Effects of binocular disparity on binocular luminance combination.

This study aimed to examine the effects of binocular disparity on binocular combination of brightness information coming from luminance increments and decrements. The point of subjective equality was determined by asking the observers to judge which stimulus appeared brighter-a bar stimulus with variable disparity or another stimulus with zero disparity. For the bar stimulus, the interocular luminance ratio was varied to trace an equal brightness curve. Binocular disparity had no effect on luminance increments presented on a gray or black background. In contrast, when luminance decrements were presented on a gray background, non-zero disparities elevated points of subjective equality for stimuli with interocular luminance differences. This means that the binocular brightness combination of the two monocular signals shifted from winner-take-all summation toward linear averaging. It has been argued that this effect may be caused by non-zero binocular disparities attenuating interocular suppression, which is deemed to operate normally with zero disparity.

Changes in Choroidal Thickness and Structure Induced by 1% Atropine Instillation in Children With Hyperopic Anisometropic Amblyopia.

PURPOSE: To investigate the effects of 1% atropine eye drops on the choroidal thickness and structure of amblyopic and fellow eyes in children with hyperopic anisometropic amblyopia. METHODS: This study included 16 children with hypermetropic anisometropic amblyopia. All patients received 1% atropine eye drops in both eyes twice a day for 7 days. In the subfoveal choroidal region, choroidal thickness, total choroidal area, luminal area, and stromal area were measured quantitatively using swept-source optical coherence tomography. The choroidal parameters of the amblyopic and fellow eyes were compared between the baseline and atropine conditions. RESULTS: There were no significant differences in all choroidal parameters of the amblyopic eye between baseline and atropine conditions. However, the subfoveal choroidal thickness in the fellow eye was significantly higher for the atropine condition than the baseline condition. This change was accompanied by a significant increase in both the luminal and stromal areas of the choroid. The median differences of subfoveal choroidal thickness between the conditions were larger for the fellow eye (6.46%) than the amblyopic eye (0.26%). CONCLUSIONS: The choroidal structural change induced by 1% atropine instillation was smaller for the amblyopic eye than the fellow eye in children with hyperopic anisometropic amblyopia. Mechanisms of choroidal thickness changes could be inhibited in amblyopic eyes. [J Pediatr Ophthalmol Strabismus. 2023;60(1):39-45.].

Learning to see after early and extended blindness: A scoping review.

Purpose: If an individual has been blind since birth due to a treatable eye condition, ocular treatment is urgent. Even a brief period of visual deprivation can alter the development of the visual system. The goal of our structured scoping review was to understand how we might better support children with delayed access to ocular treatment for blinding conditions. Method: We searched MEDLINE, Embase and Global Health for peer-reviewed publications that described the impact of early (within the first year) and extended (lasting at least 2 years) bilateral visual deprivation. Results: Of 551 reports independently screened by two authors, 42 studies met our inclusion criteria. Synthesizing extracted data revealed several trends. The data suggests persistent deficits in visual acuity, contrast sensitivity, global motion, and visual-motor integration, and suspected concerns for understanding complex objects and faces. There is evidence for resilience in color perception, understanding of simple shapes, discriminating between a face and non-face, and the perception of biological motion. There is currently insufficient data about specific (re)habilitation strategies to update low vision services, but there are several insights to guide future research in this domain. Conclusion: This summary will help guide the research and services provision to help children learn to see after early and extended blindness.

Choroidal vessel density in unilateral hyperopic amblyopia using en-face optical coherence tomography.

