Binocular visual training to promote recovery from monocular deprivation

The effect of training on sensitivity and stability of double fusion in Panum's limiting case

Panum's limiting case is a phenomenon of monocular occlusion in binocular vision. This occurs when one object is occluded by the other object for one eye, but the two objects are both visible for the other eye. Although previous studies have found that vertical gradient of horizontal disparity and cue conflict are two important factors for double fusion, the effect of training on the sensitivity and stability of Panum's limiting case remains unknown. The current study trained 26 participants for 5 days with several of Panum's configurations (Gilliam, Frisby, and Wang series). The latency and duration of double fusion were recorded to examine the effects of training on sensitivity and stability of double fusion in Panum's limiting case. For each level of vertical gradient of horizontal disparity and cue conflict, the latency of double fusion decreased and the duration of double fusion increased with each additional training session. The results showed that vertical gradient of horizontal disparity and cue conflict interacted, and the duration of high cue conflict was significantly shorter than that of medium and low cue conflict for each level of vertical gradient of horizontal disparity. The findings suggest that there is an effect of training for vertical gradient of horizontal disparity and cue conflict in Panum's limiting case, and that the three factors jointly affect the sensitivity and stability of double fusion.

Contrast Response Function Estimation with Nonparametric Bayesian Active Learning

Multidimensional psychometric functions can typically be estimated nonparametrically for greater accuracy or parametrically for greater efficiency. By recasting the estimation problem from regression to classification, however, powerful machine learning tools can be leveraged to provide an adjustable balance between accuracy and efficiency. Contrast Sensitivity Functions (CSFs) are behaviorally estimated curves that provide insight into both peripheral and central visual function. Because estimation can be impractically long, current clinical workflows must make compromises such as limited sampling across spatial frequency or strong assumptions on CSF shape. This paper describes the development of the Machine Learning Contrast Response Function (MLCRF) estimator, which quantifies the expected probability of success in performing a contrast detection or discrimination task. A machine learning CSF can then be derived from the MLCRF. Using simulated eyes created from canonical CSF curves and actual human contrast response data, the accuracy and efficiency of the MLCSF was evaluated in order to determine its potential utility for research and clinical applications. With stimuli selected randomly, the MLCSF estimator converged slowly toward ground truth. With optimal stimulus selection via Bayesian active learning, convergence was nearly an order of magnitude faster, requiring only tens of stimuli to achieve reasonable estimates. Inclusion of an informative prior provided no consistent advantage to the estimator as configured. MLCSF achieved efficiencies on par with quickCSF, a conventional parametric estimator, but with systematically higher accuracy. Because MLCSF design allows accuracy to be traded off against efficiency, it should be explored further to uncover its full potential.

Precis

Machine learning classifiers enable accurate and efficient contrast sensitivity function estimation with item-level prediction for individual eyes.

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.

Efficacy of binocular vision training and Fresnel press-on prism on children with esotropia and amblyopia

PURPOSE

In the process of clinical diagnosis and treatment of amblyopia, we have found that the treatment time of this disease was significantly different among different patients. The purpose of this study was to compare the efficacy of binocular vision training (BVT) and Fresnel press-on prism (FPP) on children with esotropia combined with amblyopia.

METHODS

From May 2015 to December 2018, a total of 101 children aged 3-9 years with esotropia and amblyopia who were in our hospital were enrolled in this randomized clinical trial. They were randomly divided into combined group (48 cases) and prism group (53 cases): the children in the prism group received FPP treatment, and those in the combined group received the combined treatment of BVT and FPP. The visual acuity, the binocular function and the strabismic therapeutic effects were compared between two groups.

RESULTS

After treatment, the visual acuity in both groups was both significantly improved compared with that before treatment (P = 0.0079). The binocular-monocular function, including synoptophore visual function and the Titmus stereopsis, in both groups was significantly improved compared with those before treatment (P < 0.05), and it was more significant in the combined group compared with the prism group (P < 0.05). The cure rate of strabismus was 87.50% (42/48) and 30.19% (16/53) in the combined group and the prism group, respectively, and there was significant difference between groups (P = 0.0036). The cure time was shortened with the lower of the degree of esotropia.

