Absolute and relative disparity mechanisms revealed by an equivalent noise analysis.

The precision of stereopsis and vergence are ultimately limited by internal binocular disparity noise. Here we propose an equivalent noise model with both global and local internal disparity noises to provide a unified explanation of both absolute and relative disparity thresholds. To test this model, we developed a psychophysical procedure to measure the equivalent internal disparity noise by adding external disparity noise to random-Gabor-patch stereograms. We used the method of constant stimuli to measure the minimum and maximum disparity thresholds (Dmin and Dmax) for both absolute and relative disparity. Consistent with previous studies, we found that Dmin thresholds are substantially worse for absolute disparity than for relative disparity. We tested three relative disparity mechanisms: (1) the difference between the monocular separations of targets projecting to the two eyes; (2) the direct measurement of relative disparity; and (3) the difference of absolute disparities of targets. Computing the difference of absolute disparities when detecting relative disparity, Mechanism 3 cancels global noise, resulting in a much lower relative Dmin threshold, and provides a reasonable fit to the experimental data. We also found that the presence of as much as 2400 arcsec of external disparity noise does not appear to affect the Dmax threshold. This observation suggests that Dmax is implicated in a mechanism that disregards the disparity variance of individual items, relying instead on the average disparity across all items, supporting the depth model proposed in our previous study (Ding & Levi, 2021), which posits distinct mechanisms governing Dmin and Dmax thresholds.

Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency.

PURPOSE: To compare the effectiveness and efficiency of supervised dichoptic action-videogame play to occlusion therapy in children with amblyopia. METHODS: Newly diagnosed children with amblyopia aged 4-12 years were recruited, excluding strabismus >30PD. After 16 weeks of refractive adaptation children were randomized to gaming 1 h/week supervised by the researcher, or electronically monitored occlusion 2 h/day. The gaming group played a dichoptic action-videogame using virtual reality goggles, which included the task of catching a snowflake presented intermittently to the amblyopic eye. Contrast for the fellow eye was self-adjusted until 2 identical images were perceived. The primary outcome was visual acuity (VA) change from baseline to 24 weeks. RESULTS: We recruited 96 children, 29 declined and 2 were excluded for language or legal issues. After refractive adaptation, 24 of the remaining 65 no longer met the inclusion criteria for amblyopia, and 8 dropped out. Of 16 children treated with gaming, 7 (6.7 years) completed treatment, whereas 9 younger children (5.3 years) did not. Of 17 treated with occlusion, 14 (5.1 years) completed treatment and 3 (4.5 years) did not. Of 5 children with small-angle strabismus, 3 treated with occlusion completed treatment and 2 treated with gaming did not. Median VA improved by 0.30 logMAR (IQR 0.20-0.40) after gaming, 0.20 logMAR (0.00-0.30) after occlusion (p = 0.823). Treatment efficiency was 1.25 logMAR/100 h (range 0.42-2.08) with gaming, 0.08 (-0.19-0.68) with occlusion (p < 0.001). CONCLUSION: Dichoptic gaming seems a viable alternative for older children with refractive amblyopia after glasses adaptation. Treatment efficiency with gaming under continuous supervision was 15 times higher than with occlusion at home.

Isolating objective and subjective filling-in using the drift diffusion model.

Spatial context is known to influence the behavioral sensitivity (d') and the decision criterion (c) when detecting low-contrast targets. Of interest here is the effect on the decision criterion. Polat and Sagi (2007) demonstrated that, for a Gabor target positioned between two similar co-aligned high-contrast flankers, the observers' reports of seeing the target (Hit and False Alarm) decreased with increasing target-flanker distance. This effect was more pronounced when the distance was randomized within testing blocks compared to when it was fixed. According to signal detection theory (SDT), the latter result suggests that the decision criterion is adjusted to a specific distance-dependent combination of signal (S) and noise (N) when the S and N statistics are fixed, but not when they vary across trials. However, SDT cannot differentiate between changes in the decision bias (the criterion shift) and changes introduced by variations in S and N (the signal and noise shift). To circumvent this limitation of SDT, we analyzed the reaction time (RT) data within the framework of the drift diffusion model (DDM). We performed an RT analysis of the target-flanker interactions using data from Polat and Sagi (2007) and Zomet et al. (2008; 2016). The analysis revealed a stronger dependence on flankers for faster RTs and a weaker dependence for slower RTs. The results can be explained by DDM, where an evidence accumulation process depends on the flankers via a change in the rate of the evidence (signal and noise shift) and on observers' prior knowledge via a change in the starting point (criterion shift), leading to RT-independent and RT-dependent effects, respectively. The RT-independent distance-dependent response bias is attributed to the observers' inability to learn multiple internal distributions required to accommodate the distance-dependent effects of the flankers on both the signal and noise.

