Amblyopia Affects the ON Visual Pathway More than the OFF

Interocular suppression in chromoluminance patterns measured with SSVEP

Many cells in the early human visual system respond to either chromatic or luminance contrast or a combination of both. In addition, depending on their location in the visual hierarchy, these cells may receive input from either one eye or both eyes. It is well understood that spatial luminance contrast patterns undergo binocular normalization: Inputs from each eye mutually suppress each other so that monocular and binocular percepts appear similar. Recent reports suggest that interocular normalization computations may depend on spatial and temporal frequency. Here, we examined the effect of chromaticity and spatial frequency on binocular normalization computations using a dichoptic frequency-tagged, steady-state visually evoked potential (SSVEP) paradigm. We found that normalization as indexed by changes in eye-tagged input SSVEP frequencies and intermodulation terms depends significantly on both spatial frequency and color. We also found that binocular combination must occur in neurons that carry half-wave rectified signals due to 1F combination frequencies being present. Overall, our results are not well explained by a model in which neurons that code low spatial frequency color are segregated anatomically in the centers of ocular dominance columns. Significant levels of binocular interaction must occur in neurons that code both color and luminance and in neurons sensitive to both low and high spatial frequencies.

Retinal Responses to Short- and Longer-Term Predominant ON or OFF Stimulation in Emmetropes and Myopes

Purpose

The link between nearwork and myopia is controversially discussed. Features of the viewing target may stimulate eye growth, for example, black-on-white text was found to stimulate retinal OFF pathways and promote choroidal thinning, whereas inverted text led to ON pathway stimulation and thicker choroids. We used electroretinograms (ERGs) to compare retinal activity for both stimuli in the parafovea in emmetropes and myopes and studied the effects of adaptation.

Methods

ERGs were recorded in 42 subjects (18-30 years) during 200 ms-flashes on a CRT monitor, superimposed with an annulus or circles filled with gray or inverted or standard text. Ganzfeld ERGs (500 ms) were taken before and after 30 minutes of reading standard or inverted text at 25 cm to determine adaptation effects. The ON- (b-wave) and OFF-responses (d-wave) were analyzed using linear mixed effects models and pointwise t-testing.

Results

(1) Stimulus size affected retinal ON-responses of both groups (p < 0.001), with larger responses to a 6 to 12 degrees annulus than to a 12-degree circle. (2) Myopes displayed larger ON-responses to inverted text contrast than emmetropes within 6 to 12 degrees. (3) After adaptation to text, ON-responses were reduced (p = 0.010) irrespective of refraction and contrast. (4) Emmetropes showed reduced ON- and OFF-responses to inverted text contrast. (5) Only emmetropes had reduced ON- and larger OFF-responses after adapting to standard text.

Conclusions

Myopes had largest ON-responses with inverted contrast in the perifovea. Emmetropes displayed larger adaptive changes after ON/OFF stimulation. In both groups, inverted contrast still reduced ON-responses, suggesting that efficient activation of retinal ON channels to inhibit myopia might require additional OFF channel suppression.

Visual Field Asymmetries in Responses to ON and OFF Pathway Biasing Stimuli

Recent reports suggest the ON and OFF pathways are differentially susceptible to selective vision loss in glaucoma. Thus, perimetric assessment of ON- and OFF-pathway function may serve as a useful diagnostic. However, this necessitates a developed understanding of normal ON/OFF pathway function around the visual field and as a function of input intensity. Here, using electroencephalography, we measured ON- and OFF-pathway biased contrast response functions in the upper and lower visual fields. Using the steady-state visually evoked potential paradigm, we flickered achromatic luminance probes according to a saw-tooth waveform, the fast phase of which biased responses towards the ON or OFF pathways. Neural responses from the upper and lower visual fields were simultaneously measured using frequency tagging - probes in the upper visual field modulated at 3.75 Hz, while those in the lower visual field modulated at 3 Hz. We find that responses to OFF/decrements are larger than ON/increments, especially in the lower visual field. In the lower visual field, both ON and OFF responses were well described by a sigmoidal non-linearity. In the upper visual field, the ON pathway function was very similar to that of the lower, but the OFF pathway function showed reduced saturation and more cross-subject variability. Overall, this demonstrates that the relationship between the ON and OFF pathways depends on the visual field location and contrast level, potentially reflective of natural scene statistics.