CONCLUSION

BVT combined with FPP can effectively promote the recovery of binocular vision in children with esotropia combined with amblyopia, and some children can achieve complete cure of strabismus.

Functional Deficits and Structural Changes Associated With the Visual Attention Network During Resting State in Adult Strabismic and Anisometropic Amblyopes

Our previous study has shown impaired blood oxygen level-dependent (BOLD)/functional magnetic resonance imaging (fMRI) activation of the visual attention network in strabismic amblyopia (SA). However, there has been no comparison of resting state fMRI activation and functional connectivity (FC) in brain regions of interest (ROIs) along the visual attention network including visual cortex (V1), intraparietal sulcus (IPS), and frontal eye fields (FEFs) during closed eye resting across the SA (n = 20, 13LE), or anisometropic amblyopes (AA) (n = 20, 13LE) groups. Hence, we compared, gray matter volume (GMV), amplitude of low frequency fluctuations (ALFFs), regional homogeneity (ReHo), and FC in the left and right hemisphere ROIs of the visual attention network in SA, AA, and healthy controls (HCs) (n = 21). Correlation analyses of corrected visual acuity (cVA) of amblyopic eye and MRI results were also performed and showed that the LogMAR cVA of the amblyopic eye positively correlated with right zALFF and zReHo FEF of SA and right IPS of AA only. GMV of both left and right hemisphere V1 areas was significantly greater but ALFF was significantly lower for SA compared to AA and HC groups. zALFF and zReHo analyses in the AA and SA groups indicated significantly higher activation than that in the HC group in the right FEF and IPS but lower than that in the HC group in the left FEF, and only the SA group showed lower activation in both V1 areas than the HC group. FC values of the right FEF–left V1, right FEF–right V1, and right FEF–right IPS pathways in the SA and AA groups were also significantly higher than those in the HC group whereas all other FC values were non-significant. Thus, this study indicates that even during resting-state the visual attention network function is impaired in SA and AA participants with only right hemisphere FEF showing significant activation in SA and IPS in AA suggesting that the slower saccade activation times characteristic of amblyopic eyes lead to the dominant eye controlling activation of the visual attention network.

Outcomes of using Bangerter foils for the treatment of residual amblyopia following patching therapy

PURPOSE

To evaluate the effectiveness of additional treatment using Bangerter foil (BF) for children with residual amblyopia.

METHODS

Patients with residual amblyopia who were treated with BF between 2015 and 2020 were reviewed. Residual amblyopia was defined as no further improvement in vision following patching therapy for at least 6 months. BF that corresponds to the VA of the amblyopic eye was applied to the spectacle lens of the fellow eye. Patients were divided into two groups: group A, which included patients treated with BF alone, and group B, which included patients treated with BF and a head-mounted display. After at least 2 months of treatment, baseline and final VA and stereoacuity were compared.

RESULTS

Seventy-four patients with a mean age of 8.0 ± 1.6 years at the time of BF treatment were included. The mean duration of the BF treatment was 10.4 ± 5.6 months. After a mean follow-up period of 24.9 ± 11.9 months after BF treatment, the median (IQR) VA of the amblyopic eye changed from 0.20 (0.15-0.40) LogMAR to 0.10 (0.04-0.20) LogMAR (P = 0.001). The median (IQR) stereoacuity changed from 3.19 (2.53-3.75) log arcsec to 2.60 (2.15-3.48) log arcsec (P = 0.001). The number of patients improved vision by 0.2 LogMAR or more lines was 18 patients (30%) for group A and 3 patients (23%) for group B. The VA of the amblyopic eye before BF treatment was significantly associated with vision improvement.

