Phrenic nerve stimulation.

Weakness of the limbs and respiratory muscles has increasingly been found to be a frequent event that complicates the medical history of patients in Intensive Care. The problem normally affects more serious cases and presents as muscular weakness leading to flaccid paralysis and difficulty in weaning patients off mechanical ventilation. This latter sign leads the intensivist to suspect possible involvement of the neuromuscular respiratory system. Unfortunately, in-depth clinical assessment of the neuromuscular respiratory system is difficult with critically ill patients, and electrophysiological studies have been used instead to overcome this problem. Of these latter, electric and electromagnetic stimulation of the phrenic nerve have been successful (along with needle electromyography of the diaphragm) in identifying the causes of neuromuscular respiratory insufficiency, especially in Intensive Care. In this brief chapter, we will be discussing the technique of electric stimulation of the phrenic nerve and neuromuscular respiratory insufficiency within the field of critical illness polyneuropathy.

Intrasaccadic perception.

Mammalian vision has a lowpass frequency characteristic that filters out fast temporal oscillations. Thus, fast-drifting gratings cannot be detected with static eyes, but the same gratings can easily be detected by executing saccades. Because these gratings are invisible under fixation, they are useful for isolating and studying intrasaccadic perception, which is normally masked by presaccadic and postsaccadic perception. We have conducted a number of psychophysical studies using these stimuli, and here we report that intrasaccadic visual processing allows for motion perception, that gratings drifting in the direction of a saccade are perceived as having more contrast than the same gratings drifting in the opposite direction, and that intrasaccadic contrast perception has sufficient grain to allow psychophysical matching of the perceived contrast of gratings drifting in opposite directions. The conditions in which these phenomena occur disprove a recent hypothesis that intrasaccadic motion perception occurs for stimuli processed by the magnocellular system, and our results can be explained by assuming that the temporal lowpass characteristic that accounts for flicker fusion phenomena under vision with static eyes is also operative during saccades.

Luminance artifacts of cathode-ray tube displays for vision research.

Phosphor persistence, video bandwidth, DC restoration and high-voltage regulation affect the appearance of images presented on cathode-ray tubes (CRTs), potentially resulting in differences between nominal and actual stimuli. We illustrate these effects by measuring physical parameters of horizontal and vertical static and counter-phase flickering gratings, and we illustrate problems for vision research by measuring contrast sensitivity to these gratings. We also measured the extent to which calibration protocols actually result in the monitor being calibrated over its entire area regardless of image size. The results of our physical measurements indicate substantial differences between gratings that nominally differ only as to orientation. Consistent with these differences, our psychophysical measurements indicate different sensitivities when the bars of the gratings are parallel or orthogonal to raster lines, regardless of the retinal orientation of the gratings. The results of our calibration check show that only a small region around the target area of calibration can be regarded as effectively linearized, and only if the size of the test image used during the check is similar to the size of the calibration patch. Overall, our results indicate potentially severe problems with the use of CRTs in vision research, and we discuss some published results that are likely to have been affected by these problems.

Vision multiplexing: an engineering approach to vision rehabilitation device development.

Multiplexing is the transmission of two or more messages simultaneously over the same communication channel in a way that enables them to be separated and used at the receiving end. The normal visual system provides us with a very wide field of view at an apparent high resolution. The wide field of view is continuously monitored at a low resolution, providing information for navigation and detection of objects of interest. These objects of interest are sampled over time using the high-resolution fovea. Most disabling visual conditions impact only one of the components, the peripheral low-resolution wide field or the central high-resolution fovea. The loss of one of these components prevents the interplay of central and peripheral vision needed for normal function and causes disability. Traditionally low-vision aids replace or supplement the missing function, but usually at a cost of a significant loss in the surviving function. For example, magnifying devices increase resolution but reduce the field of view, whereas minifying devices increase the field of view but reduce resolution. A proposal to resolve many of the problems of current visual aids by exploring a general engineering approach--vision multiplexing--that takes advantage of the dynamic nature of human vision is presented. Vision multiplexing seeks to provide both the wide field of view and the high-resolution information in ways that could be accessed and interpreted by the visual system. This paper describes the use of optical methods and computer technologies in the development of a number of new visual aids, all of which apply vision multiplexing to restore the interplay of central and peripheral vision using eye movements in a natural way.

Contrast sensitivity function and image discrimination.

