Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories.

Bilateral eye movement (EM) is a critical component in eye movement desensitization and reprocessing (EMDR), an effective treatment for post-traumatic stress disorder. However, the role of bilateral EM in alleviating trauma-related symptoms is unclear. Here we hypothesize that bilateral EM selectively disrupts the perceptual representation of traumatic memories. We used the trauma film paradigm as an analog for trauma experience. Nonclinical participants viewed trauma films followed by a bilateral EM intervention or a static Fixation period as a control. Perceptual and semantic memories for the film were assessed with different measures. Results showed a significant decrease in perceptual memory recognition shortly after the EM intervention and subsequently in the frequency and vividness of film-related memory intrusions across one week, relative to the Fixation condition. The EM intervention did not affect the explicit recognition of semantic memories, suggesting a dissociation between perceptual and semantic memory disruption. Furthermore, the EM intervention effectively reduced psychophysiological affective responses, including the skin conductance response and pupil size, to film scenes and subjective affective ratings of film-related intrusions. Together, bilateral EMs effectively reduce the perceptual representation and affective response of trauma-related memories. Further theoretical developments are needed to elucidate the mechanism of bilateral EMs in trauma treatment.

Effectiveness of visual and acoustic biofeedback eccentric viewing training in conjunction with home exercises on visual function: a retrospective observational review.

The aim of this study is to evaluate the effectiveness of an eccentric viewing training program that combines biofeedback training using micro-perimetry with home exercises on multiple visual function parameters and to explore potential relationships between post-treatment visual function parameters. A retrospective observational review of 27 participants who underwent the training program was performed. Eligible participants were diagnosed with bilateral central scotomas secondary to age-related macular degeneration. All participants undertook up to 15 visual and acoustic biofeedback training sessions and were required to partake in traditional home exercises between sessions. The biofeedback training was conducted in the better eye using the Macular Integrity Assessment microperimeter (MAIA). Distance and near acuity, contrast sensitivity and fixation stability quantified by the P1 and P2 values and the 63% and 95% bivariate contour ellipse area (BCEA) before and after the rehabilitation program were recorded. Significant improvement was noted post-training for distance visual acuity (t(26) = 4938 p = .000), near visual acuity (Z = -4.461 p = .000), contrast sensitivity (Z = -3.647 p = .000) and fixation stability for all measures, including P1 (t(26) = -9.490 p = .000), P2 (t(26) = -7.338 p = 0.000), 63% BCEA (Z = 3.569 p = .000) and 95% BCEA (t(26) = 4.687 p = .000). Significant medium-to-large correlations were also found between most visual function variables. Visual and acoustic biofeedback in conjunction with home exercises has the potential to improve visual function parameters in patients with age-related macular degeneration and irreversible central vision loss.

"Look at the future": Maintained fixation impoverishes future thinking.

We evaluated the relationship between eye movements and future thinking. More specifically, we evaluated whether maintained fixation could influence cognitive characteristics of future thinking. We invited participants to imagine future events in two conditions: while freely exploring a white wall and while fixating a cross on the wall. Results demonstrated fewer and longer fixations, as well as fewer and shorter saccades during maintained fixation condition than in the free gaze condition. Shorter total amplitude of saccades was also observed during the maintained fixation condition than during the free-gaze condition. Regarding the cognitive characteristics of future thinking, fewer spatiotemporal details and less visual imagery, slower retrieval time, and shorter descriptions were observed for future thinking during maintained fixation than during free-gaze condition. These results demonstrate that maintaining fixation results in an effortful construction of future scenarios. We suggest that maintained fixation limits the cognitive resources that are required for future thinking.

Imagery-related eye movements in 3D space depend on individual differences in visual object imagery.

During recall of visual information people tend to move their eyes even though there is nothing to see. Previous studies indicated that such eye movements are related to the spatial location of previously seen items on 2D screens, but they also showed that eye movement behavior varies significantly across individuals. The reason for these differences remains unclear. In the present study we used immersive virtual reality to investigate how individual tendencies to process and represent visual information contribute to eye fixation patterns in visual imagery of previously inspected objects in three-dimensional (3D) space. We show that participants also look back to relevant locations when they are free to move in 3D space. Furthermore, we found that looking back to relevant locations depends on individual differences in visual object imagery abilities. We suggest that object visualizers rely less on spatial information because they tend to process and represent the visual information in terms of color and shape rather than in terms of spatial layout. This finding indicates that eye movements during imagery are subject to individual strategies, and the immersive setting in 3D space made individual differences more likely to unfold.