CONCLUSION

BF can be considered an alternative treatment plan to provide further benefit for children with residual amblyopia.

Dark Rearing Promotes the Recovery of Visual Cortical Responses but Not the Morphology of Geniculocortical Axons in Amblyopic Cat

Monocular deprivation (MD) of vision during early postnatal life induces amblyopia, and most neurons in the primary visual cortex lose their responses to the closed eye. Anatomically, the somata of neurons in the closed-eye recipient layer of the lateral geniculate nucleus (LGN) shrink and their axons projecting to the visual cortex retract. Although it has been difficult to restore visual acuity after maturation, recent studies in rodents and cats showed that a period of exposure to complete darkness could promote recovery from amblyopia induced by prior MD. However, in cats, which have an organization of central visual pathways similar to humans, the effect of dark rearing only improves monocular vision and does not restore binocular depth perception. To determine whether dark rearing can completely restore the visual pathway, we examined its effect on the three major concomitants of MD in individual visual neurons, eye preference of visual cortical neurons and soma size and axon morphology of LGN neurons. Dark rearing improved the recovery of visual cortical responses to the closed eye compared with the recovery under binocular conditions. However, geniculocortical axons serving the closed eye remained retracted after dark rearing, whereas reopening the closed eye restored the soma size of LGN neurons. These results indicate that dark rearing incompletely restores the visual pathway, and thus exerts a limited restorative effect on visual function.

A New Dichoptic Training Strategy Leads to Better Cooperation Between the Two Eyes in Amblyopia

Recent clinical trials failed to endorse dichoptic training for amblyopia treatment. Here, we proposed an alternative training strategy that focused on reducing signal threshold contrast in the amblyopic eye under a constant and high noise contrast in the fellow eye (HNC), and compared it to a typical dichoptic strategy that aimed at increasing the tolerable noise contrast in the fellow eye (i.e., TNC strategy). We recruited 16 patients with amblyopia and divided them into two groups. Eight patients in Group 1 received the HNC training, while the other eight patients in Group 2 performed the TNC training first (Phase 1) and then crossed over to the HNC training (Phase 2). We measured contrast sensitivity functions (CSFs) separately in the amblyopic and fellow eyes when the untested eye viewed mean luminance (monocularly unmasked) or noise stimuli (dichoptically masked) before and after training at a particular frequency. The area under the log contrast sensitivity function (AULCSF) of masked and unmasked conditions, and dichoptic gain (the ratio of AULCSF of masked to unmasked condition) were calculated for each eye. We found that both dichoptic training paradigms substantially improved masked CSF, dichoptic gain, and visual acuity in the amblyopic eye. As opposed to the TNC paradigm, the HNC training produced stronger effects on masked CSFs, stereoacuity, dichoptic gain, and visual acuity in the amblyopic eye. Interestingly, the second-phase HNC training in Group 2 also induced further improvement in the masked contrast sensitivity and AULCSF in the amblyopic eye. We concluded that the HNC training strategy was more effective than the TNC training paradigm. Future design for dichoptic training should not only focus on increasing the tolerable noise contrast in the fellow eye but should also "nurture" the amblyopic eye under normal binocular viewing conditions and sustained interocular suppression.

A Primer on Constructing Plasticity Phenotypes to Classify Experience-Dependent Development of the Visual Cortex

Many neural mechanisms regulate experience-dependent plasticity in the visual cortex (V1), and new techniques for quantifying large numbers of proteins or genes are transforming how plasticity is studied into the era of big data. With those large data sets comes the challenge of extracting biologically meaningful results about visual plasticity from data-driven analytical methods designed for high-dimensional data. In other areas of neuroscience, high-information content methodologies are revealing more subtle aspects of neural development and individual variations that give rise to a richer picture of brain disorders. We have developed an approach for studying V1 plasticity that takes advantage of the known functions of many synaptic proteins for regulating visual plasticity. We use that knowledge to rebrand protein measurements into plasticity features and combine those into a plasticity phenotype. Here, we provide a primer for analyzing experience-dependent plasticity in V1 using example R code to identify high-dimensional changes in a group of proteins. We describe using PCA to classify high-dimensional plasticity features and use them to construct a plasticity phenotype. In the examples, we show how to use this analytical framework to study and compare experience-dependent development and plasticity of V1 and apply the plasticity phenotype to translational research questions. We include an R package “PlasticityPhenotypes” that aggregates the coding packages and custom code written in RStudio to construct and analyze plasticity phenotypes.

