Inverse Occlusion: A Binocularly Motivated Treatment for Amblyopia

The impact of eye movements on amblyopic vision: A mini-review

Our eyes move constantly to search for and inspect objects of interest, to track moving objects, to read along a line of text and to prevent image fading. However, persons with amblyopia (PWA), in addition to a broad array of visual deficits, have abnormal eye movements. This review briefly describes the types of eye movements deficits in persons with amblyopia and how they are measured. We then go on to discuss what is known about how abnormal eye movements in persons with amblyopia affect their vision. Finally, we ask whether the abnormal eye movements are amenable to amblyopia treatment and whether they can be used to diagnose/classify amblyopia.

The interplay between Hebbian and homeostatic plasticity in the adult visual cortex

Homeostatic and Hebbian plasticity co-operate during the critical period, refining neuronal circuits; however, the interaction between these two forms of plasticity is still unclear, especially in adulthood. Here, we directly investigate this issue in adult humans using two consolidated paradigms to elicit each form of plasticity in the visual cortex: the long-term potentiation-like change of the visual evoked potential (VEP) induced by high-frequency stimulation (HFS) and the shift of ocular dominance induced by short-term monocular deprivation (MD). We tested homeostatic and Hebbian plasticity independently, then explored how they interacted by inducing them simultaneously in a group of adult healthy volunteers. We successfully induced both forms of plasticity: 60 min of MD induced a reliable change in ocular dominance and HFS reliably modulated the amplitude of the P1 component of the VEP. Importantly, we found that, across participants, homeostatic and Hebbian plasticity were negatively correlated, indicating related neural mechanisms, potentially linked to intracortical excitation/inhibition balance. On the other hand, we did not find an interaction when the two forms of plasticity were induced simultaneously. Our results indicate a largely preserved plastic potential in the visual cortex of the adult brain, for both short-term homeostatic and Hebbian plasticity. Crucially, we show for the first time a direct relationship between these two forms of plasticity in the adult human visual cortex, which could inform future research and treatment protocols for neurological diseases. KEY POINTS: Homeostatic and Hebbian plasticity co-operate during the critical period to refine neuronal circuits in the visual cortex. The interaction between these two forms of plasticity is still unknown, especially after the closure of the critical periods and in humans. We directly investigate the interplay between Hebbian and homeostatic visual plasticity in adult humans using non-invasive paradigms. We found a negative correlation between these forms of plasticity showing for the first time a direct relationship between Hebbian and homeostatic plasticity. Our results could inform future research and treatment protocols for neurological diseases.

Attention enhances short-term monocular deprivation effect

Patching one eye of an adult human for a few hours has been found to promote the dominance of the patched eye, which is called short-term monocular deprivation effect. Interestingly, recent work has reported that prolonged eye-specific attention can also cause a shift of ocular dominance toward the unattended eye though visual inputs during adaptation are balanced across the eyes. Considering that patching blocks all input information from one eye, attention is presumably deployed to the opposite eye. Therefore, the short-term monocular deprivation effect might be, in part, mediated by eye-specific attentional modulation. Yet this question remains largely unanswered. To address this issue, here we asked participants to perform an attentive tracking task with one eye patched. During the tracking, participants were presented with both target gratings (attended stimuli) and distractor gratings (unattended stimuli) that were distinct from each other in fundamental visual features. Before and after one hour of tracking, they completed a binocular rivalry task to measure perceptual ocular dominance. A larger shift of ocular dominance toward the deprived eye was observed when the binocular rivalry testing gratings shared features with the target gratings during the tracking compared to when they shared features with the distractor gratings. This result, for the first time, suggests that attention can boost the strength of the short-term monocular deprivation effect. Therefore, the present study sheds new light on the role of attention in ocular dominance plasticity.

