Oscillopsia and retinal slip. Evidence supporting a clinical test

The contribution of image minification to discomfort experienced in wearable optics

Wearable optics have a broad range of uses, for example, in refractive spectacles and augmented/virtual reality devices. Despite the long-standing and widespread use of wearable optics in vision care and technology, user discomfort remains an enduring mystery. Some of this discomfort is thought to derive from optical image minification and magnification. However, there is limited scientific data characterizing the full range of physical and perceptual symptoms caused by minification or magnification during daily life. In this study, we aimed to evaluate sensitivity to changes in retinal image size introduced by wearable optics. Forty participants wore 0%, 2%, and 4% radially symmetric optical minifying lenses binocularly (over both eyes) and monocularly (over just one eye). Physical and perceptual symptoms were measured during tasks that required head movement, visual search, and judgment of world motion. All lens pairs except the controls (0% binocular) were consistently associated with increased discomfort along some dimension. Greater minification tended to be associated with greater discomfort, and monocular minification was often-but not always-associated with greater symptoms than binocular minification. Furthermore, our results suggest that dizziness and visual motion were the most reported physical and perceptual symptoms during naturalistic tasks. This work establishes preliminary guidelines for tolerances to binocular and monocular image size distortion in wearable optics.

Using VR to Investigate the Relationship between Visual Acuity and Severity of Simulated Oscillopsia

PURPOSE

Oscillopsia is a debilitating symptom resulting from involuntary eye movement most commonly associated with acquired nystagmus. Investigating and documenting the effects of oscillopsia severity on visual acuity (VA) is challenging. This paper aims to further understanding of the effects of oscillopsia using a virtual reality simulation.

METHODS

Fifteen right-beat horizontal nystagmus waveforms, with different amplitude (1°, 3°, 5°, 8° and 11°) and frequency (1.25 Hz, 2.5 Hz and 5 Hz) combinations, were produced and imported into virtual reality to simulate different severities of oscillopsia. Fifty participants without ocular pathology were recruited to read logMAR charts in virtual reality under stationary conditions (no oscillopsia) and subsequently while experiencing simulated oscillopsia. The change in VA (logMAR) was calculated for each oscillopsia simulation (logMAR VA with oscillopsia - logMAR VA with no oscillopsia), removing the influence of different baseline VAs between participants. A one-tailed paired t-test was used to assess statistical significance in the worsening in VA caused by the oscillopsia simulations.

RESULTS

VA worsened with each incremental increase in simulated oscillopsia intensity (frequency x amplitude), either by increasing frequency or amplitude, with the exception of statistically insignificant changes at lower intensity simulations. Theoretical understanding predicted a linear relationship between increasing oscillopsia intensity and worsening VA. This was supported by observations at lower intensity simulations but not at higher intensities, with incremental changes in VA gradually levelling off. A potential reason for the difference at higher intensities is the influence of frame rate when using digital simulations in virtual reality.

CONCLUSIONS

The frequency and amplitude were found to equally affect VA, as predicted. These results not only consolidate the assumption that VA degrades with oscillopsia but also provide quantitative information that relates these changes to amplitude and frequency of oscillopsia.

Downregulation of early visual cortex excitability mediates oscillopsia suppression

Objective:

To identify in an observational study the neurophysiologic mechanisms that mediate adaptation to oscillopsia in patients with bilateral vestibular failure (BVF).

Methods:

We directly probe the hypothesis that adaptive changes that mediate oscillopsia suppression implicate the early visual-cortex (V1/V2). Accordingly, we investigated V1/V2 excitability using transcranial magnetic stimulation (TMS) in 12 avestibular patients and 12 healthy controls. Specifically, we assessed TMS-induced phosphene thresholds at baseline and cortical excitability changes while performing a visual motion adaptation paradigm during the following conditions: baseline measures (i.e., static), during visual motion (i.e., motion before adaptation), and during visual motion after 5 minutes of unidirectional visual motion adaptation (i.e., motion adapted).

Results:

Patients had significantly higher baseline phosphene thresholds, reflecting an underlying adaptive mechanism. Individual thresholds were correlated with oscillopsia symptom load. During the visual motion adaptation condition, no differences in excitability at baseline were observed, but during both the motion before adaptation and motion adapted conditions, we observed significantly attenuated cortical excitability in patients. Again, this attenuation in excitability was stronger in less symptomatic patients.

Conclusions:

Our findings provide neurophysiologic evidence that cortically mediated adaptive mechanisms in V1/V2 play a critical role in suppressing oscillopsia in patients with BVF.

Eye Movements Are Correctly Timed During Walking Despite Bilateral Vestibular Hypofunction

Individuals with bilateral vestibular hypofunction (BVH) often report symptoms of oscillopsia (the perception that the world is bouncing or unstable) during walking. Efference copy/proprioception contributes to locomotion gaze stability in animals, sometimes inhibiting the vestibulo-ocular reflex (VOR). Gaze stability requires both adequate eye velocity and appropriate timing of eye movements. It is unknown whether eye velocity (VOR gain), timing (phase), or both are impaired for individuals with BVH during walking. Identifying the specific mechanism of impaired gaze stability can better inform rehabilitation options. Gaze stability was measured for eight individuals with severe BVH and eight healthy age- and gender-matched controls while performing a gaze fixation task during treadmill walking. Frequency response functions (FRF) were calculated from pitch eye and head velocity. A one-way ANOVA was conducted to determine group differences for each frequency bin of the FRF. Pearson correlation coefficients were calculated to determine the relationship between the real and imaginary parts of the FRF and the Oscillopsia Visual Analog Scale (oVAS) scores. Individuals with BVH demonstrated significantly lower gains than healthy controls above 0.5 Hz, but their phase was ideally compensatory for frequencies below 3 Hz. Higher oVAS scores were correlated with lower gain. Individuals with BVH demonstrated ideal timing for vertical eye movements while walking despite slower than ideal eye velocity when compared to healthy controls. Rehabilitation interventions focusing on enhancing VOR gain during walking should be developed to take advantage of the intact timing reported here. Specifically, training VOR gain while walking may reduce oscillopsia severity and improve quality of life.

