Investigation of light-induced lacrimation and pupillary responses in episodic migraine.

The purpose of this pilot study was to investigate the light-induced pupillary and lacrimation responses mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs) in migraine. Ten participants with episodic migraine and normal tear production, as well as eleven visually normal controls participated in this study. Following an initial baseline trial (no light flash), participants received seven incremental and alternating red and blue light flashes. Pupillometry recording of the left eye and a 1-min anesthetized Schirmer's test of the right eye (using 0.5% proparacaine) were performed simultaneously. Intrinsic and extrinsic ipRGC photoactivities did not differ between migraine participants and controls across all intensities and wavelengths. Migraine participants, however, had significantly lower lacrimation than controls following the highest blue intensity. A positive correlation was found between melanopsin-driven post-illumination pupillary responses and lacrimation following blue stimulation in both groups. Our results show that participants with self-reported photophobia have normal ipRGC-driven responses, suggesting that photophobia and pupillary function may be mediated by distinct ipRGC circuits. The positive correlation between melanopsin-driven pupillary responses and light-induced lacrimation suggests the afferent arm of the light-induced lacrimation reflex is melanopsin-mediated and functions normally in migraine. Lastly, the reduced melanopsin-mediated lacrimation at the highest stimulus suggests the efferent arm of the lacrimation reflex is attenuated under certain conditions, which may be a harbinger of dry eye in migraine.

Impaired Spatial Hearing in Amblyopia: Evidence for Calibration of Auditory Maps by Retinocollicular Input in Humans.

Purpose: Evidence from animals and blind humans suggests that early visual experience influences the developmental calibration of auditory localization. Hypothesizing that unilateral amblyopia may involve cross-modal deficits in spatial hearing, we measured the precision and accuracy of sound localization in humans with amblyopia. Methods: All participants passed a standard hearing test. Experiment 1 measured sound localization precision for click stimuli in 10 adults with amblyopia and 10 controls using a minimum audible angle (MAA) task. Experiment 2 measured sound localization error (i.e., accuracy) for click train stimuli in 14 adults with amblyopia and 16 controls using an absolute sound localization task. Results: In Experiment 1, the MAA (mean ± SEM) was significantly greater in the amblyopia group compared with controls (2.75 ± 0.30° vs. 1.69 ± 0.09°, P = 0.006). In Experiment 2, the overall sound localization error was significantly greater in the amblyopia group compared with controls (P = 0.047). The amblyopia group also showed significantly greater sound localization error in the auditory hemispace ipsilateral to the amblyopic eye (P = 0.036). At a location within this auditory hemispace, the magnitude of sound localization error correlated significantly with deficits in stereo acuity (P = 0.036). Conclusions: The precision and accuracy of sound localization are impaired in unilateral amblyopia. The asymmetric pattern of sound localization error suggests that amblyopic vision may interfere with the development of spatial hearing via the retinocollicular pathway.

Audiovisual perception in amblyopia: A review and synthesis.

Amblyopia is a common developmental sensory disorder that has been extensively and systematically investigated as a unisensory visual impairment. However, its effects are increasingly recognized to extend beyond vision to the multisensory domain. Indeed, amblyopia is associated with altered cross-modal interactions in audiovisual temporal perception, audiovisual spatial perception, and audiovisual speech perception. Furthermore, although the visual impairment in amblyopia is typically unilateral, the multisensory abnormalities tend to persist even when viewing with both eyes. Knowledge of the extent and mechanisms of the audiovisual impairments in amblyopia, however, remains in its infancy. This work aims to review our current understanding of audiovisual processing and integration deficits in amblyopia, and considers the possible mechanisms underlying these abnormalities.

Binocular Summation in Postillumination Pupil Response Driven by Melanopsin-Containing Retinal Ganglion Cells.

