Neural correlates of visual spatial selective attention are altered at early and late processing stages in human amblyopia.

Amblyopia is a neurodevelopmental visual disorder which results in reduced visual acuity in one eye and impaired binocular interactions. Previous studies suggest attentional deficits in amblyopic individuals. However, spatial cues which orient attention to a visual field improved performance. Here, we investigate the neural correlates of auditory-visual spatial selective attention in amblyopia during EEG recording. An auditory cue, that was followed by the presentation of two Gabor patches presented in the lower left and right visual fields, indicated the most likely location of an upcoming target Gabor. The target Gabor differed in orientation from the more frequently presented non-target Gabor patches. Adults with amblyopia and neurotypical observers were asked to detect the target Gabor monocularly at the cued location, while withholding their response to targets presented at the uncued location and to all non-target Gabor patches. Higher response rates were observed for cued compared to uncued targets in both groups. However, amblyopic individuals detected targets less efficiently with their amblyopic eye as compared to their fellow eye. Correspondingly, event-related potentials (ERPs) recorded to the onset of the non-target Gabor patches were delayed at early processing stages (150-300 ms: posterior N100) and reduced in amplitude at later time windows (150-350 ms: P200, 300-500 ms: sustained activity) in the amblyopic eye compared to the fellow eye. Such interocular differences were not observed in neurotypical observers. These findings suggest that neural resources allocated to the early formation of visual discrimination as well as later stimulus recognition processes are altered in the amblyopic eye.

Both saccadic and manual responses in the amblyopic eye of strabismics are irreducibly delayed.

Abnormal early visual development can result in a constellation of neural and visual deficits collectively known as amblyopia. Among the many deficits, a common finding is that both saccadic and manual reaction times to targets presented to the amblyopic eye are substantially delayed when compared to the fellow eye or to normal eyes. Given the well-known deficits in contrast sensitivity in the amblyopic eye, a natural question is whether the prolonged reaction times are simply a consequence of reduced stimulus visibility. To address this question, in Experiment 1 we measure saccadic reaction times (RT) to perifoveal stimuli as a function of effective stimulus contrast (i.e., contrast scaled by the amblyopic eye's contrast threshold). We find that when sensory differences between the eyes are minimized, the asymptotic RTs of our anisometropic amblyopes were similar in the two eyes. However, our results suggest that some strabismic amblyopes have an irreducible delay at the asymptote. That is, even when the sensory differences of the stimulus were accounted for, these observers still had large interocular differences (on average, 77 ms) in saccadic reaction time. In Experiment 2, to assess the role of fixation on saccadic reaction time we compared reaction time with and without a foveal target (the "gap effect"). Our results suggest that, while removing the fixation target does indeed speed up reaction time in the amblyopic eye, the gap effect is similar in the two eyes. Therefore, the gap effect does not eliminate the irreducible delay in the amblyopic eye. Finally, in Experiment 3 we compared the interocular differences in saccadic and manual reaction times in the same observers. This allowed us to determine the relationship between the latencies in the two modalities. We found a strong correlation between the differences in saccadic and manual reaction times; however, the manual RT difference is about half that of saccadic RT, suggesting that there may be two separable effects on saccadic reaction time: (a) a central problem with directing actions to a target, related to disengagement of attention at the fovea, which results in delays in both saccadic and manual reaction times, and (b) a further delay in saccadic reaction times because of the motor refractory period from a previous saccade or microsaccade, made in an attempt to stabilize the amblyopic eye of strabismics.

Intramodal cortical plastic changes after moderate visual impairment in human amblyopia.

Early blindness results in alterations in the neural responses to auditory stimuli. Here we show that even moderately reduced vision in one eye early in life is sufficient to induce neural plastic changes in voice processing. We asked individuals with reduced visual acuity in one eye due to amblyopia to attend to vocal cues during electroencephalogram recording. We found enhanced frontal auditory responses at 125 ms-225 ms, which were correlated with reduced vision in the amblyopic eye, but not the fellow eye. Our results indicate intramodal reorganization, typically observed after congenital profound visual deprivation.

Inattentional blindness with the same scene at different scales.

People with severely restricted peripheral visual fields have difficulty walking confidently and safely in the physical environment. Augmented vision devices that we are developing for low-vision rehabilitation implement vision multiplexing, providing two views of the same scene at two different scales (sizes), with a cartooned minified wide view overlaying a natural see-through view. Inattentional blindness may partially limit the utility of these devices as low-vision aids. Inattentional blindness, the apparent inability to notice significant but unexpected events in an unattended scene when attention is fixed on another scene, has classically been demonstrated by overlaying two unrelated game scenes, with unexpected events occurring in one scene while attention is maintained on the other scene by a distractor task. We hypothesized that context like that provided by the related wide view in our devices might mitigate inattentional blindness in a study with two simultaneous views of the same scene shown at different scales. It did not, and unexpected event detection rates were remarkably consistent with our and other mixed-scene studies. Still, detecting about half of the unexpected events bodes well for our use of vision aids that employ vision multiplexing. Without the aids, is it likely that many more events would be missed.

An action video game for the treatment of amblyopia in children: A feasibility study.

The gold-standard treatment for childhood amblyopia remains patching or penalizing the fellow eye, resulting in an average of about a one line (0.1 logMAR) improvement in visual acuity following ≈120 h of patching in children 3-8 years old. However, compliance with patching and other treatment options is often poor. In contrast, fast-paced action video games can be highly engaging, and have been shown to yield broad-based improvements in vision and attention in adult amblyopia. Here, we pilot-tested a custom-made action video game to treat children with amblyopia. Twenty-one (n = 21) children (mean age 9.95 ±â€¯3.14 [se]) with unilateral amblyopia (n = 12 anisometropic and n = 9 strabismic) completed 20 h of game play either monocularly, with the fellow eye patched (n = 11), or dichoptically, with reduced contrast to the fellow eye (n = 10). Participants were assessed for visual acuity (VA), stereo acuity and reading speed at baseline, and following 10 and 20 h of play. Additional exploratory analyses examined improvements after 6-10 weeks of completion of training (follow-up). Following 20 h of training, VA improved, on average, by 0.14 logMAR (≈38%) for the dichoptic group and by 0.06 logMAR (≈15%) for the monocular group. Similarly, stereoacuity improved by 0.07 log arcsec (≈17%) following dichoptic training, and by 0.06 log arcsec (≈15%) following monocular training. Across both treatment groups, 7 of the 12 individuals with anisometropic amblyopia showed improvement in stereoacuity, whereas only 1 of the 9 strabismic individuals improved. Most improvements were largely retained at follow-up. Our feasibility study therefore suggests that the action video game approach may be used as an effective adjunct treatment for amblyopia in children, achieving results similar to those of the gold-standard treatment in shorter duration.