Daily dose-response from short-term monocular deprivation in adult humans.

Short-term monocular deprivation (MD) shifts sensory eye balance in favour of the previously deprived eye. The effect of MD on eye balance is significant but brief in adult humans. Recently, researchers and clinicians have attempted to implement MD in clinical settings for adults with impaired binocular vision. Although the effect of MD has been studied in detail in single-session protocols, what is not known is whether the effect of MD on eye balance deteriorates after repeated periods of MD (termed 'perceptual deterioration'). An answer to this question is relevant for two reasons. Firstly, the effect of MD (i.e., dose-response) should not decrease with repeated use if MD is to be used therapeutically (e.g., daily for weeks). Second, it bears upon the question of whether the neural basis of the effects of MD and contrast adaptation, a closely related phenomenon, is the same. The sensory change from contrast adaptation depends on recent experience. If the observer has recently experienced the same adaptation multiple times for consecutive days, then the adaptation effect will be smaller because contrast adaptation exhibits perceptual deterioration, so it is of interest to know if the effects of MD follow suit. This study measured the effect of 2-h MD for seven consecutive days on binocular balance of 15 normally sighted adults. We found that the shift in eye balance from MD stayed consistent, showing no signs of deterioration after subjects experienced multiple periods of MD. This finding shows no loss of effectiveness of repeated daily doses of MD if used therapeutically to rebalance binocular vision in otherwise normal individuals. Furthermore, ocular dominance plasticity, which is the basis of the effects of short-term MD, does not seem to share the property of 'perceptual deterioration' with contrast adaptation, suggesting different neural bases for these two related phenomena.

The dichoptic contrast ordering test: A method for measuring the depth of binocular imbalance.

In binocular vision, the relative strength of the input from the two eyes can have significant functional impact. These inputs are typically balanced; however, in some conditions (e.g., amblyopia), one eye will dominate over the other. To quantify imbalances in binocular vision, we have developed the Dichoptic Contrast Ordering Test (DiCOT). Implemented on a tablet device, the program uses rankings of perceived contrast (of dichoptically presented stimuli) to find a scaling factor that balances the two eyes. We measured how physical interventions (applied to one eye) affect the DiCOT measurements, including neutral density (ND) filters, Bangerter filters, and optical blur introduced by a +3-diopter (D) lens. The DiCOT results were compared to those from the Dichoptic Letter Test (DLT). Both the DiCOT and the DLT showed excellent test-retest reliability; however, the magnitude of the imbalances introduced by the interventions was greater in the DLT. To find consistency between the methods, rescaling the DiCOT results from individual conditions gave good results. However, the adjustments required for the +3-D lens condition were quite different from those for the ND and Bangerter filters. Our results indicate that the DiCOT and DLT measures partially separate aspects of binocular imbalance. This supports the simultaneous use of both measures in future studies.

Metaplasticity: Dark exposure boosts local excitability and visual plasticity in adult human cortex.