Asymmetric Activation of Retinal ON and OFF Pathways by AOSLO Raster-Scanned Visual Stimuli

Adaptive optics scanning light ophthalmoscopy (AOSLO) enables high-resolution retinal imaging, eye tracking, and stimulus delivery in the living eye. AOSLO-mediated visual stimuli are created by temporally modulating the excitation light as it scans across the retina. As a result, each location within the field of view receives a brief flash of light during each scanner cycle (every 33-40 ms). Here we used in vivo calcium imaging with AOSLO to investigate the impact of this intermittent stimulation on the retinal ON and OFF pathways. Raster-scanned backgrounds exaggerated existing ON-OFF pathway asymmetries leading to high baseline activity in ON cells and increased response rectification in OFF cells.

OPTICAL BLUR AFFECTS DIFFERENTLY ON AND OFF VISUAL PATHWAYS

The human eye has a crystalline lens that focuses retinal images at the point of fixation. Outside this fixation region, images are distorted by optical blur, which increases light scatter and reduces the spatial resolution and contrast processed by neuronal pathways. The spectacle lenses that humans use for optical correction also minify or magnify the images, affecting neuronal surround suppression in visual processing. Because light and dark stimuli are processed with ON and OFF pathways that have different spatial resolution, contrast sensitivity and surround suppression, optical blur and image magnification should affect differently the two pathways and the perception of lights and darks. Our results provide support for this prediction in cats and humans. We demonstrate that optical blur expands ON receptive fields while shrinking OFF receptive fields, as expected from the expansion of light stimuli and shrinkage of dark stimuli with light scatter. Spectacle-induced image magnification also shrinks OFF more than ON receptive fields, as expected from the stronger surround suppression in OFF than ON pathways. Optical blur also decreases the population response of OFF more than ON pathways, consistent with the different effects of light scatter on dark and light stimuli and the ON-OFF pathway differences in contrast sensitivity. Based on these results, we conclude that optical blur and image magnification reduce the receptive field sizes and cortical responses of OFF more than ON pathways, making the ON-OFF response balance a reliable signal to optimize the size and quality of the retinal image.

Understanding contrast perception in amblyopia: a psychophysical analysis of the ON and OFF visual pathways

Purpose

The study aimed to explore potential discrepancies in contrast sensitivity in the ON and OFF visual pathways among individuals with amblyopia compared to controls.

Methods

Eleven adult amblyopes (26.2 ± 4.4 [SD] years old) and 10 controls (24.6 ± 0.8 years old) with normal or corrected to normal visual acuity (logMAR VA ≤ 0) participated in this study. Using the quick contrast sensitivity function (qCSF) algorithm, we measured balanced CSF which would stimulate the ON and OFF pathways unselectively, and CSFs for increments and decrements that would selectively stimulate the ON and OFF visual pathways. Contrast sensitivity and area under log contrast sensitivity function were extracted for statistical analysis.

Results

For the balanced CSF, we found significant interocular differences in sensitivity and area under log contrast sensitivity function in both amblyopes [F(1,10) = 74.992, p < 0.001] and controls [F(1,9) = 35.6, p < 0.001], while such differences were more pronounced in amblyopes than in controls. For increment and decrement CSFs, we found that the increment sensitivity (p = 0.038) and area under log contrast sensitivity function (p = 0.001) were significantly lower than the decrement in the amblyopic eye. Such differences between increment and decrement CSFs were not observed in the fellow eye of the amblyopes or in the controls.

Conclusion

There is a subtle difference in the contrast sensitivity of the amblyopic eye when exposed to stimulation in the ON and OFF pathways.

Integrative neurovascular coupling and neurotransmitter analyses in anisometropic and visual deprivation amblyopia children

The association between visual abnormalities and impairments in cerebral blood flow and brain region potentially results in neural dysfunction of amblyopia. Nevertheless, the differences in the complex mechanisms of brain neural network coupling and its relationship with neurotransmitters remain unclear. Here, the neurovascular coupling mechanism and neurotransmitter activity in children with anisometropic amblyopia (AA) and visual deprivation amblyopia (VDA) was explored. The neurovascular coupling of 17 brain regions in amblyopia children was significantly abnormal than in normal controls. The classification abilities of coupling units in brain regions differed between two types of amblyopia. Correlations between different coupling effects and neurotransmitters were different. The findings of this study demonstrate a correlation between the neurovascular coupling and neurotransmitter in children with AA and VDA, implying their impaired neurovascular coupling function and potential molecular underpinnings. The neuroimaging evidence revealed herein offers potential for the development of neural therapies for amblyopia.

