Pupillary dynamics, accommodation and vergence in concussion

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

Comparison of vergence mechanisms between university students with good and poor sleep quality

AIM

To compare the vergence mechanisms between good and poor sleepers in university students.

METHODS

A total of 64 university students were recruited in this study. The validated Malay version of Pittsburgh Sleep Quality Index questionnaire (PSQI-M) was used to measure the participants' sleep quality over the past month. Participants were categorized as good sleepers (n=32) and poor sleepers (n=32) based on the PSQI-M scores. Heterophoria and fusional vergences were measured at distance and near. Mann-Whitney U test was used to compare heterophoria, negative fusional vergence (NFV), and positive fusional vergence (PFV) at distance and near between good and poor sleepers. Spearman correlation analysis was used to study the relationship between PSQI-M score and PFV at distance.

RESULTS

Both distance and near heterophorias were not significantly different between good and poor sleepers (P>0.05). There was a difference in distance PFV (P<0.05) between good and poor sleepers, but not in distance NFV, near NFV, and near PFV (P>0.05). Distance PFV was negatively correlated with PSQI-M score (rs=-0.33, P<0.05).

CONCLUSION

University students with poor sleep quality demonstrates a reduced ability to maintain fusion with increasing convergence demand at distance. Sleep quality assessment during binocular vision examination in university students is recommended.

How Do Most Young Moderate Hyperopes Avoid Strabismus?

Purpose

Uncorrected hyperopic children must overcome an apparent conflict between accommodation and vergence demands to focus and align their retinal images. This study tested hypotheses about simultaneous accommodation and vergence performance of young hyperopes to gain insight into ocular motor strategies used to maintain eye alignment.

Methods

Simultaneous eccentric photorefraction and Purkinje image tracking were used to assess accommodative and vergence responses of 26 adult emmetropes (AE) and 94 children (0-13 years) viewing cartoons. Children were habitually uncorrected (CU) (spherical equivalent refractive error [SE] -0.5 to +4 D), corrected and aligned (CCA), or corrected with a history of refractive esotropia (CCS). Accommodative and vergence accuracy, dissociated heterophoria, and vergence/accommodation ratios in the absence of retinal disparity cues were measured for 33- and 80-cm viewing distances.

Results

In binocular viewing, median accommodative lags for 33 cm were 1.0 D (AE), 1.33 D (CU), 1.25 D (CCA), and 1.0 D (CCS). Median exophorias at 80 and 33 cm were 1.2 and 4.5 pd (AE), 0.8 and 2.5 pd (CU), and 0 and 1.2 pd (CCA), respectively. Without disparity cues, most response vergence/accommodation ratios were between 1 and 2 meter angle/D (∼5-10 pd/D) (69% of AE, 44% of CU, 60% of CCA, and 50% of CCS).

Conclusions

Despite apparent conflict in motor coupling, uncorrected hyperopes were typically exophoric and achieved adultlike accuracy of both vergence and accommodation simultaneously, indicating ability to compensate for conflicting demands rather than bias to accurate vergence while tolerating inaccurate accommodation. Large lags and esophoria are therefore atypical. This analysis provides normative guidelines for clinicians and a deeper mechanistic understanding of how hyperopes avoid strabismus.

Objective assessment of eye alignment and disparity-driven vergence in Parkinson's disease

Background

Self-reported diplopia is described in up to one-third of Parkinson's disease (PD) patients.

Objective

The purpose of our study was to expand our understanding of the mechanistic underpinnings of diplopia in PD. We hypothesize that the time-based control of eye alignment and increased eye deviation under binocular viewing will be related to the fusion-initiating and fusion-maintaining component deficits of disparity-driven vergence in PD.

Methods

We used high-resolution video-oculography to measure eye alignment under binocular and monocular viewing and disparity-driven vergence in 33 PD and 10 age-matched healthy participants. We computed eye deviation and time-based control of eye alignment, occurrence of conjugate saccadic eye movements, latency and gain of vergence (fusion initiation), and variance of eye position at the end of dynamic vergence (fusion maintenance).

Results

We categorized PD subjects into three groups, considering their time-based control of eye alignment as compared to healthy controls in binocular viewing. Group 1 = 45% had good control and spent >80% of the time when the eyes were well-aligned, Group 2 = 26% had intermediate control and spent <80% but greater >5% of the time when the eyes were well-aligned, and Group 3 = 29% had very poor control with increased eye deviation majority of the times (<5% of the time when the eyes were well-aligned). All three groups exhibited greater eye deviation under monocular viewing than controls. PD subjects exhibited fusion-initiating and fusion-maintaining vergence deficits (prolonged latencies, reduced vergence gain, increased variance of fusion-maintaining component) with a greater probability of saccadic movements than controls. Group 2 and Group 3 subjects were more likely to exhibit failure to initiate vergence (>20%) than Group 1 (13%) and controls (0%) trials. No significant difference was found in the Unified Parkinson's Disease Rating Scale (UPDRS-a tool to measure the severity of PD) values between the three PD groups (Group 1 = 33.69 ± 14.22, Group 2 = 38.43 ± 22.61, and Group 3 = 23.44 ± 1, p > 0.05).

Conclusion

The majority of PD subjects within our cohort had binocular dysfunction with increased eye deviation under monocular viewing and disparity-driven vergence deficits. PD subjects with intermediate or poor control of eye deviation under binocular viewing had greater fusion-initiating and fusion-maintaining vergence deficits. The study highlights the importance of assessing binocular dysfunction in PD subjects independent of the severity of motor symptoms.