An interlude of dark exposure for about 1 week is known to shift excitatory/inhibitory (E/I) balance of the mammalian visual cortex, promoting plasticity and accelerating visual recovery in animals that have experienced cortical lesions during development. However, the translational impact of our understanding of dark exposure from animal studies to humans remains elusive. Here, we used magnetic resonance spectroscopy as a probe for E/I balance in the primary visual cortex (V1) to determine the effect of 60 min of dark exposure, and measured binocular combination as a behavioural assay to assess visual plasticity in 14 normally sighted human adults. To induce neuroplastic changes in the observers, we introduced 60 min of monocular deprivation, which is known to temporarily shift sensory eye balance in favour of the previously deprived eye. We report that prior dark exposure for 60 min strengthens local excitability in V1 and boosts visual plasticity in normal adults. However, we show that it does not promote plasticity in amblyopic adults. Nevertheless, our findings are surprising, given the fact that the interlude is very brief. Interestingly, we find that the increased concentration of the excitatory neurotransmitter is not strongly correlated with the enhanced functional plasticity. Instead, the absolute degree of change in its concentration is related to the boost, suggesting that the dichotomy of cortical excitation and inhibition might not explain the physiological basis of plasticity in humans. We present the first evidence that an environmental manipulation that shifts cortical E/I balance can also act as a metaplastic facilitator for visual plasticity in humans. KEY POINTS: A brief interlude (60 min) of dark exposure increased the local concentration of glutamine/glutamate but not that of GABA in the visual cortex of adult humans. After dark exposure, the degree of the shift in sensory eye dominance in favour of the previously deprived eye from short-term monocular deprivation was larger than that from only monocular deprivation. The neurochemical and behavioural measures were associated: the magnitude of the shift in the concentration of glutamine/glutamate was correlated with the boost in perceptual plasticity after dark exposure. Surprisingly, the increase in the concentration of glutamine/glutamate was not correlated with the perceptual boost after dark exposure, suggesting that the physiological mechanism of how E/I balance regulates plasticity is not deterministic. In other words, an increased excitation did not unilaterally promote plasticity.

Temporal synchrony discrimination is abnormal in dichoptic but not monocular visual processing in treated anisometropic amblyopes.

PURPOSE: To evaluate whether temporal synchrony processing deficits remain when normal visual acuity is restored in adults with unilateral anisometropic amblyopia. METHODS: We recruited 14 clinically treated anisometropic amblyopes (mean age 23.17 ± 2.53 years) with best-corrected visual acuity ≤ 0.1 logMAR and 15 age-matched emmetropes (mean age 24.40 ± 1.92 years) with normal vision to participate in our experiment. We presented two pairs of flicking Gaussian dots (1 Hz) as visual stimuli: one pair of dots was synchronous (reference), and the other pair of dots was asynchronous (signal). Subjects were asked to determine the position of the asynchronous pair. We applied the constant stimuli method to measure the temporal synchrony threshold under monocular and dichoptic viewing conditions. There were eight temporal phase lags in the asynchronous pair. The minimum degree of the temporal phase at which a participant can discriminate a signal pair is defined as the temporal synchrony threshold. RESULTS: Under monocular viewing conditions where both the reference and signal pairs were presented to one eye, the temporal synchrony thresholds of previous amblyopic eyes and fellow eyes were not significantly different (p = 0.15). Under dichoptic viewing conditions where both the reference and signal pairs were dichoptically presented to both eyes, the temporal synchrony threshold in the treated anisometropic amblyopes was significantly higher than that of the controls (119.34 ± 20.43 vs. 99.78 ± 16.60 ms, p = 0.009). There was no significant correlation between the monocular and dichoptic viewing conditions in the treated amblyopes (r = -0.22, p = 0.94). CONCLUSIONS: Temporal synchrony discrimination is abnormal under dichoptic but not under monocular visual stimulation in treated anisometropic amblyopes with normalised visual acuity.

A brief light reduction induces a significant delay in the previously dimmed eye.

PURPOSE: We investigated how a short-term luminance reduction in one eye can influence temporal processing of that eye after luminance is restored by measuring the relative delay between the eyes. METHODS: A paradigm based on the Pulfrich effect, which is a visual illusion of depth when no depth cue is present, was used to measure relative delay in visual processing between the eyes. We deprived the monocular luminance in adults with normal vision across different intensities. In the first experiment, the ratio of the light level between the eyes stayed constant, whereas the absolute value was allowed to vary. In the second experiment, both the ratio and the absolute light level stayed constant, by controlling the environmental light level. In both experiments, we measured the changes in relative delay before and after 60 min of light deprivation. RESULTS: Our results indicated that short-term monocular deprivation of luminance slows the processing in the previously dimmed eye and that the magnitude of the delay is correlated with the degree of luminance reduction. In addition, we observed that the absolute luminance difference, rather than the absolute luminance levels seen by the dimmed eye, is important in determining the magnitude of delay in the previously dimmed eye. These findings differ from what has been reported previously for the monocular deprivation of contrast. CONCLUSIONS: Taken together, these findings support the view that short-term deprivation of visual information could affect two distinct mechanisms (contrast gain and temporal dynamics) of neural plasticity.

