Neural mechanisms for the control of vergence eye movements

Behind mouse eyes: The function and control of eye movements in mice

The mouse visual system has become the most popular model to study the cellular and circuit mechanisms of sensory processing. However, the importance of eye movements only started to be appreciated recently. Eye movements provide a basis for predictive sensing and deliver insights into various brain functions and dysfunctions. A plethora of knowledge on the central control of eye movements and their role in perception and behaviour arose from work on primates. However, an overview of various eye movements in mice and a comparison to primates is missing. Here, we review the eye movement types described to date in mice and compare them to those observed in primates. We discuss the central neuronal mechanisms for their generation and control. Furthermore, we review the mounting literature on eye movements in mice during head-fixed and freely moving behaviours. Finally, we highlight gaps in our understanding and suggest future directions for research.

Exploring Binocular Visual Attention by Presenting Rapid Dichoptic and Dioptic Series

This study addresses an issue in attentional distribution in a binocular visual system using RSVP tasks under Attentional Blink (AB) experimental protocols. In Experiment 1, we employed dichoptic RSVP to verify whether, under interocular competition, attention may be captured by a monocular channel. Experiment 2 was a control experiment, where a monoptic RSVP assessed by both or only one eye determines whether Experiment 1 monocular condition results were due to an allocation of attention to one eye. Experiment 3 was also a control experiment designed to determine whether Experiment 1 results were due to the effect of interocular competition or to a diminished visual contrast. Results from Experiment 1 revealed that dichoptic presentations caused a delay in the type stage of the Wyble's eSTST model, postponing the subsequent tokenization process. The delay in monocular conditions may be further explained by a visual attenuation, due to fusion of target and an empty frame. Experiment 2 evidenced the attentional allocation to monocular channels when forced by eye occlusion. Experiment 3 disclosed that monocular performance in Experiment 1 differs significantly from conditions with interocular competition. While both experiments revealed similar performance in monocular conditions, rivalry conditions exhibit lower detection rates, suggesting that competing stimuli was not responsible for Experiment 1 results. These findings highlight the differences between dichoptic and monoptic presentations of stimuli, particularly on the AB effect, which appears attenuated or absent in dichoptic settings. Furthermore, results suggest that monoptic presentation and binocular fusion stages were a necessary condition for the attentional allocation.

Pupillary dynamics, accommodation and vergence in concussion

Concussion, which is usually associated with head injuries, has received considerable attention in recent years because of its possible long-term cognitive and visual consequences. The review summarised the mild traumatic brain injury literature. Pupillary dynamics, which are primarily mediated by the autonomic nervous system, play an important function in regulating the amount of light entering the eye, but they can be dramatically impacted after a concussion. This can result in aberrant pupillary responses, which may have ramifications for light sensitivity, a common post-concussion symptom. In concussed individuals, accommodation and vergence - the visual processes responsible for focusing on near and distant objects - might be interrupted, potentially leading to fuzzy vision, eyestrain, and difficulty with tasks that require precise visual coordination. Understanding the delicate interplay between these three components of vision in the setting of concussions is critical for creating more targeted diagnostic and rehabilitative techniques, ultimately enhancing the quality of life for those who have had head injuries.

Using Natural Scenes to Enhance our Understanding of the Cerebral Cortex's Role in Visual Search

Using natural scenes is an approach to studying the visual and eye movement systems approximating how these systems function in everyday life. This review examines the results from behavioral and neurophysiological studies using natural scene viewing in humans and monkeys. The use of natural scenes for the study of cerebral cortical activity is relatively new and presents challenges for data analysis. Methods and results from the use of natural scenes for the study of the visual and eye movement cortex are presented, with emphasis on new insights that this method provides enhancing what is known about these cortical regions from the use of conventional methods.

Utility of a cheiroscope to test for simultaneous perception and sensory fusion

CLINICAL RELEVANCE

The synoptophore has been used clinically to assess simultaneous perception and sensory fusion in strabismic patients; however, due to suppression or the visual condition of patients with normal stereopsis, a synoptophore does not always detect simultaneous perception or sensory fusion. A cheiroscope may be a better alternative.

BACKGROUND

The aim of this work was ro determine whether a cheiroscope could be useful for examining simultaneous perception and sensory fusion in strabismus patients.

METHODS

Thirty-three patients with strabismus who could undergo cheiroscopic tracing were categorised into two groups: the intermittent exotropia group (XT; n = 19; mean age 9.8 ± 5.6 yrs, range 5-23 yrs) and the esotropia group (ET; n = 14; mean age 10.2 ± 6.0 yrs, range 4-23 yrs). Two sizes of square line drawings (20° and 6°) were used for the cheiroscopic tracing. The cheiroscopic tracing results were compared with those of synoptophore testing for simultaneous perception and sensory fusion.

RESULTS

The rate of cheiroscopic tracing of detecting sensory fusion was significantly higher than that of the synoptophore. With the synoptophore, simultaneous perception was detected in 89.5% and 85.7% of the XT and ET patients, and sensory fusion was detected in 73.7% and 71.4%, respectively. The synoptophore identified 11 patients who had no simultaneous perception or sensory fusion. Among them, eight patients were associated with suppression and two patients were 4 years old.

CONCLUSION

Cheiroscopic tracing is useful for determining the presence of simultaneous perception and sensory fusion if they are not detected by a synoptophore due to age < 5 years or suppression.

Pre- and post-season visio-vestibular function in healthy adolescent athletes

OBJECTIVE

To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes.

METHODS

This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season).

RESULTS

Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25).

CONCLUSIONS

Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.

Eye Movements in Mild Traumatic Brain Injury: Ocular Biomarkers

Mild traumatic brain injury (mTBI, or concussion), results from direct and indirect trauma to the head (i.e. a closed injury of transmitted forces), with or without loss of consciousness. The current method of diagnosis is largely based on symptom assessment and clinical history. There is an urgent need to identify an objective biomarker which can not only detect injury, but inform prognosis and recovery. Ocular motor impairment is argued to be ubiquitous across mTBI subtypes and may serve as a valuable clinical biomarker with the recent advent of more affordable and portable eye tracking technology. Many groups have positively correlated the degree of ocular motor impairment to symptom severity with a minority attempting to validate these findings with diffusion tract imaging and functional MRI. However, numerous methodological issues limit the interpretation of results, preventing any singular ocular biomarker from prevailing. This review will comprehensively describe the anatomical susceptibility, clinical measurement, and current eye tracking literature surrounding saccades, smooth pursuit, vestibulo-ocular reflex, vergence, pupillary light reflex, and accommodation in mTBI.