Dimensionality reduction reveals separate translation and rotation populations in the zebrafish hindbrain

In many brain areas, neuronal activity is associated with a variety of behavioral and environmental variables. In particular, neuronal responses in the zebrafish hindbrain relate to oculomotor and swimming variables as well as sensory information. However, the precise functional organization of the neurons has been difficult to unravel because neuronal responses are heterogeneous. Here, we used dimensionality reduction methods on neuronal population data to reveal the role of the hindbrain in visually driven oculomotor behavior and swimming. We imaged neuronal activity in zebrafish expressing GCaMP6s in the nucleus of almost all neurons while monitoring the behavioral response to gratings that rotated with different speeds. We then used reduced-rank regression, a method that condenses the sensory and motor variables into a smaller number of "features," to predict the fluorescence traces of all ROIs (regions of interest). Despite the potential complexity of the visuo-motor transformation, our analysis revealed that a large fraction of the population activity can be explained by only two features. Based on the contribution of these features to each ROI's activity, ROIs formed three clusters. One cluster was related to vergent movements and swimming, whereas the other two clusters related to leftward and rightward rotation. Voxels corresponding to these clusters were segregated anatomically, with leftward and rightward rotation clusters located selectively to the left and right hemispheres, respectively. Just as described in many cortical areas, our analysis revealed that single-neuron complexity co-exists with a simpler population-level description, thereby providing insights into the organization of visuo-motor transformations in the hindbrain.

Monitoring Eye Movement in Patients with Parkinson's Disease: What Can It Tell Us?

Parkinson's disease (PD) affects approximately 10 million individuals worldwide. Visual impairments are a common feature of PD. Patients report difficulties with visual scanning, impaired depth perception and spatial navigation, and blurry and double vision. Examination of PD patients reveals abnormal fixational saccades, strabismus, impaired convergence, and abnormal visually-guided saccades. This review aims to describe objective features of abnormal eye movements in PD and to discuss the structures and pathways through which these abnormalities may manifest.

Frequency dependence of coordinated pupil and eye movements for binocular disparity tracking

Introduction

Coordinated alignment of the eyes during gaze fixation and eye movements are an important component of normal visual function. We have previously described the coordinated behavior of convergence eye movements and pupillary responses using a 0.1  Hz binocular disparity-driven sine profile and a step profile. The goal of this publication is to further characterize ocular vergence-pupil size coordination over a wider range of frequencies of ocular disparity stimulation in normal subjects.

Methods

Binocular disparity stimulation is generated by presentation of independent targets to each eye on a virtual reality display, while eye movements and pupil size are measured by an embedded video-oculography system. This design allows us to study two complimentary analyses of this motion relationship. First, a macroscale analysis describes the vergence angle of the eyes in response to binocular disparity target movement and pupil area as a function of the observed vergence response. Second, a microscale analysis performs a piecewise linear decomposition of the vergence angle and pupil relationship to permit more nuanced findings.

Results

These analyses identified three main features of controlled coupling of pupil and convergence eye movements. First, a near response relationship operates with increasing prevalence during convergence (relative to the "baseline" angle); the coupling is higher with increased convergence in this range. Second, the prevalence of "near response"-type coupling decreases monotonically in the diverging direction; the decrease persists after the targets move (converge back) from maximum divergence toward the baseline positions, with a minimum prevalence of near response segments near the baseline target position. Third, an opposite polarity pupil response is infrequent, but tends to be more prevalent when the vergence angles are at maximum convergence or divergence for a sinusoidal binocular disparity task.

Discussion

We suggest that the latter response is an exploratory "range-validation" when binocular disparity is relatively constant. In a broader sense, these findings describe operating characteristics of the near response in normal subjects and form a basis for quantitative assessments of function in conditions such as convergence insufficiency and mild traumatic brain injury.

The role of binocular vision in the control and development of visually guided upper limb movements

Vision provides a key sensory input for the performance of fine motor skills, which are fundamentally important to daily life activities, as well as skilled occupational and recreational performance. Binocular visual function is a crucial aspect of vision that requires the ability to combine inputs from both eyes into a unified percept. Summation and fusion are two aspects of binocular processing associated with performance advantages, including more efficient visuomotor control of upper limb movements. This paper uses the multiple processes model of limb control to explore how binocular viewing could facilitate the planning and execution of prehension movements in adults and typically developing children. Insight into the contribution of binocularity to visuomotor control also comes from examining motor performance in individuals with amblyopia, a condition characterized by reduced visual acuity and poor binocular function. Overall, research in this field has advanced our understanding of the role of binocular vision in the development and performance of visuomotor skills, the first step towards developing assessment tools and targeted rehabilitation for children with neurodevelopment disorders at risk of poor visuomotor outcomes. This article is part of a discussion meeting issue 'New approaches to 3D vision'.

Vergence and accommodation responses in the control of intermittent exotropia

PURPOSE

Individuals with different types of intermittent exotropia (IXT) may use neurally coupled accommodation and vergence responses differently from those without exotropia to achieve eye alignment. This study examined the relationship between simultaneously recorded accommodation and vergence responses in children and young adults with a range of types of IXT while aligned and deviated.

METHODS

Responses of 29 participants with IXT (4-31 years) and 24 age-matched controls were recorded using simultaneous eye-tracking and eccentric photorefraction while they watched a movie in binocular or monocular viewing at varying viewing distances. Gradient response AC/A ratios and fusional vergence ranges were also assessed. Eight participants had divergence or pseudo-divergence excess type IXT, 5 had convergence insufficiency and 16 had basic IXT.

RESULTS

Control and IXT participants accommodated similarly both in monocular and binocular-aligned conditions to visual targets at 80 and 33 cm. When deviated in binocular viewing, most participants with IXT exhibited changes in accommodation <0.5D relative to alignment. Gradient response AC/A ratios were similar for control [0.56 MA/D (IQR: 0.51 MA/D)] and IXT participants [0.42 MA/D (0.54 MA/D); p  = 0.60]. IXT participants showed larger vergence to accommodation ratios with changes from distance to near fixation [1.19 MA/D (1.45 MA/D)] than control participants [0.78 MA/D (0.60 MA/D); p = 0.02], especially among IXT participants with divergence or pseudo-divergence excess. Participants with IXT exhibited typical fusional divergence ranges beyond their dissociated position [8.86 Δ (7.10 Δ)] and typical fusional convergence ranges from alignment [18 Δ (15.75 Δ)].

CONCLUSIONS

This study suggests that control of IXT is typically neither driven by accommodative convergence alone nor associated with over-accommodation secondary to fusional convergence efforts. These simultaneous measurements confirmed that proximal vergence contributed significantly to IXT control, particularly for divergence or pseudo-divergence excess type IXT. For IXT participants in this study, achieving eye alignment did not conflict with having clear vision.