BACKGROUND: Structural changes of the choroid, such as choroidal thickening, have been indicated in amblyopic eyes with hyperopic anisometropia as compared to fellow or healthy eyes. The purpose of the present study was to investigate choroidal vascular density (CVD) in children with unilateral hyperopic amblyopia. METHODS: This study included 88 eyes of 44 patients with unilateral amblyopia due to hyperopic anisometropia with or without strabismus and 29 eyes of 29 age-matched normal controls. The CVD of Haller's layer was quantified from en-face images constructed by 3-dimensional swept-source optical coherence tomography images flattened relative to Bruch's membrane. The analysis area was a 3 × 3-mm square of macula after magnification correction. Relationships between CVD and other parameters [best-corrected visual acuity (BCVA), refractive error and subfoveal choroidal thickness (SFCT)] were investigated, and CVDs were compared between amblyopic, fellow, and normal control eyes. RESULTS: Mean CVD was 59.11 ± 0.66% in amblyopic eyes, 59.23 ± 0.81% in fellow eyes, and 59.29 ± 0.74% in normal control eyes. CVD showed a significant positive relationship with SFCT (p = 0.004), but no relationships with other parameters. No significant differences in CVD were evident among amblyopic, fellow, and normal control eyes after adjusting for SFCT (p = 0.502). CONCLUSIONS: CVD was unrelated to BCVA, and CVD did not differ significantly among amblyopic, fellow and normal control eyes. These results suggest that the local CVD of Haller's layer is unaffected in unilateral hyperopic amblyopic eyes.

Perceptual enhancement of suprathreshold luminance modulation in stereoscopic patterns.

Previous studies have shown that the binocular summation of luminance contrast signals depends on the parameters involved in stereopsis when the luminance contrast is at the detection threshold. However, less attention has been paid to the perception of luminance modulation in stereoscopic patterns at suprathreshold contrast. To address this issue, we determined the contrast of stereoscopic patterns at the perceptual match to a standard contrast as a function of binocular disparity. The matched contrast was close to the standard contrast at 0 degrees disparity, but decreased as disparity deviated from 0 degrees, suggesting that sufficient disparity perceptually enhances luminance contrast. The reduction of matched contrast was more evident for uncrossed disparities than for crossed disparities, which almost disappeared when the contrast was near the threshold and also occurred when vertical disparity was introduced. We argue that the perceptual enhancement of the luminance contrast is due to the weaker interocular suppression for stimuli with large disparities.

Long-Range Interocular Suppression in Adults with Strabismic Amblyopia: A Pilot fMRI Study.

Interocular suppression plays an important role in the visual deficits experienced by individuals with amblyopia. Most neurophysiological and functional MRI studies of suppression in amblyopia have used dichoptic stimuli that overlap within the visual field. However, suppression of the amblyopic eye also occurs when the dichoptic stimuli do not overlap, a phenomenon we refer to as long-range suppression. We used functional MRI to test the hypothesis that long-range suppression reduces neural activity in V1, V2 and V3 in adults with amblyopia, indicative of an early, active inhibition mechanism. Five adults with amblyopia and five controls viewed monocular and dichoptic quadrant stimuli during fMRI. Three of five participants with amblyopia experienced complete perceptual suppression of the quadrants presented to their amblyopic eye under dichoptic viewing. The blood oxygen level dependant (BOLD) responses within retinotopic regions corresponding to amblyopic and fellow eye stimuli were analyzed for response magnitude, time to peak, effective connectivity and stimulus classification. Dichoptic viewing slightly reduced the BOLD response magnitude in amblyopic eye retinotopic regions in V1 and reduced the time to peak response; however, the same effects were also present in the non-dominant eye of controls. Effective connectivity was unaffected by suppression, and the results of a classification analysis did not differ significantly between the control and amblyopia groups. Overall, we did not observe a neural signature of long-range amblyopic eye suppression in V1, V2 or V3 using functional MRI in this initial study. This type of suppression may involve higher level processing areas within the brain.

Foveal avascular zone and macular vessel density after correction for magnification error in unilateral amblyopia using optical coherence tomography angiography.