A previous study tested the validity of simulations of the appearance of a natural image (from different observation distances) generated by using a visual model and contrast sensitivity functions of the individual observers [J. Opt. Soc. Am. A 13, 1131 (1996)]. Deleting image spatial-frequency components that should be undetectable made the simulations indistinguishable from the original images at distances larger than the simulated distance. The simulated observation distance accurately predicted the distance at which the simulated image could be discriminated from the original image. Owing to the 1/f characteristic of natural images' spatial spectra, the individual contrast sensitivity functions (CSF's) used in the simulations of the previous study were actually tested only over a narrow range of retinal spatial frequencies. To test the CSF's over a wide range of frequencies, the same simulations and testing procedure were applied to five contrast versions of the images (10-300%). This provides a stronger test of the model, of the simulations, and specifically of the CSF's used. The relevant CSF for a discrimination task was found to be obtained by using 1-octave Gabor stimuli measured in a contrast detection task. The relevant CSF data had to be measured over a range of observation distances, owing to limitations of the displays.

Discrimination of wide-field images as a test of a peripheral-vision model.

In order to test a model of peripheral vision, various contrast sensitivity functions (CSF's) and fundamental eccentricity constants (FEC's) [see J. Opt. Soc. Am. A 8, 1762 (1991)] were applied to real-world, wide-field (6.4 degrees-32 degrees eccentricity) images. The FEC is used to model the change in contrast sensitivity as a function of retinal eccentricity. The processed test images were tested perceptually by determining the threshold FEC for which the observers could discriminate the test images from the original image. It was expected that higher CSF sensitivity would be associated with higher FEC's; and in fact, for images processed with low-pass (variable-window stimuli) CSF's, the threshold FEC's were larger for the higher-sensitivity (pattern-detection) CSF than for the lower-sensitivity (orientation detection) CSF. When two higher-sensitivity CSF's were compared, the bandpass (constant-window stimuli) CSF resulted in essentially the same FEC threshold as did the low-pass (variable-window stimuli) CSF. The fact that the FEC compensated for complex differences in the form of the CSF suggested that the discrimination task was mediated by a limited range of spatial frequencies over which the two CSF's were similar. Image contrast was then varied in order to extend the range of spatial frequencies tested. The FEC's estimated with the lower-contrast test images were unchanged for test images obtained with the high-sensitivity, bandpass CSF but increased for test images obtained with the high-sensitivity, low-pass CSF. These results suggest that peripheral contrast sensitivity as used in the present discrimination task is based on a high-sensitivity, bandpass CSF. The peripheral-vision model validated by the present analysis has practical applications in the evaluation of wide-field simulator images as well as area-of-interest or other foveating systems.

Appearance of images through a multifocal intraocular lens.

The appearance of images through a multifocal intraocular lens (IOL) was simulated. The optical transfer function (OTF) of a model eye containing the multifocal lens was measured and divided by the OTF of the model eye with a monofocal IOL. This ratio was used to filter digital images, generating simulations that represent the retinal images seen through a multifocal intraocular lens when viewed through an eye with a monofocal lens. A dichoptic side-by-side display was used to present the original image to one eye, implanted with the multifocal lens, while the other eye, implanted with monofocal lens, viewed the simulations and variations on the simulations to derive a point of subjective equivalence. Four subjects with such bilateral lens implants were tested for near and distance vision. The results validate the test methodology and the simulations. Referenced to the nominal theoretical filter, the prediction was within a 0.25-diopter (D) blur for distance simulation and within a 0.50-D blur for the near-vision simulation.

Field expansion for homonymous hemianopia by optically induced peripheral exotropia.

PURPOSE: To describe a novel method for prism correction of hemianopia that provides field-of-view expansion in a convenient and functional format and to evaluate initial clinical application. METHOD: To expand the upper quadrant of the field, a high power prism segment (30-40delta) is placed base-out across the upper part of the spectacle lens, on the side of the loss, at about the level of the limbus. A similar prism segment at the lower part of the lens is used to treat the lower field. The peripheral location of the prisms causes peripheral exotropia. As a result a scene segment as high as the vertical span of the prism is shifted laterally by 15 to 20 degrees relative to the view of the other eye. At the edge of the hemianopic field loss, objects that would fall in the scotoma of one eye are seen through the prism in the other eye, providing a simultaneous awareness of details within the otherwise absent field-of-view. An approach for fitting the system to patients with abnormal binocular vision (strabismus and amblyopia, with or without diplopia) is discussed as well. The effect of the prisms was evaluated in a noncomparative case series (12 patients). RESULTS: The field expansion is provided at any position of lateral gaze, including gaze away from the side of the scotoma. The effect of this technique on field expansion was demonstrated using standard binocular perimetry. Most patients reported substantial improvement in function and in obstacle avoidance. CONCLUSION: A novel method for the optical treatment of hemianopia was developed and tested. It was found to be effective in expanding the field and helping patients' mobility.

Lack of covariation of the effects of luminance and eccentricity on contrast sensitivity.