Neural and behavioral effects of modification of visual attention in body dysmorphic disorder.

In individuals with body dysmorphic disorder (BDD), perceptual appearance distortions may be related to selective attention biases and aberrant visual scanning, contributing to imbalances in global vs. detailed visual processing. Treatments for the core symptom of perceptual distortions are underexplored in BDD; yet understanding their mechanistic effects on brain function is critical for rational treatment development. This study tested a behavioral strategy of visual-attention modification on visual system brain connectivity and eye behaviors. We acquired fMRI data in 37 unmedicated adults with BDD and 30 healthy controls. Participants viewed their faces naturalistically (naturalistic viewing), and holding their gaze on the image center (modulated viewing), monitored with an eye-tracking camera. We analyzed dynamic effective connectivity and visual fixation duration. Modulated viewing resulted in longer mean visual fixation duration compared to during naturalistic viewing, across groups. Further, modulated viewing resulted in stronger connectivity from occipital to parietal dorsal visual stream regions, also evident during the subsequent naturalistic viewing, compared with the initial naturalistic viewing, in BDD. Longer fixation duration was associated with a trend for stronger connectivity during modulated viewing. Those with more severe BDD symptoms had weaker dorsal visual stream connectivity during naturalistic viewing, and those with more negative appearance evaluations had weaker connectivity during modulated viewing. In sum, holding a constant gaze on a non-concerning area of one's face may confer increased communication in the occipital/parietal dorsal visual stream, facilitating global/holistic visual processing. This effect shows persistence during subsequent naturalistic viewing. Results have implications for perceptual retraining treatment designs.

Transcutaneous auricular vagus nerve stimulation increases eye-gaze on salient facial features and oxytocin release.

Non-invasive, transcutaneous electrical stimulation of the auricular branch of the vagus nerve (taVNS) via the ear is used therapeutically in epilepsy, pain, and depression, and may also have beneficial effects on social cognition. However, the underlying mechanisms of taVNS are unclear and evidence regarding its role in social cognition improvement is limited. To investigate the impact of taVNS on social cognition we have studied its effects on gaze toward emotional faces in combination with eye-tracking and on the release of the neuropeptide oxytocin which plays a key role in influencing social cognition and motivation. A total of 54 subjects were enrolled (49 were included in the final analysis) in a sham-controlled, participant-blind, crossover experiment, consisting of two treatment sessions 1 week apart. In one session participants received 30-min taVNS (tragus), and in the other, they received 30-min sham (earlobe) stimulation with the treatment order counterbalanced. The proportion of time spent viewing the faces and facial features (eyes, nose, and mouth) was measured together with resting pupil size. Additionally, saliva samples were taken for the measurement of oxytocin concentrations by enzyme-linked immunoassay. Saliva oxytocin concentrations increased significantly after taVNS compared to sham stimulation, while resting pupil size did not. In addition, taVNS increased time spent viewing the nose region irrespective of face emotion, and this was positively correlated with increased saliva oxytocin concentrations. Our findings suggest that taVNS biases visual attention toward socially salient facial features across different emotions and this is associated with its effects on increasing endogenous oxytocin release.

Arousal-based pupil modulation is dictated by luminance.

Pupillometry has become a standard measure for assessing arousal state. However, environmental factors such as luminance, a primary dictator of pupillary responses, often vary across studies. To what degree does luminance interact with arousal-driven pupillary changes? Here, we parametrically assessed luminance-driven pupillary responses across a wide-range of luminances, while concurrently manipulating cognitive arousal using auditory math problems of varying difficulty. At the group-level, our results revealed that the modulatory effect of cognitive arousal on pupil size interacts multiplicatively with luminance, with the largest effects occurring at low and mid-luminances. However, at the level of individuals, there were qualitatively distinct individual differences in the modulatory effect of cognitive arousal on luminance-driven pupillary responses. Our findings suggest that pupillometry as a measure for assessing arousal requires more careful consideration: there are ranges of luminance levels that are more ideal in observing pupillary differences between arousal conditions than others.

A feasibility study of eye gaze with biofeedback in a human-robot interface.