Perspectives on Aging Vestibular Function

Much is known about age-related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing. However, despite advancements in clinical diagnostics, much remains unknown about the functional impact that an aging vestibular system has on daily life activities such as standing and walking. Modern diagnostic tests are very good at characterizing neural activity of the isolated vestibular system, but the tests themselves are artificial and do not reflect the multisensory aspects of natural human behavior. Also, the majority of clinical diagnostic tests are passively applied because active behavior can enhance performance. In this perspective paper, we review anatomical and behavioral changes associated with an aging vestibular system and highlight several areas where a more functionally relevant perspective can be taken. For postural control, a multisensory perturbation approach could be used to bring balance rehabilitation into the arena of precision medicine. For walking and complex gaze stability, this may result in less physiologically specific impairments, but the trade-off would be a greater understanding of how the aging vestibular system truly impacts the daily life of older adults.

Effects of horizontal acceleration on human visual acuity and stereopsis

The effect of horizontal acceleration on human visual acuity and stereopsis is demonstrated in this study. Twenty participants (mean age 22.6 years) were enrolled in the experiment. Acceleration from two different directions was performed at the Taiwan High-Speed Rail Laboratory. Gx and Gy (< and >0.1 g) were produced on an accelerating platform where the subjects stood. The visual acuity and stereopsis of the right eye were measured before and during the acceleration. Acceleration <0.1 g in the X- or Y-axis did not affect dynamic vision and stereopsis. Vision decreased (mean from 0.02 logMAR to 0.25 logMAR) and stereopsis declined significantly (mean from 40 s to 60.2 s of arc) when Gx > 0.1 g. Visual acuity worsened (mean from 0.02 logMAR to 0.19 logMAR) and poor stereopsis was noted (mean from 40 s to 50.2 s of arc) when Gy > 0.1 g. The effect of acceleration from the X-axis on the visual system was higher than that from the Y-axis. During acceleration, most subjects complained of ocular strain when reading. To our knowledge, this study is the first to report the exact levels of visual function loss during Gx and Gy.

Effects of distance and duration on vertical dynamic visual acuity in screening healthy adults and people with vestibular disorders

BACKGROUND

Dynamic visual acuity (DVA) testing may be a useful, indirect indicator of vestibulo-ocular reflex function. Previous evidence shows that acuity for 2 m targets differs little between patients and normals using a 75 ms display duration and that healthy subjects do not differ in acuity when standing and walking while viewing a far target but they do differ when viewing a near target.

OBJECTIVE

Improve the protocol of a screening tool by testing the hypothesis that healthy control subjects and patients and with unilateral peripheral vestibular weakness differ on DVA when viewing far targets while seated.

METHODS

Controls and patients were tested while they were seated in a chair that oscillated vertically at 2 Hz. They viewed a computer screen 4 m away, while stationary and while moving, with viewing times of either 75 ms or 500 ms.

RESULTS

The amount of change between static and dynamic conditions did not differ significantly between patients and controls for the 75 ms condition but controls had lower difference scores than patients when using the 500 ms duration. The ROC value was low, 0.68. Compared to historical data using the 75 ms duration at a distance of 2 m, subjects in both diagnostic groups had better visual acuity at the 75 ms/4 m distance.

CONCLUSIONS

These results suggest that using the longer duration is better for differentiating patients from healthy controls and they support previous evidence showing that near target viewing is more challenging.

Ocular tremor in Parkinson's disease is due to head oscillation

BACKGROUND

We investigated the origin of a recently reported ocular microtremor in patients with Parkinson's disease (PD).

METHODS

Eye movements were recorded in 2 unselected patients with PD. Two recording techniques were used to control for artifacts: infrared video-oculography and infrared scleral reflection techniques. Head movements were also recorded with 2 different accelerometers.

RESULTS

We recorded ocular oscillations in both patients (microtremor). Ocular tremor was accompanied by a recordable (but clinically nonvisible) head tremor of equal fundamental frequency and high coherence with both the eye oscillation and a recordable limb tremor. The eye movements were in the opposite direction to the head oscillation (ie, compensatory) and were suppressed by head restraint. There was no subjective oscillopsia, nor ocular tremor on fundoscopy.

CONCLUSIONS

The "ocular tremor" observed in patients with PD disease is a compensatory eye movement secondary to transmitted head tremor, in agreement with clinical wisdom that these patients do not report oscillopsia.

The Influence of Adaptation on Visual Motion Detection in Chronic Sixth Nerve Palsy After Treatment with Botulinum Toxin

PURPOSE

To investigate changes in visual motion perception after treatment with botulinum toxin in patients with unilateral chronic lateral rectus muscle palsy.

METHODS

Five patients and control subjects were asked to report the perceived drift direction of a sinusoidal grating that was initially stationary and then began to accelerate at 0.09 degrees /sec2 in a horizontal direction. The grating had a field size of 18.5 degrees and was presented monocularly with a contrast just above threshold for visibility for central vision. Both the paretic and non-affected eyes were tested. Psychophysical testing was performed under the following conditions: 1) before treatment and testing, patients occluded their paretic eye for at least three days to avoid diplopia. 2) After treatment with botulinum toxin, alignment was corrected and patients stopped occluding their paretic eye for at least three days before testing. The control subjects occluded their non-dominant eye for three days before testing.