Purpose: To investigate how melanopsin-mediated intrinsically photosensitive retinal ganglion cell (ipRGC) signals are integrated binocularly using chromatic pupillometry. We hypothesized that if the melanopsin system is summative, there will be a greater postillumination pupillary response (PIPR) under binocular conditions after viewing bright blue light. Methods: Pupillary responses in 10 visually normal participants were recorded with an eye tracker following full-field stimulation of red (long wavelength) and blue (short wavelength) light of equal intensity (dim: 0.1 cd [candela]/m2, bright: 60 cd/m2) and duration (400 ms). Individual monocular (left eye) pupil responses were measured first, followed by binocular responses. Each participant repeated the same protocol on 3 separate days, at similar times of day. PIPR was recorded for bright red and blue conditions only, whereas maximum pupillary constriction (MPC) was measured under both bright and dim conditions during red and blue light stimulation. Results: Bright blue light stimulation induced greater PIPR under binocular than monocular viewing conditions (F(1,9) = 79.52, P < 0.001). Bright red light stimulation induced minimal PIPR and showed no significant difference between viewing conditions post Bonferroni correction (F(1,9) = 5.49, P = 0.04). MPC was greater during binocular than monocular viewing conditions for all light stimuli, but was greatest following blue compared to red light stimulation. Conclusions: A larger PIPR was induced using a binocular than a monocular full-field stimulus of equal intensity and duration, demonstrating that melanopsin-mediated ipRGC signals are summated binocularly. This study expands our current understanding of the melanopsin system and may be used as an additional marker to stratify diseases according to their etiologies.

Ocular Topical Anesthesia Does Not Attenuate Light-Induced Discomfort Using Blue and Red Light Stimuli.

Purpose: To investigate whether melanopsin-containing ophthalmic trigeminal ganglion cells provide significant input to mediate light-induced discomfort. This is done by studying the effect of ocular topical anesthesia on light-induced discomfort threshold to blue light and red light stimuli using a psychophysical approach. Method: Ten visually normal participants completed the experiment consisting of two trials: an anesthesia trial in which light stimuli were presented to both eyes following 0.5% proparacaine eye drops administration, and a placebo trial in which normal saline drops were used. In each trial, a randomized series of 280 blue and red light flashes were presented over seven intensity steps with 20 repetitions for each color and light intensity. Participants were instructed to report whether they perceived each stimulus as either "uncomfortably bright" or "not uncomfortably bright" by pressing a button. The proportion of "uncomfortable" responses was pooled to generate individual psychometric functions, from which 50% discomfort thresholds (defined as the light intensity at which the individuals perceived the stimulus to be uncomfortably bright/unpleasant 50% of the time) were calculated. Results: When blue light was presented, there was no significant difference in the light-induced discomfort thresholds between anesthesia and placebo trials (P = 0.44). Similarly, when red light was used, no significant difference in threshold values was found between the anesthesia and placebo trials (P = 0.28). Conclusions: Ocular topical anesthesia does not alter the light-induced discomfort thresholds to either blue or red light, suggesting that the melanopsin-containing ophthalmic trigeminal ganglion cells provide little or no significant input in mediating light-induced discomfort under normal physiologic conditions.

Visual search deficits in amblyopia.

Amblyopia is a neurodevelopmental disorder defined as a reduction in visual acuity that cannot be corrected by optical means. It has been associated with low-level deficits. However, research has demonstrated a link between amblyopia and visual attention deficits in counting, tracking, and identifying objects. Visual search is a useful tool for assessing visual attention but has not been well studied in amblyopia. Here, we assessed the extent of visual search deficits in amblyopia using feature and conjunction search tasks. We compared the performance of participants with amblyopia (n = 10) to those of controls (n = 12) on both feature and conjunction search tasks using Gabor patch stimuli, varying spatial bandwidth and orientation. To account for the low-level deficits inherent in amblyopia, we measured individual contrast and crowding thresholds and monitored eye movements. The display elements were then presented at suprathreshold levels to ensure that visibility was equalized across groups. There was no performance difference between groups on feature search, indicating that our experimental design controlled successfully for low-level amblyopia deficits. In contrast, during conjunction search, median reaction times and reaction time slopes were significantly larger in participants with amblyopia compared with controls. Amblyopia differentially affects performance on conjunction visual search, a more difficult task that requires feature binding and possibly the involvement of higher-level attention processes. Deficits in visual search may affect day-to-day functioning in people with amblyopia.

