Binocular summation and other forms of non-dominant eye contribution in individuals with strabismic amblyopia during habitual viewing

BACKGROUND

Adults with amblyopia ('lazy eye'), long-standing strabismus (ocular misalignment) or both typically do not experience visual symptoms because the signal from weaker eye is given less weight than the signal from its fellow. Here we examine the contribution of the weaker eye of individuals with strabismus and amblyopia with both eyes open and with the deviating eye in its anomalous motor position.

METHODOLOGY/RESULTS

The task consisted of a blue-on-yellow detection task along a horizontal line across the central 50 degrees of the visual field. We compare the results obtained in ten individuals with strabismic amblyopia with ten visual normals. At each field location in each participant, we examined how the sensitivity exhibited under binocular conditions compared with sensitivity from four predictions, (i) a model of binocular summation, (ii) the average of the monocular sensitivities, (iii) dominant-eye sensitivity or (iv) non-dominant-eye sensitivity. The proportion of field locations for which the binocular summation model provided the best description of binocular sensitivity was similar in normals (50.6%) and amblyopes (48.2%). Average monocular sensitivity matched binocular sensitivity in 14.1% of amblyopes' field locations compared to 8.8% of normals'. Dominant-eye sensitivity explained sensitivity at 27.1% of field locations in amblyopes but 21.2% in normals. Non-dominant-eye sensitivity explained sensitivity at 10.6% of field locations in amblyopes but 19.4% in normals. Binocular summation provided the best description of the sensitivity profile in 6/10 amblyopes compared to 7/10 of normals. In three amblyopes, dominant-eye sensitivity most closely reflected binocular sensitivity (compared to two normals) and in the remaining amblyope, binocular sensitivity approximated to an average of the monocular sensitivities.

CONCLUSIONS

Our results suggest a strong positive contribution in habitual viewing from the non-dominant eye in strabismic amblyopes. This is consistent with evidence from other sources that binocular mechanisms are frequently intact in strabismic and amblyopic individuals.

The relationship between anisometropia and amblyopia

This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2-3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and anisometropia may be similar. Amblyopia is present in 1-3% of humans and around one-half to two-thirds of amblyopes have anisometropia either alone or in combination with strabismus. The frequent co-existence of amblyopia and anisometropia at a child's first clinical examination promotes the belief that the anisometropia has caused the amblyopia, as has been demonstrated in animal models of the condition. In reviewing the human and monkey literature however it is clear that there are additional paths beyond this classic hypothesis to the co-occurrence of anisometropia and amblyopia. For example, after the emergence of amblyopia secondary to either deprivation or strabismus, anisometropia often follows. In cases of anisometropia with no apparent deprivation or strabismus, questions remain about the failure of the emmetropization mechanism that routinely eliminates infantile anisometropia. Also, the chronology of amblyopia development is poorly documented in cases of 'pure' anisometropic amblyopia. Although indirect, the therapeutic impact of refractive correction on anisometropic amblyopia provides strong support for the hypothesis that the anisometropia caused the amblyopia. Direct evidence for the aetiology of anisometropic amblyopia will require longitudinal tracking of at-risk infants, which poses numerous methodological and ethical challenges. However, if we are to prevent this condition, we must understand the factors that cause it to develop.

Test-retest reproducibility of accommodation measurements gathered in an unselected sample of UK primary school children

PURPOSE

To determine the test-retest reproducibility of accommodation measurements gathered in an unselected sample of primary school children.

METHODS

Monocular and binocular amplitudes of accommodation (AA) were collected by five different Testers using the push-up method in an unselected sample of school children (n=137, age: 8.1±2.1 years). Testing was conducted on three occasions (average testing interval: 8 days) in 91.2% of the children.

RESULTS

The median AA was 19.1D, the variation due to the identity of the Tester was 3.1D (p<0.001) and the within-subject variation (which takes the variation due to Tester identity into account) was 5.2D. Around 75-79% of children exhibited monocular AAs≥12D when tested on the first occasion, but more than 90% exhibited an AA≥12D when subsequently tested. Around 74-80% of those with an AA<12D on the first occasion had values≥12D on subsequent testing even though no treatment had been undertaken. Poorer initial AA measurements were less likely to improve on repeat testing.