Binocular Integration in the Primate Primary Visual Cortex

binocular vision, binocular fusion, binocular combination, LGN, V1.

Post-traumatic headaches and vision: A review

BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.

Bedside Assessment of Vergence in Stroke Patients

BACKGROUND

Given the widely distributed network of midbrain, pontine, cerebellar, and cortical areas involved in the neural control of vergence, one might expect various vergence deficits in stroke patients. In this article, we investigated the localizing value of bedside vergence testing with respect to different supratentorial and infratentorial infarction locations.

METHODS

Three hundred five stroke patients and 50 age-matched controls were examined prospectively by means of bedside tests to assess slow and fast binocular (i.e., symmetrical) as well as slow and fast monocular (i.e., asymmetrical) convergence. Infarction locations, as identified on MRI, were correlated with vergence performance using multinomial logistic regression.

RESULTS

Vergence deteriorated with age in both stroke patients and healthy controls. Most infarction locations did not show significant associations with vergence parameters, apart from cases with parietal lobe lesions, which exhibited insufficient asymmetrical, slow and fast vergence for both the left and the right eye. Finally, patients with severe ischemic small vessel disease showed a slight but significant decrease in their fast binocular vergence performance.

CONCLUSIONS

There is only a limited localizing value of vergence deficits in stroke. Parietal lobe infarctions are more frequently associated with insufficient binocular and monocular vergence. Midbrain strokes were too few to draw final conclusions. However the most robust factor to emerge from our data is age. Older subjects show poor slow binocular as well as slow and fast monocular vergence. Extended white matter lesions are also correlated with deficient vergence ability suggesting a role for subcortical wide range connections in maintaining an intact vergence circuitry.

Vergence Fusion Sustaining Oscillations

INTRODUCTION

Previous studies have shown that the slow, or fusion sustaining, component of disparity vergence contains oscillatory behavior as would be expected if fusion is sustained by visual feedback. This study extends the examination of this behavior to a wider range of frequencies and a larger number of subjects.

METHODS

Disparity vergence responses to symmetrical 4.0 deg step changes in target position were recorded in 20 subjects. Approximately three seconds of the late component of each response were isolated using interactive graphics and the frequency spectrum calculated. Peaks in these spectra associated with oscillatory behavior were identified and examined.

RESULTS

All subjects exhibited oscillatory behavior with fundamental frequencies ranging between 0.37 and 0.55 Hz; much lower than those identified in the earlier study. All responses showed significant higher frequency components. The relationship between higher frequency components and the fundamental frequency suggest may be harmonics. A correlation was found across subjects between the amplitude of the fundamental frequency and the maximum velocity of the fusion initiating component probably due to the gain of shared neural pathways.

CONCLUSION

Low frequency oscillatory behavior was found in all subjects adding support that the slow, or fusion sustaining, component is mediated by a feedback control.

Underlying neurological mechanisms associated with symptomatic convergence insufficiency

Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.

Reliability of Frontal Eye Fields Activation and Very Low-Frequency Oscillations Observed during Vergence Eye Movements: an fNIRS Study

Functional near-infrared spectroscopy (fNIRS), an imaging tool that utilizes infrared light to measure changes within the concentration of oxygenated (HbO) and deoxygenated (HbR) hemoglobin, holds promise to study functional activity from motor, visual, and memory cortical regions using stimulus-induced tasks. This study investigated the reliability for fNIRS to examine cortical activations within the frontal eye fields (FEF) while initiating vergence eye movements, the inward and outward rotation of the eyes. FNIRS data were collected from twenty participants with normal binocular vision while performing vergence eye movements compared to sustained gaze fixation within a block design during two different sessions. Reliability of the experimental protocol was assessed using the intraclass correlation coefficient (ICC). The ICC values ranged from 0.6 to 0.7 for measuring the HbO activation within the vicinity of the FEF. A frequency power spectrum analysis revealed two predominant frequencies within the functional activation signals from the FEF. One high-intensity signal was present at 0.029 Hz, centering around the block design frequency. The peak-intensity signal was observed between 0.012 and 0.018 Hz where this very low-frequency oscillation (VLFO) was hypothesized to be generated by the macrovasculature present near the FEF and should be avoided as a block design frequency in future fNIRS studies to avoid false positive results.

Test-Retest Reliability of Functional Magnetic Resonance Imaging Activation for a Vergence Eye Movement Task

Vergence eye movements are the inward and outward rotation of the eyes responsible for binocular coordination. While studies have mapped and investigated the neural substrates of vergence, it is not well understood whether vergence eye movements evoke the blood oxygen level-dependent signal reliably in separate experimental visits. The test-retest reliability of stimulus-induced vergence eye movement tasks during a functional magnetic resonance imaging (fMRI) experiment is important for future randomized clinical trials (RCTs). In this study, we established region of interest (ROI) masks for the vergence neural circuit. Twenty-seven binocularly normal young adults participated in two functional imaging sessions measured on different days on the same 3T Siemens scanner. The fMRI experiments used a block design of sustained visual fixation and rest blocks interleaved between task blocks that stimulated eight or four vergence eye movements. The test-retest reliability of task-activation was assessed using the intraclass correlation coefficient (ICC), and that of spatial extent was assessed using the Dice coefficient. Functional activation during the vergence eye movement task of eight movements compared to rest was repeatable within the primary visual cortex (ICC = 0.8), parietal eye fields (ICC = 0.6), supplementary eye field (ICC = 0.5), frontal eye fields (ICC = 0.5), and oculomotor vermis (ICC = 0.6). The results demonstrate significant test-retest reliability in the ROIs of the vergence neural substrates for functional activation magnitude and spatial extent using the stimulus protocol of a task block stimulating eight vergence eye movements compared to sustained fixation. These ROIs can be used in future longitudinal RCTs to study patient populations with vergence dysfunctions.

Target Eccentricity and Form Influences Disparity Vergence Eye Movements Responses: A Temporal and Dynamic Analysis

This study sought to investigate whether stimulation to the fovea or the parafovea with different color combinations influenced the temporal and dynamic features of 4° disparity vergence step responses. Twelve unique types of stimuli were displayed within a haploscope presented along the participant's midsagittal plane. Vergence eye movement responses from fifteen naïve participants were recorded using video-based infrared eye tracking instrumentation. Latency and peak velocity from left and right eye movement responses were quantified. Results show that the type of stimulus projection (foveal versus parafoveal) significantly (p<0.001) influences the vergence response latency but did not impact peak velocity. Vergence responses to eccentric circles with 6° eccentricity targeting the parafovea resulted in a significantly faster response latency compared to vergence responses to a cross with 2° eccentricity stimuli targeting the fovea. Results have implications for the stimulus design of a variety of applications from virtual reality to vision therapy interventions.