Play is a vital activity in which children learn skills and explore the environment through object manipulation. Assistive robots have been used to provide access to play, and Forbidden Region Virtual Fixture (FRVF) guidance at the user interface could help the users make the robot traverse the play environment more efficiently because it behaves like virtual walls to follow. Eye gaze was used to indicate the user's intended target and generate the location of the virtual walls in a card sorting task. We eliminated the typical computer screen required for visual feedback to confirm gaze location, and examined the use of alternative feedback. In this feasibility study, first a group of adults without physical impairment tested the system with auditory and vibrotactile feedback modalities for the gaze fixation and with the virtual walls on and off for robot movement. Then case studies with children and individuals with physical impairments were performed. Even though gaze fixation feedback and the virtual wall did not improve the performance of adult participants without impairment, the feedback increased the speed and accuracy of the gaze fixation and the virtual walls improved the movement efficiency for the participants with impairment and a 6-year-old child without impairment.

Pictorial low-level features in mental images: evidence from eye fixations.

It is known that eye movements during object imagery reflect areas visited during encoding. But will eye movements also reflect pictorial low-level features of imagined stimuli? In this paper, three experiments are reported in which we investigate whether low-level properties of mental images elicit specific eye movements. Based on the conceptualization of mental images as depictive representations, we expected low-level visual features to influence eye fixations during mental imagery, in the absence of a visual input. In a first experiment, twenty-five participants performed a visual imagery task with high vs. low spatial frequency and high vs. low contrast gratings. We found that both during visual perception and during mental imagery, first fixations were more often allocated to the low spatial frequency-high contrast grating, thus showing that eye fixations were influenced not only by physical properties of visual stimuli but also by its imagined counterpart. In a second experiment, twenty-two participants imagined high contrast and low contrast stimuli that they had not encoded before. Again, participants allocated more fixations to the high contrast mental images than to the low contrast mental images. In a third experiment, we ruled out task difficulty as confounding variable. Our results reveal that low-level visual features are represented in the mind's eye and thus, they contribute to the characterization of mental images in terms of how much perceptual information is re-instantiated during mental imagery.

An Overview of Preferred Retinal Locus and Its Application in Biofeedback Training for Low-Vision Rehabilitation.

Central vision loss (CVL) caused by macular damage generally disables common daily tasks, which cannot be reversed by present treatments. Fortunately, it has been found that biofeedback training by inducing or reinforcing preferred retinal locus (PRL) as an eccentric fixation reference contributes to the improvement of visual performance in patients with CVL. However, the clinical application is still under controversy due to poor knowledge of its fundamental and inconsistent practical standards. This article aims to summarize the possible rationale for the development, location, re-location and evaluating indicators of PRL, and the general apparatus, protocol, and outcome of biofeedback PRL training.

Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes.

BACKGROUND: Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus. METHODS: Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus. RESULTS: Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training. CONCLUSIONS: Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Perceived gaze direction affects concreteness effects in words memory: an event-related potentials study.

Previous studies have revealed that word concreteness effects could be influenced by contextual cues such as emotional context. However, it is unclear whether concreteness effects might be influenced by social context such as perception of gaze direction, which plays an important role in social interaction. This study uses event-related potentials (ERPs) to investigate whether perceived gaze direction could affect concreteness effects in words memory. Concrete and abstract words were presented on direct- or averted-gaze faces, and participants were asked to memorize the words. Behavioral results verified the direct-gaze memory advantage, showing that memory performance was better for words presented with direct gaze than with averted gaze. ERP results showed that concrete words were associated with a larger N400 and a smaller late positive component (LPC) than abstract words. ERP results also revealed a significant interaction between gaze direction and word concreteness on the LPC component: specifically, the LPC concreteness effect occurred only in the direct-gaze condition. Our results suggested that the gaze direction could be interpreted as a complex social context that differs from pure emotional cues in its influence on mental imagery in concreteness effects. This study provides a new perspective for investigating word concreteness effects with contextual cues.

Eye movements during visual imagery and perception show spatial correspondence but have unique temporal signatures.

Eye fixation patterns during mental imagery are similar to those during perception of the same picture, suggesting that oculomotor mechanisms play a role in mental imagery (i.e., the "looking at nothing" effect). Previous research has focused on the spatial similarities of eye movements during perception and mental imagery. The primary aim of this study was to assess whether the spatial similarity translates to the temporal domain. We used recurrence quantification analysis (RQA) to assess the temporal structure of eye fixations in visual perception and mental imagery and we compared the temporal as well as the spatial characteristics in mental imagery with perception by means of Bayesian hierarchical regression models. We further investigated how person and picture-specific characteristics contribute to eye movement behavior in mental imagery. Working memory capacity and mental imagery abilities were assessed to either predict gaze dynamics in visual imagery or to moderate a possible correspondence between spatial or temporal gaze dynamics in perception and mental imagery. We were able to show the spatial similarity of fixations between visual perception and imagery and we provide first evidence for its moderation by working memory capacity. Interestingly, the temporal gaze dynamics in mental imagery were unrelated to those in perception and their variance between participants was not explained by variance in visuo-spatial working memory capacity or vividness of mental images. The semantic content of the imagined pictures was the only meaningful predictor of temporal gaze dynamics. The spatial correspondence reflects shared spatial structure of mental images and perceived pictures, while the unique temporal gaze behavior could be driven by generation, maintenance and protection processes specific to visual imagery. The unique temporal gaze dynamics offer a window to new insights into the genuine process of mental imagery independent of its similarity to perception.