Experience-Dependent Reorganization Drives Development of a Binocularly Unified Cortical Representation of Orientation

Across sensory areas, neural microcircuits consolidate streams of information into unified representations of the external world. In the carnivore visual cortex, where eye-specific inputs first converge, it has been posited that a single, binocularly aligned modular orientation representation develops independent of sensory experience. In this study of ferret visual cortex using in vivo calcium imaging, we find evidence for a different developmental process. Early in development, contralateral, ipsilateral, or binocular stimulation each yield well-organized modular representations of orientation that display features of mature cortex. However, comparison of these representations reveals considerable misalignment that is evident at both modular and cellular scales. Experience-dependent processes drive reorganization of these three representations toward a single binocularly aligned representation resembling the early binocular representation through shifts in cellular orientation preference. Thus, while orderly modular networks of orientation preference initially arise independent of visual experience, experience is critical for the alignment of these early representations.

The critical period for darkness-induced recovery of the vision of the amblyopic eye following early monocular deprivation

Exposure of kittens to complete darkness for 10 days has been shown (Duffy & Mitchell, 2013) to reverse the loss of visual acuity that follows a prior period of monocular deprivation (MD). In that study, recovery of acuity in the previously deprived eye was fast despite the fact that darkness was imposed 2 months after the period of MD when kittens were 3 months old. In a later study (Holman, Duffy, & Mitchell, 2018), it was demonstrated that the same period of darkness was ineffective when it was imposed on cats about 1 year old, suggesting that dark exposure may only promote recovery when applied within an early critical period. To determine the profile of this critical period, the identical period of darkness (10 days) was imposed on kittens at various ages that had all received the same 7-day period of MD from postnatal day 30 (P30). Recovery of the acuity of the deprived eye as measured by use of a jumping stand was complete when darkness was imposed prior to P186 days, but thereafter, darkness induced progressively smaller acuity improvements and was ineffective in kittens when it began at or beyond P191 days of age. These data indicate a critical period for darkness-induced recovery with an abrupt end over a 5-day period.

Classification of Visual Cortex Plasticity Phenotypes following Treatment for Amblyopia

Monocular deprivation (MD) during the critical period (CP) has enduring effects on visual acuity and the functioning of the visual cortex (V1). This experience-dependent plasticity has become a model for studying the mechanisms, especially glutamatergic and GABAergic receptors, that regulate amblyopia. Less is known, however, about treatment-induced changes to those receptors and if those changes differentiate treatments that support the recovery of acuity versus persistent acuity deficits. Here, we use an animal model to explore the effects of 3 visual treatments started during the CP (n = 24, 10 male and 14 female): binocular vision (BV) that promotes good acuity versus reverse occlusion (RO) and binocular deprivation (BD) that causes persistent acuity deficits. We measured the recovery of a collection of glutamatergic and GABAergic receptor subunits in the V1 and modeled recovery of kinetics for NMDAR and GABA_AR. There was a complex pattern of protein changes that prompted us to develop an unbiased data-driven approach for these high-dimensional data analyses to identify plasticity features and construct plasticity phenotypes. Cluster analysis of the plasticity phenotypes suggests that BV supports adaptive plasticity while RO and BD promote a maladaptive pattern. The RO plasticity phenotype appeared more similar to adults with a high expression of GluA2, and the BD phenotypes were dominated by GABA_A α1, highlighting that multiple plasticity phenotypes can underlie persistent poor acuity. After 2-4 days of BV, the plasticity phenotypes resembled normals, but only one feature, the GluN2A:GluA2 balance, returned to normal levels. Perhaps, balancing Hebbian (GluN2A) and homeostatic (GluA2) mechanisms is necessary for the recovery of vision.