RESULTS

In condition 1, no differences in motion detection values between patients and control subjects were found. In condition 2, motion detection thresholds were raised approximately 0.15 degrees /sec as compared to pre-treatment values and compared to the control group.

CONCLUSIONS

After treatment, a raised threshold for motion detection is one mechanism used to avoid oscillopsia and visuo-vestibular disorientation during head movements in patients with chronic paralytic squint. This study lends evidence that perceptual-adaptive, compensatory mechanisms develop to reduce oscillopsia and disorientation rather than being caused by abnormal cortical motion processing or defective eye muscle action.

An update on acquired nystagmus

Proper evaluation and treatment of acquired nystagmus requires accurate characterization of nystagmus type and visual effects. This review addresses important historical and examination features of nystagmus and current concepts of pathogenesis and treatment of gaze-evoked nystagmus, nystagmus due to vision loss, acquired pendular nystagmus, peripheral and central vestibular nystagmus, and periodic alternating nystagmus.

Unilateral vestibular failure suppresses cortical visual motion processing

Patients with unilateral vestibular failure (UVF) experience oscillopsia (apparent motion of the visual scene) during rapid head movements due to increased retinal slip caused by vestibulo-ocular reflex impairment. Oscillopsia is always smaller than the net retinal slip and decreases over time in patients with acquired vestibular loss; this correlates with increased thresholds for visual motion detection and increased tolerance to retinal slip. We investigated the underlying cortical adaptive processes using visual motion stimulation during blood oxygen level-dependent (BOLD) fMRI. Optokinetic nystagmus was elicited in seven patients with right-sided and seven patients with left-sided unilateral vestibular neurectomy and in seven age- and gender-matched healthy controls. Patients showed diminished activation of bilateral visual cortex areas (including the motion-sensitive area MT/V5, cuneus, middle occipital, fusiform and lingual areas) and ocular motor regions compared to their controls during visual motion stimulation. Concurrent BOLD signal decreases of temporo-parietal and insular multisensory cortical areas occurred in controls and patients. The diminished activation of visual motion processing areas plausibly reflects an adaptive mechanism that suppresses distressing oscillopsia in patients with UVF and thereby stabilizes the perceived visual surroundings. This study provides for the first time neuroimaging evidence of suppressed cortical visual motion processing in patients with vestibulopathy.

Oscillopsies : approches physiopathologique et thérapeutique

Oscillopsia is an illusion of an unstable visual world. It is associated with poor visual acuity and is a disabling and stressful symptom reported by numerous patients with neurological disorders. The goal of this paper is to review the physiology of the systems subserving stable vision, the various pathophysiological mechanisms of oscillopsia and the different treatments available. Visual stability is conditioned by two factors. First, images of the seen world projected onto the retina have to be stable, a sine qua non condition for foveal discriminative function. Vestibulo-ocular and optokinetic reflexes act to stabilize the retinal images during head displacements; ocular fixation tends to limit the occurrence of micro ocular movements during gazing; a specific system also acts to maintain the eyes stable during eccentric gaze. Second, although we voluntary move our gaze (body, head and eye displacements), the visual world is normally perceived as stable, a phenomenon known as space constancy. Indeed, complex cognitive processes compensate for the two sensory consequences of gaze displacement, namely an oppositely-directed retinal drift and a change in the relationship between retinal and spatial (or subject-centered) coordinates of the visual scene. In patients, oscillopsia most often results from abnormal eye movements which cause excessive motion of images on the retina, such as nystagmus or saccadic intrusions or from an impaired vestibulo-ocular reflex. Understanding the exact mechanisms of impaired eye stability may lead to the different treatment options that have been documented in recent years. Oscillopsia could also result from an impairment of spatial constancy mechanisms that in normal condition compensate for gaze displacements, but clinical data in this case are scarce. However, we suggest that some visuo-perceptive deficits consecutive to temporo-parietal lesions resemble oscillopsia and could result from a deficit in elaborating spatial constancy.

Gentamicin ototoxicity: clinical features and the effect on the human vestibulo-ocular reflex

CONCLUSIONS

Gentamicin ototoxicity presents with gait imbalance and oscillopsia, but only rarely with hearing loss and vertigo. Sinusoidal rotational stimuli with high accelerations such as the bedside head-thrust test or rotational step changes in velocity are useful to diagnose bilateral vestibulopathy.

OBJECTIVE

To describe the salient clinical features and vestibular testing results in gentamicin ototoxicity.

PATIENTS AND METHODS

A retrospective review of the quantitative vestibular function testing results for patients presenting to the UCLA Neurotology Clinic with gentamicin ototoxicity over the past 10 years (n=35).

RESULTS

All patients presented with imbalance and 33 out of 35 had oscillopsia. Three patients reported a noticeable change in hearing and five reported vertigo. Of the 35 patients, 15 were in renal failure at the time of gentamicin administration. Patients with pre-existing peripheral neuropathy compensated poorly. Sinusoidal rotational testing demonstrated profoundly decreased gain and increased phase lead over the entire frequency range, with a subset of patients having relatively preserved gain at the intermediate frequencies (0.8-1.6 Hz) and low acceleration (<30 degrees/s). There was little or no response to high acceleration step changes in velocity. The time constant measured both by sinusoidal and step responses was ultra-low. All patients tested had a positive head-thrust test bilaterally.