The efficacy of biofeedback visual rehabilitation therapy in patients with infantile nystagmus syndrome: A retrospective study.

OBJECTIVE: To report fixation stability changes in patients with different forms of infantile nystagmus syndrome (INS), who have undergone a visual rehabilitation through biofeedback fixation training (BFT) with microperimetry (MP). DESIGN: Retrospective study. METHODS: Patients 6 to 12 years-old with INS who performed BFT with MP. Initially 10 once-weekly followed by eight twice-weekly sessions of BFT during a minimum of 6 months period were performed. Visual acuity (VA) and MP fixation stability indices were analyzed, including displacement from fixation point (P1, P2) and percentage of retinal loci used during fixation attempt (BCEA 63% and 95%). Statistical analysis was conducted at baseline (BL), 10 weeks (W10) and 6 months (M6). RESULTS: Twelve patients (mean age 8.9 years.) with INS completed the whole training session. All patients showed significant improvement in the mean BCEA fixation area (deg2): For BCEA@95% BL was 78.0, 46.1 at W10, and 27.4 at M6 (p-value = 0.004). For BCEA@63% BL was 27.3, 15.4 in W10, and 9.17 at M6 (p = 0.01). The ANOVA test for the FS indices of P1 and P2, as well as for BCVA showed no significant difference when compared at the same intervals. CONCLUSION: Fixation stability (FS) indices of BCEAs (63% and 95%) improved at W10 and M6, while P1 and P2 showed significant improvement at W10 but not at M6, probably because BCEA involves a much larger area than P1 and P2. VA did not show significant improvement at any time point.

Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma.

PURPOSE: To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. MATERIALS AND METHODS: 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. RESULTS: The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). CONCLUSION: Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.

Transcutaneous Vagus Nerve Stimulation in Humans Induces Pupil Dilation and Attenuates Alpha Oscillations.

Vagus nerve stimulation (VNS) is widely used to treat drug-resistant epilepsy and depression. While the precise mechanisms mediating its long-term therapeutic effects are not fully resolved, they likely involve locus coeruleus (LC) stimulation via the nucleus of the solitary tract, which receives afferent vagal inputs. In rats, VNS elevates LC firing and forebrain noradrenaline levels, whereas LC lesions suppress VNS therapeutic efficacy. Noninvasive transcutaneous VNS (tVNS) uses electrical stimulation that targets the auricular branch of the vagus nerve at the cymba conchae of the ear. However, the extent to which tVNS mimics VNS remains unclear. Here, we investigated the short-term effects of tVNS in healthy human male volunteers (n = 24), using high-density EEG and pupillometry during visual fixation at rest. We compared short (3.4 s) trials of tVNS to sham electrical stimulation at the earlobe (far from the vagus nerve branch) to control for somatosensory stimulation. Although tVNS and sham stimulation did not differ in subjective intensity ratings, tVNS led to robust pupil dilation (peaking 4-5 s after trial onset) that was significantly higher than following sham stimulation. We further quantified, using parallel factor analysis, how tVNS modulates idle occipital alpha (8-13Hz) activity identified in each participant. We found greater attenuation of alpha oscillations by tVNS than by sham stimulation. This demonstrates that tVNS reliably induces pupillary and EEG markers of arousal beyond the effects of somatosensory stimulation, thus supporting the hypothesis that tVNS elevates noradrenaline and other arousal-promoting neuromodulatory signaling, and mimics invasive VNS.SIGNIFICANCE STATEMENT Current noninvasive brain stimulation techniques are mostly confined to modulating cortical activity, as is typical with transcranial magnetic or transcranial direct/alternating current electrical stimulation. Transcutaneous vagus nerve stimulation (tVNS) has been proposed to stimulate subcortical arousal-promoting nuclei, though previous studies yielded inconsistent results. Here we show that short (3.4 s) tVNS pulses in naive healthy male volunteers induced transient pupil dilation and attenuation of occipital alpha oscillations. These markers of brain arousal are in line with the established effects of invasive VNS on locus coeruleus-noradrenaline signaling, and support that tVNS mimics VNS. Therefore, tVNS can be used as a tool for studying how endogenous subcortical neuromodulatory signaling affects human cognition, including perception, attention, memory, and decision-making; and also for developing novel clinical applications.