BACKGROUND: To investigate the area of foveal avascular zone (FAZ) and macular vessel density (VD) after correction for magnification error in unilateral amblyopia using optical coherence tomography angiography (OCTA). METHODS: Participants comprised 15 patients with unilateral amblyopia due to anisometropia with or without strabismus (mean age, 9.8 ± 3.4 years; range, 6-17 years). OCTA images were obtained by using spectral-domain OCT with angiography software. The OCTA scanning protocol used was 3 × 3-mm volume scan centered on the fovea. OCTA images were corrected for magnification errors using individual axial length (AL), and an adjusted 2.3 × 2.3-mm square was derived as a region of interest. The FAZ area and VD in both superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers, foveal minimum thickness (FMT) were assessed using built-in OCTA software and ImageJ software (NIH, Bethesda, MD). RESULTS: LogMAR in the amblyopic eyes was significantly poorer than that of the fellow eye (p < 0.001). AL was significantly shorter in the amblyopic eye than in the fellow eye (p < 0.001). FAZ area of SCP in amblyopic eyes was significantly smaller than that of fellow eyes (p < 0.001). No significant differences were seen in FAZ area of DCP, VD of SCP, VD of DCP, and FMT between amblyopic and fellow eyes (p = 0.07, 0.43, 0.55, and 0.25, respectively). CONCLUSIONS: Our present study after magnification error correction found smaller FAZ area of SCP in the amblyopic eye compared with the fellow eyes, but there was no significant difference in the macular VD between the amblyopic and fellow eyes.

Suprathreshold Motion Perception in Anisometropic Amblyopia: Interocular Speed Matching and the Pulfrich Effect.

SIGNIFICANCE: Our results indicate that the difference in perceived luminance between the amblyopic and fellow eyes that is present under dichoptic viewing conditions does not affect the perceived speed of suprathreshold motion stimuli. This finding provides a new insight into suprathreshold perception in amblyopia. PURPOSE: Interocular matching experiments indicate that dichoptically presented stimuli have a lower perceived luminance in amblyopic eyes relative to fellow eyes. This may be a consequence of interocular suppression. We investigated whether this effect extends to suprathreshold motion perception. METHODS: Participants with amblyopia and control observers matched the perceived speed of dichoptically presented random-dot kinematograms and the perceived luminance of gray patches. Control participants also performed the speed matching task with a neutral density filter over one eye to simulate a perceived luminance reduction. RESULTS: The amblyopia group exhibited lower perceived luminance in the amblyopic than in the fellow eye, as has previously been reported. However, interocular speed matching was veridical. For control observers, perceived speed was reduced in the eye with a neutral density filter relative to the nonfiltered eye. To assess whether the perceived luminance reduction in the amblyopic eye affected binocular function, we also measured the Pulfrich effect in the amblyopia group with equal luminance presented to each eye. No patients reported a spontaneous Pulfrich effect. CONCLUSIONS: The results suggest that suprathreshold speed perception is intact in the amblyopic eye when both eyes are open.

Effect of amblyopia treatment on choroidal thickness in hypermetropic anisometropic amblyopia using swept-source optical coherence tomography.

BACKGROUND: Recent studies using optical coherence tomography (OCT) have indicated that choroidal thickness (CT) in the anisometropic amblyopic eye is thicker than that of the fellow and normal control eyes. However, it has not yet been established as to how amblyopia affects the choroid thickening. The purpose of the present study was to investigate the effect of amblyopia treatment on macular CT in eyes with anisometropic amblyopia using swept-source OCT. METHODS: Thirteen patients (mean age: 6.2 ± 2.4 years) with hypermetropic anisometropic amblyopia were included in this study. Visual acuity (VA), axial length (AL), and CT were measured at the enrollment visit and at the final visit, after at least 6 months of treatment. CT measurements were corrected for magnification error and were automatically analyzed using built-in software and divided into three macular regions (subfoveal choroidal thickness (SFCT), center 1 mm, and center 6 mm). A one-way analysis of covariance using AL as a covariate was performed to determine whether CT in amblyopic eyes changed after amblyopia treatment. RESULTS: The average observation period was 22.2 ± 11.0 months. After treatment, VA (logMAR) improvement in the amblyopic eyes was 0.41 ± 0.19 (p < 0.001). SFCT, center 1 mm CT, and center 6 mm CT were significantly thicker in the amblyopic eyes compared with the fellow eyes both before and after treatment (p < 0.05 for all comparisons). There were no significant changes in SFCT, center 1 mm CT, or center 6 mm CT before and after treatment in the amblyopic (p = 0.25, 0.21, and 0.84, respectively) and fellow (p = 0.75, 0.84, and 0.91, respectively) eyes. The correlation between changes in logMAR versus changes in CT after treatment was not significant. CONCLUSIONS: Although VA in amblyopic eyes was significantly improved after treatment, the choroid thickening of anisometropic amblyopic eyes persisted, and there was no significant change found in the CT after the treatment. Our findings suggest that thickening of the CT in amblyopia is not directly related to visual dysfunction.