Functional magnetic resonance imaging activation for different vergence eye movement subtypes

INTRODUCTION

Maddox suggested that there were four convergence subtypes, each driven by a different stimulus. The purpose of this study was to assess the neural correlates for accommodative convergence, proximal convergence (convergence stimulus provided), disparity convergence and voluntary convergence (no specific convergence stimulus provided) using functional magnetic resonance imaging (fMRI).

METHODS

Ten subjects (mean age = 24.4 years) with normal binocular vision participated. The blood oxygenation level-dependent (BOLD) signals of the brain from fMRI scans were measured when subjects made vergence eye movements while: (1) alternately viewing letters monocularly where one eye viewed through a -2.00 D lens, (2) alternately viewing Difference of Gaussian targets monocularly at distance and near, (3) viewing random dot stereograms with increasing disparity and (4) voluntarily converging the eyes with binocular viewing.

RESULTS

The accommodative convergence paradigm resulted in activation on the right side in the right fusiform cortex and the right middle occipital cortex. The proximal convergence stimulus mainly activated areas in the right occipital lobe. The disparity stimulus activated areas in the left occipital cortex and the left frontal cortex. Finally, the voluntary convergence paradigm resulted in activation primarily in the occipital lobe and mostly bilaterally.

CONCLUSION

The accommodative, proximal, disparity and voluntary convergence paradigms resulted in activation in unique areas in the brain with functional MRI. Activation was found in more areas in the proximal and voluntary conditions compared with the accommodative and disparity conditions.

How vergence influences the perception of being looked at

Perceiving other people's direct gaze is important for many areas of everyday activity. For horizontal and vertical eye movements, the area of being looked at, known as the cone of gaze, has been well explored. Previous research has shown a range of eye rotations (up to eccentricities of 4°-9°) that people accept as direct gaze. Vergence is an important cue for perceiving the depth of fixation. This study examines the range of vergence angles that support the perception of being looked at. In two experiments, observers adjusted the degree of vergence of the lookers' eyes until they felt just (not) looked at. The first experiment also asked to adjust the point of being exactly looked at, which was 0° (parallel eyes). The thresholds of being just (not) looked at were around 4.5° of convergence and 2.5° divergence, which results in a depth of 7° of vergence. This depth was replicated in Experiment 2, while the thresholds of convergence (3.5°) and divergence (3.5°) slightly differ from Experiment 1. The results indicate a consistent area of vergences being accepted as direct gaze, yielding first-time evidence for a third dimension-the depth dimension-of direct gaze.

Reduced activity of vertically acting motoneurons during convergence

Previous studies have revealed unexpected relationships between the firing rates of horizontally acting motoneurons and vergence. During a vergence task, for example, antidromically identified abducens internuclear neurons show a negative correlation between vergence angle and firing rate, which is the opposite of the modulation displayed by the medial rectus motoneurons to which they project. For a given horizontal eye position, medial rectus motoneurons discharge at a higher rate if the eyes are converged than if the same eye position is reached during a task that requires version; paradoxically, however, the horizontal rectus eye muscles show corelaxation during vergence. These complex and unexpected relationships inspired the present author to investigate whether the tonic firing rates of vertically acting motoneurons in oculomotor nucleus are correlated with vergence angle. Monkeys were trained to fixate a single, randomly selected, visual target among an array of 60 red plus-shaped LEDs, arranged at 12 different distances in three-dimensional space. The targets were arranged to permit dissociation of vertical eye position and vergence angle. Here I report, for the first time, that most vertically acting motoneurons in oculomotor nucleus show a significant negative correlation between tonic firing rate and vergence angle. This suggests the possibility that there may be a general corelaxation of extraocular muscles during vergence.NEW & NOTEWORTHY An array of 60 plus-shaped LEDs, positioned at various locations in three-dimensional space, was used to elicit conjugate and disjunctive saccades while single neurons in oculomotor nucleus were recorded from rhesus monkeys. This study demonstrates that most vertically acting motoneurons in oculomotor nucleus discharge at a lower rate when the eyes are converged.

When Does Blur Matter? A Narrative Review and Commentary

Blur is the subjective awareness that the edges of a high contrast image are indistinct. The concept of blur is fundamental to the understanding of vision, accommodation, refractive error, concomitant strabismus, and asthenopia. It is easy for clinicians to believe that blur always needs to be avoided or resolved, or that everyone responds to blur similarly. This narrative review outlines the literature on blur and the accommodation to resolve it, and relates it to current clinical practice. Laboratory studies have traditionally been highly controlled, using expert observers, but more recent research using naïve participants suggests that variability and tolerance of blur are common and more widespread than often thought, especially in children and clinical groups. Objective and subjective responses can differ widely, and it cannot be assumed that because we expect accommodation to have occurred, that it always has. A deeper understanding of the role of blur and objective accommodation in vision, refractive error and strabismus may help us understand the variability that exists in clinical practice. We may use blur to help investigation and treatment but also be relaxed about what is normal. Many patients are led to believe that they should always achieve constant clear vision, when this is unrealistic. Although pathological blur must be identified and treated, normal everyday blur may become medicalized into "a problem" by well-meaning professionals.

Vision-related symptoms, accommodative and binocular vision performance in young diabetics vs. normal controls

PURPOSE

To compare accommodative and binocular vision performance between young diabetic subjects and normal controls, and to investigate the correlation of accommodative/binocular indices with the severity of diabetes.

METHODS

Thirty young subjects with diabetes mellitus (DM) and 30 age-matched normal controls were recruited in this hospital-based cross-sectional study. DM was diagnosed by a haemoglobin A1c (HbA1c) higher than 6.5%. The status of vision-related symptoms was examined by the convergence insufficiency symptoms survey (CISS). All participants underwent a complete optometric examination including visual acuity measurement, objective and subjective refraction, accommodative and binocular vision assessments.