Driver eye movements in relation to unfamiliar traffic signs: An eye tracking study.

Traffic signs are an integral part of the traffic control plan and they provide road users with necessary information on the upcoming situation. This paper aims to examine the level of understanding of traffic sign imagery used in different countries and to track participants' eye movement when they encounter unfamiliar signs. Tobii eye tracking glasses were used to track gaze differences between familiar and unfamiliar traffic signs. Our findings show that sign characteristics (such as the amount of information on the sign) and the observer's knowledge of the sign meaning have a significant impact on eye behaviour. Signs containing more information (loaded with more content) and unfamiliar to the participant systematically produced the longest overall and average fixations and gazing duration. Given that longer gaze time for unfamiliar traffic signs presents a potential traffic hazard, we evaluated the need for standardization of traffic signs.

Computational discrimination between natural images based on gaze during mental imagery.

When retrieving image from memory, humans usually move their eyes spontaneously as if the image were in front of them. Such eye movements correlate strongly with the spatial layout of the recalled image content and function as memory cues facilitating the retrieval procedure. However, how close the correlation is between imagery eye movements and the eye movements while looking at the original image is unclear so far. In this work we first quantify the similarity of eye movements between recalling an image and encoding the same image, followed by the investigation on whether comparing such pairs of eye movements can be used for computational image retrieval. Our results show that computational image retrieval based on eye movements during spontaneous imagery is feasible. Furthermore, we show that such a retrieval approach can be generalized to unseen images.

Long-Term Value Memory in the Primate Posterior Thalamus for Fast Automatic Action.

The thalamus is known to process information from various brain regions and relay it to other brain regions, serving an essential role in sensory perception and motor execution. The thalamus also receives inputs from basal ganglia nuclei (BG) involved in value-based decision making, suggesting a role in the value process. We found that neurons in a particular area of the rhesus macaque posterior thalamus encoded the historical value memory of visual objects. Many of these value-coding neurons were located in the suprageniculate nucleus (SGN). This thalamic area directly received anatomical input from the superior colliculus (SC), and the neurons showed visual responses with contralateral preferences. Notably, the value discrimination activity of these thalamic neurons increased during learning, with the learned values stably retained even more than 200 days after learning. Our data indicate that single neurons in the posterior thalamus not only processed simple visual information but also represented historical values. Furthermore, our data suggest an SC-posterior thalamus-BG-SC subcortical loop circuit that encodes the historical value, enabling a quick automatic gaze by bypassing the visual cortex.

Biofeedback fixation training method for improving eccentric vision in patients with loss of foveal function secondary to different maculopathies.

PURPOSE: Fixation stability (FS) of the preferred retinal locus (PRL) may be improved by biofeedback fixation training (BFT) with microperimetry. Such training can be done on the patient's PRL or in different retinal loci with better functional characteristics. We studied both options and compared the outcomes. METHODS: Sixty-seven consecutive patients with bilateral central vision loss, poor FS and visual acuity (VA) lower than 0.3 LogMAR were recruited for BFT with microperimeter. Patients were assigned into 2 groups. In group A, BFT was performed on the patient's spontaneous PRL. In group B, PRL was located between 2 adjacent loci with the highest light sensitivity and the lowest distance from the fovea. Two sets of 12 weekly BFT sessions were performed. Primary outcomes were: FS, VA and reading speed. RESULTS: Outcomes were statistically significantly better in group B. Mean percentage of FS at therapy end improved from 32 to 35% for group A and from 40 to 55% in group B. Mean VA improved from 1 to 0.86 in group A and from 1 to 0.84 in group B. Reading speed (wpm) improved from 56 to 58 in group A and from 63 to 89 in group B. CONCLUSIONS: This study describes a reliable methodology of improving eccentric fixation stability using BFT in microperimetry, when the fixation training locus is individualized as the retinal area with best functional characteristics. Further studies are needed to validate its value in a larger scale of patients, at different stages of the disease, and its persistence over time.