Post-therapy Functional Magnetic Resonance Imaging in Adults with Symptomatic Convergence Insufficiency

SIGNIFICANCE

Prior studies have demonstrated the effectiveness of vergence-accommodative therapy in the treatment of convergence insufficiency (CI). These results show the changes in brain activation following therapy through the use of functional magnetic resonance imaging (fMRI).

PURPOSE

The purpose of this study was to investigate changes in brain activation following office-based vergence-accommodative therapy versus placebo therapy for CI using the blood oxygenation level-dependent signal from fMRI.

METHODS

Adults (n = 7, aged 18 to 30 years) with symptomatic CI were randomized to 12 weeks of vergence-accommodative therapy (n = 4) or placebo therapy (n = 3). Vergence eye movements were performed during baseline and outcome fMRI scans.

RESULTS

Before therapy, activation (z score ≥ 2.3) was observed in the occipital lobe and areas of the brain devoted to attention, with the largest areas of activation found in the occipital lobe. After vergence-accommodative therapy, activation in the occipital lobe decreased in spatial extent but increased in the level of activation in the posterior, inferior portion of the occipital lobe. A new area of activation appeared in the regions of the lingual gyrus, which was not seen after placebo therapy. A significant decrease in activation was also observed in areas of the brain devoted to attention after vergence-accommodative therapy and to a lesser extent after placebo therapy.

CONCLUSIONS

Observed activation pre-therapy consistent with top-down processing suggests that convergence requires conscious effort in symptomatic CI. Decreased activation in these areas after vergence-accommodative therapy was associated with improvements in clinical signs such as fusional vergence after vergence-accommodative therapy. The increase in blood oxygen level-dependent response in the occipital areas following vergence-accommodative therapy suggests that disparity processing for both depth and vergence may be enhanced following vergence-accommodative therapy.

A differential role for the posterior cerebellum in the adaptive control of convergence eye movements

INTRODUCTION

The vergence oculomotor system possesses two robust adaptive mechanisms; a fast "dynamic" and a slow "tonic" system that are both vital for single, clear and comfortable binocular vision. The neural substrates underlying these vergence adaptive mechanisms in humans is unclear.

METHODS

We investigated the role of the posterior cerebellum in convergence adaptation using inhibitory continuous theta-burst repetitive transcranial magnetic stimulation (cTBS) within a double-blind, sham controlled design while eye movements were recorded at 250hz via infrared oculography.

RESULTS

In a preliminary experiment we validated our stimulation protocols by reproducing results from previous work on saccadic adaptation during the classic double-step adaptive shortening paradigm. Following this, across a series of three separate experiments we observed a clear dissociation in the effect of cTBS on convergence adaptation. Dynamic adaptation was substantially reduced while tonic adaptation was unaffected. Baseline dynamic fusional vergence response were also unaffected by stimulation.

CONCLUSIONS

These results indicate a differential role for the posterior cerebellum in the adaptive control of convergence eye movements and provide initial evidence that repetitive transcranial magnetic stimulation is a viable tool to investigate the neurophysiology of vergence control. The results are discussed in the context of the current models of implicit motor adaptation of vergence and their application to clinical populations and technology design in virtual and augmented head mounted display architectures.

SIGNIFICANCE STATEMENT

The cerebellum plays a critical role in the adaptive control of motor systems. Vergence eye movements shift our gaze in depth allowing us to see in 3D and exhibit two distinct adaptive mechanisms that are engaged under a range of conditions including reading, wearing head-mounted displays and using a new spectacle prescription. It is unclear what role the cerebellum plays in these adaptive mechanisms. To answer this, we temporarily disrupted the function of the posterior cerebellum using non-invasive brain stimulation and report impairment of only one adaptive mechanism, providing evidence for neural compartmentalization. The results have implications for vergence control models and applications to comfort and experience studies in head-mounted displays and the rehabilitation of clinical populations exhibiting vergence dysfunctions.

Surgical Responses and Outcomes of Bilateral Medial Rectus Recession in Esotropia With Spinocerebellar Ataxia

PURPOSE

To evaluate the surgical responses and outcomes of bilateral medial rectus (BMR) recession in esotropic patients with spinocerebellar ataxia (SCA) and to compare the results with normal controls.

METHODS

The medical records of patients with SCA who underwent strabismus surgery for esotropia between 2006 and 2015 were reviewed retrospectively. Five esotropic patients with SCA (SCA group) and 10 esotropic patients without neurologic disorders (control group) who underwent BMR recession were included. Success rates, surgical responses, and the amount of preoperative and postoperative distance-near disparity were evaluated and compared between the groups.

RESULTS

The mean preoperative esodeviation was not different between the SCA and control groups (20 vs 17.3 prism diopters [PD], P = .214). However, patients with SCA showed significant undercorrection compared with controls 1 week postoperatively (4.8 vs 1.0 PD, P = .048) and at the final follow-up (6.8 vs 1.8 PD, P = .032). The surgical success rates for the SCA and control groups were 40% and 80%, respectively (P = .095). Patients with SCA demonstrated a significantly reduced surgical response compared with controls (3.15 vs 3.87 PD/mm, P = .004), and a greater amount of postoperative distance-near disparity than controls (8.0 vs 1.1 PD, P = .001).

CONCLUSIONS

A significant undercorrection was observed following BMR recession in esotropic patients with SCA. Accordingly, the authors recommend a slight overcorrection of 5 to 10 PD or adding a slanting procedure when planning strabismus surgery for this distinct group of patients. [J Pediatr Ophthalmol Strabismus. 2019;56(4):266-270.].