Leveraging neural plasticity for the treatment of amblyopia

Amblyopia is a form of visual cortical impairment that arises from abnormal visual experience early in life. Most often, amblyopia is a unilateral visual impairment that can develop as a result of strabismus, anisometropia, or a combination of these conditions that result in discordant binocular experience. Characterized by reduced visual acuity and impaired binocular function, amblyopia places a substantial burden on the developing child. Although frontline treatment with glasses and patching can improve visual acuity, residual amblyopia remains for most children. Newer binocular-based therapies can elicit rapid recovery of visual acuity and may also improve stereoacuity in some children. Nevertheless, for both treatment modalities full recovery is elusive, recurrence of amblyopia is common, and improvements are negligible when treatment is administered at older ages. Insights derived from animal models about the factors that govern neural plasticity have been leveraged to develop innovative treatments for amblyopia. These novel therapies exhibit efficacy to promote recovery, and some are effective even at ages when conventional treatments fail to yield benefit. Approaches for enhancing visual system plasticity and promoting recovery from amblyopia include altering the balance between excitatory and inhibitory mechanisms, reversing the accumulation of proteins that inhibit plasticity, and harnessing the principles of metaplasticity. Although these therapies have exhibited promising results in animal models, their safety and ability to remediate amblyopia need to be evaluated in humans.

Collective plasticity of binocular interactions in the adult visual system

Binocular visual plasticity can be initiated via either bottom-up or top-down mechanisms, but it is unknown if these two forms of adult plasticity can be independently combined. In seven participants with normal binocular vision, sensory eye dominance was assessed using a binocular rivalry task, before and after a period of monocular deprivation and with and without selective attention directed towards one eye. On each trial, participants reported the dominant monocular target and the inter-ocular contrast difference between the stimuli was systematically altered to obtain estimates of ocular dominance. We found that both monocular light- and pattern-deprivation shifted dominance in favour of the deprived eye. However, this shift was completely counteracted if the non-deprived eye's stimulus was selectively attended. These results reveal that shifts in ocular dominance, driven by bottom-up and top-down selection, appear to act independently to regulate the relative contrast gain between the two eyes.

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

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

Negligible contribution of adaptation of ocular opponency neurons to the effect of short-term monocular deprivation

Introduction

Modeling work on binocular rivalry has described how ocular opponency neurons represent interocular conflict. These neurons have recently been considered to mediate an ocular dominance shift to the eye that has viewed a backward movie for long during which time the other eye is presented with a regular movie. Unlike typical short-term monocular deprivation, the visual inputs are comparable across eyes in that "dichoptic-backward-movie" paradigm. Therefore, it remains unclear whether the ocular opponency neurons are also responsible for the short-term monocular deprivation effect which is prevalently explained by the homeostatic compensation theory. We designed two experiments from distinct perspectives to investigate this question.

Methods

In Experiment 1, we mitigated the imbalance in the activity of opponency neurons between the two eyes during monocular deprivation by presenting video stimuli alternately. In Experiment 2, we directly evaluated the response of opponency neurons before and after monocular deprivation using SSVEP techniques.

Results

Consistent with each other, both experiments failed to provide reliable evidence supporting the involvement of ocular opponency neurons in the short-term monocular deprivation effect.

Discussion

Our results suggest that ocular opponency neurons may not play an essential role in the short-term monocular deprivation effect, potentially due to interference from the homeostatic plasticity mechanism.

Reduced interocular suppression after inverse patching in anisometropic amblyopia

Purpose

Recent investigations observed substantial enhancements in binocular balance, visual acuity, and stereovision among older children and adults with amblyopia by patching the amblyopic eye (i.e., inverse patching) for 2 h daily over 2 months. Despite these promising findings, the precise neural mechanisms underlying inverse patching remain elusive. This study endeavors to delve deeper into the neural alterations induced by inverse patching, focusing on steady-state visual evoked potentials (SSVEPs). We specifically investigate the changes in SSVEPs following monocular deprivation of either the fellow eye or the amblyopic eye in older amblyopic children and adults.