CONCLUSIONS

Our results reveal substantial intra-individual variation in AA measurements, raising questions about the usefulness of this test in children aged 4-12 years. We suggest that AA assessment may prove most useful in children in this age range as a pass/fail check for substantially reduced AA, for example, where the AA is <12D. Our sample would suggest that the prevalence of persistently reduced AA may be around 3.2% when tested under binocular conditions and 4-6.4% when tested monocularly.

Bilateral changes in foveal structure in individuals with amblyopia

PURPOSE

To examine foveal structure in amblyopia using spectral-domain optical coherence tomography (SD-OCT).

DESIGN

Prospective, cross-sectional study.

PARTICIPANTS AND CONTROLS

Two subject groups were recruited to the study: 85 amblyopes (34 adults, 51 children) and 110 visually normal controls (44 adults, 66 children).

METHODS

A detailed eye examination, including an SD-OCT scan, was performed in all participants. A total of 390 eyes of 195 subjects were imaged using a 3-dimensional (3D) macula scan covering a nominal 6 × 6-mm area with a resolution of 256 × 256 (65,536 axial scans). Data from the B-scans bisecting the fovea both horizontally and vertically were fitted with a mathematical model of the fovea to determine a range of foveal parameters.

MAIN OUTCOME MEASURES

Foveal thickness, foveal pit depth, and foveal pit slope.

RESULTS

Bilateral differences between the eyes of amblyopes compared with visually normal controls were found. The difference between foveal structure in amblyopic participants relative to structure in subjects with normal vision persisted even when variables such as age, ethnicity, axial length, and sex were taken into account. Amblyopes showed increased foveal thickness (+8.31 μm; P = 0.006) and a reduction in pit depth in the horizontal meridian (-10.06 μm; P = 0.005) but not in the vertical meridian (P = 0.082) when compared with subjects with normal vision. Foveal pit slopes were found to be approximately 1 degree flatter in the nasal (P = 0.033) and temporal (P = 0.014) meridians in amblyopes, but differences between amblyopes and controls in the superior (P = 0.061) and inferior (P = 0.087) meridians did not reach statistical significance. No statistically significant interocular differences were found in the foveal structure between amblyopic and fellow eyes.

CONCLUSIONS

Differences were found in the foveal structure in both eyes of amblyopes compared with subjects with normal vision. These differences consisted of increased foveal thickness, reduced pit depth when measured along the horizontal meridian, and flattening of the nasal and temporal sides of the foveal pit.

A limited role for suppression in the central field of individuals with strabismic amblyopia

Background

Although their eyes are pointing in different directions, people with long-standing strabismic amblyopia typically do not experience double-vision or indeed any visual symptoms arising from their condition. It is generally believed that the phenomenon of suppression plays a major role in dealing with the consequences of amblyopia and strabismus, by preventing images from the weaker/deviating eye from reaching conscious awareness. Suppression is thus a highly sophisticated coping mechanism. Although suppression has been studied for over 100 years the literature is equivocal in relation to the extent of the retina that is suppressed, though the method used to investigate suppression is crucial to the outcome. There is growing evidence that some measurement methods lead to artefactual claims that suppression exists when it does not.

Methodology/Results

Here we present the results of an experiment conducted with a new method to examine the prevalence, depth and extent of suppression in ten individuals with strabismic amblyopia. Seven subjects (70%) showed no evidence whatsoever for suppression and in the three individuals who did (30%), the depth and extent of suppression was small.

Conclusions

Suppression may play a much smaller role in dealing with the negative consequences of strabismic amblyopia than previously thought. Whereas recent claims of this nature have been made only in those with micro-strabismus our results show extremely limited evidence for suppression across the central visual field in strabismic amblyopes more generally. Instead of suppressing the image from the weaker/deviating eye, we suggest the visual system of individuals with strabismic amblyopia may act to maximise the possibilities for binocular co-operation. This is consistent with recent evidence from strabismic and amblyopic individuals that their binocular mechanisms are intact, and that, just as in visual normals, performance with two eyes is better than with the better eye alone in these individuals.