The Statistics of Eye Movements and Binocular Disparities during VR Gaming: Implications for Headset Design.

The human visual system evolved in environments with statistical regularities. Binocular vision is adapted to these such that depth perception and eye movements are more precise, faster, and performed comfortably in environments consistent with the regularities. We measured the statistics of eye movements and binocular disparities in virtual-reality (VR) - gaming environments and found that they are quite different from those in the natural environment. Fixation distance and direction are more restricted in VR, and fixation distance is farther. The pattern of disparity across the visual field is less regular in VR and does not conform to a prominent property of naturally occurring disparities. From this we predict that double vision is more likely in VR than in the natural environment. We also determined the optimal screen distance to minimize discomfort due to the vergence-accommodation conflict, and the optimal nasal-temporal positioning of head-mounted display (HMD) screens to maximize binocular field of view. Finally, in a user study we investigated how VR content affects comfort and performance. Content that is more consistent with the statistics of the natural world yields less discomfort than content that is not. Furthermore, consistent content yields slightly better performance than inconsistent content.

The eRDS v6 Stereotest and the Vivid Vision Stereo Test: Two New Tests of Stereoscopic Vision.

Purpose: To describe two new stereoacuity tests: the eRDS v6 stereotest, a global dynamic random dot stereogram (dRDS) test, and the Vivid Vision Stereo Test version 2 (VV), a local or "contour" stereotest for virtual reality (VR) headsets; and to evaluate the tests' reliability, validity compared to a dRDS standard, and learning effects. Methods: Sixty-four subjects passed a battery of stereotests, including perceiving depth from RDS. Validity was evaluated relative to a tablet-based dRDS reference test, ASTEROID. Reliability and learning effects were assessed over six sessions. Results: eRDS v6 was effective at measuring small thresholds (<10 arcsec) and had a moderate correlation (0.48) with ASTEROID. Across the six sessions, test-retest reliability was good, varying from 0.84 to 0.91, but learning occurred across the first three sessions. VV did not measure stereoacuities below 15 arcsec. It had a weak correlation with ASTEROID (0.27), and test-retest reliability was poor to moderate, varying from 0.35 to 0.74; however, no learning occurred between sessions. Conclusions: eRDS v6 is precise and reliable but shows learning effects. If repeated three times at baseline, this test is well suited as an outcome measure for testing interventions. VV is less precise, but it is easy and rapid and shows no learning. It may be useful for testing interventions in patients who have no global stereopsis. Translational Relevance: eRDS v6 is well suited as an outcome measure to evaluate treatments that improve adult stereodepth perception. VV can be considered for screening patient with compromised stereovision.

Applications and implications for extended reality to improve binocular vision and stereopsis.

Extended reality (XR) devices, including virtual reality (VR), augmented reality (AR), and mixed reality (MR) devices, are immersive technologies that can swap or merge the natural environment with virtual content (e.g., videogames, movies, or other content). Although these devices are widely used for playing videogames and other applications, they have one distinct feature that makes them potentially very useful for the measurement and treatment of binocular vision anomalies-they can deliver different content to the two eyes simultaneously. Indeed, horizontally shifting the images in the two eyes (thereby creating binocular disparity) can provide the user with a compelling percept of depth through stereopsis. Because these devices are stereoscopic, they can also be used as high-tech synoptophores, in which the images to the two eyes differ in contrast, luminance, size, position, and content for measuring and treating binocular anomalies. The inclusion of eye tracking in VR adds an additional dimension to its utility in measuring and treating binocular vision anomalies, as well as other conditions. This paper describes the essential requirements for testing and treating binocular anomalies and reviews current studies in which XR devices have been used to measure and treat binocular vision anomalies.

The effect of spatial structure on binocular contrast perception.