Visual motion detection in patients with absent vestibular function

Labyrinthine defective subjects (LDS) experience oscillopsia during head movements due to the absence of the vestibulo-ocular reflex (VOR). The purpose of this study was to compare horizontal and vertical visual motion detection in LDS during (i) body-stationary and (ii) horizontal whole-body oscillation conditions. Twelve LDS and controls detected the onset of drift direction of a grating that moved with accelerating velocity. Thresholds were raised in the patient group in both conditions. The loss of the VOR per se cannot explain raised thresholds in the body-stationary condition nor during whole-body (horizontal) oscillation with vertical grating motion. Findings indicate changes in visual processing that make LDS less sensitive to visual motion. It is postulated that these changes are due to adaptive mechanisms involved to reduce oscillopsia.

Elevated visual motion detection thresholds in adults with acquired ophthalmoplegia

AIMS

To test the hypothesis that in patients with acquired chronic bilateral ophthalmoplegia, abnormal retinal image slippage during head movements would result in abnormal thresholds for visual perception of motion.

METHODS

Five patients (two males and three females) with ophthalmoplegia were included in the study. The average age was 44 years (range 30-69 years). The aetiology of ophthalmoplegia was myasthenia gravis (MG; n=2), chronic progressive external ophthalmoplegia (CPEO; n=2), and chronic idiopathic orbital inflammation. Visual motion detection thresholds were assessed using horizontal and vertical gratings (spatial frequency) set at thresholds for visibility. The grating was then accelerated at 0.09 deg/s(2). The subject's task was to detect the drift direction of the stimulus.

RESULTS

Visual motion detection thresholds were raised to a mean of 0.434 deg/s (SD 0.09) (mean normal value 0.287 deg/s (SD 0.08)) for horizontal motion; and to a mean of 0.425 deg/s (SD 0.1) (mean normal value 0.252 deg/s (SD 0.08)) for vertical motion. The difference in values for both horizontal and vertical motion detection were statistically significant when compared with age matched controls; p <0.023 for horizontal motion and p<0.07 for vertical motion (two tailed t test).

CONCLUSION

Abnormally raised visual motion thresholds were found in patients with ophthalmoplegia. This may represent a centrally mediated adaptive mechanism to ignore excessive retinal slip and thus avoid oscillopsia during head movements.

Increased retinal image velocity after vestibular lesion

The vestibulo-ocular reflex stabilizes gaze during head movements by producing compensatory eye movements. Retinal image velocity (RIV) is defined as the difference between the eye and head velocities. The RIV of 20 vestibular schwannoma (VS) patients and 17 healthy controls was measured with a head autorotation test. The head autorotation test had a sensitivity of 80% and a specificity of 88%. The mean RIV (degree/second) +/- 95% confidence intervals of the VS patients in the 5 frequency bands of 1 to 5 Hz was respectively 4.8 (4.2 to 5.5), 11.5 (8.6 to 14.4), 21.7 (15.5 to 27.9), 25.2 (17.1 to 33.4), and 26.1 (13.1 to 39.1). The RIV of the VS patients was asymmetrically larger on the operated side (P<0.05) in the frequency band of 1 Hz. The mean RIV was significantly (P<0.05) larger in the VS patients than in the controls in the frequency bands of 1 to 4 Hz. The vestibulo-ocular reflex is inaccurate after VS surgery; but the inaccuracy may not lead to the occurrence of any symptoms.

Adaptation to oscillopsia: a psychophysical and questionnaire investigation

In this study we explore the reasons why patients with bilateral vestibular failure report disparate degrees of oscillopsia. Twelve bilateral labyrinthine-defective (LD) subjects and twelve normal healthy controls were tested using a self- versus visual-motion psychophysical experiment. The LD subjects also completed a questionnaire designed to quantify the severity of handicap caused by oscillopsia. Additional standardized questionnaires were completed to identify the role of personality, personal beliefs and affective factors in adaptation to oscillopsia. During the psychophysical experiment subjects sat on a motorized Barany chair whilst viewing a large-field projected video image displayed on a screen in front of them. The chair and video image oscillated sinusoidally at 1 Hz in counter-phase at variable amplitudes which were controlled by the subject but constrained, so that the net relative motion of the chair and video image always resulted in a sinusoid with a peak velocity of 50 degrees /s. The subject's task was to find the ratio of chair versus video image motion that subjectively produced the 'most comfortable visual image'. Eye movements were recorded during the experiment in order that the net retinal image slip at the point of maximum visual comfort could be measured. The main findings in the LD subjects were that, as a group, they selected lower chair motion amplitude settings to obtain visual comfort than did the normal control subjects. Responses to the questionnaires highlighted considerable variation in reported handicap due to oscillopsia. Greater oscillopsia handicap scores were significantly correlated with a greater external locus of control (i.e. the perception of having little control over one's health). Retinal slip speed was negatively correlated with oscillopsia handicap score so that patients who suffered the greatest retinal slip were those least handicapped by oscillopsia. The results suggest that adaptation to oscillopsia is partly related to the patient's personal attitude to the recovery process and partly associated with the development of tolerance to the movement of images on the retina during self-motion. The latter is likely to be related to previously described changes in visual motion sensitivity in these patients.

Oscillopsia: visual function during motion in the absence of vestibulo-ocular reflex

OBJECTIVES

To investigate (1) the effects of loss of vestibular function on spatiotemporal vision and (2) the mechanisms which enable labyrinthine defective (LD) patients to adapt to oscillopsia.

METHODS

Visual function and eye movements were assessed in seven normal subjects and four LD patients with oscillopsia due to absent vestibulo-ocular reflex. Temporal vision was assessed by measurement of threshold sensitivity for detection of a target which moved across a flickering, spatially uniform background field. Spatial vision was investigated by measurements of threshold sensitivity for the detection of a target moving across a spatially modulated background in the form of square wave gratings. Velocity discrimination was assessed with drifting gratings. All measurements were made under static conditions and during oscillatory movement of either the visual stimulus or the subject (1 Hz, peak velocity 50 degrees/s).