Method

Ten participants (17.60 ± 2.03 years old; mean ± SEM), clinically diagnosed with anisometropic amblyopia, were recruited for this study. Each participant underwent a 120 min patching session on their fellow eye on the first day, followed by a similar session on their amblyopic eye on the second day. Baseline steady-state visual evoked potentials (SSVEPs) measurements were collected each day prior to patching, with post-patching SSVEPs measurements obtained immediately after the patching session. The experimental design incorporated a binocular rivalry paradigm, utilizing SSVEPs measurements.

Results

The results revealed that inverse patching induced a heightened influence on neural plasticity, manifesting in a reduction of interocular suppression from the fellow eye to the amblyopic eye. In contrast, patching the fellow eye demonstrated negligible effects on the visual cortex. Furthermore, alterations in interocular suppression subsequent to inverse patching exhibited a correlation with the visual acuity of the amblyopic eye.

Conclusion

Inverse patching emerges as a promising therapeutic avenue for adolescents and adults grappling with severe anisometropic amblyopia that proves refractory to conventional interventions. This innovative approach exhibits the potential to induce more robust neural plasticity within the visual cortex, thereby modulating neural interactions more effectively than traditional amblyopia treatments.

The Suppressive Basis of Ocular Dominance Changes Induced by Short-Term Monocular Deprivation in Normal and Amblyopic Adults

Purpose

We aimed to study the effect of short-term monocular deprivation on the suppressive interocular interactions in normals and amblyopes by using a dichoptic masking paradigm.

Methods

Nine adults with anisometropic or mixed amblyopia and 10 control adults participated in our study. The contrast sensitivity in discriminating a target Gabor dichoptically masked was measured before and after 2 hours of monocular deprivation. The mask consisted of bandpass-filtered noise. Both the target and the mask were horizontally oriented at the spatial frequency of 1.31 cpd. Deprivation was achieved using an opaque patch on the amblyopic eye of amblyopes and the dominant eye of controls.

Results

Results were similar in both controls and amblyopes. After 2 hours of monocular deprivation, the previously patched eye showed a significant increase in contrast sensitivity under dichoptic masking, which also suggested reduced suppressive effect from the nonpatched eye. Meanwhile, the contrast sensitivity of the nonpatched eye remained almost unchanged under dichoptic masking.

Conclusions

We demonstrate that the ocular dominance changes induced by short-term monocular deprivation-namely, the strengthening of the deprived eye's contribution-are associated with the unilateral and asymmetric changes in suppressive interaction. The suppression from the nondeprived eye is reduced after short-term monocular deprivation. This provides a better understanding of how inverse patching (patching of the amblyopic eye) could, by reducing the suppressive drive from the normally sighted (nondeprived) eye, form the basis of a new treatment for the binocular deficit in amblyopia.

Human deprivation amblyopia: treatment insights from animal models

Amblyopia is a common visual impairment that develops during the early years of postnatal life. It emerges as a sequela to eye misalignment, an imbalanced refractive state, or obstruction to form vision. All of these conditions prevent normal vision and derail the typical development of neural connections within the visual system. Among the subtypes of amblyopia, the most debilitating and recalcitrant to treatment is deprivation amblyopia. Nevertheless, human studies focused on advancing the standard of care for amblyopia have largely avoided recruitment of patients with this rare but severe impairment subtype. In this review, we delineate characteristics of deprivation amblyopia and underscore the critical need for new and more effective therapy. Animal models offer a unique opportunity to address this unmet need by enabling the development of unconventional and potent amblyopia therapies that cannot be pioneered in humans. Insights derived from studies using animal models are discussed as potential therapeutic innovations for the remediation of deprivation amblyopia. Retinal inactivation is highlighted as an emerging therapy that exhibits efficacy against the effects of monocular deprivation at ages when conventional therapy is ineffective, and recovery occurs without apparent detriment to the treated eye.