Binocular Eye Movements Are Adapted to the Natural Environment

Humans and many animals make frequent saccades requiring coordinated movements of the eyes. When landing on the new fixation point, the eyes must converge accurately or double images will be perceived. We asked whether the visual system uses statistical regularities in the natural environment to aid eye alignment at the end of saccades. We measured the distribution of naturally occurring disparities in different parts of the visual field. The central tendency of the distributions was crossed (nearer than fixation) in the lower field and uncrossed (farther) in the upper field in male and female participants. It was uncrossed in the left and right fields. We also measured horizontal vergence after completion of vertical, horizontal, and oblique saccades. When the eyes first landed near the eccentric target, vergence was quite consistent with the natural-disparity distribution. For example, when making an upward saccade, the eyes diverged to be aligned with the most probable uncrossed disparity in that part of the visual field. Likewise, when making a downward saccade, the eyes converged to enable alignment with crossed disparity in that part of the field. Our results show that rapid binocular eye movements are adapted to the statistics of the 3D environment, minimizing the need for large corrective vergence movements at the end of saccades. The results are relevant to the debate about whether eye movements are derived from separate saccadic and vergence neural commands that control both eyes or from separate monocular commands that control the eyes independently.SIGNIFICANCE STATEMENT We show that the human visual system incorporates statistical regularities in the visual environment to enable efficient binocular eye movements. We define the oculomotor horopter: the surface of 3D positions to which the eyes initially move when stimulated by eccentric targets. The observed movements maximize the probability of accurate fixation as the eyes move from one position to another. This is the first study to show quantitatively that binocular eye movements conform to 3D scene statistics, thereby enabling efficient processing. The results provide greater insight into the neural mechanisms underlying the planning and execution of saccadic eye movements.

Clinical Validation of Eye Vergence as an Objective Marker for Diagnosis of ADHD in Children

OBJECTIVE

ADHD youth show poor oculomotor control. Recent research shows that attention-related eye vergence is weak in ADHD children.

METHOD

To validate vergence as a marker to classify ADHD, we assessed the modulation in the angle of vergence of children ( n = 43) previously diagnosed with ADHD while performing an attention task and compared the results with age-matched clinical controls ( n = 19) and healthy peers ( n = 30).

RESULTS

We observed strong vergence responses in healthy participants and weak vergence in the clinical controls. ADHD children showed no significant vergence responses. Machine-learning models classified ADHD patients ( n = 21) from healthy controls ( n = 21) with an accuracy of 96.3% (false positive [FP]: 5.12%; false negative [FN]: 0%; area under the curve [AUC]: 0.99) and ADHD children ( n = 11) from clinical controls ( n = 14) with an accuracy of 85.7% (FP: 4.5%; FN: 19.2%, AUC: 0.90).

CONCLUSION

In combination with an attention task, vergence responses can be used as an objective marker to detect ADHD in children.

Patterns of Pupillary Activity During Binocular Disparity Resolution

This study examined the dynamic coordination between disconjugate, vergence eye movements, and pupil size in 52 normal subjects during binocular disparity stimulation in a virtual reality display. Eye movements and pupil area were sampled with a video-oculographic system at 100 Hz during performance of two tasks, (1) fusion of a binocular disparity step (±1.5° of visual angle in the horizontal plane) and (2) pursuit of a sinusoidally varying binocular disparity stimulus (0.1 Hz, ±2.6° of visual angle in the horizontal plane). Pupil size data were normalized on the basis of responses to homogeneous illumination increments ranging from 0.42 to 65.4 cd/m². The subjects produced robust vergence eye movements in response to disparity step shifts and high fidelity sinusoidal vergence responses (R² relative to stimulus profile: 0.933 ± 0.088), accompanied by changes in pupil area. Trajectory plots of pupil area as a function of vergence angle showed that the pupil area at zero vergence is altered between epochs of linear vergence angle—pupil area relations. Analysis with a modified Gath-Geva clustering algorithm revealed that the dynamic relationship between the ocular vergence angle and pupil size includes two different transient, synkinetic response patterns. The near response pattern, pupil constriction during convergence and pupil dilation during divergence, occurred ~80% of the time across subjects. An opposite, previously undescribed synkinetic pattern was pupil constriction during divergence and pupil dilatation during convergence; it occurred ~15% of the time across subjects. The remainder of the data were epochs of uncorrelated activity. The pupil size intercepts of the synkinetic segments, representing pupil size at initial tropia, had different relationships to vergence angle for the two main coordinated movement types. Hippus-like movements of the pupil could also be accompanied by vergence movements. No pupil coordination was observed during a conjugate pursuit task. In terms of the current dual interaction control model (1), findings suggest that the synkinetic eye and pupillary movements are produced by a dynamic switch of the influence of vergence related information to pupil control, accompanied by a resetting of the pupil aperture size at zero-vergence.

Functional anatomy of human extraocular muscles during fusional divergence

We employed magnetic resonance imaging to quantify human extraocular muscle contractility during centered target fusion and fusional divergence repeated with each eye viewing monocularly at 20 cm through 8Δ and at 400 cm through 4Δ base in prism. Contractility, indicated by posterior partial volume (PPV) change, was analyzed in transverse rectus and in medial and lateral superior oblique (SO) muscle compartments and by cross-sectional area change in the inferior oblique (IO). At 20 cm, 3.1 ± 0.5° (SE) diverging eye abduction in 10 subjects was associated with 4.2 ± 1.5% whole lateral rectus (LR) PPV increase ( P < 0.05) and 1.7 ± 1.1% overall medial rectus (MR) PPV decrease attributable to 3.1 ± 1.8% reduction in the superior compartment ( P < 0.025), without change in its inferior compartment or in muscles of the aligned eye. At 400 cm, 2.2 ± 0.5° diverging eye abduction in nine subjects was associated with 6.1 ± 1.3% whole LR PPV increase ( P < 10^-5) but no change in MR, with compartmentally similar relaxation in the LR and MR of the aligned eye. Unlike convergence, there were no IO or SO contractile changes for divergence to either target nor any change in rectus pulley positions. Results confirm and extend to proximal divergence the unique role of the superior MR compartment, yet no MR role for far divergence. Corelaxation of aligned eye LR and MR combined with failure of MR relaxation during divergence is consistent with the limited behavioral range of divergence. NEW & NOTEWORTHY Magnetic resonance imaging shows that the lateral rectus muscle must overcome continued contraction by its opponent the medial rectus when humans diverge their visual axes to achieve single, binocular vision. While the upper but not lower compartment of the medial rectus assists by relaxing for near targets, it does not do so when targets are far away. This behavior violates Sherrington's law of reciprocal action of antagonists and conventional assumptions about the ocular motor system.

Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children

OBJECTIVE

Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children.

DESIGN

A retrospective cohort of pediatric patients with concussion.

SETTING

A subspecialty pediatric concussion program.

PATIENTS (OR PARTICIPANTS)

Four hundred thirty-two patient records were abstracted.

ASSESSMENT OF RISK FACTORS

Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program.

MAIN OUTCOME MEASURES

The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels.

RESULTS

Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time.

CONCLUSIONS

Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.