RESULTS

Temporal responses--Normal subjects and LD patients exhibited similar responses while static and under body oscillation. Spatial responses--The two groups achieved similar results under static conditions but body oscillation reduced threshold sensitivities and shifted the spatial response function towards lower spatial frequencies in the LD patients only. Similar changes in the spatial responses were seen during oscillation of the visual stimulus but these occurred in both normal subjects and LD patients. Velocity discrimination--Two LD patients achieved normal velocity discrimination but the other two showed abnormal responses to visual stimulus movement; one displayed a loss of velocity discrimination during whole body oscillation, and the other mismatched the velocity of two moving grating stimuli.

CONCLUSIONS

The changes in the spatial responses are attributed to the presence of retinal slip during visual stimulus motion in all subjects or body oscillation in the LD patients. It is concluded that any visual adaptation to oscillopsia achieved by the LD patients does not influence the measured spatial response functions, which arise at an early stage of visual processing. The abnormal velocity discrimination may relate to the progressive improvement in oscillopsia reported by LD patients.

Bilateral vestibular failure impairs visual motion perception even with the head still

Visual motion perception of a single object, moving with a constant angular velocity of 40 min of arc/s in four orthogonal directions, was measured in eight patients with chronic bilateral vestibular failure (BVF) with the head stationary. Perception of object motion was more severely impaired for horizontal than for vertical directions and the impairment was more pronounced in the dominant eye than the nondominant eye. Impaired motion perception in patients with BVF is best explained by a central visual mechanism that suppresses oscillopsia due to the involuntary retinal slip caused by the defective vestibulo-ocular reflex (VOR). This mechanism cannot be switched off with the head stationary (inactive VOR) and thus causes a measurable deficit of motion perception.

Peripheral stimulus localization by infants with eye and head movements during visual attention

The effect of attention to a focal stimulus on 14, 20 and 26-week-old infant's peripheral stimulus localization with eye and head movements was examined in this study. Fixation was engaged on a stimulus in the central visual field and a stimulus was presented in the periphery immediately or after a delay. Peripheral stimulus localization occurred less frequently near the beginning of fixation and when a significant heart rate deceleration had occurred (sustained attention), compared with when no focal stimulus was present or after heart rate had returned to prestimulus level (attention termination). Localization was accompanied by head movements on more than two-thirds of the trials, and the likelihood of head movements was positively associated with stimulus eccentricity. The saccades to localize the peripheral stimulus had unusually high velocities in the attention conditions for the two older aged groups relative to their saccades in inattentive conditions. There were unusual "localizing head movements" in the attention conditions in the absence of localizing saccades or changes in fixation for the two older age groups. Infant attention modulates eye movement characteristics of infants. These data also support the hypothesis that eye and head movement systems are relatively independent in the infant, and that eye-head relations during infant attention may be different from during inattention.

Perception of direction of visual motion. I. Influence of angular body acceleration and tilt

We investigated, psychophysically, the influence of body rotation on visual motion direction thresholds for both upright sitting and tilted observers. Four angular accelerations (0, 20, 40 and 60 degrees/s2) were combined with 3 concurrent backward-tilt positions (0, 45 and 90 degrees). This led to combined stimulation of the semicircular canals and otoliths. Vestibular stimulation was combined with a visual motion stimulus. Random-dot kinematograms in which varying percentages of pixels coherently moving to the left were presented upon a background of otherwise randomly moving pixels (random walk). The smallest percentage of coherently moving pixels leading to a clear perception of motion direction represented as the perceptual threshold. Angular accelerations about the longitudinal body axis significantly increased motion-direction thresholds. Concurrent backward tilt did not influence thresholds. These results differ from those of studies in which translational linear acceleration was employed. Our results support the view that it is necessary to distinguish between linear acceleration caused by gravitational forces and that caused by additional linear accelerations about the x-, y-, and z-axes.

Processing of visual motion direction in the fronto-parallel plane in the stationary or moving observer

To examine the effect of concurrent self-motion on the perception of the direction of object-motion, random-dot kinematograms were employed in which the strength of the directional signal was manipulated by varying the percentage of coherently moving pixels. The subject's task was to indicate the motion direction of briefly presented displays while undergoing whole body rotations with angular accelerations of 0, 5, 15, or 45 degrees/s2. The perception of the direction of visual motion in the horizontal plane was impaired only when visual and vestibular motion directions were incongruous. The impairment increases with both increasing angular acceleration and decreasing percentage of coherently moving pixels. For object-motion in the vertical plane, an impairment was found for both congruous and incongruous combination of visual and vestibular stimulation, although not as pronounced for the latter (i.e., visual upward, vestibular downward stimulation, and vice versa). These results are discussed in terms of postnatal development and neurophysiological optimization processes resulting from intersensory 'updating' through every-day experience of object-motion during self-motion.

Vision during motion in patients with absent vestibular function

We have measured a spatial visual response and visual velocity discrimination in 4 patients with long standing vestibular loss and 6 controls. The spatial response was measured during; i) body and visual display stationary conditions, ii) whole-body oscillation (1 Hz +/- 50 degrees/s) and iii) visual stimulus oscillation (1 Hz +/- 50 degrees/s). Velocity discrimination was assessed during conditions i) and ii). The visual tests applied were selected on the basis that the spatial response is known to reflect peripheral processes of the retina, whereas velocity processing is more central in origin. Patients had normal spatial responses under static conditions and they suffered a degradation in their spatial responses during whole-body oscillation, whereas, normals' responses remained unaltered. During oscillation of the visual display both patients and normals suffered a degradation in their spatial responses, and for patients the change was very similar to that observed during whole-body oscillation. The changes in the spatial responses were dependent on the gain of the eye movements which compensated for the whole-body or visual display oscillation. In 3 patients and all controls whole-body oscillation did not alter the discrimination of velocity of a vertically moving horizontally orientated grating compared with when the subjects were stationary. One patient suffered a severe reduction in the ability to discriminate velocity under whole-body oscillation, which suggests that central suppression of motion perception reduces oscillopsia.