BACKGROUND AND PURPOSE: Qualitative individual differences in visual processing along various stimulus dimensions have been previously documented. For instance, as compared to the foveal contrast sensitivity function (CSF), the peripheral CSF of some subjects shifts toward lower frequencies, but it scales down for others; also, sensitivity to low spatial frequencies increases monotonically with luminance in some subjects, but it displays a decline at high luminances in others. Although these qualitatively distinct eccentricity- and luminance-related patterns have been thoroughly described separately, their joint occurrence has never been studied. This study aimed at determining whether there is covariation between the effects of luminance and eccentricity on contrast sensitivity, i.e., whether each eccentricity-related pattern occurs with one and only one of the luminance-related patterns. METHODS: We have measured contrast sensitivity to sine-wave grating patches as a function of luminance and eccentricity in a sample of 18 subjects. RESULTS: We found positive evidence of lack of covariation between the effects of eccentricity and luminance: we found subjects who show the same eccentricity-related pattern but differ as to their luminance-related patterns, and we have also found a subject who, unlike the rest, shows qualitatively distinct luminance-related patterns at different eccentricities. CONCLUSION: The dependence of contrast sensitivity on eccentricity and luminance is subject to qualitative variations both across and within individuals, suggesting that meaningful conclusions on the effects of luminance and eccentricity on contrast sensitivity cannot be drawn when the data from all available subjects are aggregated.

The visual effects of head-mounted display (HMD) are not distinguishable from those of desk-top computer display.

Concerns about potentially harmful effects on the visual system due to the use of head mounted displays (HMDs) in general, and stereoscopic systems in particular, have been raised in the literature. Most of the concerns were based on studies measuring visual function changes following short-term use of HMDs. This study measured functional changes in binocular vision, accommodation, and resolution following 30 min use of HMD in both stereoscopic- and non-stereoscopic modes, and compared them to changes following the same task performed on a desk-top CRT display. No functional differences were found between HMD and CRT and most measured changes were too small to be considered clinically meaningful. An evaluation of subjective comfort found a statistically significant difference in the impression of comfort between the CRT and the HMD in stereoscopic mode, with the latter being less comfortable. It can be concluded that the functional changes reported following short term use of HMDs are not specific to stereoscopic presentation and do not differ from those caused by desk-top CRT display.

Benefits of rapid serial visual presentation (RSVP) over scrolled text vary with letter size.

We previously reported that low vision readers do not benefit from a rapid serial visual presentation (RSVP) display relative to a scroll display. Each reader in those studies was presented with only one letter size, and it was the same for both displays. In the current study, we systematically varied the size of the letters and compared reading rates from the 2 displays for letters that were 2, 4, 6, 8, and 10 times each reader's acuity threshold. Using this paradigm, we found that subjects with normal vision (n = 12) read faster with RSVP for all text sizes. Low vision subjects (N = 20) showed no benefit of RSVP until the text was at least 8x their acuity threshold. As in our prior studies, there was a great deal of variability within the low vision group, and for a small number of subjects (25%), reading was faster from the scroll than from the RSVP display.

The transition from DeVries-Rose to Weber's laws: comments on Rovamo, Mustonen and Näsänen (1995)

Rovamo et al. [Vision Research (1995), 35, 767-774] measured contrast sensitivity at several frequencies in the fovea and periphery as a function of retinal illuminance, concluding that the critical illuminance for the transition from DeVries-Rose to Weber's laws is proportional to squared frequency at all retinal locations. Yet, inspection of their data clearly reveals that the DeVries-Rose range was hardly ever followed by a Weber range: either no sign of any second range was apparent or the transition was to a qualitatively different range in which sensitivity decreased with increasing illuminance. The validity of their conclusions is questioned, and the status of the "DeVries-Rose to Weber transition" as a description of the relationship between sensitivity and illuminance is discussed in the light of mounting empirical evidence of a decreasing range in this relationship.

Simulated cataract does not reduce the benefit of RSVP.

Normally sighted younger and older (mean age 71 years) observers read sentences and random lists of words from a rapid serial visual presentation (RSVP) display and a scroll display using their normal vision and through two levels of cataract simulators. Unlike patients with central field loss (CFL), there was no decrease in the benefit of RSVP with reduced vision due to the cataract simulators. However, the usefulness of sentence-level context was reduced as visual acuity was reduced. In addition, older readers did not benefit as much from RSVP as younger readers, and many in the older group were unable to read using the more severe cataract simulators from either display format. From these data we conclude that the benefits of RSVP are not reduced with reduced acuity and contrast sensitivity, and that there are age-related changes in reading rates from dynamic text displays not related to acuity.