Contrast Sensitivity of ON and OFF Human Retinal Pathways in Myopia

The human visual cortex processes light and dark stimuli with ON and OFF pathways that are differently modulated by luminance contrast. We have previously demonstrated that ON cortical pathways have higher contrast sensitivity than OFF cortical pathways and the difference increases with luminance range (defined as the maximum minus minimum luminance in the scene). Here, we demonstrate that these ON-OFF cortical differences are already present in the human retina and that retinal responses measured with electroretinography are more affected by reductions in luminance range than cortical responses measured with electroencephalography. Moreover, we show that ON-OFF pathway differences measured with electroretinography become more pronounced in myopia, a visual disorder that elongates the eye and blurs vision at far distance. We find that, as the eye axial length increases across subjects, ON retinal pathways become less responsive, slower in response latency, less sensitive, and less effective and slower at driving pupil constriction. Based on these results, we conclude that myopia is associated with a deficit in ON pathway function that decreases the ability of the retina to process low contrast and regulate retinal illuminance in bright environments.

Measuring the Interocular Delay and its Link to Visual Acuity in Amblyopia

Purpose

Research on interocular synchronicity in amblyopia has demonstrated a deficit in synchronization (i.e., a neural processing delay) between the two eyes. Current methods for assessing interocular delay are either costly or ineffective for assessments in severe amblyopia. In this study, we adapted a novel protocol developed by Burge and Cormack based on continuous target tracking to measure the interocular delay on a wide range of amblyopes. Our main aims were to assess the accessibility of this protocol and to investigate the relationship between interocular delay and visual acuity.

Methods

This protocol, which consists of tracking a target undergoing random lateral motion with the mouse cursor, is performed both binocularly and monocularly. The processing speed of a given eye is computed by comparing the changes in velocity of the target and mouse via cross-correlation. The difference in processing speed between the eyes defines the interocular delay.

Results

Cross-correlations revealed that the amblyopic eye tends to be delayed in time compared with the fellow eye. Interocular delays fell in the range of 0.6 to 114.0 ms. The magnitude of the delay was positively correlated with differences in interocular visual acuity (R2 = 0.484; P = 0.0002).

Conclusions

These results demonstrate the accessibility of this new protocol and further support the link between interocular synchronicity and amblyopia. Furthermore, we determine that the interocular delay in amblyopia is best explained by a deficit in the temporal integration of the amblyopic eye.

Analysis of the improvement in monocular amblyopia visual acuity caused by the changes in non-amblyopia visual acuity in 74 adults

To observe the clinical phenomenon of amblyopia vision improvement in patients with monocular amblyopia over 18 years old after non-amblyopia diseases, analyze the conditions and causes of vision improvement, explore the plasticity of the adult optic nerve, and provide a clinical basis for the treatment of adult amblyopia. A total of 74 patients with monocular amblyopia combined with non-amblyopia visual acuity decline from 2018 to 2021 were collected. The patient's age, initial best-corrected visual acuity (BCVA), pattern visual evoked potential examination results, and visual acuity regression were recorded. The BCVA of amblyopia was recorded every 3 months using an early treatment of diabetic retinopathy study visual acuity chart. In the 3rd month, BCVA increased by 16.2%, reaching 98% in the 9th month and 100% in the 12th months. According to the age of patients, the group aged 18 to 35 years was better than the group aged 35 to 60 years, whereas the group aged 35 to 60 years was better than the group aged over 60 years (P < .05). According to the comparison of initial visual acuity, the BCVA of the < 5 letter group was lower than that of the other 2 groups (P < .05). According to the pattern visual evoked potential results, the peak time of the < 10 ms group was better than that of the 10 to 20 ms group; the 10 to 20 ms group was better than that of the > 20 ms group; the peak decrease of the < 30% group was better than that of the 30% to 50% group; and the 30% to 50% group was better than that of the > 50% group (P < .05). The visual acuity regression of amblyopia in the 0.5 to 1-year group was higher than that in the other 2 groups (P < .05). This study confirms that adult amblyopia can still be cured under certain conditions. This visual plasticity is related to age, initial visual acuity, and excitability of the visual center. This study provides new clinical evidence and diagnostic ideas for the study of the pathogenesis of adult amblyopia.