A Novel Visual Psychometric Test for Light-Induced Discomfort Using Red and Blue Light Stimuli Under Binocular and Monocular Viewing Conditions.

Purpose: To develop an objective psychophysical method to quantify light-induced visual discomfort, and to measure the effects of viewing condition and stimulus wavelength. Methods: Eleven visually normal subjects participated in the study. Their pupils were dilated (2.5% phenylephrine) before the experiment. A Ganzfeld system presented either red (1.5, 19.1, 38.2, 57.3, 76.3, 152.7, 305.3 cd/m2) or blue (1.4, 7.1, 14.3, 28.6, 42.9, 57.1, 71.4 cd/m2) randomized light intensities (1 s each) in four blocks. Constant white-light stimuli (3 cd/m2, 4 s duration) were interleaved with the chromatic trials. Participants reported each stimulus as either "uncomfortably bright" or "not uncomfortably bright." The experiment was done binocularly and monocularly in separate sessions, and the order of color/viewing condition sequence was randomized across participants. The proportion of "uncomfortable" responses was used to generate individual psychometric functions, from which 50% discomfort thresholds were calculated. Results: Light-induced discomfort was higher under blue compared with red light stimulation, both during binocular (t(10) = 3.58, P < 0.01) and monocular viewing (t(10) = 3.15, P = 0.01). There was also a significant difference in discomfort between viewing conditions, with binocular viewing inducing more discomfort than monocular viewing for blue (P < 0.001), but not for red light stimulation. Conclusions: The light-induced discomfort characteristics reported here are consistent with features of the melanopsin-containing intrinsically photosensitive retinal ganglion cell light irradiance pathway, which may mediate photophobia, a prominent feature in many clinical disorders. This is the first psychometric assessment designed around melanopsin spectral properties that can be customized further to assess photophobia in different clinical populations.

Temporal Ventriloquism Reveals Intact Audiovisual Temporal Integration in Amblyopia.

Purpose: We have shown previously that amblyopia involves impaired detection of asynchrony between auditory and visual events. To distinguish whether this impairment represents a defect in temporal integration or nonintegrative multisensory processing (e.g., cross-modal matching), we used the temporal ventriloquism effect in which visual temporal order judgment (TOJ) is normally enhanced by a lagging auditory click. Methods: Participants with amblyopia (n = 9) and normally sighted controls (n = 9) performed a visual TOJ task. Pairs of clicks accompanied the two lights such that the first click preceded the first light, or second click lagged the second light by 100, 200, or 450 ms. Baseline audiovisual synchrony and visual-only conditions also were tested. Results: Within both groups, just noticeable differences for the visual TOJ task were significantly reduced compared with baseline in the 100- and 200-ms click lag conditions. Within the amblyopia group, poorer stereo acuity and poorer visual acuity in the amblyopic eye were significantly associated with greater enhancement in visual TOJ performance in the 200-ms click lag condition. Conclusions: Audiovisual temporal integration is intact in amblyopia, as indicated by perceptual enhancement in the temporal ventriloquism effect. Furthermore, poorer stereo acuity and poorer visual acuity in the amblyopic eye are associated with a widened temporal binding window for the effect. These findings suggest that previously reported abnormalities in audiovisual multisensory processing may result from impaired cross-modal matching rather than a diminished capacity for temporal audiovisual integration.

Optimal Audiovisual Integration in the Ventriloquism Effect But Pervasive Deficits in Unisensory Spatial Localization in Amblyopia.