Measuring the reliability of binocular rivalry

Binocular rivalry is a widely used tool in sensory and cognitive neuroscience to investigate different aspects of vision and cognition. The dynamics of binocular rivalry (e.g., duration of perceptual dominance phases and mixed percept proportions) differ across individuals; based on rivalry dynamics, it is also possible to calculate an index of ocular dominance (by comparing the perceptual dominance of the images in the two eyes). In this study, we investigated the reliability of binocular rivalry dynamics using different methods for dichoptic stimulation and different rivalry stimuli. For the three main indices we defined (ocular dominance, phase durations and mixed percept proportions), we found a high test-retest reliability across sessions. Moreover, the test-retest reliability of the ocular dominance index was predictable from its internal consistency, supporting its stability over time. Phase durations and mixed percept proportions, in contrast, had worse test-retest reliability than expected based on internal consistency, indicating that these parameters are susceptible to state-dependent changes. Our results support the use of the ocular dominance index and binocular rivalry in the measurement of sensory eye dominance and its plasticity, but advise caution when investigating the association between phase durations or mixed percepts and stable characteristics like psychological traits or disorders.

Short-term monocular pattern deprivation reduces the internal additive noise of the visual system

Previous studies have shown that short-term monocular pattern deprivation can shift perceptual dominance in favor of the deprived eye. However, little is known about the effect of monocular pattern deprivation on contrast sensitivity (CS) and its corresponding mechanisms. Here, contrast sensitivity function (CSF) in the nondominant eye of normal subjects was evaluated before and after 150 min of monocular pattern deprivation. To obtain a CSF with high precision and efficiency before deprivation effect washout, a quick CSF (qCSF) method was used to assess CS over a wide range of spatial frequencies and at two external noise levels. We found that (1) monocular pattern deprivation effectively improved the CS of the deprived eye with larger effect on high spatial frequencies, (2) CS improvement only occurred when external noise was absent and its amount was spatial frequency dependent, and (3) a perceptual template model (PTM) revealed that decreased internal additive noise accounted for the mechanism of the monocular pattern derivation effect. These findings help us better understand the features of short-term monocular pattern deprivation and shed light on the treatment of amblyopia.

Short-term homeostatic visual neuroplasticity in adolescents after two hours of monocular deprivation

In healthy adults with normal vision, temporary deprivation of one eye's visual experience produces transient yet robust homeostatic plasticity effects, where the deprived eye becomes more dominant. This shift in ocular dominance is short-lived and compensatory. Previous work shows that monocular deprivation decreases resting state gamma aminobutyric acid (GABA; inhibitory neurotransmitter) levels in visual cortex, and that those with the greatest reduction in GABA have stronger shifts due to monocular deprivation. Components of the GABAergic system in visual cortex vary with age (early childhood, early teen years, ageing); hence if GABA is critical to homeostatic plasticity within the visual system, adolescence may be a key developmental period where differences in plasticity manifest. Here we measured short-term visual deprivation effects on binocular rivalry in 24 adolescents (aged 10-15 years) and 23 young adults (aged 20-25 years). Despite differences in baseline features of binocular rivalry (adolescents showed more mixed percept p < 0.001 and a tendency for faster switching p = 0.06 compared to adults), deprived eye dominance increased (p = 0.01) similarly for adolescents and adults after two hours of patching. Other aspects of binocular rivalry - time to first switch (heralding the onset of rivalry) and mixed percept - were unaltered by patching. These findings suggest that binocular rivalry after patching can be used as a behavioral proxy for experience-dependent visual cortical plasticity in adolescents in the same way as adults, and that homeostatic plasticity to compensate for temporarily reduced visual input is established and effective by adolescence.

Visual Plasticity in Adulthood: Perspectives from Hebbian and Homeostatic Plasticity

The visual system retains profound plastic potential in adulthood. In the current review, we summarize the evidence of preserved plasticity in the adult visual system during visual perceptual learning as well as both monocular and binocular visual deprivation. In each condition, we discuss how such evidence reflects two major cellular mechanisms of plasticity: Hebbian and homeostatic processes. We focus on how these two mechanisms work together to shape plasticity in the visual system. In addition, we discuss how these two mechanisms could be further revealed in future studies investigating cross-modal plasticity in the visual system.

