A reinterpretation of critical flicker-frequency (CFF) data reveals key details about light adaptation and normal and abnormal visual processing

Closing eyes with artificial tears: A simple and effective strategy to combat screen-related asthenopia and dry eye symptoms

Background

The widespread use of various video display terminals (VDTs) always had a detrimental impact on ocular health. Prolonged use of smartphones has been one of the leading causes of dry eye (DE) and asthenopia. Therefore, the purpose of this study is to find a simple and effective strategy to combat screen-related DE and asthenopia.

Methods

A group of healthy participants aged 18 and above were randomly assigned to three groups and tasked with a 2 h smartphone reading task. After 1 ​h of usage, each group adopted different methods of rest: no rest (Group A), a 10 min eye-closed rest (Group B), or a 10 min eye-closed joint artificial tears rest (Group C). Ophthalmological examinations and questionnaires were administered to all participants before and after the 2 h reading task.

Results

90 qualified volunteers, including 29 males and 61 females, were randomly assigned to three groups. Group A demonstrated a significant increase in the severity of DE and asthenopia as evidenced by all the evaluated indices. On the other hand, Group C did not exhibit any notable change in DE and asthenopia symptoms, with an improvement in corneal fluorescein staining (CFS) results (P ​> ​0.05) when compared to the pre-reading values. Group B showed a significant increase in ocular surface disease index (OSDI) (P ​≤ ​0.05) and a decrease in critical flicker frequency (CFF) (P ​≤ ​0.05).

Conclusions

Close-eye rest with artificial tears may be a convenient and effective prevention strategy for screen-related DE and asthenopia.

Trichromatic critical flicker frequency as potential visual test in cataract and macula disease patients

PURPOSE

To investigate the capacity of critical flicker frequency (CFF) in discriminating cataract eyes with or without macula disease using trichromatic flickers, and to develop a model to predict postoperative best corrected visual acuity (BCVA).

METHODS

Patients were divided into two groups based on the presence or absence of macular disease. CFF threshold measurements of red (R-CFF), green (G-CFF), and yellow (Y-CFF) flickers were conducted both preoperatively and postoperatively. A generalized estimating equations model (GEE) was employed to examine the relationship between CFF threshold and 3-month postoperative BCVA.

RESULTS

A total of 115 eyes were enrolled, with 59 eyes in the cataract alone group and 56 eyes in the cataract with macular disease group completing the follow-up. R-CFF was found to be consistent before and after cataract removal (P = 0.06), even in cases where OCT was not performed successfully (P > 0.05). Y-CFF showed the highest AUC (0.798) for differentiating ocular comorbidities. According to the GEE model, in patients with a CFF threshold below 26 Hz, the odds ratios for achieving a postoperative VA of 20/40 or better were 34.8% for R-CFF, 26.0% for G-CFF, and 24.5% for Y-CFF.

CONCLUSION

CFF emerges as a promising tool for predicting postoperative BCVA, providing valuable supplementary insights when fundus examination is obstructed. R-CFF demonstrates the best resistance to cataracts, while Y-CFF exhibits the highest sensitivity both in identifying macular diseases and predicting postoperative BCVA of 20/40 or better.

Temporal Sensitivity for Achromatic and Chromatic Flicker across the Visual Cortex

The retinal ganglion cells (RGCs) receive different combinations of L, M, and S cone inputs and give rise to one achromatic and two chromatic postreceptoral channels. The goal of the current study was to determine temporal sensitivity across the three postreceptoral channels in subcortical and cortical regions involved in human vision. We measured functional magnetic resonance imaging (fMRI) responses at 7 T from three participants (two males, one female) viewing a high-contrast, flickering, spatially uniform wide field (∼140°). Stimulus flicker frequency varied logarithmically between 2 and 64 Hz and targeted the L + M + S, L - M, and S - (L + M) cone combinations. These measurements were used to create temporal sensitivity functions of the primary visual cortex (V1) across eccentricity and spatially averaged responses from the lateral geniculate nucleus (LGN), and the V2/V3, hV4, and V3A/B regions. fMRI responses reflected the known properties of the visual system, including higher peak temporal sensitivity to achromatic versus chromatic stimuli and low-pass filtering between the LGN and V1. Peak temporal sensitivity increased across levels of the cortical visual hierarchy. Unexpectedly, peak temporal sensitivity varied little across eccentricity within area V1. Measures of adaptation and distributed pattern activity revealed a subtle influence of 64 Hz achromatic flicker in area V1, despite this stimulus evoking only a minimal overall response. The comparison of measured cortical responses to a model of the integrated retinal output to our stimuli demonstrates that extensive filtering and amplification are applied to postretinal signals.