To obtain a single percept of the world, the visual system must combine inputs from the two eyes. Understanding the principles that govern this binocular combination process has important real-world clinical and technological applications. However, most research examining binocular combination has relied on relatively simple visual stimuli and it is unclear how well the findings apply to real-world scenarios. For example, it is well-known that, when the two eyes view sine wave gratings with differing contrast (dichoptic stimuli), the binocular percept often matches the higher contrast grating. Does this winner-take-all property of binocular contrast combination apply to more naturalistic imagery, which include broadband structure and spatially varying contrast? To better understand binocular combination during naturalistic viewing, we conducted psychophysical experiments characterizing binocular contrast perception for a range of visual stimuli. In two experiments, we measured the binocular contrast perception of dichoptic sine wave gratings and naturalistic stimuli, and asked how the contrast of the surrounding context affected percepts. Binocular contrast percepts were close to winner-take-all across many of the stimuli when the surrounding context was the average contrast of the two eyes. However, we found that changing the surrounding context modulated the binocular percept of some patterns and not others. We show evidence that this contextual effect may be due to the spatial orientation structure of the stimuli. These findings provide a step toward understanding binocular combination in the natural world and highlight the importance of considering the effect of the spatial interactions in complex stimuli.

Visual cortical γ-aminobutyric acid and perceptual suppression in amblyopia.

In amblyopia, abnormal visual experience during development leads to an enduring loss of visual acuity in adulthood. Physiological studies in animal models suggest that intracortical GABAergic inhibition may mediate visual deficits in amblyopia. To better understand the relationship between visual cortical γ-aminobutyric acid (GABA) and perceptual suppression in persons with amblyopia (PWA), we employed magnetic resonance spectroscopy (MRS) to quantify GABA levels in both PWA and normally-sighted persons (NSP). In the same individuals, we obtained psychophysical measures of perceptual suppression for a variety of ocular configurations. In PWA, we found a robust negative correlation between the depth of amblyopia (the difference in visual acuity between the amblyopic and non-amblyopic eyes) and GABA concentration that was specific to visual cortex and was not observed in a sensorimotor cortical control region. Moreover, lower levels of visual cortical GABA were associated with weaker perceptual suppression of the fellow eye by the amblyopic eye and stronger suppression of the amblyopic eye by the fellow eye. Taken together, our findings provide evidence that intracortical GABAergic inhibition is an important component of the pathology of human amblyopia and suggest possible therapeutic interventions to restore vision in the amblyopic eye through enhancement of visual cortical GABAergic signaling in PWA.

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.

Learning to see in depth.

Stereopsis provides us with a vivid impression of the depth and distance of objects in our 3- dimensional world. Stereopsis is important for a number of everyday visual tasks, including (but not limited to) reaching and grasping, fine visuo-motor control, and navigating in our world. This review briefly discusses the neural substrate for normal binocular vision and stereopsis and its development in primates; outlines some of the issues and limitations of stereopsis tests and examines some of the factors that limit the typical development of stereopsis and the causes and consequences of stereo-deficiency and stereo-blindness. Finally, we review several approaches to improving or recovering stereopsis in both neurotypical individuals and those with stereo-deficiency and stereo-blindness and outline some emerging strategies for improving stereopsis.

Cortical distance unifies the extent of parafoveal contour interactions.

It is well known that crowding, the disruptive influence of flanking items on identification of targets, is the primary limiting factor to object identification in the periphery, while limits in the fovea are more determined by the ability to resolve individual items. Whether this is a dichotomous or merely a quantitative difference, and the transition between these two regimes, has remained unexplained. Here, using an adaptive optics system for optimal control of optical and stimulus factors, we measured threshold acuity for identification of Tumbling Es flanked by bars at a variety of flanker spacings and eight eccentricities in the parafovea. Thresholds at each eccentricity were influenced by resolution, contour interaction, and a saturating pedestal effect. When target-flanker spacing was plotted in terms of cortical distance, a single canonical clipped-line fit unified the resultant curves. The critical spacing for letters flanked by bars was found to be 1.3 to 1.5 cortical millimeters, corresponding to approximately 0.1*E outside the fovea.

Binocular vision and the control of foot placement during walking in natural terrain.

Coordination between visual and motor processes is critical for the selection of stable footholds when walking in uneven terrains. While recent work (Matthis et al. in Curr Biol 8(28):1224-1233, 2018) demonstrates a tight link between gaze (visual) and gait (motor), it remains unclear which aspects of visual information play a role in this visuomotor control loop, and how the loss of this information affects that relationship. Here we examine the role of binocular information in the visuomotor control of walking over complex terrain. We recorded eye and body movements while normally-sighted participants walked over terrains of varying difficulty, with intact vision or with vision in one eye blurred to disrupt binocular vision. Gaze strategy was highly sensitive to the complexity of the terrain, with more fixations dedicated to foothold selection as the terrain became more difficult. The primary effect of increased sensory uncertainty due to disrupted binocular vision was a small bias in gaze towards closer footholds, indicating greater pressure on the visuomotor control process. Participants with binocular vision losses due to developmental disorders (i.e., amblyopia, strabismus), who have had the opportunity to develop alternative strategies, also biased their gaze towards closer footholds. Across all participants, we observed a relationship between an individual's typical level of binocular visual function and the degree to which gaze is shifted toward the body. Thus the gaze-gait relationship is sensitive to the level of sensory uncertainty, and deficits in binocular visual function (whether transient or long-standing) have systematic effects on gaze strategy in complex terrains. We conclude that binocular vision provides useful information for locating footholds during locomotion. Furthermore, we have demonstrated that combined eye/body tracking in natural environments can be used to provide a more detailed understanding of the impact of a type of vision loss on the visuomotor control process of walking, a vital everyday task.