Autorotation test of the horizontal vestibulo-ocular reflex in Menière's disease

Sixty-four patients with the diagnosis of Menière's disease were tested at the House Ear Clinic with an active head-rotation test system, the Vestibular Autorotation Test (VAT). The VAT is a portable, computerized test that measures the horizontal vestibulo-ocular reflex (VOR) with the use of high-frequency (2 to 6 Hz) active head movements to obtain gain and phase. The purpose of this study was to characterize the horizontal VOR at high frequencies in patients with Menière's disease. At frequencies from 5 to 6 Hz, all patients demonstrated horizontal phase greater than 180 degrees and 85% showed abnormal VAT results. The most common patterns were decreased gain or increased phase values, or both, relative to normative data. No significant differences in the degree of abnormality in gain and phase were noted among groups of patients when the patients were clinically staged. We conclude that, in our test population of patients with Menière's disease, the VAT shows common gain and phase patterns and abnormalities of the horizontal VOR. This may contribute to high retinal image velocities, which render the patient unable to stabilize retinal images during locomotion (visual field image slip), in as many as 85% of the patients tested, regardless of clinical stage. Such high-frequency testing can reveal abnormalities of the horizontal VOR not apparent from conventional vestibular testing. Thus VAT provides additional information about the functioning VOR when combined with the present vestibular test battery.

The relationship between vestibulo-ocular reflex plasticity and changes in apparent concomitant motion

The vestibulo-ocular reflex (VOR) and the apparent motion of a spot stimulus fixated during head movement (apparent concomitant motion, ACM) were measured before and after an adaptation period during which subjects attempted fixation of a stimulus which moved either in the same or opposite direction as head oscillations. Movements of the head were voluntary and paced by a metronome at either 0.5 or 2.0 Hz during the 4 min adaptation period. Pre- and post-adaptation measures of VOR and ACM were obtained for both frequencies of head oscillation. VOR and ACM were altered similarly by the period of exposure to correlated head and stimulus motion. Viewing a stimulus moving in the same direction as head motion resulted in decreased VOR gain and increased ACM in the opposite direction as head motion. Viewing a stimulus moving opposite head motion resulted in increased VOR gain and increased ACM in the same direction as head movement. Differences between pre- and post-measures tended to be maximal at the adaptation frequency, but transferred to a lesser degree to the other frequency. The results indicate that changes in motor and perceptual systems are related, and are consistent with the proposal that VOR gain is a determinant of ACM.

Oculomotor function during space flight and susceptibility to space motion sickness

Horizontal vestibulo-ocular reflex (VOR) and saccadic eye movements (SEM) were studied in 18 subjects before and during five Space Shuttle missions to evaluate the effects of weightlessness and correlations between results and susceptibility to and actual presence of space motion sickness (SMS). Active sinusoidal head oscillation was the stimulus for VOR tests with vision (VVOR), with eyes shaded (VOR-ES), and VOR suppression (VOR-S). Eye movements were recorded by electrooculography and head position by a potentiometer. No pathological nystagmus or other abnormal eye movements were seen. No significant in-flight changes were seen in the gain, phase shift or waveform of VVOR, VOR-ES, or VOR-S. Statistically significant increases in saccadic latency and decreases in saccadic velocity were seen, with no change in saccadic accuracy. Preflight differences between SMS susceptible and non-susceptible subjects were noted only in VOR-S, with less complete suppression in susceptible subjects, a finding also seen in flight. During flight, VVOR gain was significantly increased in three non-affected subjects. Saccades of SMS-affected subjects showed increased latency and velocity and decreased accuracy compared to saccades of unaffected subjects.

Impairment of auditory processing by simultaneous vestibular stimulation: psychophysical and electrophysiological data

The aim of the experiments reported here was to demonstrate auditory-vestibular interaction both on a psychophysical and on an electrophysiological basis in humans. These results correspond to those recently obtained during simultaneous visual and vestibular stimulation and illustrate experimentally the importance of auditory information processing in spatial orientation. Time to detect the motion of a sound source is significantly increased when simultaneous vestibular stimulation is induced by passive sinusoidal head oscillations. This effect increased with the peak acceleration of the vestibular stimulus (197, 790 and 1777 degrees/s2). Vestibular influence on general auditory information processing without the quality of (object-) motion could be electrophysiologically demonstrated by means of brainstem auditory evoked potentials. The amplitude of component V generated by the inferior colliculi or by neuronal structures located slightly lower in the auditory tract was significantly reduced during concurrent vestibular stimulation. This neuronal brainstem area is a predominant location of biconvergent vestibulo-auditory neurons mediating intersensory information processing at an early neuronal level.

Head stability and gaze during vertical whole-body oscillations

To understand head and eye stabilities during upright locomotion, we investigated head and eye movements during vertical whole-body oscillations of various amplitudes (1 to 10 cm) and frequencies (1 to 3 Hz) in both normal subjects (n = 10) and patients with bilateral labyrinthine loss (n = 5). Vertical oscillations produced pitching motions of the head, of which the amplitude was markedly altered by a change in the oscillation frequency or the displacement. Vertical eye movements, being correlated with pitching head movements, were scarcely modified by gaze at 2 and 3 Hz. Acquired bilateral lesions presented deteriorated head stability and physically induced eye movements under stronger stimulations. However, significant increase of head movement upon stepping and suppression of pitching motion upon running, both characteristically found in bilateral lesions, were not reproduced by passive oscillations. Thus, these features during active locomotion may result from imbalance produced by alternate bipedal motions and from adaptation to minimize oscillopsia, respectively.