The effects of optically and digitally simulated aniseikonia on stereopsis.

PURPOSE: To simulate both lens-induced and screen-induced aniseikonia, and to assess its influence on stereopsis. Additionally, to determine if screen-based size differences could neutralise the effects of lens-induced aniseikonia. METHOD: A four-circle (4-C) paradigm was developed, where one circle appears in front or behind the others because of crossed or uncrossed disparity. This stereotest was used for three investigations: (1) Comparison with the McGill modified random dot stereogram (RDS), with anisometropia introduced with +2 D spheres and cylinders, and with aniseikonia introduced with 6% overall and 6% meridional (×180, ×90) magnifiers before the right eye; (2) Comparison of lens-induced and screen-induced 6% overall and meridional magnifications and (3) Determining if lens and screen effects neutralised, by opposing 6% lens-induced magnification to the right eye with screen-inducements of either 6% left eye magnification or 6% right eye minification. A pilot study of the effect of masking versus not masking the surround was also conducted. RESULTS: The 4-C test gave higher stereo-thresholds than the RDS test by 0.5 ± 0.2 log units across both anisometropic and aniseikonic conditions. However, variations in power, meridian and magnification affected the two tests similarly. The pilot study indicated that surround masking improved neutralisation of screen and lens effects. With masking, lens-induced and screen-induced magnifications increased stereo-thresholds similarly. With lens and screen effects opposed, for most participants stereo-thresholds returned to baseline for overall and ×180 magnifications, but not for ×90 magnification. Only three of seven participants showed good compensation for ×90 magnification. CONCLUSIONS: Effects of lens-induced aniseikonia on stereopsis cannot always be successfully simulated with a screen-based method. The ability to neutralise refractive aniseikonia using a computer-based method, which is the basis of digital clinical measurement, was reasonably successful for overall and ×180 meridional aniseikonia, but not very successful for ×90 aniseikonia.

Cholinergic Modulation of Binocular Vision.

The endogenous neurotransmitter acetylcholine (ACh) is known to affect the excitatory/inhibitory (E/I) balance of primate visual cortex, enhancing feedforward thalamocortical gain while suppressing corticocortical synapses. Recent advances in the study of the human visual system suggest that ACh is a likely component underlying interocular interactions. However, our understanding of its precise role in binocular processes is currently lacking. Here we use binocular rivalry as a probe of interocular dynamics to determine ACh's effects, via the acetylcholinesterase inhibitor (AChEI) donepezil, on the binocular visual system. A total of 23 subjects (13 male) completed two crossover experimental sessions where binocular rivalry measurements were obtained before and after taking either donepezil (5 mg) or a placebo (lactose) pill. We report that enhanced cholinergic potentiation attenuates perceptual suppression during binocular rivalry, reducing the overall rate of interocular competition while enhancing the visibility of superimposition mixed percepts. Considering recent evidence that perceptual suppression during binocular rivalry is causally modulated by the inhibitory neurotransmitter GABA, our results suggest that cholinergic activity counteracts the effect of GABA with regards to interocular dynamics and may modulate the inhibitory drive within the visual cortex.SIGNIFICANCE STATEMENT Our research demonstrates that the cholinergic system is implicated in modulating binocular interactions in the human visual cortex. Potentiating the transmission of acetylcholine (ACh) via the cholinergic drug donepezil reduces the extent to which the eyes compete for perceptual dominance when presented two separate, incongruent images.

Shifting eye balance using monocularly directed attention in normal vision.