Three-dimensional binocular eye-hand coordination in normal vision and with simulated visual impairment

Sensorimotor coupling in healthy humans is demonstrated by the higher accuracy of visually tracking intrinsically-rather than extrinsically-generated hand movements in the fronto-parallel plane. It is unknown whether this coupling also facilitates vergence eye movements for tracking objects in depth, or can overcome symmetric or asymmetric binocular visual impairments. Human observers were therefore asked to track with their gaze a target moving horizontally or in depth. The movement of the target was either directly controlled by the observer's hand or followed hand movements executed by the observer in a previous trial. Visual impairments were simulated by blurring stimuli independently in each eye. Accuracy was higher for self-generated movements in all conditions, demonstrating that motor signals are employed by the oculomotor system to improve the accuracy of vergence as well as horizontal eye movements. Asymmetric monocular blur affected horizontal tracking less than symmetric binocular blur, but impaired tracking in depth as much as binocular blur. There was a critical blur level up to which pursuit and vergence eye movements maintained tracking accuracy independent of blur level. Hand-eye coordination may therefore help compensate for functional deficits associated with eye disease and may be employed to augment visual impairment rehabilitation.

Pupillometry: Psychology, Physiology, and Function

Pupils respond to three distinct kinds of stimuli: they constrict in response to brightness (the pupil light response), constrict in response to near fixation (the pupil near response), and dilate in response to increases in arousal and mental effort, either triggered by an external stimulus or spontaneously. In this review, I describe these three pupil responses, how they are related to high-level cognition, and the neural pathways that control them. I also discuss the functional relevance of pupil responses, that is, how pupil responses help us to better see the world. Although pupil responses likely serve many functions, not all of which are fully understood, one important function is to optimize vision either for acuity (small pupils see sharper) and depth of field (small pupils see sharply at a wider range of distances), or for sensitivity (large pupils are better able to detect faint stimuli); that is, pupils change their size to optimize vision for a particular situation. In many ways, pupil responses are similar to other eye movements, such as saccades and smooth pursuit: like these other eye movements, pupil responses have properties of both reflexive and voluntary action, and are part of active visual exploration.

Response of supraoculomotor area neurons during combined saccade-vergence movements

Combined saccade-vergence movements allow humans and other primates to align their eyes with objects of interest in three-dimensions. In the absence of saccades, vergence movements are typically slow, symmetrical movements of the two eyes in opposite directions. However, combined saccade-vergence movements produce vergence velocities that exceed values observed during vergence alone. This phenomenon is often called "vergence enhancement", or "saccade-facilitated vergence," though it is important to consider that rapid vergence changes, known as "vergence transients," are also observed during conjugate saccades. We developed a visual target array that allows monkeys to make saccades in all directions between targets spaced at distances that correspond to ~1° intervals of vergence angle relative to the monkey. We recorded the activity of vergence-sensitive neurons in the supra-oculomotor area (SOA), located dorsal and lateral to the oculomotor nucleus while monkeys made saccades with vergence amplitudes ranging from 0 to 10°. The primary focus of this study was to test the hypothesis that neurons in the SOA fire a high frequency burst of spikes during saccades that could generate the enhanced vergence. We found that individual neurons encode vergence velocity during both saccadic and non-saccadic vergence, yet firing rates were insufficient to produce the observed enhancement of vergence velocity. Our results are consistent with the hypothesis that slow vergence changes are encoded by the SOA while fast vergence movements require an additional contribution from the saccadic system. NEW & NOTEWORTHY Research into combined saccade-vergence movements has so far focused on exploring the saccadic neural circuitry, leading to diverging hypotheses regarding the role of the vergence system in this behavior. In this study, we report the first quantitative analysis of the discharge of individual neurons that encode vergence velocity in the monkey brain stem during combined saccade-vergence movements.

Reeducation of vergence dynamics improves postural control

INTRODUCTION

The purpose was to investigate the effect of vergence reeducation on postural control, in subjects with isolated vergence disorders.

MATERIAL AND METHODS

We studied the dynamics of vergence in 19 subjects (20-44 years old) using video-oculography (Eye See Cam). On the basis of orthoptic and symptomatology assessments, ten of the subjects were diagnosed for vergence disorders then vergence eye movements were reeducated with the REMOBI method (US8851669, 5 weekly sessions lasting for 35min). Postural control was measured before and after reeducation, postural recording was done in upright stance (Dynaport), with both eyes closed or open and looking a visual target located at 2m distance.

RESULTS

After reeducation with REMOBI, the visual symptomatology faded away and the stereoacuity improved at least for some subjects; the vergence latency decreased significantly and the vergence accuracy increased significantly. In terms of posture, the Mean Power Frequency (MPF) of the body sway decreased significantly in both eyes open and eyes closed conditions. Considering all subjects together (i.e. healthy subjects and subjects with vergence disorders before the reeducation), the antero-posterior body sway (Root Mean Square A/P) was positively correlated with the visual symptomatology: the higher the visual symptomatology, the higher was the body sway.

CONCLUSION

The results bring evidence for synergy between the quality of vergence and the quality of postural control. They open a new research line that bridges the gap between neuroscience, ophthalmology-orthoptics and posturology.

Eye vergence responses during a visual memory task

In a previous report it was shown that covertly attending visual stimuli produce small convergence of the eyes, and that visual stimuli can give rise to different modulations of the angle of eye vergence, depending on their power to capture attention. Working memory is highly dependent on attention. Therefore, in this study we assessed vergence responses in a memory task. Participants scanned a set of 8 or 12 images for 10 s, and thereafter were presented with a series of single images. One half were repeat images - that is, they belonged to the initial set - and the other half were novel images. Participants were asked to indicate whether or not the images were included in the initial image set. We observed that eyes converge during scanning the set of images and during the presentation of the single images. The convergence was stronger for remembered images compared with the vergence for nonremembered images. Modulation in pupil size did not correspond to behavioural responses. The correspondence between vergence and coding/retrieval processes of memory strengthen the idea of a role for vergence in attention processing of visual information.

Attentional Selection Accompanied by Eye Vergence as Revealed by Event-Related Brain Potentials

Neural mechanisms of attention allow selective sensory information processing. Top-down deployment of visual-spatial attention is conveyed by cortical feedback connections from frontal regions to lower sensory areas modulating late stimulus responses. A recent study reported the occurrence of small eye vergence during orienting top-down attention. Here we assessed a possible link between vergence and attention by comparing visual event related potentials (vERPs) to a cue stimulus that induced attention to shift towards the target location to the vERPs to a no-cue stimulus that did not trigger orienting attention. The results replicate the findings of eye vergence responses during orienting attention and show that the strength and time of eye vergence coincide with the onset and strength of the vERPs when subjects oriented attention. Our findings therefore support the idea that eye vergence relates to and possibly has a role in attentional selection.

