Perceptual learning based on a temporal stimulus enhances visual function in adult amblyopic subjects.

Studies have shown that Perceptual Learning (PL) can lead to enhancement of spatial visual functions in amblyopic subjects. Here we aimed to determine whether a simple flickering stimulus can be utilized in PL to enhance temporal function performance and whether enhancement will transfer to spatial functions in amblyopic subjects. Six adult amblyopic and six normally sighted subjects underwent an evaluation of their performance of baseline psychophysics spatial functions (Visual acuity (VA), contrast sensitivity (CS), temporal functions (critical fusion frequency (CFF) test), as well as a static and flickering stereopsis test, and an electrophysiological evaluation (VEP). The subjects then underwent 5 training sessions (on average, a total of 150 min over 2.5 weeks), which included a task similar to the CFF test using the method of constant stimuli. After completing the training sessions, subjects repeated the initial performance evaluation tasks. All amblyopic subjects showed improved temporal visual performance (CFF) in the amblyopic eye (on average, 17%, p << 0.01) following temporal PL. Generalization to spatial, spatio-temporal, and binocular tasks was also found: VA increased by 0.12 logMAR (p = 0.004), CS in backward masking significantly increased (by up to 19%, p = 0.003), and flickering stereopsis increased by 85 arcsec (p = 0.048). These results were further electrophysiologically manifested by an increase in VEP amplitude (by 43%, p = 0.03), increased Signal-to-Noise ratio (SNR) (by 39%, p = 0.024) to levels not different from normally sighted subjects, along with an improvement in inter-ocular delay (by 5.8 ms, p = 0.003). In contrast, no significant effect of training was found in the normally sighted group. These results highlight the potential of PL based on a temporal stimulus to improve the temporal and spatial visual performance in amblyopes. Future work is needed to optimize this method for clinical applications.

Temporal synchronization elicits enhancement of binocular vision functions.

Integration of information over the CNS is an important neural process that affects our ability to perceive and react to the environment. The visual system is required to continuously integrate information arriving from two different sources (the eyes) to create a coherent percept with high spatiotemporal precision. Although this neural integration of information is assumed to be critical for visual performance, it can be impaired under some pathological or developmental conditions. Here we took advantage of a unique developmental condition, amblyopia ("lazy eye"), which is characterized by an impaired temporal synchronization between the two eyes, to meticulously study the effect of synchronization on the integration of binocular visual information. We measured the eyes' asynchrony and compensated for it (with millisecond temporal resolution) by providing time-shifted stimuli to the eyes. We found that the re-synchronization of the ocular input elicited a significant improvement in visual functions, and binocular functions, such as binocular summation and stereopsis, were regained. This phenomenon was also evident in neurophysiological measures. Our results can shed light on other neural processing aspects and might also have translational relevance for the field of training, rehabilitation, and perceptual learning.

A dichoptic presentation device and a method for measuring binocular temporal function in the visual system.

Recent studies highlight the importance of the temporal domain in visual processing. Critical Flicker Frequency (CFF), the frequency at which a flickering light is perceived as continuous, is a widely used measure for evaluating visual temporal processing. Another important issue to investigate is the cortical interactions arising between the flicker stimuli of both eyes. This paper presents a robust and reliable dichoptic tool for evaluating the CFF threshold in both eyes. This system is based on an analog output device used to independently drive two LEDs through a custom-written MATLAB code (using a laptop PC) for eliciting sinusoidal flickering stimuli and for psychophysically measuring the perceived CFF threshold. The luminance and phases of each LED are individually controlled, enabling the investigation of the effect of phase and luminance differences on binocular summation in subjects with different ocular pathologies. Experiments were designed to evaluate the CFF threshold through a psychophysical test, based on a discrimination task with a stimulus duration of 1 s, based on a temporal alternative forced-choice paradigm. The target stimulus temporal features were modulated using the staircase method. Subjects were requested to discriminate between a target stimulus (a flickering light at various frequencies) and a flickering light at a frequency of 120 Hz, which is significantly higher than the CFF in humans; therefore, it is perceived as constant. One of the main advantages of the introduced dichoptic presentation system is that it enables the visual temporal performance to be measured under both monocular and binocular conditions where phenomena such as temporal binocular summation (BS) can be evaluated. Moreover, the system offers great flexibility by introducing a stimulus phase shift, which enables studying how stimulus timing affects the temporal function at millisecond scale resolution. Our results confirm that no crosstalk exists between the eyes and that the system can reliably separate the stimuli presented to the eyes. Using this set-up, we observed the binocular summation of CFF for low target luminance levels. The CFF was significantly (p = 0.011) higher (5.2%) under binocular compared with monocular viewing conditions. More importantly, introducing an inter - ocular phase shift reduced the binocular CFF in normally sighted subjects. Finally, in amblyopic subjects the amblyopic eye showed a decrease of 3.9 Hz (15%) in CFF, compared with the fellow eye (p = 0.001). The ability to assess binocular temporal performance using a dichoptic display can shed light on visual temporal performance in general, and on binocular temporal summation processes in particular, both for subjects with normal binocular vision and for subjects with impaired binocular vision (e.g., amblyopic subjects). Furthermore, such a presentation set-up may facilitate the development of training paradigms aimed at improving binocular vision performance. In this paper we describe the system and methods in detail and provide all necessary computer code and other details that will enable an easy and quick adaptation of the method by scientists interested in studying the temporal resolution of the visual system in general, and in studying inter-ocular differences or interactions in particular.

Evaluation of Critical Flicker-Fusion Frequency Measurement Methods for the Investigation of Visual Temporal Resolution.

Recent studies highlight the importance of the temporal domain in visual processing. Critical Flicker-Fusion Frequency (CFF), the frequency at which a flickering light is perceived as continuous, is widely used for evaluating visual temporal processing. However, substantial variability in the psychophysical paradigms, used for measuring CFF, leads to substantial variability in the reported results. Here, we report on a comprehensive comparison of CFF measurements through three different psychophysical paradigms: methods of limits; method of constant stimuli, and staircase method. Our results demonstrate that the CFF can be reliably measured with high repeatability by all three psychophysics methods. However, correlations (r = 0.92, p≪0.001) and agreement (Bland Altman test indicated 95% confidence limit variation of ±3.6 Hz), were highest between the staircase and the constant stimuli methods. The time required to complete the test was significantly longer for the constant stimuli method as compared to other methods (p < 0.001). Our results highlight the suitability of the adaptive paradigm for efficiently measuring temporal resolution in the visual system.