Modification of Peak Plasticity Induced by Brief Dark Exposure

The capacity for neural plasticity in the mammalian central visual system adheres to a temporal profile in which plasticity peaks early in postnatal development and then declines to reach enduring negligible levels. Early studies to delineate the critical period in cats employed a fixed duration of monocular deprivation to measure the extent of ocular dominance changes induced at different ages. The largest deprivation effects were observed at about 4 weeks postnatal, with a steady decline in plasticity thereafter so that by about 16 weeks only small changes were measured. The capacity for plasticity is regulated by a changing landscape of molecules in the visual system across the lifespan. Studies in rodents and cats have demonstrated that the critical period can be altered by environmental or pharmacological manipulations that enhance plasticity at ages when it would normally be low. Immersion in complete darkness for long durations (dark rearing) has long been known to alter plasticity capacity by modifying plasticity-related molecules and slowing progress of the critical period. In this study, we investigated the possibility that brief darkness (dark exposure) imposed just prior to the critical period peak can enhance the level of plasticity beyond that observed naturally. We examined the level of plasticity by measuring two sensitive markers of monocular deprivation, namely, soma size of neurons and neurofilament labeling within the dorsal lateral geniculate nucleus. Significantly larger modification of soma size, but not neurofilament labeling, was observed at the critical period peak when dark exposure preceded monocular deprivation. This indicated that the natural plasticity ceiling is modifiable and also that brief darkness does not simply slow progress of the critical period. As an antecedent to traditional amblyopia treatment, darkness may increase treatment efficacy even at ages when plasticity is at its highest.

The Effect of Combined Patching and Citalopram on Visual Acuity in Adults with Amblyopia: A Randomized, Crossover, Placebo-Controlled Trial

Nonhuman animal models have demonstrated that selective serotonin reuptake inhibitors (SSRIs) can enhance plasticity within the mature visual cortex and enable recovery from amblyopia. The aim of this study was to test the hypothesis that the SSRI citalopram combined with part-time patching of the fellow fixing eye would improve amblyopic eye visual acuity in adult humans. Following a crossover, randomized, double-blind, placebo-controlled design, participants completed two 2-week blocks of fellow fixing eye patching. One block combined patching with citalopram (20 mg/day) and the other with a placebo tablet. The blocks were separated by a 2-week washout period. The primary outcome was change in amblyopic eye visual acuity. Secondary outcomes included stereoacuity and electrophysiological measures of retinal and cortical function. Seven participants were randomized, fewer than our prespecified sample size of 20. There were no statistically significant differences in amblyopic eye visual acuity change between the active (mean ± SD change = 0.08 ± 0.16 logMAR) and the placebo (mean change = −0.01 ± 0.03 logMAR) blocks. No treatment effects were observed for any secondary outcomes. However, 3 of 7 participants experienced a 0.1 logMAR or greater improvement in amblyopic eye visual acuity in the active but not the placebo blocks. These results from a small sample suggest that larger-scale trials of SSRI treatment for adult amblyopia may be warranted. Considerations for future trials include drug dose, treatment duration, and recruitment challenges. This study was preregistered as a clinical trial (ACTRN12611000669998).

Effectiveness of binocularity-stimulating treatment in children with residual amblyopia following occlusion

BACKGROUND

To evaluate the effectiveness of binocularity-stimulating treatment in children with residual amblyopia following occlusion therapy for more than 6 months.