Test--retest variability of Randot stereoacuity measures gathered in an unselected sample of UK primary school children

AIM

To determine the test-retest reliability of the Randot stereoacuity test when used as part of vision screening in schools.

METHODS

Randot stereoacuity (graded-circles) and logMAR visual acuity measures were gathered in an unselected sample of 139 children (aged 4-12, mean 8.1±2.1 years) in two schools. Randot testing was repeated on two occasions (average interval between successive tests 8 days, range: 1-21 days). Three Randot scores were obtained in 97.8% of children.

RESULTS

Randot stereoacuity improved by an average of one plate (ie, one test level) on repeat testing but was little changed when tested on the third occasion. Within-subject variability was up to three test levels on repeat testing. When stereoacuity was categorised as 'fine', 'intermediate' or 'coarse', the greatest variability was found among younger children who exhibited 'intermediate' or 'coarse'/nil stereopsis on initial testing. Whereas 90.8% of children with 'fine' stereopsis (≤50 arc-seconds) on the first test exhibited 'fine' stereopsis on both subsequent tests, only ∼16% of children with 'intermediate' (>50 but ≤140 arc-seconds) or 'coarse'/nil (≥200 arc-seconds) stereoacuity on initial testing exhibited stable test results on repeat testing.

CONCLUSIONS

Children exhibiting abnormal stereoacuity on initial testing are very likely to exhibit a normal result when retested. The value of a single, abnormal Randot graded-circles stereoacuity measure from school screening is therefore questionable.

Changes to control of adaptive gait in individuals with long-standing reduced stereoacuity

PURPOSE

Gait during obstacle negotiation is adapted in visually normal subjects whose vision is temporarily and unilaterally blurred or occluded. This study was conducted to examine whether gait parameters in individuals with long-standing deficient stereopsis are similarly adapted.

METHODS

Twelve visually normal subjects and 16 individuals with deficient stereopsis due to amblyopia and/or its associated conditions negotiated floor-based obstacles of different heights (7-22 cm). Trials were conducted during binocular viewing and monocular occlusion. Analyses focused on foot placement before the obstacle and toe clearance over it.

RESULTS

Across all viewing conditions, there were significant group-by-obstacle height interactions for toe clearance (P < 0.001), walking velocity (P = 0.003), and penultimate step length (P = 0.022). Toe clearance decreased (approximately 0.7 cm) with increasing obstacle height in visually normal subjects, but it increased (approximately 1.5 cm) with increasing obstacle height in the stereo-deficient group. Walking velocity and penultimate step length decreased with increasing obstacle height in both groups, but the reduction was more pronounced in stereo-deficient individuals. Post hoc analyses indicated group differences in toe clearance and penultimate step length when negotiating the highest obstacle (P < 0.05).

CONCLUSIONS

Occlusion of either eye caused significant and similar gait changes in both groups, suggesting that in stereo-deficient individuals, as in visually normal subjects, both eyes contribute usefully to the execution of adaptive gait. Under monocular and binocular viewing, obstacle-crossing performance in stereo-deficient individuals was more cautious when compared with that of visually normal subjects, but this difference became evident only when the subjects were negotiating higher obstacles; suggesting that such individuals may be at greater risk of tripping or falling during everyday locomotion.

Repeatability and reproducibility of macular thickness measurements using fourier domain optical coherence tomography

Aim:

To evaluate repeatability and reproducibility of macular thickness measurements in visually normal eyes using the Topcon 3D OCT-1000.

Methods:

Phase 1 investigated scan repeatability, the effect of age and pupil dilation. Two groups (6 younger and 6 older participants) had one eye scanned 5 times pre and post- dilation by 1 operator. Phase 2 investigated between-operator, within and between-visit reproducibility. 10 participants had 1 un-dilated eye scanned 3 times on 2 separate visits by 2 operators.