Electrophysiological evidence for visual-vestibular interaction in man

The aim of the experiments reported here was to confirm electrophysiologically the results of psychophysical experiments, which demonstrated that thresholds for object-motion detection are significantly raised during both concurrent active or passive sinusoidal head oscillations and during visually induced self-motion perception (circularvection, CV). This intersensory inhibition could now be demonstrated electrophysiologically by recording visual motion evoked potentials both during concurrent sinusoidal head oscillations and during visually induced apparent self-motion of the objectively stationary subject. Recordings of visual contrast reversal evoked potentials failed to reveal such an interaction. Perceptual phenomena with multisensory stimulation are well described in the literature. Berthoz et al. demonstrated the dominant influence of the visual channel on vestibular thresholds such that the detection of a suprathreshold vestibular stimulation was clearly impaired by a simultaneously moving visual pattern inducing linearvection and vice versa. Comparable results are reported for circularvection. Evidence for inhibitory interaction between object-motion and simultaneous self-motion perception also exists. Electrophysiological data on intersensory interaction in humans have only been reported between electrical stimulation of a limb and its concurrent movement by means of scalp-recorded somatosensory-evoked potentials (SSEPs) (e.g. refs. 3, 5). Electrophysiological evidence for the interaction of visual object-motion and vestibular self-motion perception in humans has never been reported in the literature thus far, though Hood and Kayan demonstrated that retinal image motion makes a contribution to the vestibularly evoked bioelectric response.

Mechanisms of recovery following unilateral labyrinthectomy: a review

This paper reviews the literature on the mechanisms responsible for the behavioural recovery which occurs following unilateral labyrinthectomy (UL), UL causes a syndrome of ocular motor and postural disorders, which diminish over time in a process of behavioural recovery known as vestibular compensation. Electrophysiological studies show that the VIIIth nerve does not undergo a functional recovery, therefore vestibular compensation has been attributed to CNS plasticity. However, the nature of the plasticity responsible for vestibular compensation is not understood. Single-neuron studies have demonstrated that a significant recovery of resting activity has occurred in the vestibular nuclei (VN) ipsilateral to the UL by the time symptoms such as spontaneous nystagmus and roll head tilt (static symptoms) have largely disappeared. However, many of the deficits in the response of VN neurons to head acceleration persist and may be permanent. This lack of recovery in the response of neurons to head acceleration correlates with the incomplete and sometimes poor recovery of the vestibulo-ocular and vestibulo-spinal reflex responses to head movement (dynamic symptoms). The major neuronal change in the VN during vestibular compensation appears to be the recovery of resting activity in the VN ipsilateral to the UL, although this recovery is more pronounced in the medial VN than in the lateral VN. The mechanism responsible for the regeneration of resting activity in VN neurons is unknown. In frogs, there is evidence to suggest that transcommissural synaptic input to the VN, from the contralateral (intact) labyrinth, increases in efficacy.(ABSTRACT TRUNCATED AT 250 WORDS)

Vestibulo-ocular reflex and gaze functions in a patient with congenital inner ear anomalies

We report on the vestibulo-ocular reflex (VOR) and gaze functions during horizontal rotations as well as upright locomotions in a fisherman with congenital inner ear anomalies. The finding of a marked gaze disturbance due to low VOR gain during passive rotations resembled that found in early acquired lesions. There was an improvement during active rotations, suggesting an intensified cervico-ocular reflex. Although head oscillations in the horizontal plane were abnormally large during stepping and running, they were compensated for visually even at high frequencies. The absence of complaints of oscillopsia as well as his ability to achieve proper balance seemed to be accomplished by his optokinetic ability, regularly transformed head oscillations and modified perceptive mechanisms at higher cortical levels.

Oscillopsia of peripheral vestibular origin. Central and cervical compensatory mechanisms

Eight patients with absent vestibular function categorized into four grades according to the disability they suffered from oscillopsia have been studied with a view to correlating its severity with the development of gaze stabilizing compensatory mechanisms. Eye movements were recorded while the following sinusoidal rotational stimuli were delivered: 1) trunk on head oscillation in the dark (COR); 2) head on trunk oscillation in the dark; 3) head on trunk and whole body (head and trunk) oscillation in the light in the presence of optic fixation. The COR was potentiated in all the patients regardless of their clinical status. Velocity gains (peak slow phase eye velocity/peak head velocity) during whole body rotation were significantly lower than head on trunk gains in the light in the better compensated patients. Since in the absence of vestibular function whole body rotation involves only the otokinetic system (OKN), this finding implies a depression of the OKN in these patients which can be corrected during head on trunk movements by virtue of a dynamic input from the neck. The results suggest that the processes of recovery from oscillopsia are dependent, in the main, upon the development of central mechanisms by means of which undesirable image movement across the retina is perceptually suppressed. Depression of OKN may be secondary to this perceptual rearrangement.

Familial congenital vestibular areflexia

Three cases in one family are presented with oscillopsia due to vestibular areflexia, but without hearing loss. There was no history of other neurological or otological diseases (including infectious diseases) or use of neuro-ototoxic drugs. Laboratory tests, including tests for autoimmune diseases, were undisturbed. Petrosal radiographs and brain CT scans were normal. The pedigree suggested autosomal recessive inheritance.