Purpose: Classically understood as a deficit in spatial vision, amblyopia is increasingly recognized to also impair audiovisual multisensory processing. Studies to date, however, have not determined whether the audiovisual abnormalities reflect a failure of multisensory integration, or an optimal strategy in the face of unisensory impairment. We use the ventriloquism effect and the maximum-likelihood estimation (MLE) model of optimal integration to investigate integration of audiovisual spatial information in amblyopia. Methods: Participants with unilateral amblyopia (n = 14; mean age 28.8 years; 7 anisometropic, 3 strabismic, 4 mixed mechanism) and visually normal controls (n = 16, mean age 29.2 years) localized brief unimodal auditory, unimodal visual, and bimodal (audiovisual) stimuli during binocular viewing using a location discrimination task. A subset of bimodal trials involved the ventriloquism effect, an illusion in which auditory and visual stimuli originating from different locations are perceived as originating from a single location. Localization precision and bias were determined by psychometric curve fitting, and the observed parameters were compared with predictions from the MLE model. Results: Spatial localization precision was significantly reduced in the amblyopia group compared with the control group for unimodal visual, unimodal auditory, and bimodal stimuli. Analyses of localization precision and bias for bimodal stimuli showed no significant deviations from the MLE model in either the amblyopia group or the control group. Conclusions: Despite pervasive deficits in localization precision for visual, auditory, and audiovisual stimuli, audiovisual integration remains intact and optimal in unilateral amblyopia.

Alterations in audiovisual simultaneity perception in amblyopia.

Amblyopia is a developmental visual impairment that is increasingly recognized to affect higher-level perceptual and multisensory processes. To further investigate the audiovisual (AV) perceptual impairments associated with this condition, we characterized the temporal interval in which asynchronous auditory and visual stimuli are perceived as simultaneous 50% of the time (i.e., the AV simultaneity window). Adults with unilateral amblyopia (n = 17) and visually normal controls (n = 17) judged the simultaneity of a flash and a click presented with both eyes viewing. The signal onset asynchrony (SOA) varied from 0 ms to 450 ms for auditory-lead and visual-lead conditions. A subset of participants with amblyopia (n = 6) was tested monocularly. Compared to the control group, the auditory-lead side of the AV simultaneity window was widened by 48 ms (36%; p = 0.002), whereas that of the visual-lead side was widened by 86 ms (37%; p = 0.02). The overall mean window width was 500 ms, compared to 366 ms among controls (37% wider; p = 0.002). Among participants with amblyopia, the simultaneity window parameters were unchanged by viewing condition, but subgroup analysis revealed differential effects on the parameters by amblyopia severity, etiology, and foveal suppression status. Possible mechanisms to explain these findings include visual temporal uncertainty, interocular perceptual latency asymmetry, and disruption of normal developmental tuning of sensitivity to audiovisual asynchrony.

Temporal Binding Window of the Sound-Induced Flash Illusion in Amblyopia.

Purpose: Amblyopia is a neurodevelopmental visual disorder caused by abnormal visual experience in childhood. In addition to known visual deficits, there is evidence for changes in audiovisual integration in amblyopia using explicit tasks. We examined audiovisual integration in amblyopia using an implicit task that is more relevant in a real-world context. Methods: A total of 11 participants with amblyopia and 16 controls were tested binocularly and monocularly on the sound-induced flash illusion, in which flashes and beeps are presented concurrently and the perceived number of flashes is influenced by the number of beeps. The task used 1 to 2 rapid peripheral flashes presented with 0 to 2 beeps, at 5 stimulus onset asynchronies, that is, beep (-200 milliseconds, -100 milliseconds) or flash leading (100 milliseconds, 200 milliseconds) or simultaneous (0 milliseconds). Participants reported the number of perceived flashes. Susceptibility was indicated by a "2 flashes" response to "fission" (1 flash, 2 beeps) or "1 flash" to "fusion" (2 flashes, 1 beep). Results: For fission with the beep leading during binocular viewing, controls showed an expected decrease in illusion strength as stimulus onset asynchronies increased, whereas the illusion strength remained constant in participants with amblyopia, indicating a wider temporal binding window in amblyopia (P = 0.007). For fusion, participants with amblyopia showed reduced illusion strength during amblyopic eye viewing (P = 0.044) with the flash leading. Conclusions: Amblyopia is associated with the widening of the temporal binding window, specifically for fission when viewing binocularly with the beep leading. This suggests a developmental adaptation to delayed amblyopic eye visual processing to optimize audiovisual integration.

The Relation Between Light-Induced Lacrimation and the Melanopsin-Driven Postillumination Pupil Response.