Results:

Conclusion:

A high level repeatability, close to 6µm, of macular thickness measurement is possible using the 3D OCT- 1000. Measured differences in macular thickness between successive visits that exceed 6µm in pre-presbyopic individuals are therefore likely to reflect actual structural change. OCT measures are more variable in older individuals and it is advisable to take a series of scans so that outliers can be more easily identified.

Early age-related decline in the effective number of trajectories tracked in adult human vision

Human performance in many visual and cognitive tasks declines with age, the rate of decline being task dependent. Here, we used a multiple-object tracking (MOT) task to provide a clear demonstration of a steep cognitive decline that begins relatively early in adult life. Stimuli consisted of 8 dots that moved along linear trajectories from left to right. At the midpoint of their trajectories, a certain number of dots, D (1, 2 or 3), deviated either clockwise or counter-clockwise by a certain magnitude (57 degrees, 38 degrees or 19 degrees); the task for observers was to identify the direction of deviation. Percent correct responses were measured for 22 observers aged 18-62 years and were converted to effective numbers of tracked trajectories (E) (S. P. Tripathy, S. Narasimhan, & B. T. Barrett, 2007). In 5 of the 7 conditions tested, there was a significant negative correlation between age and E, indicating an age-related decline in tracking ability. This decline was found to be equivalent to a mean performance drop of 16% per decade over the four decades of adulthood tested. Further analysis suggests that performance in this task starts to decline at around 30 years of age and falls off at the rate of approximately 20% every subsequent decade.

Replication of the recessive STBMS1 locus but with dominant inheritance

PURPOSE

Strabismus is a common eye disorder with a prevalence of 1% to 4%. Comitant strabismus accounts for approximately 75% of all strabismus, yet more is known about the less common incomitant disorders. Comitant strabismus is at least partly inherited, but only one recessive genetic susceptibility locus, on chromosome 7p, has been identified in one family. The purpose of this study was to determine the frequency of STBMS1 as a cause of primary nonsyndromic comitant esotropia (PNCE).

METHODS

Twelve families were recruited within the UK Hospital Eye Service as children attended for treatment of PNCE. All consenting persons were clinically assessed, and DNA was sampled. Chromosome 7 microsatellite markers were genotyped in all 12 families, and LOD scores were calculated under recessive and dominant models.

RESULTS

One family was linked to STBMS1; in three, linkage was significantly excluded; and the remainder were uninformative. Twenty-six members from three generations of the linked family were analyzed further. Five family members were defined as affected; two had esotropia with an accommodative element; and three underwent strabismus surgery and appeared to have had an infantile/early-onset esotropia. A maximum LOD score of 3.21 was obtained under a dominant mode of inheritance; a recessive model gave an LOD score of 1.2.

CONCLUSIONS

This study confirms that PNCE can result from sequence variants in an unknown gene at the STBMS1 locus. However, this locus accounts for only a proportion of cases, and other genetic loci remain to be identified. In contrast with the previously reported family, the pedigree described in this study is consistent with dominant rather than recessive inheritance at the STBMS1 locus.

On the effective number of tracked trajectories in normal human vision

Z. W. Pylyshyn and R. W. Storm (1988) have shown that human observers can accurately track four to five items at a time. However, when a threshold paradigm is used, observers are unable to track more than a single trajectory accurately (S. P. Tripathy & B. T. Barrett, 2004). This difference between the two studies is examined systematically using substantially suprathreshold stimuli. The stimuli consisted of one (Experiment 1) or more (Experiments 2 and 3) bilinear target trajectories embedded among several linear distractor trajectories. The target trajectories deviated clockwise (CW) or counterclockwise (CCW) (by 19 degrees, 38 degrees, or 76 degrees in Experiments 1 and 2 and by 19 degrees, 38 degrees, or 57 degrees in Experiment 3), and observers reported the direction of deviation. From the percentage of correct responses, the "effective" number of tracked trajectories was estimated for each experimental condition. The total number of trajectories in the stimulus and the number of deviating trajectories had only a small effect on the effective number of tracked trajectories; the effective number tracked was primarily influenced by the angle of deviation of the targets and ranged from four to five trajectories for a +/-76 degrees deviation to only one to two trajectories for a +/-19 degrees deviation, regardless of whether the different magnitudes of deviation were blocked (Experiment 2) or interleaved (Experiment 3). Simple hypotheses based on "averaging of orientations," "preallocation of resources," or pop-out, crowding, or masking of the target trajectories are unlikely to explain the relationship between the effective number tracked and the angle of deviation of the target trajectories. This study reconciles the difference between the studies cited above in terms of the number of trajectories that can be tracked at a time.