In search of a contrast metric: matching the perceived contrast of Gabor patches at different phases and bandwidths.

The definition of contrast in a complex scene is a long-standing problem. The local contrast in an image may be approximated by the contrast of a Gabor patch of varying phase and bandwidth. Observers' perceived (apparent) contrast, as indicated by matching of such patterns, were compared here to the physical contrast calculated by a number of definitions. The 2 c/deg 1-octave Gabor patch stimuli of different phases were presented side by side, separated by 4 deg. During each session the subjects (n = 5) were adapted to the average luminance, and four different contrast levels were randomly interleaved. The subject's task was to indicate which of the two patterns was lower in contrast. Equal apparent contrast was determined by fitting a psychometric function to the data. The results of the matching rejected the hypothesis that either the Michelson formula or the King-Smith and Kulikowski contrast metric (CKK = (Lmax-Lbackground)/Lbackground) was used by the subjects to set the matching. The use of the Nominal contrast (the Michelson contrast of the underlying sinusoid) as an estimate of apparent contrast could not be rejected. In a second experiment the apparent contrast of a 1-octave Gabor patch was matched to the apparent contrast of a 2-octave Gabor patch (of Nominal contrast of 0.1, 0.3, 0.6, 0.8) using the method of adjustment. The results of this experiment disagree with the prediction of the Nominal contrast definition as well. The local band-limited contrast measure (Peli, 1990), when used with the modifications suggested by Lubin (1995) as an estimate of apparent contrast, could not be rejected by the results of either experiment. These results suggest that a computational contrast metric based on multi-scale bandpass filtering is a better estimate of apparent perceived contrast than any of the other metrics tested.

Contrast perception across changes in luminance and spatial frequency.

The interaction of the effects of luminance and spatial frequency on perception of suprathreshold contrast was studied with use of a contrast-matching paradigm. Four subjects matched the appearance of Gabor patches at different luminances and spatial frequencies. The contrast of a 1-octave Gabor test patch at one of five frequencies [1-16 cycles/degree (c/deg) in 1-octave steps] and at one of seven mean luminance levels (0.5-50 cd/m2 in 1/3-log-unit steps) was matched, by the method of adjustment to a standard patch of 3 c/deg at 50 cd/m2 at a nominal contrast of 0.3. For each block of trials the spatial frequency of the test patch was randomly changed (three repetitions at each frequency per block) while the luminance was fixed. The subject regularly shifted fixation between the two targets in response to a metronome tone every 1.5 s. Contrast constancy was demonstrated across the entire luminance range tested for all but the two highest frequencies. For 8 c/deg the perceived test contrast was reduced only when the luminance was less than 2 cd/m2. For 16 c/deg, perceived contrast decreased linearly (with a slope of -1/2 on a log scale) with decreases in luminance across the entire luminance range. As at threshold, reduction in luminance across the levels commonly available on a CRT display has only minimal effects on low-frequency suprathreshold contrast perception. However, the apparent contrast of high-frequency features, in binocular free-viewing conditions, is rapidly reduced with a local reduction in screen luminance. This effect has important implications for visual models used in image-quality analysis.

The role of context in reading with central field loss.

It has been suggested that readers with central field loss (CFL) may not be able to use context to facilitate reading in the same way that normally sighted readers do because their processing capacity is fully utilized decoding the degraded visual stimulus. If true, this could account for their slow reading, even when text is appropriately magnified. Readers with CFL and normally sighted, age-matched controls read sentences and lists of random words from two dynamic text displays. We used sentence-gain (the ratio of reading rates for sentences to random words) to assess the use of context. Sentence-gain was equivalent across groups. Therefore, reduced reliance on context cannot explain the slower reading rates of people with CFL.

The necessary field of view to read with an optimal stand magnifier.

BACKGROUND: For most people with low vision, some form of magnification is necessary to read. Using a magnifier reduces the number of letters that can be seen simultaneously (field of view), which has been shown to decrease reading rates. This study sought to determine how many letters are necessary to attain maximal reading rates with a stand magnifier. METHODS: Younger and older normally-sighted and visually-impaired observers read short passages using a fiber optic stand magnifier (taper). The optical properties of this magnifier allowed the field of view to be precisely varied. Each subject read using at least four field sizes (3, 5, 9 and 13 characters visible) while reading speed was measured. RESULTS: Reading rates continued to increase with as many as 13 characters visible, regardless of age or vision status. In addition, reading with the taper was slower for all subject groups than reading without the magnifier. CONCLUSIONS: This study confirms reports that reading rates increase as the field of view increases when reading from a page of text. The need for this large field of view relative to other low vision reading aids (i.e., computer-generated scroll displays) is likely the result of the readers' need to actively navigate across the page of text.