Differences in visual stimulation between reading and walking and implications for myopia development

Visual input plays an important role in the development of myopia (nearsightedness), a visual disorder that blurs vision at far distances. The risk of myopia progression increases with the time spent reading and decreases with outdoor activity for reasons that remain poorly understood. To investigate the stimulus parameters driving this disorder, we compared the visual input to the retina of humans performing two tasks associated with different risks of myopia progression, reading and walking. Human subjects performed the two tasks while wearing glasses with cameras and sensors that recorded visual scenes and visuomotor activity. When compared with walking, reading black text in white background reduced spatiotemporal contrast in central vision and increased it in peripheral vision, leading to a pronounced reduction in the ratio of central/peripheral strength of visual stimulation. It also made the luminance distribution heavily skewed toward negative dark contrast in central vision and positive light contrast in peripheral vision, decreasing the central/peripheral stimulation ratio of ON visual pathways. It also decreased fixation distance, blink rate, pupil size, and head-eye coordination reflexes dominated by ON pathways. Taken together with previous work, these results support the hypothesis that reading drives myopia progression by understimulating ON visual pathways.

Clinical analysis of eye movement-based data in the medical diagnosis of amblyopia

Amblyopia is an abnormal visual processing-induced developmental disorder of the central nervous system that affects static and dynamic vision, as well as binocular visual function. Currently, changes in static vision in one eye are the gold standard for amblyopia diagnosis. However, there have been few comprehensive analyses of changes in dynamic vision, especially eye movement, among children with amblyopia. Here, we proposed an optimization scheme involving a video eye tracker combined with an "artificial eye" for comprehensive examination of eye movement in children with amblyopia; we sought to improve the diagnostic criteria for amblyopia and provide theoretical support for practical treatment. The resulting eye movement data were used to construct a deep learning approach for diagnostic and predictive applications. Through efforts to manage the uncooperativeness of children with strabismus who could not complete the eye movement assessment, this study quantitatively and objectively assessed the clinical implications of eye movement characteristics in children with amblyopia. Our results indicated that an amblyopic eye is always in a state of adjustment, and thus is not "lazy." Additionally, we found that the eye movement parameters of amblyopic eyes and eyes with normal vision are significantly different. Finally, we identified eye movement parameters that can be used to supplement and optimize the diagnostic criteria for amblyopia, providing a diagnostic basis for evaluation of binocular visual function.

Luminance Contrast Shifts Dominance Balance between ON and OFF Pathways in Human Vision

Human vision processes light and dark stimuli in visual scenes with separate ON and OFF neuronal pathways. In nature, stimuli lighter or darker than their local surround have different spatial properties and contrast distributions (Ratliff et al., 2010; Cooper and Norcia, 2015; Rahimi-Nasrabadi et al., 2021). Similarly, in human vision, we show that luminance contrast affects the perception of lights and darks differently. At high contrast, human subjects of both sexes locate dark stimuli faster and more accurately than light stimuli, which is consistent with a visual system dominated by the OFF pathway. However, at low contrast, they locate light stimuli faster and more accurately than dark stimuli, which is consistent with a visual system dominated by the ON pathway. Luminance contrast was strongly correlated with multiple ON/OFF dominance ratios estimated from light/dark ratios of performance errors, missed targets, or reaction times (RTs). All correlations could be demonstrated at multiple eccentricities of the central visual field with an ON-OFF perimetry test implemented in a head-mounted visual display. We conclude that high-contrast stimuli are processed faster and more accurately by OFF pathways than ON pathways. However, the OFF dominance shifts toward ON dominance when stimulus contrast decreases, as expected from the higher-contrast sensitivity of ON cortical pathways (Kremkow et al., 2014; Rahimi-Nasrabadi et al., 2021). The results highlight the importance of contrast polarity in visual field measurements and predict a loss of low-contrast vision in humans with ON pathway deficits, as demonstrated in animal models (Sarnaik et al., 2014).SIGNIFICANCE STATEMENT ON and OFF retino-thalamo-cortical pathways respond differently to luminance contrast. In both animal models and humans, low contrasts drive stronger responses from ON pathways, whereas high contrasts drive stronger responses from OFF pathways. We demonstrate that these ON-OFF pathway differences have a correlate in human vision. At low contrast, humans locate light targets faster and more accurately than dark targets but, as contrast increases, dark targets become more visible than light targets. We also demonstrate that contrast is strongly correlated with multiple light/dark ratios of visual performance in central vision. These results provide a link between neuronal physiology and human vision while emphasizing the importance of stimulus polarity in measurements of visual fields and contrast sensitivity.