Severe loss of positional information when detecting deviations in multiple trajectories

Human observers can simultaneously track up to five targets in motion (Z. W. Pylyshyn & R. W. Storm, 1988). We examined the precision for detecting deviations in linear trajectories by measuring deviation thresholds as a function of the number of trajectories (T ). When all trajectories in the stimulus undergo the same deviation, thresholds are uninfluenced by T for T <or= 10. When only one of the trajectories undergoes a deviation, thresholds rise steeply as T is increased [e.g., 3.3 degrees (T = 1), 12.3 degrees (T = 2), 32.9 degrees (T = 4) for one observer]; observers are unable to simultaneously process more than one trajectory in our threshold-measuring paradigm. When the deviating trajectory is cued (e.g., using a different color), varying T has little influence on deviation threshold. The use of a different color for each trajectory does not facilitate deviation detection. Our current data suggest that for deviations that have low discriminability (i.e., close to threshold) the number of trajectories that can be monitored effectively is close to one. In contrast, when the stimuli containing highly discriminable (i.e., substantially suprathreshold) deviations are used, as many as three or four trajectories can be simultaneously monitored (S. P. Tripathy, 2003). Our results highlight a severe loss of positional information when attempting to track multiple objects, particularly in a threshold paradigm.

Motion-Sensitive Neurones in V5/MT Modulate Perceived Spatial Position

Until recently, it was widely believed that object position and object motion were represented independently in the visual cortex. However, several studies have shown that adaptation to motion produces substantial shifts in the perceived position of subsequently viewed stationary objects. Two stages of motion adaptation have been proposed: an initial stage at the level of V1 and a secondary stage thought to be located in V5/MT. Indeed, selective adaptation can be demonstrated at each of these levels of motion analysis. What remains unknown is which of these cortical sites are involved in modulating the positional representation of subsequently viewed objects. To answer this question directly, we disrupted cortical activity by using transcranial magnetic stimulation (TMS) immediately after motion adaptation. When TMS was delivered to V5/MT after motion adaptation, the perceived offset of the test stimulus was greatly reduced. In marked contrast, TMS of V1 had no effect on the changes that normally occur in perceived position after motion adaptation. This result demonstrates that the anatomical locus at which motion and positional information interact is area V5/MT rather than V1/V2.

A comparison of the effects of ageing upon vernier and bisection acuity

While most positional acuity tasks exhibit an age-related decline in performance, the effect of ageing upon vernier acuity continues to be the subject of some debate. In the present study we employed a stimulus design that enabled the simultaneous determination of bisection and vernier acuities in 36 subjects, aged between 22 and 84 years. This approach provided a means for directly testing the hypothesis that ageing affects bisection acuity but not vernier acuity by ensuring that differences in stimulus configuration and in the subject's task were kept to an absolute minimum. Optimum thresholds increased as a function of age for both bisection and vernier tasks. Inter-subject threshold variability also increased with age. Issues surrounding the comparison of absolute vernier thresholds across different studies are discussed and two important methodological factors are identified: the precise statistical method used to estimate thresholds, and the magnitude, in angular terms, of the smallest spatial offset of the elements of the vernier stimulus which can be displayed. Comparison with previously published data indicates that the discrepancy between this study and most previous investigations with respect to the effect of age upon vernier performance can be at least partly accounted for by differences in the minimum displayable vernier offset. Vernier thresholds do increase with age. The increased variability of vernier thresholds in older subjects would appear to limit the diagnostic value of the test as a means of enabling normal ageing to be distinguished from visual loss due to pathology of the eye or visual system.