Vergence Neural Pathways: A Systematic Narrative Literature Review

Research in the neural pathway for vergence is less understood in comparison to the other four visual eye movements. The aim of this study was to review the literature on vergence neural pathways and associated disorders. A review of previous published literature though to March 2016 was conducted. Intracranial pathologies that affect entire neural functioning were found to cause convergence insufficiencies. In contrast, pathologies with a more localised intracranial lesion cause more specific vergence disorders. There is debate as to the potential presence of a "divergence centre." Detailed information on the divergence pathway is lacking and warrants further research.

Attention-Related Eye Vergence Measured in Children with Attention Deficit Hyperactivity Disorder

Recent evidence shows a novel role for eye vergence in orienting attention in adult subjects. Here we investigated whether such modulation in eye vergence by attention is present in children and whether it is altered in children with ADHD compared to control subjects. We therefore measured the angle of eye vergence in children previously diagnosed with ADHD while performing a cue task and compared the results to those from age-matched controls. We observed a strong modulation in the angle of vergence in the control group and a weak modulation in the ADHD group. In addition, in the control group the modulation in eye vergence was different between the informative cue and uninformative cue condition. This difference was less noticeable in the ADHD group. Our study supports the observation of deficient binocular vision in ADHD children. We argue that the observed disruption in vergence modulation in ADHD children is manifest of altered cognitive processing of sensory information. Our work may provide new insights into attention disorders, like ADHD.

Deficits in the Activation of Human Oculomotor Nuclei in Chronic Traumatic Brain Injury

Binocular eye movements form a finely tuned system that requires accurate coordination of the oculomotor dynamics of the brainstem control nuclei when tracking the fine binocular disparities required for 3D vision. They are particularly susceptible to disruption by brain injury and other neural dysfunctions. Here, we report functional magnetic resonance imaging activation of the brainstem oculomotor control nuclei by binocular saccadic and vergence eye movements, and significant reductions in their response amplitudes in mild or diffuse traumatic brain injury (dTBI). Bilateral signals were recorded from a non-TBI control group (n = 11) in the oculomotor control system of the superior colliculi, the oculomotor nuclei, the abducens nuclei, and in the supra-oculomotor area (SOA), which mediate vergence eye movements. Signals from these nuclei were significantly reduced overall in a dTBI group (n = 12) and in particular for the SOA for vergence movements, which also showed significant decreases in velocity for both the convergence and divergence directions.

Mapping the macaque superior temporal sulcus: functional delineation of vergence and version eye-movement-related activity

It is currently thought that the primate oculomotor system has evolved distinct but interrelated subsystems to generate different types of visually guided eye movements (e.g., saccades/smooth pursuit/vergence). Although progress has been made in elucidating the neural basis of these movement types, no study to date has investigated all three movement types on a large scale and within the same animals. Here, we used fMRI in rhesus macaque monkeys to map the superior temporal sulcus (STS) for BOLD modulation associated with visually guided eye movements. Further, we ascertained whether modulation in a given area was movement type specific and, if not, the modulation each movement type elicited relative to the others (i.e., dominance). Our results show that multiple areas within STS modulate during all movement types studied, including the middle temporal, medial superior temporal, fundus of the superior temporal, lower superior temporal, and dorsal posterior inferotemporal areas. Our results also reveal an area in dorsomedial STS that is modulated almost exclusively by vergence movements. In contrast, we found that ventrolateral STS is driven preferentially during versional movements. These results illuminate an STS network involved in processes associated with multiple eye movement types, illustrate unique patterns of modulation within said network as a function of movement type, and provide evidence for a vergence-specific area within dorsomedial STS. We conclude that producing categorically different eye movement types requires access to a common STS network and that individual network nodes are recruited differentially based upon the type of movement generated.

A pilot study of disparity vergence and near dissociated phoria in convergence insufficiency patients before vs. after vergence therapy

Purpose: This study examined the relationship between the near dissociated phoria and disparity vergence eye movements. Convergence insufficiency (CI) patients before vergence therapy were compared to: (1) the same patients after vergence therapy; and (2) binocularly normal controls (BNC).

Methods: Sixteen subjects were studied—twelve BNC and four with CI. Measurements from the CI subjects were obtained before and after 18 h of vergence eye movement therapy. The near dissociated phoria was measured using the flashed Maddox rod technique. Vergence responses were stimulated from 4° symmetrical disparity vergence step stimuli. The peak velocity of the vergence response and the magnitude of the fusion initiating component (FIC) from an independent component analysis (ICA) were calculated. A linear regression analysis was conducted studying the vergence peak velocity as a function of the near dissociated phoria where the Pearson correlation coefficient was computed.

Results: Before vergence therapy, the average with one standard deviation FIC magnitude of convergence responses from CI subjects was 0.29° ± 0.82 and significantly less than the FIC magnitude of 1.85° ± 0.84 for BNC (p < 0.02). A paired t-test reported that the FIC and near dissociated phoria before vergence therapy for CI subjects significantly increased to 1.49° ± 0.57 (p < 0.04) and became less exophoric to 3.5Δ ± 1.9 exo (p < 0.02) after vergence therapy. A significant correlation (r = 0.87; p < 0.01) was observed between the near dissociated phoria and the vergence ratio of convergence peak velocity divided by divergence peak velocity.

Conclusion: The results have clinical translational impact in understanding the mechanism by which vergence therapy may be changing the vergence system leading to a sustained reduction in visual symptoms.

A Neural Model of Distance-Dependent Percept of Object Size Constancy

Size constancy is one of the well-known visual phenomena that demonstrates perceptual stability to account for the effect of viewing distance on retinal image size. Although theories involving distance scaling to achieve size constancy have flourished based on psychophysical studies, its underlying neural mechanisms remain unknown. Single cell recordings show that distance-dependent size tuned cells are common along the ventral stream, originating from V1, V2, and V4 leading to IT. In addition, recent research employing fMRI demonstrates that an object's perceived size, associated with its perceived egocentric distance, modulates its retinotopic representation in V1. These results suggest that V1 contributes to size constancy, and its activity is possibly regulated by feedback of distance information from other brain areas. Here, we propose a neural model based on these findings. First, we construct an egocentric distance map in LIP by integrating horizontal disparity and vergence through gain-modulated MT neurons. Second, LIP neurons send modulatory feedback of distance information to size tuned cells in V1, resulting in a spread of V1 cortical activity. This process provides V1 with distance-dependent size representations. The model supports that size constancy is preserved by scaling retinal image size to compensate for changes in perceived distance, and suggests a possible neural circuit capable of implementing this process.