Internal neural states influence the short-term effect of monocular deprivation in human adults

The adult human visual system maintains the ability to be altered by sensory deprivation. What has not been considered is whether the internal neural states modulate visual sensitivity to short-term monocular deprivation. In this study we manipulated the internal neural state and reported changes in intrinsic neural oscillations with a patched eye open or closed. We investigated the influence of eye open/eye closure on the unpatched eye's contrast sensitivity and ocular dominance (OD) shifts induced by short-term monocular deprivation. The results demonstrate that internal neural states influence not only baseline contrast sensitivity but also the extent to which the adult visual system can undergo changes in ocular dominance.

Altered functional connectivity of the thalamus in primary angle-closure glaucoma patients: A resting-state fMRI study

Background and objectives

Glaucoma is one of the leading irreversible causes of blindness worldwide, and previous studies have shown that there is abnormal functional connectivity (FC) in the visual cortex of glaucoma patients. The thalamus is a relay nucleus for visual signals; however, it is not yet clear how the FC of the thalamus is altered in glaucoma. This study investigated the alterations in thalamic FC in patients with primary angle-closure glaucoma (PACG) by using resting-state functional MRI (rs-fMRI). We hypothesized that PACG patients have abnormal FC between the thalamus and visual as well as extravisual brain regions.

Methods

Clinically confirmed PACG patients and age- and gender-matched healthy controls (HCs) were evaluated by T1 anatomical and functional MRI on a 3 T scanner. Thirty-four PACG patients and 33 HCs were included in the rs-fMRI analysis. All PACG patients underwent complete ophthalmological examinations; included retinal nerve fiber layer thickness (RNFLT), intraocular pressure (IOP), average cup-to-disc ratio (A-C/D), and vertical cup-to-disc ratio (V-C/D). After the MRI data were preprocessed, the bilateral thalamus was chosen as the seed point; and the differences in resting-state FC between groups were evaluated. The brain regions that significantly differed between PACG patients and HCs were identified, and the correlations were then evaluated between the FC coefficients of these regions and clinical variables.

Results

Compared with the HCs, the PACG patients showed decreased FC between the bilateral thalamus and right transverse temporal gyrus, between the bilateral thalamus and left anterior cingulate cortex, and between the left thalamus and left insula. Concurrently, increased FC was found between the bilateral thalamus and left superior frontal gyrus in PACG patients. The FC between the bilateral thalamus and left superior frontal gyrus was positively correlated with RNFLT and negatively correlated with the A-C/D and V-C/D. The FC between the left thalamus and left insula was negatively correlated with IOP.

Conclusion

Extensive abnormal resting-state functional connections between the thalamus and visual and extravisual brain areas were found in PACG patients, and there were certain correlations with clinical variables, suggesting that abnormal thalamic FC plays an important role in the progression of PACG.

Rapid alternate monocular deprivation does not affect binocular balance and correlation in human adults

Recent studies show that the human adult visual system exhibits neural plasticity. For instance, short-term monocular deprivation shifts the eye dominance in favor of the deprived eye. This phenomenon is believed to occur in the primary visual cortex by reinstating neural plasticity. However, it is unknown whether the changes in eye dominance after monocularly depriving the visual input can also be induced by alternately depriving both eyes. In this study, we found no changes in binocular balance and interocular correlation sensitivity after a rapid (7 Hz), alternate and monocular deprivation for one hour in adults. Therefore, the effect of short-term monocular deprivation cannot seem to be emulated by alternately and rapidly depriving both eyes.Significance statementPrevious work has shown that short-term binocular function disruption, which its most extreme form is monocular deprivation, could induce neural plasticity in adult visual system. In this study, we found a balanced deprivation of binocular function could not induce a neuroplastic change in human adults. It appears that ocular dominance plasticity in human adults is unique in so far as it is only driven by an input imbalance not balanced deprivation of binocular function.

