[Quantification of ocular dominance for better management of eye disease]. / Vers une quantification de la dominance oculaire pour une meilleure prise en charge des pathologies de l'œil.

INTRODUCTION: The dominant eye is defined as the one we unconsciously choose when we have to perform monocular tasks. In the field of clinical neuro-ophthalmology, it is well-established that ocular dominance plays a key role in several eye diseases. Furthermore, the accurate quantification of ocular dominance is crucial with regard to certain surgical techniques. However, classical preoperative tests cannot determine the amount of ocular dominance. MATERIALS AND METHODS: In order to obtain further insight into the phenomenon of ocular dominance, we study its influence at behavioral and neurophysiological levels (experiments 1 and 2). Based on these new data, we suggest a method to improve quantification of ocular dominance (experiment 3). RESULTS: We demonstrate that ocular dominance has an influence on hand movements and on interhemispheric transfer time. Moreover, we show that an analysis of the dynamics of saccades allows us to sort out participants with strong or weak ocular dominance. CONCLUSION: In conclusion, this better understanding of the phenomenon of ocular dominance, coupled with the analysis of saccadic dynamics, might, in the short or medium term, lead to the establishment of a quick and straightforward battery of tests allowing determination of the amount of ocular dominance for each patient.

Long-term sensorimotor and therapeutical effects of a mild regime of prism adaptation in spatial neglect. A double-blind RCT essay.

Spatial neglect (SN) is commonly associated with poor functional outcome. Adaptation to a rightward optical deviation of vision has been shown to benefit to SN rehabilitation. The neurophysiological foundations and the optimal modalities of prism adaptation (PA) therapy however remain to be validated. This study is aimed at exploring the long-term sensory-motor, cognitive and functional effects produced by weekly PA sessions over a period of four weeks. A double-blind, monocentric randomized and controlled trial (RCT) was carried out. Twenty patients with left SN secondary to stroke were included, 10 in the "prism" group and 10 in the "control" group. The sensory-motor effects of PA were evaluated by measurement of manual and visual straight-ahead, and also by precision of pointing without visual feedback before and after each PA session. The functional independence measure (FIM) was evaluated before and at 1, 3 and 6 months after PA, while SN severity was assessed using the Behavioural Inattention Test (BIT) before and 6 months after PA. Before the intervention, only manual straight-ahead pointing constituted a reproducible sensory-motor measurement. During prism exposure, a questionnaire showed that not a single patient were aware of the direct effects of optical deviation on pointing movement performance. The sensory-motor after-effects produced by the PA produced a more rapid reduction of the rightward manual straight-ahead, which was secondarily followed by visual straight-ahead. These sensory-motor effects helped to clarify the action mechanisms of PA on SN. At the conclusion of the 6-month follow-up, the two groups showed similar improvement, indicating that a weekly PA session over 4 weeks was not sufficient to produce long-term functional benefit. This improvement was correlated with the evolution of visual straight-ahead, which can be proposed as a marker for patients outcome.

Effects of structural and functional cerebellar lesions on sensorimotor adaptation of saccades.

The cerebellum is critically involved in the adaptation mechanisms that maintain the accuracy of goal-directed acts such as saccadic eye movements. Two categories of saccades, each relying on different adaptation mechanisms, are defined: reactive (externally triggered) saccades and voluntary (internally triggered) saccades. The contribution of the medio-posterior part of the cerebellum to reactive saccades adaptation has been clearly demonstrated, but the evidence that other parts of the cerebellum are also involved is limited. Moreover, the cerebellar substrates of voluntary saccades adaptation have only been marginally investigated. Here, we addressed these two questions by investigating the adaptive capabilities of patients with cerebellar or pre-cerebellar stroke. We recruited three groups of patients presenting focal lesions located, respectively, in the supero-anterior cerebellum, the infero-posterior cerebellum and the lateral medulla (leading to a Wallenberg syndrome including motor dysfunctions similar to those resulting from lesion of the medio-posterior cerebellum). Adaptations of reactive saccades and of voluntary saccades were tested during separate sessions in all patients and in a group of healthy participants. The functional lesion of the medio-posterior cerebellum in Wallenberg syndrome strongly impaired the adaptation of both reactive and voluntary saccades. In contrast, patients with lesion in the supero-anterior part of the cerebellum presented a specific adaptation deficit of voluntary saccades. Finally, patients with an infero-posterior cerebellar lesion showed mild adaptation deficits. We conclude that the medio-posterior cerebellum is critical for the adaptation of both saccade categories, whereas the supero-anterior cerebellum is specifically involved in the adaptation of voluntary saccades.