RESULTS

All study participants were between 18 and 40 years of age. There were no statistically significant differences in best-corrected visual acuity (BCVA), sphere, cylinder and spherical equivalent refraction (SE) between the diabetes and control groups. The median near point of convergence (NPC) was significantly more remote in diabetics compared with the control group. Mean accommodative amplitude (AA) and vergence facility (VF) and the median monocular accommodative facility (AF) were significantly lower in diabetic subjects compared with normal controls. In addition, the median accommodative lag in the diabetic group was significantly higher than the control group. A significantly higher percentage of the diabetic group were symptomatic (26.6%), compared with the controls (6.6%). The NPC and accommodative lag showed a significant positive correlation with the HbA1c level, while VF, AA and AF exhibited a significant negative correlation with HbA1c.

CONCLUSION

Aspects of accommodative and binocular vision performance are strongly affected by DM. There is also a significant correlation between accommodative and binocular disorders with the severity of DM. A significant percentage of young subjects with DM have severe vision-related symptoms.

Predicting Dyslexia and Reading Speed in Adolescents from Eye Movements in Reading and Non-Reading Tasks: A Machine Learning Approach

There is evidence that abnormalities in eye movements exist during reading in dyslexic individuals. A few recent studies applied Machine Learning (ML) classifiers to such eye movement data to predict dyslexia. A general problem with these studies is that eye movement data sets are limited to reading saccades and fixations that are confounded by reading difficulty, e.g., it is unclear whether abnormalities are the consequence or the cause of reading difficulty. Recently, Ward and Kapoula used LED targets (with the REMOBI & AIDEAL method) to demonstrate abnormalities of large saccades and vergence eye movements in depth demonstrating intrinsic eye movement problems independent from reading in dyslexia. In another study, binocular eye movements were studied while reading two texts: one using the "Alouette" text, which has no meaning and requires word decoding, the other using a meaningful text. It was found the Alouette text exacerbates eye movement abnormalities in dyslexics. In this paper, we more precisely quantify the quality of such eye movement descriptors for dyslexia detection. We use the descriptors produced in the four different setups as input to multiple classifiers and compare their generalization performances. Our results demonstrate that eye movement data from the Alouette test predicts dyslexia with an accuracy of 81.25%; similarly, we were able to predict dyslexia with an accuracy of 81.25% when using data from saccades to LED targets on the Remobi device and 77.3% when using vergence movements to LED targets. Noticeably, eye movement data from the meaningful text produced the lowest accuracy (70.2%). In a subsequent analysis, ML algorithms were applied to predict reading speed based on eye movement descriptors extracted from the meaningful reading, then from Remobi saccade and vergence tests. Remobi vergence eye movement descriptors can predict reading speed even better than eye movement descriptors from the meaningful reading test.

A Study to Assess the Feasibility of Utilising Virtual Reality for the Treatment of Accommodative and Vergence Infacility

Background:

To assess the feasibility, as well as viability, of utilising gaming using virtual reality (VR) to treat accommodative and vergence infacilities.

Methods:

Forty-two emmetropic and asymptomatic participants between the ages of 18 and 30, with normal binocular visual function, were selected for the study in 2018. Participants with binocular accommodative infacilities and/or vergence infacilities comprised the study population. The binocular accommodative facilities (BAF) were assessed using amplitude-scaled facilities (probe lens = 30% amplitude of accommodation; test distance = 45% amplitude of accommodation). All those with less than 10 cycles per minute (cpm) were regarded as failing. Vergence facilities were assessed using 12 pd base out and 3 pd base in prisms. All those with less than 15 cpm were regarded as failing. The participants were separated into age-matched experimental and control groups. The experimental group played a fast-paced game using Samsung Gear VR (SM-R323), whilst the control group watched a television film projected onto a two-dimensional screen at a distance of one metre. Pre-test and post-test binocular amplitude-scaled facilities and vergence facilities were measured for both groups after exposure for 25 minutes.

Results:

There was a significant, mean increase in binocular accommodative facilities of 4.67 ± 5.05 cpm (p = 0.008) for the experimental group (n = 12). There was a significant mean increase in vergence facilities of 3.72 ± 3.18 cpm (p < 0.001) for the experimental group (n = 32). A statistically significant mean difference of 4.07 cpm (95%CI: 0.97, 9.19; p = 0.03) between the respective control and experimental groups was found for binocular accommodative facilities and 2.45 cpm (95%CI: 0.68, 4.22; p = 0.008) for vergence facilities.

Conclusion:

Binocular accommodative facilities and vergence facilities increased after 25 minutes of VR gaming in asymptomatic emmetropic participants with accommodative infacilities and vergence infacilities. However, due to the small-scale, unmasked and unrandomised nature of the study more research is needed to confirm the results of this study.

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.

Dyslexics' Fragile Oculomotor Control Is Further Destabilized by Increased Text Difficulty

Dyslexic adolescents demonstrate deficits in word decoding, recognition, and oculomotor coordination as compared to healthy controls. Our lab recently showed intrinsic deficits in large saccades and vergence movements with a Remobi device independent from reading. This shed new light on the field of dyslexia, as it has been debated in the literature whether the deficits in eye movements are a cause or consequence of reading difficulty. The present study investigates how these oculomotor problems are compensated for or aggravated by text difficulty. A total of 46 dyslexic and 41 non-dyslexic adolescents' eye movements were analyzed while reading L'Alouette, a dyslexia screening test, and 35 Kilos D'Espoir, a children's book with a reading age of 10 years. While reading the more difficult text, dyslexics made more mistakes, read slower, and made more regressive saccades; moreover, they made smaller amplitude saccades with abnormal velocity profiles (e.g., higher peak velocity but lower average velocity) and significantly higher saccade disconjugacy. While reading the simpler text, these differences persisted; however, the difference in saccade disconjugacy, although present, was no longer significant, nor was there a significant difference in the percentage of regressive saccades. We propose that intrinsic eye movement abnormalities in dyslexics such as saccade disconjugacy, abnormal velocity profiles, and cognitively associated regressive saccades can be particularly exacerbated if the reading text relies heavily on word decoding to extract meaning; increased number of regressive saccades are a manifestation of reading difficulty and not a problem of eye movement per se. These interpretations are in line with the motor theory of visual attention and our previous research describing the relationship between binocular motor control, attention, and cognition that exists outside of the field of dyslexia.

