The Effect of Gaze Angle on Visual Acuity in Infantile Nystagmus.

Purpose: Most individuals with infantile nystagmus (IN) have an idiosyncratic gaze angle at which their nystagmus intensity is minimized. Some adopt an abnormal head posture to use this "null zone," and it has therefore long been assumed that this provides people with nystagmus with improved visual acuity (VA). However, recent studies suggest that improving the nystagmus waveform could have little, if any, influence on VA; that is, VA is fundamentally limited in IN. Here, we examined the impact of the null zone on VA. Methods: Visual acuity was measured in eight adults with IN using a psychophysical staircase procedure with reversals at three horizontal gaze angles, including the null zone. Results: As expected, changes in gaze angle affected nystagmus amplitude, frequency, foveation duration, and variability of intercycle foveation position. Across participants, each parameter (except frequency) was significantly correlated with VA. Within any given individual, there was a small but significant improvement in VA (0.08 logMAR) at the null zone as compared with the other gaze angles tested. Despite this, no change in any of the nystagmus waveform parameters was significantly associated with changes in VA within individuals. Conclusions: A strong relationship between VA and nystagmus characteristics exists between individuals with IN. Although significant, the improvement in VA observed within individuals at the null zone is much smaller than might be expected from the occasionally large variations in intensity and foveation dynamics (and anecdotal patient reports of improved vision), suggesting that improvement of other aspects of visual performance may also encourage use of the null zone.

Infantile nystagmus adapts to visual demand.

PURPOSE: To determine the effect of visual demand on the nystagmus waveform. Individuals with infantile nystagmus syndrome (INS) commonly report that making an effort to see can intensify their nystagmus and adversely affect vision. However, such an effect has never been confirmed experimentally. METHODS: The eye movement behavior of 11 subjects with INS were recorded at different gaze angles while the subjects viewed visual targets under two conditions: above and then at resolution threshold. Eye movements were recorded by infrared oculography and visual acuity (VA) was measured using Landolt C targets and a two-alternative, forced-choice (2AFC) staircase procedure. Eye movement data were analyzed at the null zone for changes in amplitude, frequency, intensity, and foveation characteristics. Waveform type was also noted under the two conditions. RESULTS: Data from 11 subjects revealed a significant reduction in nystagmus amplitude (P < 0.05), frequency (P < 0.05), and intensity (P < 0.01) when target size was at visual threshold. The percentage of time the eye spent within the low-velocity window (i.e., foveation) significantly increased when target size was at visual threshold (P < 0.05). Furthermore, a change in waveform type with increased visual demand was exhibited by two subjects. CONCLUSIONS: The results indicate that increased visual demand modifies the nystagmus waveform favorably (and possibly adaptively), producing a significant reduction in nystagmus intensity and prolonged foveation. These findings contradict previous anecdotal reports that visual effort intensifies the nystagmus eye movement at the cost of visual performance. This discrepancy may be attributable to the lack of psychological stress involved in the visual task reported here. This is consistent with the suggestion that it is the visual importance of the task to the individual rather than visual demand per se which exacerbates INS. Further studies are needed to investigate quantitatively the effects of stress and psychological factors on INS waveforms.