Purpose: To investigate the chromatic characteristics and intensity-response function of light-induced reflex lacrimation and its correlation with the melanopsin-driven postillumination pupil response (PIPR). Methods: Eleven visually normal participants completed the experiment. Lacrimation was measured in one eye by placing a calibrated filter paper strip in the conjunctival sac over a 1 minute-interval (Schirmer's test) during which participants received either no light stimulation (baseline trial) or one flash of blue or red light stimuli presented binocularly with a Ganzfeld stimulator, while the pupil response was recorded simultaneously from the fellow eye by using an eye tracker. Light stimulation trials were presented in alternating fashion at seven incremental intensity steps (0.1, 1, 3.16, 10, 31.6, 100, and 400 cd/m2). Postillumination pupil response was defined as the mean pupil constriction from 10 to 30 seconds post illumination. Results: The amount of lacrimation in response to 10 to 400 cd/m2 blue light was significantly greater than baseline and increased monotonically with increasing light intensity. Red light did not induce significant reflex lacrimation until the brightest stimulation at 400 cd/m2. There was a positive linear correlation between PIPR and lacrimation in response to blue light (r = 0.74, P < 0.001) but not to red light (r = 0.13, P = 0.25). Conclusions: The chromatic characteristics and intensity-response of light-induced lacrimation are highly consistent with the features of melanopsin phototransduction. This finding is the first in vivo evidence in humans, supporting the hypothesis that light-induced reflex lacrimation is mediated primarily by melanopsin photoactivity, and provides new insight into the putative mechanisms of photophobia.

Effects of Reduced Acuity and Stereo Acuity on Saccades and Reaching Movements in Adults With Amblyopia and Strabismus.

Purpose: Our previous work has shown that amblyopia disrupts the planning and execution of visually-guided saccadic and reaching movements. We investigated the association between the clinical features of amblyopia and aspects of visuomotor behavior that are disrupted by amblyopia. Methods: A total of 55 adults with amblyopia (22 anisometropic, 18 strabismic, 15 mixed mechanism), 14 adults with strabismus without amblyopia, and 22 visually-normal control participants completed a visuomotor task while their eye and hand movements were recorded. Univariate and multivariate analyses were performed to assess the association between three clinical predictors of amblyopia (amblyopic eye [AE] acuity, stereo sensitivity, and eye deviation) and seven kinematic outcomes, including saccadic and reach latency, interocular saccadic and reach latency difference, saccadic and reach precision, and PA/We ratio (an index of reach control strategy efficacy using online feedback correction). Results: Amblyopic eye acuity explained 28% of the variance in saccadic latency, and 48% of the variance in mean saccadic latency difference between the amblyopic and fellow eyes (i.e., interocular latency difference). In contrast, for reach latency, AE acuity explained only 10% of the variance. Amblyopic eye acuity was associated with reduced endpoint saccadic (23% of variance) and reach (22% of variance) precision in the amblyopic group. In the strabismus without amblyopia group, stereo sensitivity and eye deviation did not explain any significant variance in saccadic and reach latency or precision. Stereo sensitivity was the best clinical predictor of deficits in reach control strategy, explaining 23% of total variance of PA/We ratio in the amblyopic group and 12% of variance in the strabismus without amblyopia group when viewing with the amblyopic/nondominant eye. Conclusions: Deficits in eye and limb movement initiation (latency) and target localization (precision) were associated with amblyopic acuity deficit, whereas changes in the sensorimotor reach strategy were associated with deficits in stereopsis. Importantly, more than 50% of variance was not explained by the measured clinical features. Our findings suggest that other factors, including higher order visual processing and attention, may have an important role in explaining the kinematic deficits observed in amblyopia.

Dataset of red light induced pupil constriction superimposed on post-illumination pupil response.

We collected and analyzed pupil diameter data from of 7 visually normal participants to compare the maximum pupil constriction (MPC) induced by "Red Only" vs. "Blue+Red" visual stimulation conditions. The "Red Only" condition consisted of red light (640±10 nm) stimuli of variable intensity and duration presented to dark-adapted eyes with pupils at resting state. This condition stimulates the cone-driven activity of the intrinsically photosensitive retinal ganglion cells (ipRGC). The "Blue+Red" condition consisted of the same red light stimulus presented during ongoing blue (470±17 nm) light-induced post-illumination pupil response (PIPR), representing the cone-driven ipRGC activity superimposed on the melanopsin-driven intrinsic activity of the ipRGCs ("The Absence of Attenuating Effect of Red light Exposure on Pre-existing Melanopsin-Driven Post-illumination Pupil Response" Lei et al. (2016) [1]). MPC induced by the "Red Only" condition was compared with the MPC induced by the "Blue+Red" condition by multiple paired sample t-tests with Bonferroni correction.