METHODS

Of patients with amblyopia caused by anisometropia and/or strabismus, patients with residual amblyopia following more than 6 months of occlusion therapy were included. Subjects underwent one of the following types of binocularity-stimulating therapy: Bangerter foil (BF), head-mounted display (HMD) game, or BF/HMD combination (BF + HMD). Factors including age, sex, types of amblyopia, visual acuity, and duration of treatment were investigated. Baseline and final (after at least 2 months of treatment) visual acuity were also compared.

RESULTS

Twenty-two patients with a mean age of 8.7 ± 1.3 years were included. Seven patients had anisometropic amblyopia, 8 patients had strabismic amblyopia, and 7 patients had combined amblyopia. After 4.4 ± 1.8 months of treatment, logarithm of the minimum angle of resolution (logMAR) visual acuity in the amblyopic eye improved from 0.22 ± 0.20 to 0.18 ± 0.15. Five of 22 patients (22.7%) gained more than 0.2 logMAR, including 1 of 10 patients (10.0%) in the BF group, 2 of 7 patients (28.6%) in the HMD group, and 2 of 5 patients (40.0%) in the BF + HMD group. No significant differences in clinical characteristics were identified among the three groups.

CONCLUSIONS

Binocularity-stimulating therapy is somewhat beneficial in children with residual amblyopia and might be attempted when children no longer benefit from sufficient long-term period of occlusion therapy.

Critical periods in amblyopia

The shift in ocular dominance (OD) of binocular neurons induced by monocular deprivation is the canonical model of synaptic plasticity confined to a postnatal critical period. Developmental constraints on this plasticity not only lend stability to the mature visual cortical circuitry but also impede the ability to recover from amblyopia beyond an early window. Advances with mouse models utilizing the power of molecular, genetic, and imaging tools are beginning to unravel the circuit, cellular, and molecular mechanisms controlling the onset and closure of the critical periods of plasticity in the primary visual cortex (V1). Emerging evidence suggests that mechanisms enabling plasticity in juveniles are not simply lost with age but rather that plasticity is actively constrained by the developmental up-regulation of molecular 'brakes'. Lifting these brakes enhances plasticity in the adult visual cortex, and can be harnessed to promote recovery from amblyopia. The reactivation of plasticity by experimental manipulations has revised the idea that robust OD plasticity is limited to early postnatal development. Here, we discuss recent insights into the neurobiology of the initiation and termination of critical periods and how our increasingly mechanistic understanding of these processes can be leveraged toward improved clinical treatment of adult amblyopia.

The use of in vivo, ex vivo, in vitro, computational models and volunteer studies in vision research and therapy, and their contribution to the Three Rs

Much is known about mammalian vision, and considerable progress has been achieved in treating many vision disorders, especially those due to changes in the eye, by using various therapeutic methods, including stem cell and gene therapy. While cells and tissues from the main parts of the eye and the visual cortex (VC) can be maintained in culture, and many computer models exist, the current non-animal approaches are severely limiting in the study of visual perception and retinotopic imaging. Some of the early studies with cats and non-human primates (NHPs) are controversial for animal welfare reasons and are of questionable clinical relevance, particularly with respect to the treatment of amblyopia. More recently, the UK Home Office records have shown that attention is now more focused on rodents, especially the mouse. This is likely to be due to the perceived need for genetically-altered animals, rather than to knowledge of the similarities and differences of vision in cats, NHPs and rodents, and the fact that the same techniques can be used for all of the species. We discuss the advantages and limitations of animal and non-animal methods for vision research, and assess their relative contributions to basic knowledge and clinical practice, as well as outlining the opportunities they offer for implementing the principles of the Three Rs (Replacement, Reduction and Refinement).

The effectiveness of disc synoptoscope on patients with abnormal binocular vision: a prospective cohort study

PURPOSE

We performed a prospective cohort study to evaluate the effectiveness of disc synoptoscope on binocularity in patients with abnormal binocular vision.

METHODS

39 eligible subjects were recruited for visual therapy with disc synoptoscope in treatment group and 38 were just observed as control.