Vergence Fusion Sustaining Oscillations

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Does Vergence Affect Perceived Size?

Since Kepler (1604) and Descartes (1637), it has been suggested that 'vergence' (the angular rotation of the eyes) plays a key role in size constancy. However, this has never been tested divorced from confounding cues such as changes in the retinal image. In our experiment, participants viewed a target which grew or shrank in size over 5 s. At the same time, the fixation distance specified by vergence was reduced from 50 to 25 cm. The question was whether this change in vergence affected the participants' judgements of whether the target grew or shrank in size? We found no evidence of any effect, and therefore no evidence that eye movements affect perceived size. If this is correct, then our finding has three implications. First, perceived size is much more reliant on cognitive influences than previously thought. This is consistent with the argument that visual scale is purely cognitive in nature (Linton, 2017; 2018). Second, it leads us to question whether the vergence modulation of V1 contributes to size constancy. Third, given the interaction between vergence, proprioception, and the retinal image in the Taylor illusion, it leads us to ask whether this cognitive approach could also be applied to multisensory integration.

Changes in vergence and accommodation parameters after smartphone use in healthy adults

Purpose:

To assess pre and post vergence and accommodation parameters after monitored reading on a smartphone device.

Methods:

This prospective comparative study was performed in a tertiary eye care center for a duration of 6 months (December 2017 – May 2018). A total of 47 healthy emmetropic subjects of age group ranging from 18-30 years were recruited for the study. Participants underwent an initial visual screening protocol, followed by accommodation and vergence parameters assessment. The subjects were given reading text of optotype N6 at 40cm working distance for 30 minutes in a smart phone device. Pre and post measurements were documented.

Results:

Among 47 subjects there were 17 male and 30 females with mean age group of 21.2+2.06 years. There was a statistically significant worsening of accommodative components (negative & positive relative accommodation, lag of accommodation). In vergence parameters, a statistically significant deterioration of negative (12.8 + 1.65 to 12.38 + 1.93 PD) and positive fusional vergence (15.48 + 1.53 to 16.08 +1.61 PD) was observed. The mean vergence facility also showed a statistically significant change in pre and post task measurements (13.51 + 1.64 to 10.71 + 1.91 cpm (cycles per minute)).

Conclusion:

The current study investigated that perusing text with a smart phone for 30 minutes shows significant effect on accommodative and vergence components for near task, with greater impact on vergence parameters. Drawn out exposure to digital screens at near, may bring about visual quality dysfunction.

Cerebellar projections to the macaque midbrain tegmentum: Possible near response connections

Since most gaze shifts are to targets that lie at a different distance from the viewer than the current target, gaze changes commonly require a change in the angle between the eyes. As part of this response, lens curvature must also be adjusted with respect to target distance by the ciliary muscle. It has been suggested that projections by the cerebellar fastigial and posterior interposed nuclei to the supraoculomotor area (SOA), which lies immediately dorsal to the oculomotor nucleus and contains near response neurons, support this behavior. However, the SOA also contains motoneurons that supply multiply innervated muscle fibers (MIFs) and the dendrites of levator palpebrae superioris motoneurons. To better determine the targets of the fastigial nucleus in the SOA, we placed an anterograde tracer into this cerebellar nucleus in Macaca fascicularis monkeys and a retrograde tracer into their contralateral medial rectus, superior rectus, and levator palpebrae muscles. We only observed close associations between anterogradely labeled boutons and the dendrites of medial rectus MIF and levator palpebrae motoneurons. However, relatively few of these associations were present, suggesting these are not the main cerebellar targets. In contrast, labeled boutons in SOA, and in the adjacent central mesencephalic reticular formation (cMRF), densely innervated a subpopulation of neurons. Based on their location, these cells may represent premotor near response neurons that supply medial rectus and preganglionic Edinger-Westphal motoneurons. We also identified lens accommodation-related cerebellar afferent neurons via retrograde trans-synaptic transport of the N2c rabies virus from the ciliary muscle. They were found bilaterally in the fastigial and posterior interposed nuclei, in a distribution which mirrored that of neurons retrogradely labeled from the SOA and cMRF. Our results suggest these cerebellar neurons coordinate elements of the near response during symmetric vergence and disjunctive saccades by targeting cMRF and SOA premotor neurons.

A low-cost, high-performance video-based binocular eye tracker for psychophysical research

We describe a high-performance, pupil-based binocular eye tracker that approaches the performance of a well-established commercial system, but at a fraction of the cost. The eye tracker is built from standard hardware components, and its software (written in Visual C++) can be easily implemented. Because of its fast and simple linear calibration scheme, the eye tracker performs best in the central 10 degrees of the visual field. The eye tracker possesses a number of useful features: (1) automated calibration simultaneously in both eyes while subjects fixate four fixation points sequentially on a computer screen, (2) automated realtime continuous analysis of measurement noise, (3) automated blink detection, (4) and realtime analysis of pupil centration artifacts. This last feature is critical because it is known that pupil diameter changes can be erroneously registered by pupil-based trackers as a change in eye position. We evaluated the performance of our system against that of a wellestablished commercial system using simultaneous measurements in 10 participants. We propose our low-cost eye tracker as a promising resource for studies of binocular eye movements.

Divergence bias in Hess compared to Harms screen strabismus testing

The Hess and the Harms screen test each have different testing distances. While the Harms screen test is usually performed at 2.5 m, the Hess screen test is performed at 0.5 m. The geometry of the closer testing distance of the Hess screen test requires an increase of the convergence angle by 6°. This study investigates the quantitative differences between the two frequently employed screen tests. Ocular deviation of 18 normal subjects and 36 patients with congenital or acquired paralytic or concomitant strabismus were assessed with a complete orthoptic examination including alternate prism cover testing at near (nPCT) and far (fPCT), as well as Hess and Harms screen testing. One-way ANOVA was used for statistical analysis. The Hess test recorded more overall exodeviation compared to the Harms test for patients (mean difference -3.50°, 95% limits of agreement (CI) = [-4.79, -2.21], p < .001), and controls (mean difference -1.78°, CI = [-2.99, -0.56], p = .004). For vertical deviations, there was no statistically significant difference between the two tests for patients (mean difference +0.75°, CI = [-0.41, +1.91], p = .251), and controls (mean difference -0.28°, CI = [-0.68, -0.11], p = 0.231). This study emphasizes the importance to consider the divergence bias when comparing the Hess to the Harms screen test, which is likely explained by the greater vergence demand dependent on the closer testing distance. The exodeviation shift tended to be more pronounced in patients than controls, which may imply that patients with strabismus have an impaired convergence drive.

