Dichoptic Spatial Contrast Sensitivity Reflects Binocular Balance in Normal and Stereoanomalous Subjects

Reduced Monocular Luminance Promotes Fusion But Not Mixed Perception in Amblyopia

Purpose

The purpose of this study was to understand how monocular luminance reduction affects binocular balance and examine whether it differentially influences fusion and mixed perception in amblyopia.

Methods

Twenty-three normally sighted observers and 12 adults with amblyopia participated in this study. A novel binocular rivalry task was used to measure the phase duration of four perceptual responses (right- and left-tilts, fusion, and mixed perception) before and after a neutral density (ND) filter was applied at various levels to the dominant eye (DE) of controls and the fellow eye (FE) of patients with amblyopia. Phase durations were analyzed to assess whether the duration of fusion or mixed perception shifted after monocular luminance reduction. Moreover, we quantified ocular dominance and adjusted monocular contrast and luminance separately to investigate the relationship between changes in ocular dominance induced by the two manipulations.

Results

In line with previous studies, binocular balance shifted in favor of the brighter eye in both normal adults and patients with amblyopia. As a function of the ND filter's density, the duration of fusion and mixed perception decreased in normal controls, whereas that of fusion but not mixed perception increased significantly in patients with amblyopia. In addition, changes in binocular balance from luminance reduction were more significant in more balanced amblyopes or normal observers. Furthermore, shifts in binocular balance after contrast and luminance modulation were correlated in both normal and amblyopic observers.

Conclusions

The duration of fusion but not mixed perception increased in amblyopia after monocular luminance reduction in the FE. Moreover, our findings demonstrate that changes in ocular dominance from contrast-modulation and luminance-modulation are correlated in both normal and amblyopic observers.

Spatial frequency channels depend on stimulus bandwidth in normal and amblyopic vision: an exploratory factor analysis

The Contrast Sensitivity Function (CSF) is the measure of an observer's contrast sensitivity as a function of spatial frequency. It is a sensitive measure to assess visual function in fundamental and clinical settings. Human contrast sensitivity is subserved by different spatial frequency channels. Also, it is known that amblyopes have deficits in contrast sensitivity, particularly at high spatial frequencies. Therefore, the aim of this study was to assess whether the contrast sensitivity function is subtended by the same spatial frequency channels in control and amblyopic populations. To determine these spatial frequency channels, we performed an exploratory factor analysis on five datasets of contrasts sensitivity functions of amblyopic and control participants measured using either gratings or noise patches, taken from our previous studies. In the range of 0.25-10 c/d, we identified two spatial frequency channels. When the CSF was measured with noise patches, the spatial frequency channels presented very similar tuning in the amblyopic eye and the fellow eye and were also similar to what was observed in controls. The only major difference was that the weight attributed to the high frequency channel was reduced by approximately 50% in the amblyopic eye. However, when the CSF was measured using gratings, the spatial frequency channels of the amblyopic eye were tuned toward lower spatial frequencies. These findings suggest that there is no mechanistic deficit for contrast sensitivity in amblyopia and that amblyopic vision may just be subjected to excessive internal noise and attenuation at higher spatial frequencies, thereby supporting the use of therapeutic strategies that involve rebalancing contrast.

The effect of spatial structure on binocular contrast perception

To obtain a single percept of the world, the visual system must combine inputs from the two eyes. Understanding the principles that govern this binocular combination process has important real-world clinical and technological applications. However, most research examining binocular combination has relied on relatively simple visual stimuli and it is unclear how well the findings apply to real-world scenarios. For example, it is well-known that, when the two eyes view sine wave gratings with differing contrast (dichoptic stimuli), the binocular percept often matches the higher contrast grating. Does this winner-take-all property of binocular contrast combination apply to more naturalistic imagery, which include broadband structure and spatially varying contrast? To better understand binocular combination during naturalistic viewing, we conducted psychophysical experiments characterizing binocular contrast perception for a range of visual stimuli. In two experiments, we measured the binocular contrast perception of dichoptic sine wave gratings and naturalistic stimuli, and asked how the contrast of the surrounding context affected percepts. Binocular contrast percepts were close to winner-take-all across many of the stimuli when the surrounding context was the average contrast of the two eyes. However, we found that changing the surrounding context modulated the binocular percept of some patterns and not others. We show evidence that this contextual effect may be due to the spatial orientation structure of the stimuli. These findings provide a step toward understanding binocular combination in the natural world and highlight the importance of considering the effect of the spatial interactions in complex stimuli.