3D visual discomfort predictor: analysis of horizontal disparity and neural activity statistics

Being able to predict the degree of visual discomfort that is felt when viewing stereoscopic 3D (S3D) images is an important goal toward ameliorating causative factors, such as excessive horizontal disparity, misalignments or mismatches between the left and right views of stereo pairs, or conflicts between different depth cues. Ideally, such a model should account for such factors as capture and viewing geometries, the distribution of disparities, and the responses of visual neurons. When viewing modern 3D displays, visual discomfort is caused primarily by changes in binocular vergence while accommodation in held fixed at the viewing distance to a flat 3D screen. This results in unnatural mismatches between ocular fixations and ocular focus that does not occur in normal direct 3D viewing. This accommodation vergence conflict can cause adverse effects, such as headaches, fatigue, eye strain, and reduced visual ability. Binocular vision is ultimately realized by means of neural mechanisms that subserve the sensorimotor control of eye movements. Realizing that the neuronal responses are directly implicated in both the control and experience of 3D perception, we have developed a model-based neuronal and statistical framework called the 3D visual discomfort predictor (3D-VDP)that automatically predicts the level of visual discomfort that is experienced when viewing S3D images. 3D-VDP extracts two types of features: 1) coarse features derived from the statistics of binocular disparities and 2) fine features derived by estimating the neural activity associated with the processing of horizontal disparities. In particular, we deploy a model of horizontal disparity processing in the extrastriate middle temporal region of occipital lobe. We compare the performance of 3D-VDP with other recent discomfort prediction algorithms with respect to correlation against recorded subjective visual discomfort scores,and show that 3D-VDP is statistically superior to the other methods.

Autonomic control of the eye

The autonomic nervous system influences numerous ocular functions. It does this by way of parasympathetic innervation from postganglionic fibers that originate from neurons in the ciliary and pterygopalatine ganglia, and by way of sympathetic innervation from postganglionic fibers that originate from neurons in the superior cervical ganglion. Ciliary ganglion neurons project to the ciliary body and the sphincter pupillae muscle of the iris to control ocular accommodation and pupil constriction, respectively. Superior cervical ganglion neurons project to the dilator pupillae muscle of the iris to control pupil dilation. Ocular blood flow is controlled both via direct autonomic influences on the vasculature of the optic nerve, choroid, ciliary body, and iris, as well as via indirect influences on retinal blood flow. In mammals, this vasculature is innervated by vasodilatory fibers from the pterygopalatine ganglion, and by vasoconstrictive fibers from the superior cervical ganglion. Intraocular pressure is regulated primarily through the balance of aqueous humor formation and outflow. Autonomic regulation of ciliary body blood vessels and the ciliary epithelium is an important determinant of aqueous humor formation; autonomic regulation of the trabecular meshwork and episcleral blood vessels is an important determinant of aqueous humor outflow. These tissues are all innervated by fibers from the pterygopalatine and superior cervical ganglia. In addition to these classical autonomic pathways, trigeminal sensory fibers exert local, intrinsic influences on many of these regions of the eye, as well as on some neurons within the ciliary and pterygopalatine ganglia.

Vergence eye movements in patients with schizophrenia

Previous studies have shown that smooth pursuit eye movements are impaired in patients with schizophrenia. However, under normal viewing conditions, targets move not only in the frontoparallel plane but also in depth, and tracking them requires both smooth pursuit and vergence eye movements. Although previous studies in humans and non-human primates suggest that these two eye movement subsystems are relatively independent of one another, to our knowledge, there have been no prior studies of vergence tracking behavior in patients with schizophrenia. Therefore, we have investigated these eye movements in patients with schizophrenia and in healthy controls. We found that patients with schizophrenia exhibited substantially lower gains compared to healthy controls during vergence tracking at all tested speeds (e.g. 0.25 Hz vergence tracking mean gain of 0.59 vs. 0.86). Further, consistent with previous reports, patients with schizophrenia exhibited significantly lower gains than healthy controls during smooth pursuit at higher target speeds (e.g. 0.5 Hz smooth pursuit mean gain of 0.64 vs. 0.73). In addition, there was a modest (r≈0.5), but significant, correlation between smooth pursuit and vergence tracking performance in patients with schizophrenia. Our observations clearly demonstrate substantial vergence tracking deficits in patients with schizophrenia. In these patients, deficits for smooth pursuit and vergence tracking are partially correlated suggesting overlap in the central control of smooth pursuit and vergence eye movements.

Functional activity within the frontal eye fields, posterior parietal cortex, and cerebellar vermis significantly correlates to symmetrical vergence peak velocity: an ROI-based, fMRI study of vergence training

Convergence insufficiency (CI) is a prevalent binocular vision disorder with symptoms that include double/blurred vision, eyestrain, and headaches when engaged in reading or other near work. Randomized clinical trials support that Office-Based Vergence and Accommodative Therapy with home reinforcement leads to a sustained reduction in patient symptoms. However, the underlying neurophysiological basis for treatment is unknown. Functional activity and vergence eye movements were quantified from seven binocularly normal controls (BNC) and four CI patients before and after 18 h of vergence training. An fMRI conventional block design of sustained fixation vs. vergence eye movements stimulated activity in the frontal eye fields (FEF), the posterior parietal cortex (PPC), and the cerebellar vermis (CV). Comparing the CI patients' baseline measurements to the post-vergence training data sets with a paired t-test revealed the following: (1) the percent change in the BOLD signal in the FEF, PPC, and CV significantly increased (p < 0.02), (2) the peak velocity from 4° symmetrical convergence step responses increased (p < 0.01) and (3) patient symptoms assessed using the CI Symptom Survey (CISS) improved (p < 0.05). CI patient measurements after vergence training were more similar to levels observed within BNC. A regression analysis revealed the peak velocity from BNC and CI subjects before and after vergence training was significantly correlated to the percent BOLD signal change within the FEF, PPC, and CV (r = 0.6; p < 0.05). Results have clinical implications for understanding the behavioral and neurophysiological changes after vergence training in patients with CI, which may lead to the sustained reduction in visual symptoms.