Direction discrimination thresholds in binocular, monocular, and dichoptic viewing: Motion opponency and contrast gain control.

We studied the binocular organization of motion opponency and its relationship to contrast gain control. Luminance contrast thresholds for discriminating direction of motion were measured for drifting Gabor patterns (target) presented on counterphase flickering Gabor patterns (pedestal). There were four presentation conditions: binocular, monocular, dichoptic, and half-binocular. For the half-binocular presentation, the target was presented to one eye while pedestals were presented to both eyes. In addition, to test for motion opponency, we studied two increment and decrement conditions, in which the target increased contrast for one direction of movement but decreased it for the opposite moving component of the pedestal. Threshold versus pedestal contrast functions showed a dipper shape, and there was a strong interaction between pedestal contrast and test condition. Binocular thresholds were lower than monocular thresholds but only at low pedestal contrasts. Monocular and half-binocular thresholds were similar at low pedestal contrasts, but half-binocular thresholds became higher and closer to dichoptic thresholds as pedestal contrast increased. Adding the decremental target reduced thresholds by a factor of two or more-a strong sign of opponency-when the decrement was in the same eye as the increment or the opposite eye. We compared several computational models fitted to the data. Converging evidence from the present and previous studies (Gorea, Conway, & Blake, 2001) suggests that motion opponency is most likely to be monocular, occurring before direction-specific binocular summation and before divisive, binocular gain control.

Pattern masking: the importance of remote spatial frequencies and their phase alignment.

To assess the effects of spatial frequency and phase alignment of mask components in pattern masking, target threshold vs. mask contrast (TvC) functions for a sine-wave grating (S) target were measured for five types of mask: a sine-wave grating (S), a square-wave grating (Q), a missing fundamental square-wave grating (M), harmonic complexes consisting of phase-scrambled harmonics of a square wave (Qp), and harmonic complexes consisting of phase-scrambled harmonics of a missing fundamental square wave (Mp). Target and masks had the same fundamental frequency (0.46 cpd) and the target was added in phase with the fundamental frequency component of the mask. Under monocular viewing conditions, the strength of masking depends on phase relationships among mask spatial frequencies far removed from that of the target, at least 3 times the target frequency, only when there are common target and mask spatial frequencies. Under dichoptic viewing conditions, S and Q masks produced similar masking to each other and the phase-scrambled masks (Qp and Mp) produced less masking. The results suggest that pattern masking is spatial frequency broadband in nature and sensitive to the phase alignments of spatial components.

The perceptual consequences of interocular suppression in amblyopia.

PURPOSE: It is known that information from an amblyopic eye can be strongly suppressed when both eyes are open. The authors investigated the way in which suppression influences the relative perception of suprathreshold contrast and luminance between a person's eyes under dichoptic viewing conditions. METHODS: Stimuli consisted of four patches of luminance or four patches containing gratings. Two patches were presented to each eye. Ten amblyopes with mild suppression (six strabismic, three anisometropic and strabismic, and one deprivation; mean age, 34.5 years) and three control observers with normal vision (mean age, 33.0 years) matched the appearance of the stimuli presented to each eye. The match involved manipulation of either luminance or contrast. RESULTS: Amblyopes with mild suppression decreased stimulus luminance in the fellow fixing eye or increased luminance in the amblyopic eye to achieve a match (mean matching luminance, 21.1 and 39.6 cd/m(2) for the fellow fixing eye and the amblyopic eye, respectively; standard luminance, 30 cd/m(2)). This interocular mismatch was also observed when luminance was variable and contrast was kept constant (mean matching luminance, 22.8 cd/m(2) for the fellow fixing eye). On the other hand, the amblyopic eye showed no loss of perceived contrast. There was little or no mismatch between the two eyes of control participants with normal binocular vision. CONCLUSIONS: Amblyopes have monocular deficits in contrast perception but dichoptic deficits in luminance perception, suggesting that suppression in its mild form involves luminance processing.