Age-related decline in function of ON and OFF visual pathways

Purpose

A simple psychophysical paradigm is available as a digital application in iOS devices such as iPad to measure the function of ON and OFF visual pathways. However, an age-matched normative database is not readily available. The purpose of the study is to evaluate the response of ON and OFF visual pathways as a function of age.

Methods

158 normal healthy adults (84 males and 74 females) whose age ranged 18–80 years participated in the study. None of them had any ocular disease (except cataract of grade II or less) and visual acuity of ≤ 20/25. Monocular testing (only one eye) was performed on the ‘EyeSpeed’ application on an iPad at 40cm distance. The targets ranged between 1 to 3 light or dark squares presented randomly in a noise background and participants responded by indicating the number of squares by touching the screen as fast as possible. The main outcome variables are reaction time, accuracy and performance index (1 / speed * accuracy).

Results

The median reaction time was shorter (Median (IQR): 1.53s (0.49) [dark] Vs 1.76s (0.58) [light], p < 0.001) and accuracy was higher (97.21% (3.30) [dark] Vs 95.15% (5.10) [light], p < 0.001) for dark targets than the light targets. Performance index and reaction time for both target types significantly correlated with age (ρ = -0.41 to -0.43; p < 0.001).

Conclusions

This normative database will be useful to quantify disease-specific defects. More importantly, the ON pathway function can potentially serve as a surrogate for rod photoreceptor function.

Automatic compensation enhances the orientation perception in chronic astigmatism

Astigmatism is a prevalent optical problem in which two or more focal points blur the retinal image at a particular meridian. Although many features of astigmatic vision, including orientation perception, are impaired at the retinal image level, the visual system appears to partly restore perceptual impairment after an extended period of astigmatism. However, the mechanism of orientation perception restoration in chronic astigmatism has not yet been clarified. We investigated the notable reduction of perceptual error in chronic astigmatism by comparing the orientation perception of a chronic astigmatism group with the perception of a normal-vision group, in which astigmatism was transiently induced. We found that orientation perception in the chronic group was more accurate than in the normal vision group. Interestingly, the reduction of perceptual errors was automatic; it remained even after the optical refractive errors were fully corrected, and the orientation perception was much more stable across different orientations, despite the uneven noise levels of the retinal images across meridians. We provide here a mechanistic explanation for how the compensation of astigmatic orientation perception occurred, using neural adaptation to the biased distribution of orientations.

Induced astigmatism biases the orientation information represented in multivariate electroencephalogram activities

A small physical change in the eye influences the entire neural information process along the visual pathway, causing perceptual errors and behavioral changes. Astigmatism, a refractive error in which visual images do not evenly focus on the retina, modulates visual perception, and the accompanying neural processes in the brain. However, studies on the neural representation of visual stimuli in astigmatism are scarce. We investigated the relationship between retinal input distortions and neural bias in astigmatism and how modulated neural information causes a perceptual error. We induced astigmatism by placing a cylindrical lens on the dominant eye of human participants, while they reported the orientations of the presented Gabor patches. The simultaneously recorded electroencephalogram activity revealed that stimulus orientation information estimated from the multivariate electroencephalogram activity was biased away from the neural representation of the astigmatic axis and predictive of behavioral bias. The representational neural dynamics underlying the perceptual error revealed the temporal state transition; it was transiently dynamic and unstable (approximately 350 ms from stimulus onset) that soon stabilized. The biased stimulus orientation information represented by the spatially distributed electroencephalogram activity mediated the distorted retinal images and biased orientation perception in induced astigmatism.

Darks and Lights, the 'Yin-Yang' of Vision Depends on Luminance

We all know the disappointment when, after a wonderful snapshot, the details in the photo are at much lower contrast than seen before with our own eyes. A recent study by Rahimi-Nasrabadi et al. revealed that this is because human vision accounts for actual luminance range and for accompanied asymmetric changes in dark and light contrasts.