Critical Periods in Vision Revisited

For four decades, investigations of the biological basis of critical periods in the developing mammalian visual cortex were dominated by study of the consequences of altered early visual experience in cats and nonhuman primates. The neural deficits thus revealed also provided insight into the origin and neural basis of human amblyopia that in turn motivated additional studies of humans with abnormal early visual input. Recent human studies point to deficits arising from alterations in all visual cortical areas and even in nonvisual cortical regions. As the new human data accumulated in parallel with a near-complete shift toward the use of rodent animal models for the study of neural mechanisms, it is now essential to review the human data and the earlier animal data obtained from cats and monkeys to infer general conclusions and to optimize future choice of the most appropriate animal model. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Recent Treatment Advances in Amblyopia

Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The development of active binocular vision under normal and alternate rearing conditions

The development of binocular vision is an active learning process comprising the development of disparity tuned neurons in visual cortex and the establishment of precise vergence control of the eyes. We present a computational model for the learning and self-calibration of active binocular vision based on the Active Efficient Coding framework, an extension of classic efficient coding ideas to active perception. Under normal rearing conditions with naturalistic input, the model develops disparity tuned neurons and precise vergence control, allowing it to correctly interpret random dot stereograms. Under altered rearing conditions modeled after neurophysiological experiments, the model qualitatively reproduces key experimental findings on changes in binocularity and disparity tuning. Furthermore, the model makes testable predictions regarding how altered rearing conditions impede the learning of precise vergence control. Finally, the model predicts a surprising new effect that impaired vergence control affects the statistics of orientation tuning in visual cortical neurons.

Some psychophysical tasks measure ocular dominance plasticity more reliably than others

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

Short-term monocular deprivation induces an interocular delay

Short term monocular deprivation modulates ocular dominance, such that the previously deprived eye's contribution to the binocular percept increases, supposedly as a result of changes in contrast-gain. Therefore, the processing time of the previously patched eye would be expected to speed up as a result of an increase in contrast gain. In order to test this hypothesis, this study examines the effects of short-term monocular deprivation on interocular synchronicity. The present study uses a paradigm based on the Pulfrich phenomenon. The stimulus used for testing consists of elements defining a cylinder rotating in depth, that allows measurement of any interocular delay. The interocular delay was measured at baseline before patching and at outcome, after one hour of monocular deprivation with an opaque or translucent patch. Contrary to expectations, short-term monocular deprivation induces an interocular delay, albeit not always significant, in the previously patched eye. The amplitude of this effect is larger with opaque patching compared to translucent patching. These results are the first report of a non-beneficial effect - i.e. a slowing down in the processing time of the previously patched-eye. They indicate that the plasticity effects of monocular deprivation are not exclusively mediated by contrast gain mechanisms and that light adaptation mechanisms might also be involved in the plasticity resulting from short-term monocular deprivation.

Brief period of monocular deprivation drives changes in audiovisual temporal perception

The human brain retains a striking degree of plasticity into adulthood. Recent studies have demonstrated that a short period of altered visual experience (via monocular deprivation) can change the dynamics of binocular rivalry in favor of the deprived eye, a compensatory action thought to be mediated by an upregulation of cortical gain control mechanisms. Here, we sought to better understand the impact of monocular deprivation on multisensory abilities, specifically examining audiovisual temporal perception. Using an audiovisual simultaneity judgment task, we discovered that 90 minutes of monocular deprivation produced opposing effects on the temporal binding window depending on the eye used in the task. Thus, in those who performed the task with their deprived eye there was a narrowing of the temporal binding window, whereas in those performing the task with their nondeprived eye there was a widening of the temporal binding window. The effect was short lived, being observed only in the first 10 minutes of postdeprivation testing. These findings indicate that changes in visual experience in the adult can rapidly impact multisensory perceptual processes, a finding that has important clinical implications for those patients with adult-onset visual deprivation and for therapies founded on monocular deprivation.