Neural control of rapid binocular eye movements: Saccade-vergence burst neurons

During normal viewing, we direct our eyes between objects in three-dimensional (3D) space many times a minute. To accurately fixate these objects, which are usually located in different directions and at different distances, we must generate eye movements with appropriate versional and vergence components. These combined saccade-vergence eye movements result in disjunctive saccades with a vergence component that is much faster than that generated during smooth, symmetric vergence eye movements. The neural control of disjunctive saccades is still poorly understood. Recent anatomical studies suggested that the central mesencephalic reticular formation (cMRF), located lateral to the oculomotor nucleus, contains premotor neurons potentially involved in the neural control of these eye movements. We have therefore investigated the role of the cMRF in the control of disjunctive saccades in trained rhesus monkeys. Here, we describe a unique population of cMRF neurons that, during disjunctive saccades, display a burst of spikes that are highly correlated with vergence velocity. Importantly, these neurons show no increase in activity for either conjugate saccades or symmetric vergence. These neurons are termed saccade-vergence burst neurons (SVBNs) to maintain consistency with modeling studies that proposed that such a class of neuron exists to generate the enhanced vergence velocities observed during disjunctive saccades. Our results demonstrate the existence and characteristics of SVBNs whose activity is correlated solely with the vergence component of disjunctive saccades and, based on modeling studies, are critically involved in the generation of the disjunctive saccades required to view objects in our 3D world.

Traumatic Brain Injury in Children: Do the Eyes Have It? The Orthoptic Evaluation of Traumatic Brain Injury

Because the neuropathological changes caused by mild traumatic brain injury (mTBI) more often manifest as functional impairments than structural abnormalities, the clinical diagnosis of mTBI may rely too heavily on a combination of history and self-reported symptoms. The mechanism of injury in mild traumatic brain injury (mTBI) predicts that supranuclear pathways controlling eye movement systems would be vulnerable to damage, and diagnostic tests of these systems would be high-yield. In fact, tests of oculomotor function have proven to be highly sensitive in detecting neurological soft signs, but may require expensive, specialized equipment. Fortunately, Certified Orthoptists (COs) are skilled at the evaluation of accommodative dysfunction, abnormalities of saccades, smooth pursuit, and vestibular eye movements, and vergence errors using standard ophthalmic equipment. Because COs are accustomed to adapting the sensorimotor exam to infants and pre-verbal children, they are able to modify or design objective methods, the results of which may be difficult for the patient with a functional overlay to decipher and deceive. When the patient with a history of mTBI presents to the ophthalmologist with visual symptoms and a normal routine eye exam, it is important to order a sensorimotor examination by a CO to confirm the diagnosis.

Comparisons of proximal vergence measures

BACKGROUND

Proximal vergence is defined as a vergence eye movement subtype driven by an "awareness of nearness". The purpose of this experiment was to compare values of proximal vergence calculated with and without measures of accommodation to assess the clinical utility of each measurement method.

METHODS

Thirteen participants between the ages of 22 and 37 (mean = 28.5 ± 4.5 years) were enrolled. The distance and near heterophoria were measured using the Modified Thorington technique. The near heterophoria was measured under three randomized viewing conditions (no lenses, +1.00D lenses, +2.50D lenses). Refractive error was measured with an autorefractor. Proximal vergence was calculated as the difference in calculated (far-near) and gradient (+1.00) stimulus AC/A ratios (stimulus AC/A differencing method), the difference in calculated and gradient response AC/A ratios (response AC/A differencing method), and the change in vergence from distance to near with the +2.50D lenses (uncorrected +2.50D method). This latter value was also corrected for any active accommodation with +2.50D lenses (corrected +2.50D method).

RESULTS

The mean proximal vergence values (Δ) were 7.82 ± 5.98 (stimulus AC/A differencing method), 8.29 ± 3.30 (response AC/A differencing method), 6.23 ± 3.52 (uncorrected +2.50D method), and 5.13 ± 2.98 (corrected +2.50D method). The only comparison that showed both a significant correlation (p<0.05) and a non-significant difference from the paired t-test (p>0.05) was that between the stimulus AC/A differencing method and the uncorrected +2.50D method.

CONCLUSIONS

When response accommodation was accounted for, differences occurred in the mean proximal values obtained with the various methods. The means of the methods most likely to be used clinically (stimulus AC/A differencing method and uncorrected +2.50D method) were similar, although some individuals demonstrated significant differences between these methods.

Measuring vergence and fixation disparity in 3D space

As the eyes continuously move in 3D space, they rarely converge at the exact depth of the plane even when fixating a 2D image or computer screen. Rather, the lines of gaze measured by eye movement recordings show some misalignment so-called fixation disparity. Fixation disparity occurs in front of or behind the plane, and the eyes may also be lagged vertically. For those reasons, vision research requires mathematical tools to calculate where exactly the lines of gaze cross the stimulus plane. Seminal research on vergence eye movements targeting stimuli lying on isovergence curves has been content with simple computation of the difference between the two eye rotation angles. Recently, the need of new calculations has emerged with the increasing use of eye-trackers providing the eye coordinates on a computer screen. Previous studies have made this attempt but with restrictions. We introduce here a complete calculation of fixation disparity in 3D space allowing vision researchers to study the precision of gaze regardless of the stimulus location in 3D space and of whether the eyes lag horizontally and/or vertically.

Is Primate Lens Accommodation Unilaterally or Bilaterally Controlled?