Motion-Based Acuity Task: Full Visual Field Measurement of Shape and Motion Perception

Purpose

Damage of retinal representation of the visual field affects its local features and the spared, unaffected parts. Measurements of visual deficiencies in ophthalmological patients are separated for central (shape) or peripheral (motion and space perception) properties, and acuity tasks rely on stationary stimuli. We explored the benefit of measuring shape and motion perception simultaneously using a new motion-based acuity task.

Methods

Eight healthy control subjects, three patients with retinitis pigmentosa (RP; tunnel vision), and 2 patients with Stargardt disease (STGD) juvenile macular degeneration were included. To model the peripheral loss, we narrowed the visual field in controls to 10 degrees. Negative and positive contrast of motion signals were tested in random-dot kinematograms (RDKs), where shapes were separated from the background by the motion of dots based on coherence, direction, or velocity. The task was to distinguish a circle from an ellipse. The difficulty of the task increased as ellipse became more circular until reaching the acuity limit.

Results

High velocity, negative contrast was more difficult for all, and for patients with STGD, it was too difficult to participate. A slower velocity improved acuity for all participants.

Conclusions

Proposed acuity testing not only allows for the full assessment of vision but also advances the capability of standard testing with the potential to detect spare visual functions.

Translational Relevance

The motion-based acuity task might be a practical tool for assessing vision loss and revealing undetected, undamaged, or strengthened properties of the injured visual system by standard testing, as suggested here for two patients with STGD and three patients with RP.

Retinal ganglion cells and the magnocellular, parvocellular, and koniocellular subcortical visual pathways from the eye to the brain

In primates including humans, most retinal ganglion cells send signals to the lateral geniculate nucleus (LGN) of the thalamus. The anatomical and functional properties of the two major pathways through the LGN, the parvocellular (P) and magnocellular (M) pathways, are now well understood. Neurones in these pathways appear to convey a filtered version of the retinal image to primary visual cortex for further analysis. The properties of the P-pathway suggest it is important for high spatial acuity and red-green color vision, while those of the M-pathway suggest it is important for achromatic visual sensitivity and motion vision. Recent work has sharpened our understanding of how these properties are built in the retina, and described subtle but important nonlinearities that shape the signals that cortex receives. In addition to the P- and M-pathways, other retinal ganglion cells also project to the LGN. These ganglion cells are larger than those in the P- and M-pathways, have different retinal connectivity, and project to distinct regions of the LGN, together forming heterogenous koniocellular (K) pathways. Recent work has started to reveal the properties of these K-pathways, in the retina and in the LGN. The functional properties of K-pathways are more complex than those in the P- and M-pathways, and the K-pathways are likely to have a distinct contribution to vision. They provide a complementary pathway to the primary visual cortex, but can also send signals directly to extrastriate visual cortex. At the level of the LGN, many neurones in the K-pathways seem to integrate retinal with non-retinal inputs, and some may provide an early site of binocular convergence.

Interocular ND filter suppression: Eccentricity and luminance polarity effects

The depth and extent of interocular suppression were measured in binocularly normal observers who unilaterally adapted to neutral density (ND) filters (0, 1.5, 2, and 3 ND). Suppression was measured by dichoptically matching sectors of a ring presented to the adapted eye to a fixed contrast contiguous ring presented to the non-adapted eye. Other rings of alternating polarity were viewed binocularly. Rings were defined by luminance (L), luminance with added dynamic binary luminance noise (LM), and contrast modulating the same noise (CM). Interocular suppression depth increased with increasing ND, nearing significance (p = 0.058) for 1.5 ND. For L and LM stimuli, suppression depth across eccentricity (±12° visual field) differed for luminance increment (white) versus luminance decrement (black) stimuli, potentially confounding eccentricity results. Suppression for increment-only (white) luminance stimuli was steeper centrally and extended across the visual field, but was deeper for L than for LM stimuli. Suppression for decrement-only (black) luminance stimuli revealed only central suppression. Suppression was deeper with CM than LM stimuli, suggesting that CM stimuli are extracted in areas receiving predominantly binocular input which may be more sensitive to binocular disruption. Increment (white) luminance stimuli demonstrate deeper interocular suppression in the periphery than decrement (black) stimuli, so they are more sensitive to changes in peripheral suppression. Asymmetry of suppression in the periphery for opposite polarity luminance stimuli may be due to interocular receptive field size mismatch as a result of dark adaptation separately affecting ON and OFF pathways. Clinically, measurement of suppression with CM stimuli may provide the best information about post-combination binocularity.