Right-hemispheric dominance for visual remapping in humans.

We review evidence showing a right-hemispheric dominance for visuo-spatial processing and representation in humans. Accordingly, visual disorganization symptoms (intuitively related to remapping impairments) are observed in both neglect and constructional apraxia. More specifically, we review findings from the intervening saccade paradigm in humans--and present additional original data--which suggest a specific role of the asymmetrical network at the temporo-parietal junction (TPJ) in the right hemisphere in visual remapping: following damage to the right dorsal posterior parietal cortex (PPC) as well as part of the corpus callosum connecting the PPC to the frontal lobes, patient OK in a double-step saccadic task exhibited an impairment when the second saccade had to be directed rightward. This singular and lateralized deficit cannot result solely from the patient's cortical lesion and, therefore, we propose that it is due to his callosal lesion that may specifically interrupt the interhemispheric transfer of information necessary to execute accurate rightward saccades towards a remapped target location. This suggests a specialized right-hemispheric network for visuo-spatial remapping that subsequently transfers target location information to downstream planning regions, which are symmetrically organized.

Sensorimotor adaptation of saccadic eye movements.

Sensory-motor adaptation mechanisms play a pivotal role in maintaining the performance of goal-directed movements. The saccadic system, used to explore the visual environment through fast and accurate shifts of the eyes (saccades), is a valuable model for studying adaptation mechanisms. Significant progresses have been recently made in identifying the properties and neural substrates of saccadic adaptation elicited by the double-step target paradigm. Behavioural data collected in healthy and brain-damaged subjects, and neurophysiological data from non human primates, will be reviewed in an attempt to build a coherent picture of saccadic adaptation mechanisms. Emphasis will further be put on the contextual factors of saccadic adaptation, and on the link between adaptive changes of oculomotor commands and visual perception. It will be shown that saccadic adaptation relies on multiple mechanisms according to experimental contexts, time-scales, saccade categories, and direction of adaptive changes of saccade amplitude (shortening versus lengthening). Taking into account this complexity will be a key toward a comprehensive understanding of the physiopathology of saccadic adaptation and toward the development of possible rehabilitation procedures.

Separate neural substrates in the human cerebellum for sensory-motor adaptation of reactive and of scanning voluntary saccades.

Sensory-motor adaptation processes are critically involved in maintaining accurate motor behavior throughout life. Yet their underlying neural substrates and task-dependency bases are still poorly understood. We address these issues here by studying adaptation of saccadic eye movements, a well-established model of sensory-motor plasticity. The cerebellum plays a major role in saccadic adaptation but it has not yet been investigated whether this role can account for the known specificity of adaptation to the saccade type (e.g., reactive versus voluntary). Two patients with focal lesions in different parts of the cerebellum were tested using the double-step target paradigm. Each patient was submitted to two separate sessions: one for reactive saccades (RS) triggered by the sudden appearance of a visual target and the second for scanning voluntary saccades (SVS) performed when exploring a more complex scene. We found that a medial cerebellar lesion impaired adaptation of reactive-but not of voluntary-saccades, whereas a lateral lesion affected adaptation of scanning voluntary saccades, but not of reactive saccades. These findings provide the first evidence of an involvement of the lateral cerebellum in saccadic adaptation, and extend the demonstrated role of the cerebellum in RS adaptation to adaptation of SVS. The double dissociation of adaptive abilities is also consistent with our previous hypothesis of the involvement in saccadic adaptation of partially separated cerebellar areas specific to the reactive or voluntary task (Alahyane et al. Brain Res 1135:107-121 (2007)).