The role of suppression in amblyopia.

PURPOSE: This study had three main goals: to assess the degree of suppression in patients with strabismic, anisometropic, and mixed amblyopia; to establish the relationship between suppression and the degree of amblyopia; and to compare the degree of suppression across the clinical subgroups within the sample. METHODS: Using both standard measures of suppression (Bagolini lenses and neutral density [ND] filters, Worth 4-Dot test) and a new approach involving the measurement of dichoptic motion thresholds under conditions of variable interocular contrast, the degree of suppression in 43 amblyopic patients with strabismus, anisometropia, or a combination of both was quantified. RESULTS: There was good agreement between the quantitative measures of suppression made with the new dichoptic motion threshold technique and measurements made with standard clinical techniques (Bagolini lenses and ND filters, Worth 4-Dot test). The degree of suppression was found to correlate directly with the degree of amblyopia within our clinical sample, whereby stronger suppression was associated with a greater difference in interocular acuity and poorer stereoacuity. Suppression was not related to the type or angle of strabismus when this was present or the previous treatment history. CONCLUSIONS: These results suggest that suppression may have a primary role in the amblyopia syndrome and therefore have implications for the treatment of amblyopia.

A game platform for treatment of amblyopia.

We have developed a prototype device for take-home use that can be used in the treatment of amblyopia. The therapeutic scenario we envision involves patients first visiting a clinic, where their vision parameters are assessed and suitable parameters are determined for therapy. Patients then proceed with the actual therapeutic treatment on their own, using our device, which consists of an Apple iPod Touch running a specially modified game application. Our rationale for choosing to develop the prototype around a game stems from multiple requirements that such an application satisfies. First, system operation must be sufficiently straightforward that ease-of-use is not an obstacle. Second, the application itself should be compelling and motivate use more so than a traditional therapeutic task if it is to be used regularly outside of the clinic. This is particularly relevant for children, as compliance is a major issue for current treatments of childhood amblyopia. However, despite the traditional opinion that treatment of amblyopia is only effective in children, our initial results add to the growing body of evidence that improvements in visual function can be achieved in adults with amblyopia.

Does cognitive perception have access to brief temporal events?

To determine whether conscious perception has access to brief temporal event, we asked subjects in an odd-man out paradigm to determine which of the four Gaussian blobs was flickering asynchronously in time. We measure synchrony thresholds as a function of the base temporal frequency for spatially scaled stimuli in foveal and peripheral vision. The results are consistent with a time delay of around 67 milliseconds (ms) for foveal vision and 91 ms for peripheral vision. We conclude that conscious perception has access to only relatively long (∼67 ms) time events.

A compact clinical instrument for quantifying suppression.

PURPOSE: We describe a compact and convenient clinical apparatus for the measurement of suppression based on a previously reported laboratory-based approach. In addition, we report and validate a novel, rapid psychophysical method for measuring suppression using this apparatus, which makes the technique more applicable to clinical practice. METHODS: By using a Z800 dual pro head-mounted display driven by a MAC laptop, we provide dichoptic stimulation. Global motion stimuli composed of arrays of moving dots are presented to each eye. One set of dots move in a coherent direction (termed signal) whereas another set of dots move in a random direction (termed noise). To quantify performance, we measure the signal/noise ratio corresponding to a direction-discrimination threshold. Suppression is quantified by assessing the extent to which it matters which eye sees the signal and which eye sees the noise. RESULTS: A space-saving, head-mounted display using current video technology offers an ideal solution for clinical practice. In addition, our optimized psychophysical method provided results that were in agreement with those produced using the original technique. We made measures of suppression on a group of nine adult amblyopic participants using this apparatus with both the original and new psychophysical paradigms. All participants had measurable suppression ranging from mild to severe. The two different psychophysical methods gave a strong correlation for the strength of suppression (rho = -0.83, p = 0.006). CONCLUSION: Combining the new apparatus and new psychophysical method creates a convenient and rapid technique for parametric measurement of interocular suppression. In addition, this apparatus constitutes the ideal platform for suppressors to combine information between their eyes in a similar way to binocularly normal people. This provides a convenient way for clinicians to implement the newly proposed binocular treatment of amblyopia that is based on antisuppression training.