RESULTS

Simultaneous perception in treatment group was better than controls at 6-month visit (p < 0.05). Fusional amplitude improved in treatment group but decreased in control group at 3- and 6-months visits (p < 0.001). Near and distance stereopsis in treatment group were better than controls at 3- and 6-months (p < 0.05). The improvements of monocular and binocular acuity in treatment group were better than controls at 3- and 6-months (p < 0.05). Postoperative recurrence rate in treatment group was lower than controls (p < 0.05).

CONCLUSION

Visual therapy with disc synoptoscope is effective in improving short-term binocular vision for the patients with abnormal binocular vision; disc synoptoscope could serve as an effective home-based visual therapy instrument.

Susceptibility to monocular deprivation following immersion in darkness either late into or beyond the critical period

An extended duration of darkness starting near the time of birth preserves immature neuronal characteristics and prolongs the accentuated plasticity observed in young animals. Brief periods of complete darkness have emerged as an effective means of restoring a high capacity for neural plasticity and of promoting recovery from the effects of monocular deprivation (MD). We examined whether 10 days of darkness imposed in adulthood or beyond the peak of the critical period could rejuvenate the ability of MD to reduce the size of neuron somata within deprived layers of the cat dorsal lateral geniculate nucleus (dLGN). For adult cats subjected to 10 days of darkness before 7 days of MD, we observed no alteration in neuron size or neurofilament labeling within the dLGN. At 12 weeks of age, MD that followed immediately after 10 days of darkness produced an enhanced reduction of neuron soma size within deprived dLGN layers. For this age we observed that 10 days of darkness also enhanced the loss of neurofilament protein within deprived dLGN layers. These results indicate that, although 10 days of darkness in adulthood does not enhance the susceptibility to 7 days of MD, darkness imposed near the trailing edge of the critical period can restore a heightened susceptibility to MD more typical of an earlier developmental stage. The loss of neurofilament in juveniles exposed to darkness prior to MD suggests that the enhanced capacity for structural plasticity is partially rooted in the ability of darkness to modulate molecules that inhibit plasticity. J. Comp. Neurol. 524:2643-2653, 2016. © 2016 Wiley Periodicals, Inc.

Optimization of visual training for full recovery from severe amblyopia in adults

The severe amblyopia induced by chronic monocular deprivation is highly resistant to reversal in adulthood. Here we use a rodent model to show that recovery from deprivation amblyopia can be achieved in adults by a two-step sequence, involving enhancement of synaptic plasticity in the visual cortex by dark exposure followed immediately by visual training. The perceptual learning induced by visual training contributes to the recovery of vision and can be optimized to drive full recovery of visual acuity in severely amblyopic adults.

"Global" visual training and extent of transfer in amblyopic macaque monkeys

Perceptual learning is gaining acceptance as a potential treatment for amblyopia in adults and children beyond the critical period. Many perceptual learning paradigms result in very specific improvement that does not generalize beyond the training stimulus, closely related stimuli, or visual field location. To be of use in amblyopia, a less specific effect is needed. To address this problem, we designed a more general training paradigm intended to effect improvement in visual sensitivity across tasks and domains. We used a "global" visual stimulus, random dot motion direction discrimination with 6 training conditions, and tested for posttraining improvement on a motion detection task and 3 spatial domain tasks (contrast sensitivity, Vernier acuity, Glass pattern detection). Four amblyopic macaques practiced the motion discrimination with their amblyopic eye for at least 20,000 trials. All showed improvement, defined as a change of at least a factor of 2, on the trained task. In addition, all animals showed improvements in sensitivity on at least some of the transfer test conditions, mainly the motion detection task; transfer to the spatial domain was inconsistent but best at fine spatial scales. However, the improvement on the transfer tasks was largely not retained at long-term follow-up. Our generalized training approach is promising for amblyopia treatment, but sustaining improved performance may require additional intervention.