A new optical treatment for oscillopsia

A simple optical device (spectacles plus contact lens) enabling viewing of the real world with either partial or almost-complete retinal image stabilisation has been tested in patients with oscillopsia caused by nystagmus. The device gave a useful improvement in vision in two of 14 patients. Reasons for success and failure were clear and are discussed. Obvious contraindications include severe optic atrophy, titubation and dementia. Net benefit is also unlikely if there is a good null point or area to the nystagmus, or if acuity (corrected but unstabilized) is 6/9 or better. It is not suitable for the treatment of oscillopsia caused by failure of the vestibulo-ocular reflex.

Compensatory eye movements during active head rotation for near targets: effects of imagination, rapid head oscillation and vergence

Because the center of natural head rotation lies some distance behind the centers of eye rotation, the VOR has to operate with a gain substantially above 1 for there to be stable fixation of targets lying near the head. In humans, VOR gain was increased inversely proportional to fixation distance and changed with the angle of the head for very near targets. These effects were also evident when the subject imagined the target. However, this "high-gain" VOR was found to deteriorate substantially at frequencies beyond ca 2.5 Hz. In conditions without visual feedback, the VOR gain enhancement due to near fixation was disrupted by monocular viewing. When the subjects wore lenses to relax or increase accommodation, the lenses were found to have no effect on VOR gain. On the other hand, prisms of equivalent power to the lenses had a large effect whereby gain was adjusted according to the vergence state of the eyes. This suggests that VOR gain modulation is under the direct control of convergence.

Object-motion detection affected by concurrent self-motion perception: psychophysics of a new phenomenon

Thresholds for object-motion detection are significantly raised when concurrent self-motion perception is induced by either vestibular, or visual, or cervico-somatosensory stimulation. Active sinusoidal horizontal head oscillations with compensatory vestibulo-ocular reflex (VOR) and foveal or eccentrical target presentation; 'passive' head movements with fixation suppression of the VOR; pure body oscillations with the head fixed in space (cervical stimulation); optokinetically induced apparent self-motion (circularvection). This new visual phenomenon of a physiological 'inhibitory interaction' between object- and self-motion perception seems to have a somatosensory motor analogue. It may reflect the disadventageous side effect due to unspecificness of an otherwise beneficial space constancy mechanism, which provides us with the image of a stable world during locomotion.

A discussion of the dynamic illegible "E" test: a new method of screening for aminoglycoside vestibulotoxicity

Although aminoglycoside antibiotics have been successful in controlling infections, the side effects of these drugs include vestibulotoxicity that can be irreversible. In a patient with intact visual and proprioceptive systems, the effects can be compensated for, but in a patient with impairment of one of these systems, loss of vestibular function can be devastating. There is little if any agreement in the literature about how to monitor patients undergoing therapy with these drugs. A reading test is described. It uses the ability of the vestibulo-ocular reflex to stabilize an image during head movement. The test is quantified using change in visual acuity with head movement to monitor damage to the vestibular system. Patients with loss of vestibular function are incapable of performing the test. Some evidence points to the test being more sensitive than standard caloric irrigations. We propose that it be used to monitor patients receiving aminoglycoside antibiotics.

Interaction between perceived self-motion and object-motion impairs vehicle guidance

When one is riding in a vehicle, perceptual thresholds for motion of objects are significantly elevated above those determined under corresponding but simulated conditions in the laboratory without concurrent self-motion perception. Authorities on road traffic accidents should thus consider an additional perceptual time of at least 300 milliseconds for detecting critical changes in headway beyond the usual reaction time. Detection times thus corrected consequently lead to an alteration of our conception of safe intervehicle distances in a convoy. This elevation of thresholds for object-motion during self-motion, with its consequences for visual control of vehicle guidance, can be seen as a disadvantageous side effect of an otherwise beneficial space-constancy mechanism, which provides us with a stable world during locomotion.

Changes in the human vestibulo-ocular reflex after loss of peripheral sensitivity

Quantitative rotational testing was used to study changes in the vestibulo-ocular reflex of patients with unilateral and bilateral peripheral vestibular lesions. Compared with normal subjects, the patients exhibited a characteristic pattern of decreased gain and increased phase lead at low frequencies of sinusoidal stimulation and decreased time constants on impulsive stimulation. By contrast, gain and phase measurements on high-frequency-low-amplitude sinusoidal stimulation were often normal. In the patients with bilateral lesions, the results of caloric testing correlated with the results of low-frequency rotational testing but not with the results of high-frequency testing. There are two main clinical implications of these findings. First, patients with absent response to caloric stimulation (unilateral or bilateral) may have a normal response to high-frequency sinusoidal rotation (i.e., the frequencies that constitute most natural head movements). This probably explains why such patients do not report oscillopsia. Second, low-frequency sinusoidal rotational testing and caloric testing are more sensitive than high-frequency sinusoidal or impulsive rotational testing for detecting early loss of vestibular sensitivity due, for example, to ototoxic drugs.

Looking with a paralysed eye: adaptive plasticity of the vestibulo-ocular reflex

When a patient with a peripheral monocular paresis is forced to look with the paretic eye, head movements induce the sensation of an unstable visual world. The patient behaves as if he had acute bilateral labyrinthine lesions. These symptoms are due to the lack of compensatory ocular movement and the patients complain that the visual objects move in the direction opposite to the head. The patients develop ataxia, nausea, vomiting and past pointing. The symptoms, however, are transient and consistently disappear after approximately 48 hours. The central adaptation to looking and seeing with the paralysed eye is associated with a plastic change of the VOR. This plastic adaptation is probably induced by the large retinal slip produced by the lack of compensatory movement of the eye and can be studied in the normally mobile eye in the dark. The psychophysical adaptation is probably generated by an efferent copy or corollary discharge of the vestibular system to the visual system that cancels the retinal error.