In binocular vision, even without conscious awareness of eye of origin, attention can be selectively biased toward one eye by presenting a visual stimulus uniquely to that eye. Monocularly directed visual cues can bias perceptual dominance, as shown by studies using discrete measures of percept changes in continuous-flash suppression. Here, we use binocular rivalry to determine whether eye-based visual cues can modulate eye balance using continuous percept reporting. Using a dual-task versus single-task paradigm, we investigated whether the attentional load of these cues differentially modulates eye balance. Furthermore, both color-based and motion-based cue stimuli, non-overlaid and peripheral to the rivalry grating stimuli, were used to determine whether shifts in eye balance were stimulus specific. Aligned to cue stimulus onset, time series of percept reports were constructed and averaged across trials and participants. Specifically, for the monocular attention conditions, we found a significant shift in eye balance toward the cued eye and a significant difference in the time taken to switch from the dominating percept, regardless of whether the attention stimuli is color based or motion based. Although we did not find a significant main effect of attentional load, we found a significant interaction effect between the attentionally cued eye and attentional load on the shift in eye balance, indicating an influence of monocular attention on the shift in eye balance.

Some psychophysical tasks measure ocular dominance plasticity more reliably than others.

In the recent decade, studies have shown that short-term monocular deprivation strengthens the deprived eye's contribution to binocular vision. However, the magnitude of the change in eye dominance after monocular deprivation (i.e., the patching effect) has been found to be different between different methods and within the same method. There are three possible explanations for the discrepancy. First, the mechanisms underlying the patching effect that are probed by different measurement tasks might exist at different neural sites. Second, the test-retest variability of the same test can produce inconsistent results. Third, the magnitude of the patching effect itself within the same observer can vary across separate days or experimental sessions. To explore these possibilities, we assessed the test-retest reliability of the three most commonly used tasks (binocular rivalry, binocular combination, and dichoptic masking) and the repeatability of the shift in eye dominance after short-term monocular deprivation for each of the task. Two variations for binocular phase combination were used, at one and many contrasts of the stimuli. Also, two variations for dichoptic masking were employed; the orientation of the mask grating was either horizontal or vertical. Thus, five different tasks were evaluated. We hoped to resolve some of the inconsistencies reported in the literature concerning this form of visual plasticity. In this study, we also aimed to recommend a measurement method that would allow us to better understand its physiological basis and the underpinning of visual disorders.

Effects of simulated anisometropia and aniseikonia on stereopsis.

PURPOSE: Stereopsis depends on horizontally disparate retinal images but otherwise concordance between eyes. Here we investigate the effect of spherical and meridional simulated anisometropia and aniseikonia on stereopsis thresholds. The aims were to determine effects of meridian, magnitude and the relative effects of the two conditions. METHODS: Ten participants with normal binocular vision viewed McGill modified random dot stereograms through synchronised shutter glasses. Stereoacuities were determined using a four-alternative forced-choice procedure. To induce anisometropia, trial lenses of varying power and axes were placed in front of right eyes. Seventeen combinations were used: zero (no lens) and both positive and negative, 1 and 2 D powers, at 45, 90 and 180 axes; spherical lenses were also tested. To induce aniseikonia 17 magnification power and axis combinations were used. This included zero (no lens), and 3%, 6%, 9% and 12% at axes 45, 90 and 180; overall magnifications were also tested. RESULTS: For induced anisometropia, stereopsis loss increased as cylindrical axis rotated from 180° to 90°, at which the loss was similar to that for spherical blur. For example, for 2 D meridional anisometropia threshold increased from 1.53 log sec arc (i.e. 34 sec arc) for x 180 to 1.89 log sec arc (78 sec arc) for x 90. Anisometropia induced with either positive or negative lenses had similar detrimental effects on stereopsis. Unlike anisometropia, the stereopsis loss with induced meridional aniseikonia was not affected by axis and was about 64% of that for overall aniseikonia of the same amount. Approximately, each 1 D of induced anisometropia had the same effect on threshold as did each 6% of induced aniseikonia. CONCLUSION: The axes of meridional anisometropia but not aniseikonia affected stereopsis. This suggests differences in the way that monocular blur (anisometropia) and interocular shape differences (aniseikonia) are processed during the production of stereopsis.