Purpose

In frontal-eyed mammals such as primates, eye movements are coordinated so that the lines of sight are directed at targets in a manner that adjusts for target distance. The lens of each eye must also be adjusted with respect to target distance to maintain precise focus. Whether the systems for controlling eye movements are monocularly or binocularly organized is currently a point of contention. We recently determined that the premotor neurons controlling the lens of one eye are bilaterally distributed in the midbrain. In this study, we examine whether this is due to premotor neurons projecting bilaterally to the preganglionic Edinger-Westphal nuclei, or by a mixture of ipsilaterally and contralaterally projecting cells supplying each nucleus.

Methods

The ciliary muscles of Macaca fasicularis monkeys were injected with recombinant forms of the N2c rabies virus, one eye with virus that produced a green fluorescent marker and the other eye with a virus that produced a red fluorescent marker.

Results

Preganglionic motoneurons in the Edinger-Westphal nucleus displayed the same marker as the ipsilateral injected muscle. Many of the premotor neurons in the supraoculomotor area and central mesencephalic reticular formation were doubly labeled. Others were labeled from either the ipsilateral or contralateral eye.

Conclusions

These results suggest that both monocular control and binocular control of lens accommodation are present. Binocular inputs yoke the accommodation in the two eyes. Monocular inputs may allow modification related to differences in each eye's target distance or differences in the capacities of the two ciliary muscles.

Perceptual effects of unequal saccadic adaptation produced by a dichoptic step

The binocular coordination of eye movements in a three-dimensional environment involves a combination of saccade and vergence movements. To maintain binocular accuracy and control in the face of sensory and motor changes (that occur with e.g., normal aging, surgery, corrective lenses), the oculomotor system must adapt in response to manifest visual errors. This may be achieved through a combination of binocular and monocular mechanisms, including the recalibration of saccade and vergence amplitudes in response to different visual errors induced in each eye (Maiello, Harrison, & Bex, 2016). This work has used a double-step paradigm to recalibrate eye movements in response to visual errors produced by dichoptic target steps (e.g., leftward in the left eye and rightward in the right eye). Here, we evaluated the immediate perceptual effects of this adaptation. Experiment 1 measured localization errors following adaptation by comparing the apparent locations of pre- and postsaccadic probes. Consistent with previous work showing localization errors following saccadic adaptation, our results demonstrated that adaptation to a dichoptic step produces different localization errors in the two eyes. Furthermore, in Experiment 2, this effect was reduced for a vergence shift in the absence of a saccade, indicating that saccade programming is responsible for a large component of this illusory shift. Experiment 3 measured postsaccadic stereopsis thresholds and indicated that, unlike localization judgments, adaptation did not influence stereoacuity. Together, these results demonstrate novel dichoptic visual errors following oculomotor adaptation and point to monocular and binocular mechanisms involved in the maintenance of binocular coordination.

Binocular, Accommodative and Oculomotor Alterations In Multiple Sclerosis: A Review

Multiple sclerosis (MS) is an acquired demyelinating and inflammatory neurodegenerative disease affecting the central nervous system (CNS). Clinical and subclinical ocular disturbances occur in almost all patients with MS. The objective of this narrative review was to collect and summarize the available scientific information on oculomotor, accommodative and binocular alterations that have been reported in MS. A systematic search strategy with the following descriptors was carried out: multiple sclerosis, ocular motility disorders, internuclear ophthalmoplegia, nystagmus, vergences, fixation, pupil reflex, accommodation and stereopsis. According to the search, some oculomotor alterations were found to be commonly reported in MS, such as alterations in saccades and nystagmus. In contrast, accommodative, vergence and stereopsis alterations have not been comprehensively studied despite their relevance, with only minimal evidence showing a potential negative impact of the disease on these aspects. In conclusion, oculomotor impairment is a common component of disability in MS patients and should be considered when managing this type of patients. More research is still needed to know the real impact of this disease on binocular vision and accommodation.

Active efficient coding explains the development of binocular vision and its failure in amblyopia

Brains must operate in an energy-efficient manner. The efficient coding hypothesis states that sensory systems achieve this by adapting neural representations to the statistics of sensory input signals. Importantly, however, these statistics are shaped by the organism’s behavior and how it samples information from the environment. Therefore, optimal performance requires jointly optimizing neural representations and behavior, a theory called active efficient coding. Here, we test the plausibility of this theory by proposing a computational model of the development of binocular vision. The model explains the development of accurate binocular vision under healthy conditions. In the case of refractive errors, however, the model develops an amblyopia-like state and suggests conditions for successful treatment.

The development of vision during the first months of life is an active process that comprises the learning of appropriate neural representations and the learning of accurate eye movements. While it has long been suspected that the two learning processes are coupled, there is still no widely accepted theoretical framework describing this joint development. Here, we propose a computational model of the development of active binocular vision to fill this gap. The model is based on a formulation of the active efficient coding theory, which proposes that eye movements as well as stimulus encoding are jointly adapted to maximize the overall coding efficiency. Under healthy conditions, the model self-calibrates to perform accurate vergence and accommodation eye movements. It exploits disparity cues to deduce the direction of defocus, which leads to coordinated vergence and accommodation responses. In a simulated anisometropic case, where the refraction power of the two eyes differs, an amblyopia-like state develops in which the foveal region of one eye is suppressed due to inputs from the other eye. After correcting for refractive errors, the model can only reach healthy performance levels if receptive fields are still plastic, in line with findings on a critical period for binocular vision development. Overall, our model offers a unifying conceptual framework for understanding the development of binocular vision.

Effect of Yoga Ocular Exercises on Eye Fatigue

Background

Comfortable working at near and intermediate tasks depend on the efficiency as well as coordination of accommodation and vergence systems. At present, the need for near and intermediate visual tasks has been dramatically increased, requiring prolonged computer- and gazette-related works. It demands excessive working of the extraocular and ciliary muscles. It may cause eye fatigue and other associated asthenopic symptoms. Globally, eye fatigue is one of the most commonly reported conditions in nonpresbyopic population with asthenopic symptoms. It is necessary to get relief from eye fatigue for better near and intermediate tasks.

Materials and Methods

Thirty-two undergraduate optometry students who were symptomatic based on a validated eye fatigue questionnaire were included after a baseline comprehensive eye examination. Based on the eye fatigue symptoms score, they were equally assigned to a control group and an exercise group with sixteen participants in each. The exercise group performed yoga ocular exercises for up to 6 weeks after which the eye fatigue symptoms were reassessed in both groups.