The absence of attenuating effect of red light exposure on pre-existing melanopsin-driven post-illumination pupil response.

It has been proposed that after activation by blue light, activated melanopsin is converted back to its resting state by long wavelength red light exposure, a putative mechanism of melanopsin chromophore recovery in vivo. We tested this hypothesis by investigating whether red light attenuates the ongoing post-illumination pupil response (PIPR) induced by melanopsin-activating blue light. Pupillary light responses were tested using "Blue+Red" double flashes and "Blue Only" single flash stimuli in 10 visually normal subjects. For "Blue+Red" conditions, PIPR was induced with an intense blue flash, followed by experimental red light exposure of variable intensity and duration (Experiment 1) immediately or 9s after the offset of the blue flash (Experiment 2). For "Blue Only" conditions, only the PIPR-inducing blue stimuli were presented (reference condition). PIPR was defined as the mean pupil size from 10 to 30s (Experiment 1) and from 25 to 60s (Experiment 2) after the offset of blue light stimuli. The results showed that PIPR from "Blue+Red" conditions did not differ significantly from those of "Blue Only" conditions (p=0.55) in Experiment 1. The two stimulation conditions also did not differ in Experiment 2 (p=0.38). We therefore conclude that red light exposure does not alter the time course of PIPR induced by blue light. This finding does not support the hypothesis that long wavelength red light reverses activated melanopsin; rather it lends support to the hypothesis that the wavelengths of stimuli driving both the forward and backward reactions of melanopsin may be similar.

The Initiation of Smooth Pursuit is Delayed in Anisometropic Amblyopia.

PURPOSE: Several behavioral studies have shown that the reaction times of visually guided movements are slower in people with amblyopia, particularly during amblyopic eye viewing. Here, we tested the hypothesis that the initiation of smooth pursuit eye movements, which are responsible for accurately keeping moving objects on the fovea, is delayed in people with anisometropic amblyopia. METHODS: Eleven participants with anisometropic amblyopia and 14 visually normal observers were asked to track a step-ramp target moving at ±15°/s horizontally as quickly and as accurately as possible. The experiment was conducted under three viewing conditions: amblyopic/nondominant eye, binocular, and fellow/dominant eye viewing. Outcome measures were smooth pursuit latency, open-loop gain, steady state gain, and catch-up saccade frequency. RESULTS: Participants with anisometropic amblyopia initiated smooth pursuit significantly slower during amblyopic eye viewing (206 ± 20 ms) than visually normal observers viewing with their nondominant eye (183 ± 17 ms, P = 0.002). However, mean pursuit latency in the anisometropic amblyopia group during binocular and monocular fellow eye viewing was comparable to the visually normal group. Mean open-loop gain, steady state gain, and catch-up saccade frequency were similar between the two groups, but participants with anisometropic amblyopia exhibited more variable steady state gain (P = 0.045). CONCLUSIONS: This study provides evidence of temporally delayed smooth pursuit initiation in anisometropic amblyopia. After initiation, the smooth pursuit velocity profile in anisometropic amblyopia participants is similar to visually normal controls. This finding differs from what has been observed previously in participants with strabismic amblyopia who exhibit reduced smooth pursuit velocity gains with more catch-up saccades.

Adaptation to Laterally Displacing Prisms in Anisometropic Amblyopia.