Comparison of blur and magnification effects on stereopsis: overall and meridional, monocularly- and binocularly-induced.

PURPOSE: To determine whether monocularly- and binocularly-induced spherical and meridional blur and aniseikonia had similar effects on stereopsis thresholds. METHODS: Twelve participants with normal binocular vision viewed McGill modified random dot stereograms to determine stereoacuities in a four-alternative forced-choice procedure. Astigmatism was induced by placing trial lenses in front of the eyes. Twenty-three conditions were used, consisting of zero (no lens), +1 D and +2 D spheres and cylinders at axes 180, 45 and 90 in front of the right eye, and the following binocular combinations of both lens powers: R × 180/L × 180, R × 45/L × 45, R × 90/L × 90, R sphere/L sphere, R × 180/L × 90, R × 45/L × 135, R × 90/L × 180. Aniseikonia was induced by placing magnifying lenses in front of the eyes. Twenty-three conditions were used, consisting of zero, 6% and 12% overall magnification and both magnifications at axes 180, 45 and 90 in front of the right eye only, and the following binocular combinations using 3% and 6% lenses: R × 90/L × 90, R × 45/L × 45, R × 180/L × 180, R overall/L overall, R × 90/L × 180, R × 45/L × 135, and R × 180/L × 90. RESULTS: Stereopsis losses for binocular blur effects with parallel axes (non-anisometropic) were the same as for monocular blur effects of the same axes, and these were strongly dependent on axis (spherical blur and ×90 had the greatest effects). Binocular blur effects with orthogonal axes had greater effects than with parallel axes, with the axis combination of the former having no effect (e.g. R × 90/L × 180 was similar to R × 45/L × 135). For induced aniseikonia, splitting the magnifications between the eyes improved stereopsis slightly, and the effects were not dependent on axis. CONCLUSION: Binocular blur affects stereopsis similarly to monocular meridional blur if axes in the two eyes are parallel, whereas the effect is greater if the axes are orthogonal. In meridional aniseikonia, splitting magnification between the right and left lenses produces a small improvement in stereopsis that is independent of axis direction and right/left combination.

Factors limiting sensitivity to binocular disparity in human vision: Evidence from a noise-masking approach.

Our visual system uses the disparity between the images received by the two eyes to judge three-dimensional distance to surfaces. We can measure this ability by having subjects discriminate the disparity of rendered surfaces. We wanted to know the basis of the individual differences in this ability. We tested 53 adults with normal vision using a relative disparity detection task. Targets were wedge-shaped surfaces formed from random dots. These were presented in either crossed or uncrossed disparity relative to a random dot background. The threshold disparity ranged from 24 arc seconds in the most-able subject to 275 arc seconds in the least-able subject. There was a small advantage for detecting crossed-disparity targets. We used the noise-masking paradigm to partition subject performance into two factors. These were the subject's equivalent internal noise and their processing efficiency. The parameters were estimated by fitting the linear amplifier model. We found both factors contributed to the individual differences in stereoacuity. Within subjects, those showing an advantage for one disparity direction had enhanced efficiency for that direction. Some subjects had a higher equivalent internal noise for one direction that was balanced out by an increased efficiency. Our approach provides a more thorough account of the stereo-ability of our subjects compared with measuring thresholds alone. We present a normative set of results that can be compared with clinical populations.

