmenthttps://orcid.org/0000-0003-4675-9648КотелинВ. И.KotelinV. I.

Владислав Игоревич Котелин — канд. мед. наук, старший научный сотрудник отдела клинической физиологии зрения им. С.В. Кравкова.

Ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Vladislav I. Kotelin — Cand. of Med. Sci., senior researcher, department of clinical physiology of vision named after S.V. Kravkov.

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062

https://orcid.org/0000-0002-0161-5010ЗуеваМ. В.ZuevaM. V.

Марина Владимировна Зуева — д-р биол. наук, профессор, главный научный сотрудник, начальник отдела клинической физиологии зрения им. С.В. Кравкова НМИЦ глазных болезней им. Гельмгольца, ведущий научный сотрудник ГНЦ РФ – Институт медико-биологических проблем РАН.

Ул. Садовая-Черногрязская, д. 14/19, Москва, 105062; Хорошевское шоссе, д. 76 а, Москва, 123007

Marina V. Zueva — Dr. of Biol. Sci., professor, head of the department of clinical physiology of vision named after S.V. Kravkov Helmholtz NMRC of Eye Diseases, leading researcher Institute for Biomedical Problems оf the RAS.

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062; 76 a, Khoroshevskoe highway, Moscow, 123007

visionlab@yandex.ruhttps://orcid.org/0000-0002-8383-0127СтальмаховаР. Р.StalmakhovaR. R.

Регина Расуловна Стальмахова — канд. мед. наук, научный сотрудник отдела патологии рефракции, бинокулярного зрения и офтальмоэргономики.

Ул. Садовая-Черногрязская, д. 14/19, Москва, 105062

Regina R. Stalmakhova — Cand. of Med. Sci., researcher of the department of refractive pathology, binocular vision and ophthalmoergonomics.

14/19, Sadovaya-Chernogryazskaya St., Moscow,105062

МаглакелидзеН.MaghlakelidzeN.

Наталья Маглакелидзе — канд. мед. наук, офтальмохирург Клиника «Аверси», доцент Грузино-американский университет.

Пр. Важа Пшавела, д. 27 б, Тбилиси, 0160; ул. Мераба Алексидзе, д. 10, Тбилиси, 0160

Georgia Natalia Maghlakelidze — Cand. of Med. Sci., ophthalmic surgeon Aversi Clinic, associate professor Georgian American University.

27 b, Vazha Pshavela Ave., Tbilisi, 0160; 10, Merab Aleksidze St, Tbilisi, 0160

ФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава РоссииРоссияHelmholtz National Medical Research Center of Eye DiseasesRussian FederationФГБУ «НМИЦ глазных болезней им. Гельмгольца» Минздрава России; ФГБУН «Государственный научный центр Российской Федерации – Институт медико-биологических проблем РАН»РоссияHelmholtz National Medical Research Center of Eye Diseases; Institute for Biomedical Problems of the Russian Academy of SciencesRussian FederationКлиника «Аверси»; Грузино-американский университетГрузияAversi Clinic; Georgian-American UniversityGeorgia202628092026193129136Copyright © Котелин В.И., Зуева М.В., Стальмахова Р.Р., Маглакелидзе Н., 20262026Котелин В.И., Зуева М.В., Стальмахова Р.Р., Маглакелидзе Н.Kotelin V.I., Zueva M.V., Stalmakhova R.R., Maghlakelidze N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://roj.igb.ru/jour/article/view/2237

Сегодня значительное внимание уделяется изучению клинической эффективности новых методов лечения амблиопии, таких как ТМС и tDCS, а также перцептивной и дихоптической зрительной тренировки в видеоиграх, в том числе с помощью виртуальной и дополненной реальности, целью которых является улучшение бинокулярного зрения и уменьшение межглазного подавления. Недавние достижения нейронаук позволяют по-новому взглянуть на механизмы терапевтического воздействия и определить направление новых исследований в этой области. В частности, исследования шума вызванной и спонтанной нейронной активности расширяют знания о функционировании зрительной системы при амблиопии. Фоновая нейронная активность в норме обладает сложными, самоподобными в масштабах времени колебаниями, спектр мощности которых может быть описан 1/f-функцией. 1/f-подобный спектр мощности указывает на нелинейную, фрактальную динамику нейронной активности. При амблиопии повышается вариабельность не только вызванной, но и фоновой нейронной активности, что может негативно влиять на пластичность мозга и статистические свойства колебаний. Динамика фонового шума определяет изменчивость вызванного ответа и может влиять на пластичность мозга. Предполагается, что более высокая эффективность применяемых сегодня новых методов лечения амблиопии, чем традиционных, связана с тем, что они обучают мозг лучше выделять сигнал из шума и тем самым усиливают надежность получаемой зрительной информации. С другой стороны, показано положительное влияние фрактальной фотостимуляции на вызванную биоэлектрическую активность сетчатки и зрительные характеристики пациентов с различными заболеваниями сетчатки, которые могут быть связаны с нормализацией статистических характеристик нейронного шума зрительной системы, как зависящего от стимула (вызванных зрительных ответов), так и фонового шума спонтанной активности нейронов в состоянии покоя. Можно предположить, что развитие новых фармакологических и немедикаментозных методов модуляции нейропластичности будет способствовать восстановлению структуры и функции нейронных сетей и зрительной реабилитации пациентов с амблиопией.

Today, considerable attention is being paid to the clinical efficacy of new amblyopia treatments, such as TMS and tDCS, as well as perceptual and dichoptic visual training in video games, including those using virtual and augmented reality. The aim is to improve binocular vision and reduce interocular suppression. Recent advances in neuroscience provide new insights into the mechanisms of therapeutic effects and identify new research directions in this area. In particular, studies of evoked and spontaneous neural activity (background noise) are expanding our understanding of visual system function. Normal background neural activity exhibits complex, self-similar scale-free oscillations, the power spectrum of which can be described by a 1/f function. A 1/f-like power spectrum indicates nonlinear, fractal dynamics of neural activity. In amblyopia, the variability of not only evoked but also background neural activity increases, which can negatively affect brain plasticity and the statistical properties of oscillations. The dynamics of background noise determine the variability of the evoked response and may influence brain plasticity. It is believed that the superior efficacy of new amblyopia treatments used today, compared to traditional methods, is due to their ability to better train the brain to distinguish signals from noise, thereby enhancing the reliability of received visual information. On the other hand, fractal photostimulation has been shown to have a positive effect on evoked retinal bioelectrical activity and visual characteristics in patients with various retinal diseases. This may be due to the normalization of the statistical characteristics of neural noise in the visual system, both stimulus-dependent (evoked visual responses) and background noise of spontaneous neuronal activity at rest. It can be hypothesized that the development of new pharmacological and non-pharmacological methods for modulating neuroplasticity will facilitate the restoration of the structure and function of neural networks and the visual rehabilitation of patients with amblyopia.

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The authors declare that there are no conflicts of interest present.