Quantifying sensory eye dominance in the normal visual system: a new technique and insights into variation across traditional tests.

PURPOSE: Although eye dominance assessment is used to assist clinical decision-making, current understanding is limited by inconsistencies across the range of available tests. A new psychophysical test of sensory eye dominance has been developed that objectively measures the relative contribution of each eye to a fused suprathreshold binocular percept. METHODS: Six standard tests and the newly developed test were used to measure motor and sensory dominance in a group of 44 binocularly normal individuals (mean age, 29.5 ± 9.10 years). The new test required observers to perform a motion coherence task under dichoptic viewing conditions, wherein a population of moving, luminance-defined signal (coherently moving) and noise (randomly moving) dots were presented separately to each eye. The observers judged the motion direction of the signal dots. Motion coherence thresholds were measured by varying the ratio of signal-to-noise dots, in a staircase procedure. RESULTS: The new dichoptic motion coherence threshold test revealed a clear bimodal distribution of sensory eye dominance strength, wherein the majority of the participants (61%) showed weak dominance, but a significant minority (39%) showed strong dominance. Subsequent analysis revealed that the strong-dominance group showed greater consistency across the range of traditional eye dominance tests used. CONCLUSIONS: This new quantitative dichoptic motion coherence threshold technique suggests that there are two separate sensory eye dominance strength distributions among observers with normal binocular vision: weak and strong eye dominance. This finding may provide a basis for clinical decision-making by indicating whether eye dominance is likely to be an important consideration in a particular patient.

The effects of flankers on contrast detection and discrimination in binocular, monocular, and dichoptic presentations.

We investigated how two co-aligned adjacent stimuli (flankers) influence threshold versus pedestal contrast (TvC) functions in binocular, monocular, and dichoptic presentations. Targets were presented to the two eyes or to only one eye. Pedestals and flankers were presented to the same eye to which the target was presented (binocular or monocular presentations) or to the other eye (dichoptic presentation). In the binocular presentation of targets and pedestals, the binocular flankers lowered thresholds at low pedestal contrasts. The monocular flankers had a similar effect to the binocular flanker, although the threshold reduction was smaller. In the dichoptic presentation of a target and a pedestal, flankers lowered thresholds when flankers were presented to the eye where targets were presented. In contrast, dichoptic flankers elevated thresholds at intermediate pedestal contrasts when a pedestal was also dichoptically presented. We fitted binocular contrast gain control models to the data. It follows from the fitting results that flankers modulate outputs from spatial filters in the monocular processing stage of contrast gain control.

Spatial distortions produced by purely dichoptic-based visual motion.

It is known that local, monocular motion (short-range motion) can produce local distortions of visual space. We wanted to know if local monocular motion was both sufficient and necessary for producing motion-based spatial distortions. We used a previously reported dichoptic motion stimulus in which the directional motion signal is not present in either eye's input but is only present after binocular combination. We show that such a stimulus can also induce perceived changes in spatial position. This suggests that local, monocular motion while being sufficient is not necessary for the production of motion-based illusions. It suggests that one source of motion signals responsible for this illusion is from binocular motion mechanisms.

Importance of phase alignment for interocular suppression.

We measured contrast thresholds for Gabor targets in the presence of maskers which had higher or lower spatial frequencies than the targets. A high-pass fractal masker elevated target contrast thresholds at low and intermediate pedestal contrasts in both monocular and dichoptic modes of presentation, suggesting that the masking occurs after a monocular processing stage. Moreover we found that a high-pass checkerboard masker elevated thresholds at the low and intermediate pedestal contrasts and that most of this threshold elevation disappeared when the phase of the masker's spatial components were scrambled. This masking was effective only in the dichoptic presentation, not in the monocular presentation. These results indicate that phase alignment of the high spatial frequency components plays a crucial role for interocular suppression. We speculate that phase alignments signal the existence of a luminance contour in the monocular image and that this signal suppresses processing of information in the other eye when there is no corresponding signal in that eye.