Fixation instability, astigmatism, and lack of stereopsis as factors impeding recovery of binocular balance in amblyopia following binocular therapy

Dichoptic therapy is a promising method for improving vision in pediatric and adult patients with amblyopia. However, a systematic understanding about changes in specific visual functions and substantial variation of effect among patients is lacking. Utilizing a novel stereoscopic augmented-reality based training program, 24 pediatric and 18 adult patients were trained for 20 h along a three-month time course with a one-month post-training follow-up for pediatric patients. Changes in stereopsis, distance and near visual acuity, and contrast sensitivity for amblyopic and fellow eyes were measured, and interocular differences were analyzed. To reveal what contributes to successful dichoptic therapy, ANCOVA models were used to analyze progress, considering clinical baseline parameters as covariates that are potential requirements for amblyopic recovery. Significant and lasting improvements have been achieved in stereoacuity, interocular near visual acuity, and interocular contrast sensitivity. Importantly, astigmatism, fixation instability, and lack of stereopsis were major limiting factors for visual acuity, stereoacuity, and contrast sensitivity recovery, respectively. The results demonstrate the feasibility of treatment-efficacy prediction in certain aspects of dichoptic amblyopia therapy. Furthermore, our findings may aid in developing personalized therapeutic protocols, capable of considering individual clinical status, to help clinicians in tailoring therapy to patient profiles for better outcome.

The Effect of Bangerter Filters on Visual Acuity and Contrast Sensitivity With External Noise

It is critical to address the relationship between density label of Bangerter filters and expected visual acuity, and how filters modulate contrast sensitivity (CS) at different spatial frequency and external noise levels. In the current study, the monocular visual acuity and CS at ten spatial frequencies and three noise levels were measured in normal subjects wearing no filters, 0.8, 0.4, or 0.2 Bangerter filters. Compared with the baseline condition (no filter worn), Bangerter filters degraded both visual acuity and contrast sensitivity function (CSF) in zero-noise conditions, but the reduction of both visual functions did not correlate with each other at any filter level. In addition, the stronger the filter was, the worse both visual functions became. In contrast, when external noise was present, filters improved the contrast sensitivity at low frequencies but deteriorated it at intermediate and high spatial frequencies. The perceptual template model was used to reveal the corresponding mechanism accounted for filter-induced visual function changes. Although the internal process in visual system should not be affected by the filters, the measurement of parameters was biased. To be specific, (1) the internal additive noise was elevated at all frequencies; (2) the perceptual template was improved at low spatial frequencies but impaired at intermediate spatial frequencies; and (3) the changes in both factors were highly dependent on filter intensity. We conclude that Bangerter filters influence visual acuity and contrast sensitivity differently and that their effect on contrast sensitivity depends on spatial frequency and noise.

A Dichoptic Optokinetic Nystagmus Paradigm for Interocular Suppression Quantification in Intermittent Exotropia

Purposes: To investigate the effectiveness of a dichoptic optokinetic nystagmus (dOKN) test to objectively quantify interocular suppression in intermittent exotropia (IXT) patients during the states of orthotropia and exodeviation.

Methods: The OKN motion in subjects (15 controls and 59 IXT subjects) who viewed dichoptic oppositely moving gratings with different contrast ratios was monitored and recorded by an eye tracker. Interocular suppression in control subjects was induced using neutral density (ND) filters. The OKN direction ratios were fitted to examine the changes of interocular suppression in subjects under different viewing states. Two established interocular suppression tests (phase and motion) were conducted for a comparative study.

Results: The dOKN test, which requires a minimal response from subjects, could accurately quantify the interocular suppression in both IXT and control subjects, which is in line with the established interocular suppression tests. Overall, although comparative, the strength of interocular suppression detected by the dOKN test (0.171 ± 0.088) was stronger than those of the phase (0.293 ± 0.081) and the motion tests (0.212 ± 0.068) in the control subjects with 1.5 ND filters. In IXT patients, when their eyes kept aligned, the dOKN test (0.58 ± 0.09) measured deeper visual suppression compared with the phase (0.73 ± 0.17) or the motion test (0.65 ± 0.14). Interestingly, strong interocular suppression (dOKN: 0.15 ± 0.12) was observed in IXT subjects during the periods of exodeviation, irrespective of their binocular visual function as measured by synoptophore.

Conclusion: The dOKN test provides efficient and objective quantification of interocular suppression in IXT, and demonstrates how it fluctuates under different eye positions.

Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes

Background

Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus.

Methods

Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus.

Results

Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training.

Conclusions

Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-021-02020-3.