Nearby contours abolish the binocular advantage.

That binocular viewing confers an advantage over monocular viewing for detecting isolated low luminance or low contrast objects, has been known for well over a century; however, the processes involved in combining the images from the two eyes are still not fully understood. Importantly, in natural vision, objects are rarely isolated but appear in context. It is well known that nearby contours can either facilitate or suppress detection, depending on their distance from the target and the global configuration. Here we report that at close distances collinear (but not orthogonal) flanking contours suppress detection more under binocular compared to monocular viewing, thus completely abolishing the binocular advantage, both at threshold and suprathreshold levels. In contrast, more distant flankers facilitate both monocular and binocular detection, preserving a binocular advantage up to about four times the detection threshold. Our results for monocular and binocular viewing, for threshold contrast discrimination without nearby flankers, can be explained by a gain control model with uncertainty and internal multiplicative noise adding additional constraints on detection. However, in context with nearby flankers, both contrast detection threshold and suprathreshold contrast appearance matching require the addition of both target-to-target and flank-to-target interactions occurring before the site of binocular combination. To test an alternative model, in which the interactions occur after the site of binocular combination, we performed a dichoptic contrast matching experiment, with the target presented to one eye, and the flanks to the other eye. The two models make very different predictions for abutting flanks under dichoptic conditions. Interactions after the combination site predict that the perceived contrast of the flanked target will be strongly suppressed, while interactions before the site predict the perceived contrast will be more or less veridical. The data are consistent with the latter model, strongly suggesting that the interactions take place before the site of binocular combination.

Barriers to successful dichoptic treatment for amblyopia in young children.

PURPOSE: In an ongoing randomised clinical trial comparing dichoptic VR video games with patching for amblyopia, we evaluated any potential barriers to successful use of this novel amblyopia treatment method. METHODS: From December 2017, all newly diagnosed amblyopic children were recruited. Excluded were children under age 4 and patients with strabismus exceeding 30PD. The video game was played for 1 h per week at the outpatient clinic under direct supervision. Records were kept of difficulties encountered during treatment and categorised into domains. Factors influencing the successful completion of this treatment were identified and related to patient characteristics. RESULTS: Ninety-one children were recruited for the trial, 20 parents refused participation before randomisation, because of the logistical challenges the outpatient dichoptic treatment would cause them. Of the 17 children who commenced dichoptic treatment (median age 6.2 years; IQR 4.9-8.4 years), 10 did not complete treatment. Children under age 5.5 years were unable to comprehend the game settings or the game itself. Older children (N = 7; 41%) were less willing to comply with the video game. Loss of interest in the game (N = 8; 47%) was found to be a limiting factor at all ages. CONCLUSION: Half of the children failed to complete VR dichoptic treatment, mainly due to young age. In countries with nationwide screening where amblyopia is detected before age 6, the applicability of such dichoptic treatment is limited.

Scaffolding depth cues and perceptual learning in VR to train stereovision: a proof of concept pilot study.

Stereopsis is a valuable feature of human visual perception, which may be impaired or absent in amblyopia and/or strabismus but can be improved through perceptual learning (PL) and videogames. The development of consumer virtual reality (VR) may provide a useful tool for improving stereovision. We report a proof of concept study, especially useful for strabismic patients and/or those with reduced or null stereoacuity. Our novel VR PL strategy is based on a principled approach which included aligning and balancing the perceptual input to the two eyes, dichoptic tasks, exposure to large disparities, scaffolding depth cues and perception for action. We recruited ten adults with normal vision and ten with binocular impairments. Participants played two novel PL games (DartBoard and Halloween) using a VR-HMD. Each game consisted of three depth cue scaffolding conditions, starting with non-binocular and binocular cues to depth and ending with only binocular disparity. All stereo-anomalous participants improved in the game and most (9/10) showed transfer to clinical and psychophysical stereoacuity tests (mean stereoacuity changed from 569 to 296 arc seconds, P < 0.0001). Stereo-normal participants also showed in-game improvement, which transferred to psychophysical tests (mean stereoacuity changed from 23 to a ceiling value of 20 arc seconds, P = 0.001). We conclude that a VR PL approach based on depth cue scaffolding may provide a useful method for improving stereoacuity, and the in-game performance metrics may provide useful insights into principles for effective treatment of stereo anomalies.This study was registered as a clinical trial on 04/05/2010 with the identifier NCT01115283 at ClinicalTrials.gov.