PURPOSE: Using visual feedback to modify sensorimotor output in response to changes in the external environment is essential for daily function. Prism adaptation is a well-established experimental paradigm to quantify sensorimotor adaptation; that is, how the sensorimotor system adapts to an optically-altered visuospatial environment. Amblyopia is a neurodevelopmental disorder characterized by spatiotemporal deficits in vision that impacts manual and oculomotor function. This study explored the effects of anisometropic amblyopia on prism adaptation. METHODS: Eight participants with anisometropic amblyopia and 11 visually-normal adults, all right-handed, were tested. Participants pointed to visual targets and were presented with feedback of hand position near the terminus of limb movement in three blocks: baseline, adaptation, and deadaptation. Adaptation was induced by viewing with binocular 11.4° (20 prism diopter [PD]) left-shifting prisms. All tasks were performed during binocular viewing. RESULTS: Participants with anisometropic amblyopia required significantly more trials (i.e., increased time constant) to adapt to prismatic optical displacement than visually-normal controls. During the rapid error correction phase of adaptation, people with anisometropic amblyopia also exhibited greater variance in motor output than visually-normal controls. CONCLUSIONS: Amblyopia impacts on the ability to adapt the sensorimotor system to an optically-displaced visual environment. The increased time constant and greater variance in motor output during the rapid error correction phase of adaptation may indicate deficits in processing of visual information as a result of degraded spatiotemporal vision in amblyopia.

Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review.

PURPOSE: New behavioral treatment methods, including dichoptic training, perceptual learning, and video gaming, have been proposed to improve visual function in adult amblyopia. Here, we conducted a meta-analysis of these methods to investigate the factors involved in amblyopia recovery and their clinical significance. METHODS: Mean and individual participant data meta-analyses were performed on 24 studies using the new behavioral methods in adults. Studies were identified using PubMed, Google Scholar, and published reviews. RESULTS: The new methods yielded a mean improvement in visual acuity of 0.17 logMAR with 32% participants achieving gains ≥ 0.2 logMAR, and a mean improvement in stereo sensitivity of 0.01 arcsec-1 with 42% of participants improving ≥2 octaves. The most significant predictor of treatment outcome was visual acuity at the onset of treatment. Participants with more severe amblyopia improved more on visual acuity and less on stereo sensitivity than those with milder amblyopia. Better initial stereo sensitivity was a predictor of greater gains in stereo sensitivity following treatment. Treatment type, amblyopia type, age, and training duration did not have any significant influence on visual and stereo acuity outcomes. CONCLUSIONS: Our analyses showed that some participants may benefit from the new treatments; however, clinical trials are required to confirm these findings. Despite the diverse nature of the new behavioral methods, the lack of significant differences in visual and stereo sensitivity outcomes among them suggests that visual attention-a common element among the varied treatment methods-may play an important role in amblyopia recovery.

Developmental Trajectory of McGurk Effect Susceptibility in Children and Adults With Amblyopia.

PURPOSE: The McGurk effect is an audiovisual illusion that involves the concurrent presentation of a phoneme (auditory syllable) and an incongruent viseme (visual syllable). Adults with amblyopia show less susceptibility to this illusion than visually normal controls, even when viewing binocularly. The present study investigated the developmental trajectory of McGurk effect susceptibility in adults, older children (10-17 years), and younger children (4-9 years) with amblyopia. METHODS: A total of 62 participants with amblyopia (22 adults, 12 older children, 28 younger children) and 66 visually normal controls (25 adults, 17 older children, 24 younger children) viewed videos that combined phonemes and visemes, and were asked to report what they heard. Videos with congruent (auditory and visual matching) and incongruent (auditory and visual not matching) stimuli were presented. Incorrect responses on incongruent trials correspond to high McGurk effect susceptibility, indicating that the viseme influenced the phoneme. RESULTS: Participants with amblyopia (28.0% ± 3.3%) demonstrated a less consistent McGurk effect than visually normal controls (15.2% ± 2.3%) across all age groups (P = 0.0024). Effect susceptibility increased with age (P = 0.0003) for amblyopic participants and controls. Both groups showed a similar response pattern to different speakers and syllables, but amblyopic participants invariably demonstrated a less consistent effect. CONCLUSIONS: Amblyopia is associated with reduced McGurk effect susceptibility in children and adults. Our findings indicate that the differences do not simply indicate delayed development in children with amblyopia; rather, they represent permanent alterations that persist into adulthood.