Rethinking amblyopia 2020

Recent work has transformed our ideas about the neural mechanisms, behavioral consequences and effective therapies for amblyopia. Since the 1700's, the clinical treatment for amblyopia has consisted of patching or penalizing the strong eye, to force the "lazy" amblyopic eye, to work. This treatment has generally been limited to infants and young children during a sensitive period of development. Over the last 20 years we have learned much about the nature and neural mechanisms underlying the loss of spatial and binocular vision in amblyopia, and that a degree of neural plasticity persists well beyond the sensitive period. Importantly, the last decade has seen a resurgence of research into new approaches to the treatment of amblyopia both in children and adults, which emphasize that monocular therapies may not be the most effective for the fundamentally binocular disorder that is amblyopia. These approaches include perceptual learning, video game play and binocular methods aimed at reducing inhibition of the amblyopic eye by the strong fellow eye, and enhancing binocular fusion and stereopsis. This review focuses on the what we've learned over the past 20 years or so, and will highlight both the successes of these new treatment approaches in labs around the world, and their failures in clinical trials. Reconciling these results raises important new questions that may help to focus future directions.

Neuroplasticity of the visual cortex: in sickness and in health

Brain plasticity refers to the ability of synaptic connections to adapt their function and structure in response to experience, including environmental changes, sensory deprivation and injuries. Plasticity is a distinctive, but not exclusive, property of the developing nervous system. This review introduces the concept of neuroplasticity and describes classic paradigms to illustrate cellular and molecular mechanisms underlying synapse modifiability. Then, we summarize a growing number of studies showing that the adult cerebral cortex retains a significant degree of plasticity highlighting how the identification of strategies to enhance the plastic potential of the adult brain could pave the way for the development of novel therapeutic approaches aimed at treating amblyopia and other neurodevelopmental disorders. Finally, we analyze how the visual system adjusts to neurodegenerative conditions leading to blindness and we discuss the crucial role of spared plasticity in the visual system for sight recovery.

Modulation of binocular rivalry with rapid monocular visual stimulation

Rapid visual stimulation can increase synaptic efficacy by repeated synaptic activation. This long-term potentiation-like (LTP-like) effect can induce increased excitability in the human visual cortex. To examine the effect of rapid visual stimulation on perception, we tested the hypothesis that rapid monocular visual stimulation would increase the dominance of the stimulated eye in a binocular rivalry task. Participants (n = 25) viewed orthogonal 0.5 cpd gratings presented in a dichoptic anaglyph to induce binocular rivalry. Rivalry dynamics (alternation rate, dominance, and piecemeal durations) were recorded before and after 2 min of rapid monocular stimulation (9 Hz flicker of one grating) or a binocular control condition (9 Hz alternation of the orthogonal gratings viewed binocularly). Rapid monocular stimulation did not affect alternation rates or piecemeal percept duration. Unexpectedly, the rivalry dominance of the stimulated eye was significantly reduced. A further experiment revealed that this effect could not be explained by monocular adaptation. Together, the results suggest that rapid monocular stimulation boosts dominance in the non-stimulated eye, possibly by activating homeostatic interocular gain control mechanisms.

Can Short-Term Ocular Dominance Plasticity Provide a General Index to Visual Plasticity to Personalize Treatment in Amblyopia?

Purpose

Recently, Lunghi et al. (2016) showed that amblyopic eye’s visual acuity per se after 2 months of occlusion therapy could be predicted by a homeostatic plasticity, that is, the temporary shift of perceptual eye dominance observed after a 2-h monocular deprivation, in children with anisometropic amblyopia. In this study, we assess whether the visual acuity improvement of the amblyopic eye measured after 2 months of occlusion therapy could be predicted by this plasticity.

Methods

Seven children (6.86 ± 1.46 years old; SD) with anisometropic amblyopia participated in this study. All patients were newly diagnosed and had no treatment history before participating in our study. They finished 2 months of refractive adaptation and then received a 4-h daily fellow eye patching therapy with an opaque patch for a 2-month period. Best-corrected visual acuity of the amblyopic eye was measured before and after the patching therapy. The homeostatic plasticity was assessed by measuring the temporary shift of perceptual eye dominance from 2-h occlusion of the amblyopic eye before treatment. A binocular phase combination paradigm was used for this study.