Color contrast adaptation: fMRI fails to predict behavioral adaptation.

fMRI-adaptation is a valuable tool for inferring the selectivity of neural responses. Here we use it in human color vision to test the selectivity of responses to S-cone opponent (blue-yellow), L/M-cone opponent (red-green), and achromatic (Ach) contrast across nine regions of interest in visual cortex. We measure psychophysical adaptation, using comparable stimuli to the fMRI-adaptation, and find significant selective adaptation for all three stimulus types, implying separable visual responses to each. For fMRI-adaptation, we find robust adaptation but, surprisingly, much less selectivity due to high levels of cross-stimulus adaptation in all conditions. For all BY and Ach test/adaptor pairs, selectivity is absent across all ROIs. For RG/Ach stimulus pairs, this paradigm has previously shown selectivity for RG in ventral areas and for Ach in dorsal areas. For chromatic stimulus pairs (RG/BY), we find a trend for selectivity in ventral areas. In conclusion, we find an overall lack of correspondence between BOLD and behavioral adaptation suggesting they reflect different aspects of the underlying neural processes. For example, raised cross-stimulus adaptation in fMRI may reflect adaptation of the broadly-tuned normalization pool. Finally, we also identify a longer-timescale adaptation (1h) in both BOLD and behavioral data. This is greater for chromatic than achromatic contrast. The longer-timescale BOLD effect was more evident in the higher ventral areas than in V1, consistent with increasing windows of temporal integration for higher-order areas.

Two cortical deficits underlie amblyopia: A multifocal fMRI analysis.

Amblyopia is a relatively common (incidence 3%) developmental disorder in which there is loss of vision as a consequence of a disruption to normal visual development. Although the deficit is monocular and known to be of cortical origin, the nature of the processing deficit is controversial. Human behavioral studies have identified two main deficits - a loss of contrast sensitivity and perceived spatial distortions. Here we use a multifocal fMRI approach to ascertain, in a group of anisometropic amblyopes, whether these two deficits have a single common cause or whether they are the result of two underlying independent cortical disorders. We found that fMRI magnitudes were attenuated in amblyopic eye stimulation, and that there was poor fidelity for co-localization of the activity clusters between the amblyopic and fellow-fixing eye stimulation. These effects varied across eccentricities and correlate with the degree of amblyopia but not with one another, suggesting two independent cortical deficits: a reduced responsiveness as well as reduced fidelity of spatial representation. These deficits are independent of eccentricity within the central field and consistent across early cortical visual areas.

Second-order visual sensitivity in the aging population.

Most visual and cognitive functions are affected by aging over the lifespan. In this study, our aim was to investigate the loss in sensitivity to different classes of second-order stimuli-a class of stimuli supposed to be mainly processed in extrastriate cortex-in the aging population. These stimuli will then allow one to identify specific cortical deficit independently of visibility losses in upstream parts of the visual pathway. For this purpose, we measured the sensitivity to first-order stimuli and second-order stimuli: orientation-modulated, motion-modulated or contrast-modulated as a function of spatial frequency in 50 aged participants. Overall, we observed a sensitivity loss for all classes of stimuli, but this loss differentially affects the three classes of second-order stimuli tested. It involves all modulation spatial frequencies in the case of motion modulation, but just high modulation spatial frequencies in the case of contrast- and orientation modulations. These observations imply that aging selectively affects the sensitivity to second-order stimuli depending on their type. Since there is evidence that these different second-order stimuli are processed in different regions of extrastriate cortex, this result may suggest that some visual cortical areas are more susceptible to aging effects than others.

Contribution of Short-Time Occlusion of the Amblyopic Eye to a Passive Dichoptic Video Treatment for Amblyopia beyond the Critical Period.