A comparison of vernier acuity for narrowband and broadband stimuli

This study investigates the influence of contrast and exposure duration on vernier acuity thresholds for abutting and separated narrowband stimuli, and asks whether these data can predict broadband vernier performance. Vernier thresholds were determined for sinusoidal grating stimuli at two spatial frequencies (1 and 8 c/deg) across a range of contrasts (0.05-0.8) and exposure durations (35-2100 ms). Performance was assessed for the abutting configuration, and when a gap equivalent to 0.5 to 1.5 times the spatial period of the grating was introduced between the upper and lower halves of the grating. Vernier thresholds were also determined for a square-wave stimulus as a function of contrast (0.06 to 0.78). Exposure duration was fixed at 2100 ms. In addition, thresholds were determined at the appropriate contrast levels for the fundamental frequency (1.8 c/deg) of the square-wave, and for a number of the harmonics (3F, 5F, 7F, 9F). Our results provide support for filter models of vernier acuity by showing that vernier performance for abutting and closely-separated broadband stimuli represents the envelope of vernier sensitivity of those spatial frequency mechanisms that are activated by the broadband stimulus. In the case of high frequency grating stimuli presented for long exposure durations, vernier performance can be invariant across much of the contrast range. Despite this, however, contrast independence is not exhibited for abutting broadband stimuli because, within the broadband stimuli, the contrast of the higher harmonic components never reaches a level to reveal this plateau.

Perceived contrast following adaptation: the role of adapting stimulus visibility

The issue of whether contrast adaptation can reduce the perceived contrast of gratings oriented orthogonal to the adapting stimulus to a greater extent than parallel gratings has been the subject of considerable debate (Snowden and Hammett, 1992; Ross and Speed, 1996). We compared the reductions in perceived contrast of various test gratings oriented parallel and orthogonal to the adapting stimulus across a range of spatial frequencies (2.25-9 c/deg) and adaptation contrasts (0.19-1.0). Our results show that when the adapting stimulus is low in contrast, parallel adaptation effects are always greater than the effects of orthogonal adaptation. When the adapting contrast is increased, however, the difference between parallel and orthogonal effects is reduced. Further increases in adapting contrast can produce a situation where cross-orientation adaptation effects exceed iso-orientation effects. This was observed at low spatial frequencies (2.25 and 4.5 c/deg) only. The difference in the pattern of results obtained at low and high spatial frequencies can be explained in terms of the adapting stimulus visibility. We conclude that cross-orientation adaptation effects can be greater than iso-orientation effects, but only when the adapting stimulus is highly suprathreshold.

Nonveridical visual perception in human amblyopia

PURPOSE

Amblyopia is a developmental disorder of spatial vision. There is evidence to suggest that some amblyopes misperceive spatial structure when viewing with the affected eye. However, there are few examples of these perceptual errors in the literature. This study was an investigation of the prevalence and nature of misperceptions in human amblyopia.

METHODS

Thirty amblyopes with strabismus and/or anisometropia participated in the study. Subjects viewed sinusoidal gratings of various spatial frequencies, orientations, and contrasts. After interocular comparison, subjects sketched the subjective appearance of those stimuli that had nonveridical appearances.

RESULTS

Nonveridical visual perception was revealed in 20 amblyopes ( approximately 67%). In some subjects, misperceptions were present despite the absence of a deficit in contrast sensitivity. The presence of distortions was not simply linked to the depth of amblyopia, and anisometropes were affected as well as those with strabismus. In most cases, these spatial distortions arose at spatial frequencies far below the contrast detection acuity cutoff. Errors in perception became more severe at higher spatial frequencies, with low spatial frequencies being mostly perceived veridically. The prevalence and severity of misperceptions were frequently found to depend on the orientation of the grating used in the test, with horizontal orientations typically less affected than other orientations. Contrast had a much smaller effect on misperceptions, although there were cases in which severity was greater at higher contrasts.

CONCLUSIONS

Many types of misperceptions documented in the present study have appeared in previous investigations. This suggests that the wide range of distortions previously reported reflect genuine intersubject differences. It is proposed that nonveridical perception in human amblyopia has its origins in errors in the neural coding of orientation in primary visual cortex.