Temporal sensitivity for achromatic and chromatic flicker across the visual cortex

The retinal ganglion cells (RGCs) receive different combinations of L, M, and S cone inputs and give rise to one achromatic and two chromatic post-receptoral channels. Beyond the retina, RGC outputs are subject to filtering and normalization along the geniculo-striate pathway, ultimately producing the properties of human vision. The goal of the current study was to determine temporal sensitivity across the three post-receptoral channels in subcortical and cortical regions involved in vision. We measured functional magnetic resonance imaging (MRI) responses at 7 Tesla from three participants (two males, one female) viewing a high-contrast, flickering, spatially-uniform wide field (~140°). Stimulus flicker frequency varied logarithmically between 2 and 64 Hz and targeted the L+M+S, L-M, and S-[L+M] cone combinations. These measurements were used to create temporal sensitivity functions of primary visual cortex (V1) across eccentricity, and spatially averaged responses from lateral geniculate nucleus (LGN), V2/V3, hV4, and V3A/B. Functional MRI responses reflected known properties of the visual system, including higher peak temporal sensitivity to achromatic vs. chromatic stimuli, and low-pass filtering between the LGN and V1. Peak temporal sensitivity increased across levels of the cortical visual hierarchy. Unexpectedly, peak temporal sensitivity varied little across eccentricity within area V1. Measures of adaptation and distributed pattern activity revealed a subtle influence of 64 Hz achromatic flicker in area V1, despite this stimulus evoking only a minimal overall response. Comparison of measured cortical responses to a model of integrated retinal output to our stimuli demonstrates that extensive filtering and amplification is applied to post-retinal signals.

Assessing Critical Flicker Fusion Frequency: Which Confounders? A Narrative Review

The critical flicker fusion frequency (cFFF) refers to the frequency at which a regularly recurring change of light stimuli is perceived as steady. The cFFF threshold is often assessed in clinics to evaluate the temporal characteristics of the visual system, making it a common test for eye diseases. Additionally, it serves as a helpful diagnostic tool for various neurological and internal diseases. In the field of diving/hyperbaric medicine, cFFF has been utilized to determine alertness and cognitive functions. Changes in the cFFF threshold have been linked to the influence of increased respiratory gas partial pressures, although there exist inconsistent results regarding this effect. Moreover, the use of flicker devices has produced mixed outcomes in previous studies. This narrative review aims to explore confounding factors that may affect the accuracy of cFFF threshold measurements, particularly in open-field studies. We identify five broad categories of such factors, including (1) participant characteristics, (2) optical factors, (3) smoking/drug use, (4) environmental aspects, and (5) breathing gases and partial pressures. We also discuss the application of cFFF measurements in the field of diving and hyperbaric medicine. In addition, we provide recommendations for interpreting changes in the cFFF threshold and how they are reported in research studies.

Neuropsychological and Neurophysiological Mechanisms behind Flickering Light Stimulus Processing

The aim of this review is to summarise current knowledge about flickering light and the underlying processes that occur during its processing in the brain. Despite the growing interest in the topic of flickering light, its clinical applications are still not well understood. Studies using EEG indicate an appearing synchronisation of brain wave frequencies with the frequency of flickering light, and hopefully, it could be used in memory therapy, among other applications. Some researchers have focused on using the flicker test as an indicator of arousal, which may be useful in clinical studies if the background for such a relationship is described. Since flicker testing has a risk of inducing epileptic seizures, however, every effort must be made to avoid high-risk combinations, which include, for example, red-blue light flashing at 15 Hz. Future research should focus on the usage of neuroimaging methods to describe the specific neuropsychological and neurophysiological processes occurring in the brain during the processing of flickering light so that its clinical utility can be preliminarily determined and randomised clinical trials can be initiated to test existing reports.