Dichoptic movie viewing has been shown to significantly improve visual acuity in amblyopia in children. Moreover, short-term occlusion of the amblyopic eye can transiently increase its contribution to binocular fusion in adults. In this study, we first asked whether dichoptic movie viewing could improve the visual function of amblyopic subjects beyond the critical period. Secondly, we tested if this effect could be enhanced by short-term monocular occlusion of the amblyopic eye. 17 subjects presenting stable functional amblyopia participated in this study. 10 subjects followed 6 sessions of 1.5 hour of dichoptic movie viewing (nonpatched group), and 7 subjects, prior to each of these sessions, had to wear an occluding patch over the amblyopic eye for two hours (patched group). Best-corrected visual acuity, monocular contrast sensitivity, interocular balance, and stereoacuity were measured before and after the training. For the nonpatched group, mean amblyopic eye visual acuity significantly improved from 0.54 to 0.46 logMAR (p < 0.05). For the patched group, mean amblyopic eye visual acuity significantly improved from 0.62 to 0.43 logMAR (p < 0.05). Stereoacuity improved significantly when the data of both groups were combined. No significant improvement was observed for the other visual functions tested. Our training procedure combines modern video technologies and recent fundamental findings in human plasticity: (i) long-term plasticity induced by dichoptic movie viewing and (ii) short-term adaptation induced by temporary monocular occlusion. This passive dichoptic movie training approach is shown to significantly improve visual acuity of subjects beyond the critical period. The addition of a short-term monocular occlusion to the dichoptic training shows promising trends but was not significant for the sample size used here. The passive movie approach combined with interocular contrast balancing even over such a short period as 2 weeks has potential as a clinical therapy to treat amblyopia in older children and adults.

Inverse Occlusion: A Binocularly Motivated Treatment for Amblyopia.

Recent laboratory findings suggest that short-term patching of the amblyopic eye (i.e., inverse occlusion) results in a larger and more sustained improvement in the binocular balance compared with normal controls. In this study, we investigate the cumulative effects of the short-term inverse occlusion in adults and old children with amblyopia. This is a prospective cohort study of 18 amblyopes (10-35 years old; 2 with strabismus) who have been subjected to 2 hours/day of inverse occlusion for 2 months. Patients who required refractive correction or whose refractive correction needed updating were given a 2-month period of refractive adaptation. The primary outcome measure was the binocular balance which was measured using a phase combination task; the secondary outcome measures were the best-corrected visual acuity which was measured with a Tumbling E acuity chart and converted to logMAR units and the stereoacuity which was measured with the Random-dot preschool stereogram test. The average binocular gain was 0.11 in terms of the effective contrast ratio (z = -2.344, p = 0.019, 2-tailed related samples Wilcoxon Signed Rank Test). The average acuity gain was 0.13 logMAR equivalent (t(17) = 4.76, p < 0.001, 2-tailed paired samples t-test). The average stereoacuity gain was 339 arc seconds (z = -2.533, p = 0.011). Based on more recent research concerning adult ocular dominance plasticity, we conclude that inverse occlusion in adults and old children with amblyopia does produce long-term gains to binocular balance and that acuity and stereopsis can improve in some subjects.

Temporary monocular occlusion facilitates binocular fusion during rivalry.

A few hours of monocular patching temporarily enhances the deprived eye's contribution to binocular vision, constituting a form of adult brain plasticity. Although the mechanism for this plasticity is currently unknown, several imaging studies present evidence that monocular deprivation achieves its effects by changing excitatory-inhibitory balance in the visual cortex. Much of the past work on adult monocular patching utilized binocular rivalry to quantify the patching-induced shift in perceptual eye dominance, extracting periods of exclusive visibility (in which one eye's signal is suppressed from perception) to assess each eye's contribution to binocular vision while overlooking the occurrence of mixed visibility (in which information from both eyes is combined). In this paper, we discuss two experiments to investigate the effects of short-term monocular occlusion on the relative predominance of mixed and exclusive percepts during binocular rivalry. In addition to the known perceptual eye-dominance shift, we hypothesized patching would also increase the perception of mixtures during rivalry due to deprivation-induced changes in excitatory-inhibitory balance. Our data point to two previously unknown effects of monocular deprivation: (a) a significant increase in the overall fraction and median duration of mixed visibility during rivalry that is detectable up to at least an hour after removing the patch and (b) the overall fraction of superimposition; rather than piecemeal, mixed percepts are specifically enhanced after monocular deprivation. In addition to strengthening the contribution of the deprived eye, our results show that temporary monocular patching enhances the visibility of fused binocular percepts, likely the result of attenuated interocular inhibition.