Results

We found that there was no significant correlation between the temporary shift of perceptual eye dominance observed after 2-h occlusion of the amblyopic eye and the improvement in visual acuity in the amblyopic eye from 2 months of classical patching therapy. This result, although in disagreements with the conclusions of Lunghi et al. involving the short-term patching of the amblyopic eye, is in fact consistent with a reanalysis of Lunghi and colleagues’ data.

Conclusion

The short-term changes in perceptual eye dominance as a result of short-term monocular deprivation do not provide an index of cortical plasticity in the general sense such that they are able to predict acuity outcomes from longer-term classical patching.

Action Video Gaming Does Not Influence Short-Term Ocular Dominance Plasticity in Visually Normal Adults

Action video gaming can promote neural plasticity. Short-term monocular patching drives neural plasticity in the visual system of human adults. For instance, short-term monocular patching of 0.5–5 h briefly enhances the patched eye’s contribution in binocular vision (i.e., short-term ocular dominance plasticity). In this study, we investigate whether action video gaming can influence this plasticity in adults with normal vision. We measured participants’ eye dominance using a binocular phase combination task before and after 2.5 h of monocular patching. Participants were asked to play action video games, watch action video game movies, or play non-action video games during the period of monocular patching. We found that participants’ change of ocular dominance after monocular patching was not significantly different either for playing action video games versus watching action video game movies (Comparison 1) or for playing action video games versus playing non-action video games (Comparison 2). These results suggest that action video gaming does not either boost or eliminate short-term ocular dominance plasticity, and that the neural site for this type of plasticity might be in the early visual pathway.

Patching and Suppression in Amblyopia: One Mechanism or Two?

Purpose

To determine if benefits from occlusion therapy are due to decreased suppression from the fellow eye in children with amblyopia.

Methods

Ten newly diagnosed amblyopes (7.2 ± 1.4 years old), two with strabismus and eight with anisometropia, participated. Patients were first given a 2-month period of refractive adaptation, followed by occlusion therapy (i.e., patching their fellow eye with an opaque patch for 4 h/day). Visual acuity of the amblyopic eye and interocular suppression were measured before and after 0.5, 1, 2, 4, and 6 months of occlusion therapy. We quantified interocular suppression with a binocular phase combination task.

Results

Visual acuity (in logMAR) improved from 0.50 ± 0.22 (mean ± SD) to 0.33 ± 0.20 for patients who finished a short-term (2 months) occlusion (A1–A10), from 0.53 ± 0.20 to 0.32 ± 0.22 for patients who finished a medium-term (4 months) occlusion (A1–A9), and from 0.48 ± 0.19 to 0.22 ± 0.10 for patients who finished a long-term (6 months) occlusion (A1–A8). Although their visual acuity significantly improved, their degree of suppression, which was abnormal in all cases, did not change consistently. This was true in all durations of occlusion therapy.

Conclusion

Reduced suppression from the fixing eye might not be result from occlusion therapy.

Altered Visual Plasticity in Morbidly Obese Subjects

Growing evidence indicates a close link between energy metabolism and neural plasticity as obesity is associated with alterations of cognitive functions, memory, and hippocampal neurogenesis. However, it is still unknown whether obesity can affect low-level sensory plasticity. Here we investigated this issue by probing early visual plasticity induced by short-term (2 h) monocular deprivation in a group of adult volunteers with a wide range of Body Mass Index (BMI), from normal weight to morbid obesity. We found that the effect of monocular deprivation decreased with increasing BMI, and morbidly obese subjects (BMI>40) failed to show the homeostatic plasticity effect seen in normal-weight participants. In addition, morbidly obese subjects exhibited altered binocular rivalry dynamics compared with normal-weight observers. These results show for the first time that the impact of obesity observed at the neural and cognitive level extends to basic sensory processing and plasticity.

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Cognitive decline occurs in obesity suggesting altered high-level brain plasticity

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Low-level sensory plasticity in adults declines with increasing body mass index

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Morbidly obese subjects show altered visual plasticity and interocular interactions

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

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