Amblyopia.

Amblyopia is a neurodevelopmental abnormality that results in physiological alterations in the visual pathways and impaired vision in one eye, less commonly in both. It reflects a broad range of neural, perceptual, oculomotor, and clinical abnormalities that can occur when normal visual development is disrupted early in life. Aside from refractive error, amblyopia is the most common cause of vision loss in infants and young children. It causes a constellation of perceptual deficits in the vision of the amblyopic eye, including a loss of visual acuity, position acuity, and contrast sensitivity, particularly at high spatial frequencies, as well as increased internal noise and prolonged manual and saccadic reaction times. There are also perceptual deficits in the strong eye, such as certain types of motion perception, reflecting altered neural responses and functional connectivity in visual cortex (Ho et al., 2005). Treatment in young children consists of correction of any refractive error and patching of the strong eye. Compliance with patching is challenging and a substantial proportion of amblyopic children fail to achieve normal acuity or stereopsis even after extended periods of treatment. There are a number of promising experimental treatments that may improve compliance and outcomes, such as the playing of action video games with the strong eye patched. Although there may be a sensitive period for optimal effects of treatment, there is evidence that amblyopic adults may still show some benefit of treatment. However, there is as yet no consensus on the treatment of adults with amblyopia.

Fixational stability as a measure for the recovery of visual function in amblyopia.

People with amblyopia have been shown to have decreased fixational stability, particularly those with strabismic amblyopia. Fixational stability and visual acuity have been shown to be tightly correlated across multiple studies, suggesting a relationship between acuity and oculomotor stability. Reduced visual acuity is the sine qua non of amblyopia, and recovery is measured by the improvement in visual acuity. Here we ask whether fixational stability can be used as an objective marker for the recovery of visual function in amblyopia. We tracked children's fixational stability during patching treatment over time and found fixational stability changes alongside improvements in visual acuity. This suggests fixational stability can be used as an objective measure for monitoring treatment in amblyopia and other disorders.

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.

A unified model for binocular fusion and depth perception.

We describe a new unified model to explain both binocular fusion and depth perception, over a broad range of depths. At each location, the model consists of an array of paired spatial frequency filters, with different relative horizontal shifts (position disparity) and interocular phase disparities of 0, 90, ±180, or -90°. The paired filters with different spatial profiles (non-zero phase disparity) compute interocular misalignment and provide phase-disparity energy (binocular fusion energy) to drive selection of the appropriate filters along the position disparity space until the misalignment is eliminated and sensory fusion is achieved locally. The paired filters with identical spatial profiles (0 phase disparity) compute the position-disparity energy. After sensory fusion, the combination of position and possible residual phase disparity energies is calculated for binocular depth perception. Binocular fusion occurs at multiple scales following a coarse-to-fine process. At a given location, the apparent depth is the weighted sum of fusion shifts combined with residual phase disparity in all spatial-frequency channels, and the weights depend on stimulus spatial frequency and stimulus contrast. To test the theory, we measured disparity minimum and maximum thresholds (Dmin and Dmax) at three spatial frequencies and with different intraocular contrast levels. The stimuli were Random-Gabor-Patch (RGP) stereograms consisting of Gabor patches with random positions and phases, but with a fixed spatial frequency. The two eyes viewed identical arrays of patches except that one eye's array could be shifted horizontally and could differ in contrast. Our experiments and modeling reveal two contrast normalization mechanisms: (1) Energy Normalization (EN): Binocular energy is normalized with monocular energy after the site of binocular combination. This predicts constant Dmin thresholds when varying stimulus contrast in the two eyes; (2) DSKL model Interocular interactions: Monocular contrasts are normalized before the binocular combination site through interocular contrast gain-control and gain-enhancement mechanisms. This predicts contrast dependent Dmax thresholds. We tested a range of models and found that a model consisting of a second-order pathway with DSKL interocular interactions and a first-order pathway with EN at each spatial-frequency band can account for both the Dmin and Dmax data very well. Simulations show that the model makes reasonable predictions of suprathreshold depth perception.