Saccade-vergence properties remain more stable over short-time repetition under overlap than under gap task: a preliminary study

Under natural circumstances, saccade-vergence eye movements are among the most frequently occurring. This study examines the properties of such movements focusing on short-term repetition effects. Are such movements robust over time or are they subject to tiredness? 12 healthy adults performed convergent and divergent combined eye movements either in a gap task (i.e., 200 ms between the end of the fixation stimulus and the beginning of the target stimulus) or in an overlap task (i.e., the peripheral target begins 200 ms before the end of the fixation stimulus). Latencies were shorter in the gap task than in the overlap task for both saccade and vergence components. Repetition had no effect on latency, which is a novel result. In both tasks, saccades were initiated later and executed faster (mean and peak velocities) than the vergence component. The mean and peak velocities of both components decreased over trials in the gap task but remained constant in the overlap task. This result is also novel and has some clinical implications. Another novel result concerns the accuracy of the saccade component that was better in the gap than in the overlap task. The accuracy also decreased over trials in the gap task but remained constant in the overlap task. The major result of this study is that under a controlled mode of initiation (overlap task) properties of combined eye movements are more stable than under automatic triggering (gap task). These results are discussed in terms of saccade-vergence interactions, convergence-divergence specificities and repetition versus adaptation protocols.

Task-modulated coactivation of vergence neural substrates

While functional magnetic resonance imaging (fMRI) has identified which regions of interests (ROIs) are functionally active during a vergence movement (inward or outward eye rotation), task-modulated coactivation between ROIs is less understood. This study tested the following hypotheses: (1) significant task-modulated coactivation would be observed between the frontal eye fields (FEFs), the posterior parietal cortex (PPC), and the cerebellar vermis (CV); (2) significantly more functional activity and task-modulated coactivation would be observed in binocularly normal controls (BNCs) compared with convergence insufficiency (CI) subjects; and (3) after vergence training, the functional activity and task-modulated coactivation would increase in CIs compared with their baseline measurements. A block design of sustained fixation versus vergence eye movements stimulated activity in the FEFs, PPC, and CV. fMRI data from four CI subjects before and after vergence training were compared with seven BNCs. Functional activity was assessed using the blood oxygenation level dependent (BOLD) percent signal change. Task-modulated coactivation was assessed using an ROI-based task-modulated coactivation analysis that revealed significant correlation between the FEF, PPC, and CV ROIs. Prior to vergence training, the CIs had a reduced BOLD percent signal change compared with BNCs for the CV (p<0.05), FEFs, and PPC (p<0.01). The BOLD percent signal change increased within the CV, FEF, and PPC ROIs (p<0.001) as did the task-modulated coactivation between the FEFs and CV as well as the PPC and CV (p<0.05) when comparing the CI pre- and post-training datasets. Results from the Convergence Insufficiency Symptom Survey were correlated to the percent BOLD signal change from the FEFs and CV (p<0.05).

Impaired body balance control in adults with strabismus

Previous studies revealed that people with binocular vision disorders have poor postural stability. However, most of the research was performed only on children and under binocular viewing condition, that could negatively affect the results. The aim of the current study was to investigate the influence of extra-ocular proprioceptive signals on postural stability in young adults with binocular vision disorders. Moreover, additional mental task was introduced to detect any postural compensation which could possibly hide the real influence of afferent extra-ocular signals. 21 Subjects, aged 18-45 yrs, with horizontal strabismus, were qualified to binocular vision disorders (BVD) group. 41 subjects, aged 19-45 yrs, with no strabismus formed the normal binocular vision (NBV) group. Posturography data were collected in 2 separate parts: (1) quiet standing (Single-Task), and (2) performance of a mental task while standing (Dual-Task). Each part consisted of three 60-s viewing conditions, with: (1) dominant/fellow eye (DE), (2) non-dominant/strabismic eye (NDE), and with (3) both eyes closed (EC). Subjects were looking at X located at the distance of 150 cm. Generally, BVD group showed elevated body balance during quiet stance compared to NBV group. Interestingly, better stabilization in BVD group occurred under NDE viewing. Surprisingly, additional mental task improved the postural stability in BVD group almost to the level of NBV group. These findings emphasize the role of the eye-muscle signals in postural control and suggest that suitable vision therapy can be the appropriate way to improve body balance/motor functions in people with binocular vision disorders.

Muscimol inactivation of caudal fastigial nucleus and posterior interposed nucleus in monkeys with strabismus

Previously, we showed that neurons in the supraoculomotor area (SOA), known to encode vergence angle in normal monkeys, encode the horizontal eye misalignment in strabismic monkeys. The SOA receives afferent projections from the caudal fastigial nucleus (cFN) and the posterior interposed nucleus (PIN) in the cerebellum. The objectives of the present study were to investigate the potential roles of the cFN and PIN in 1) conjugate eye movements and 2) binocular eye alignment in strabismic monkeys. We used unilateral injections of the GABAA agonist muscimol to reversibly inactivate the cFN (4 injections in exotropic monkey S1 with ≈ 4° of exotropia; 5 injections in esotropic monkey S2 with ≈ 34° of esotropia) and the PIN (3 injections in monkey S1). cFN inactivation induced horizontal saccade dysmetria in all experiments (mean 39% increase in ipsilesional saccade gain and 26% decrease in contralesional gain). Also, mean contralesional smooth-pursuit gain was decreased by 31%. cFN inactivation induced a divergent change in eye alignment in both monkeys, with exotropia increasing by an average of 9.8° in monkey S1 and esotropia decreasing by an average of 11.2° in monkey S2 (P < 0.001). Unilateral PIN inactivation in monkey S1 resulted in a mean increase in the gain of upward saccades by 13% and also induced a convergent change in eye alignment, reducing exotropia by an average of 2.7° (P < 0.001). We conclude that cFN/PIN influences on conjugate eye movements in strabismic monkeys are similar to those postulated in normal monkeys and cFN/PIN play important and complementary roles in maintaining the steady-state misalignment in strabismus.

Functional connectivity in vergence and saccade eye movement tasks assessed using Granger Causality analysis

Throughout the day, the human visual system acquires information using saccade and vergence eye movements. Previously, functional MRI (fMRI) experiments have shown both shared neural resources and spatial differentiation between these two systems. FMRI experiments can reveal which regions are activated within an experimental task but do not yield insight into how regions of interest (ROIs) interact with each other. This study investigated the number and direction of influences among ROIs using a Granger Causality Analysis (GCA)--a statistical technique used to identify if an ROI is significantly influencing or 'connected' to another ROI. Two stimulus protocols were used: first, a simple block design of fixation versus random eye movements; and second, a more cognitively demanding task using random versus predictable movements. Each protocol used saccadic movements and was then repeated using vergence movements. Eight subjects participated in each of the four experiments. Results show that when prediction was evoked, more connections between ROIs were observed compared to the simple tracking experiment. More connections were also observed during the vergence prediction task compared to the saccade prediction task. Differences within the number of connections may be due to the type of oculomotor eye movements, as well as to the amount of higher-level executive cognitive demand.