Visual plasticity and exercise revisited: No evidence for a "cycling lane".

Experiments using enriched environments have shown that physical exercise modulates visual plasticity in rodents. A recent study (Lunghi & Sale, 2015) investigated whether exercise also affects visual plasticity in adult humans. The plastic effect they measured was the shift in ocular dominance caused by 2 hr of monocular deprivation (e.g., by an eye patch). They used a binocular rivalry task to measure this shift. They found that the magnitude of the shift was increased by exercise during the deprivation period. This effect of exercise was later disputed by a study that used a different behavioral task (Zhou, Reynaud, & Hess, 2017). Our goal was to determine whether the difference in task was responsible for that study's failure to find an exercise effect. We set out to replicate Lunghi and Sale (2015). We measured ocular dominance with a rivalry task before and after 2 hr of deprivation. We measured data from two conditions in 30 subjects. On two separate days, they either performed exercise or rested during the deprivation period. Contrary to the previous study, we find no significant effect of exercise. We hypothesize that exercise may affect rivalry dynamics in a way that interacts with the measurement of the deprivation effect.

Optical treatment of amblyopia in older children and adults is essential prior to enrolment in a clinical trial.

PURPOSE: Optical treatment alone can improve visual acuity (VA) in children with amblyopia, thus clinical trials investigating additional amblyopia therapies (such as patching or videogames) for children require a preceding optical treatment phase. Emerging therapies for adult patients are entering clinical trials. It is unknown whether optical treatment is effective for adults with amblyopia and whether an optical correction phase is required for trials involving adults. METHODS: We examined participants who underwent optical treatment in the Binocular Treatment for Amblyopia using Videogames (BRAVO) clinical trial (ANZCTR ID: ACTRN12613001004752). Participants were recruited in three age groups (7 to 12, 13 to 17, or ≥18 years), and had unilateral amblyopia due to anisometropia and/or strabismus, with amblyopic eye VA of 0.30-1.00 logMAR (6/12 to 6/60, 20/40 to 20/200). Corrective lenses were prescribed based on cycloplegic refraction to fully correct any anisometropia. VA was assessed using the electronic visual acuity testing algorithm (e-ETDRS) test and near stereoacuity was assessed using the Randot Preschool Test. Participants were assessed every four weeks up to 16 weeks, until either VA was stable or until amblyopic eye VA improved to better than 0.30 logMAR, rendering the participant ineligible for the trial. RESULTS: Eighty participants (mean age 24.6 years, range 7.6-55.5 years) completed four to 16 weeks of optical treatment. A small but statistically significant mean improvement in amblyopic eye VA of 0.05 logMAR was observed (S.D. 0.08 logMAR; paired t-test p < 0.0001). Twenty-five participants (31%) improved by ≥1 logMAR line and of these, seven (9%) improved by ≥2 logMAR lines. Stereoacuity improved in 15 participants (19%). Visual improvements were not associated with age, presence of strabismus, or prior occlusion treatment. Two adult participants withdrew due to intolerance to anisometropic correction. Sixteen out of 80 participants (20%) achieved better than 0.30 logMAR VA in the amblyopic eye after optical treatment. Nine of these participants attended additional follow-up and four (44%) showed further VA improvements. CONCLUSIONS: Improvements from optical treatment resulted in one-fifth of participants becoming ineligible for the main clinical trial. Studies investigating additional amblyopia therapies must include an appropriate optical treatment only phase and/or parallel treatment group regardless of patient age. Optical treatment of amblyopia in adult patients warrants further investigation.