Results

In the exercise group, there was a statistically significant reduction in eye fatigue scores (P = 0.003), whereas the eye fatigue scores showed significant increment in the control group after 6 weeks (P = 0.044).

Conclusions

Yoga ocular exercises reduce the eye fatigue symptoms score by increasing the efficiency of extraocular muscles. Hence, it could be considered as a therapeutic and nonpharmacologic intervention for reducing the eye fatigue and associated asthenopic symptoms.

The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data

Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures.Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031.Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD.Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.

Effects of aligning prisms on the objective and subjective fixation disparity in far distance

Fixation disparity (FD) refers to a suboptimal condition of binocular vision. The oculomotor aspect of FD refers to a misadjustment in the vergence angle between the two visual axes that is measured in research with eye trackers (objective fixation disparity, oFD). The sensory aspect is psychophysically tested using dichoptic nonius lines (subjective fixation disparity, sFD). Some optometrists use nonius tests to determine the prisms for constant wear aiming to align the eyes. However, they do not (yet) use eye trackers. We investigate the effect of aligning prisms on oFD and sFD for 60 sec exposure duration of prisms determined with the clinically established Cross test in far distance vision. Without prisms, both types of FD were correlated with the aligning prism, while with prisms the FD was close to zero (these analyses included all base-in and base-out cases). The effect of base-in prisms on oFD was proportional to the amount of the aligning prism for the present 60 sec exposure, similar as for the 2- 5 sec exposure in Schmid et al. (2018). Thus, within 1 minute of prism exposure, no substantial vergence adaptation seems to occur in the present test conditions. Further studies may investigate intra-individual responses to different exposure times of aligning prisms in both prism directions.

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

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

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

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

Dynamics of the Disparity Vergence Fusion Sustain Component

The stereotypical vergence response to a step stimulus consists of two dynamic components: a high velocity fusion initiating component followed by a slower component that may mediate sustained fusion. The initial component has been well-studied and is thought to be controlled by an open-loop mechanism. Less is known about the slow, or fusion sustaining component except that it must be feedback controlled to achieve the positional precision of sustained fusion. Given the delays in disparity vergence control, a feedback control system is likely to exhibit oscillatory behavior. Vergence responses to 4 deg step changes in target position were recorded in eight subjects. The slow component of each response was isolated manually using interactive graphics and the frequency spectrum determined. The frequency spectra of all isolated slow vergence movements showed a large low frequency peak between 1.0 and 2.0 Hz and one or more higher frequency components. The higher frequency components were found to be harmonics of the low frequency oscillation. A feedback model of the slow component was developed consisting of a time delay, an integral/derivative controller and an oculomotor plant based on Robinson's model. Model simulations showed that a direction dependent asymmetry in the derivative element was primarily responsible for the higher frequency harmonic components. Simulations also showed that the base frequencies are primarily dependent on the time delay in the feedback control system. The fact that oscillatory behavior was found in all subjects provides strong support that the slow, fusion sustaining component is mediated by a feedback system.

The Importance of the Interaction Between Ocular Motor Function and Vision During Human Infancy

Numerous studies have demonstrated the impact of imposed abnormal visual experience on the postnatal development of the visual system. These studies have provided fundamental insights into the mechanisms underlying neuroplasticity and its role in clinical care. However, the ocular motor responses of postnatal human infants largely define their visual experience in dynamic three-dimensional environments. Thus, the immature visual system needs to control its own visual experience. This review explores the interaction between the developing motor and sensory/perceptual visual systems, together with its importance in both typical development and the development of forms of strabismus and amblyopia.

The mean point of vergence is biased under projection

The point of interest in three-dimensional space in eye tracking is often computed based on intersecting the lines of sight with geometry, or finding the point closest to the two lines of sight. We first start by theoretical analysis with synthetic simulations. We show that the mean point of vergence is generally biased for centrally symmetric errors and that the bias depends on the horizontal vs. vertical noise distribution of the tracked eye positions. Our analysis continues with an evaluation on real experimental data. The estimated mean vergence points seem to contain different errors among individuals but they generally show the same bias towards the observer. And it tends to be larger with an increased viewing distance. We also provided a recipe to minimize the bias, which applies to general computations of gaze estimation under projection. These findings not only have implications for choosing the calibration method in eye tracking experiments and interpreting the observed eye movements data; but also suggest to us that we shall consider the mathematical models of calibration as part of the experiment.

Mice Discriminate Stereoscopic Surfaces Without Fixating in Depth

Stereopsis is a ubiquitous feature of primate mammalian vision, but little is known about if and how rodents such as mice use stereoscopic vision. We used random dot stereograms to test for stereopsis in male and female mice, and they were able to discriminate near from far surfaces over a range of disparities, with diminishing performance for small and large binocular disparities. Based on two-photon measurements of disparity tuning, the range of disparities represented in the visual cortex aligns with the behavior and covers a broad range of disparities. When we examined their binocular eye movements, we found that, unlike primates, mice did not systematically vary relative eye positions or use vergence eye movements when presented with different disparities. Nonetheless, the representation of disparity tuning was wide enough to capture stereoscopic information over a range of potential vergence angles. Although mice share fundamental characteristics of stereoscopic vision with primates and carnivores, their lack of disparity-dependent vergence eye movements and wide neuronal representation suggests that they may use a distinct strategy for stereopsis.SIGNIFICANCE STATEMENT Binocular vision allows us to derive depth information by comparing right and left eye information. We characterized binocular integration in mice because tools exist in these animals to dissect the underlying neural circuitry for binocular vision. Using random dot stereograms, we find that behavior and disparity tuning in the visual cortex share fundamental characteristics with primates, but we did not observe any evidence of disparity-dependent changes in vergence angle. We propose that mice use a distinct strategy of stereopsis compared with primates by using a broad range of disparities to encode depth over a large field of view and to compensate for nonstereoscopic changes in vergence angle that arise during natural behavior.

Variance components affecting the repeatability of the alternating cover test

In within-subject and within-examiner repeated measures designs, measures of heterophoria with the manual prism cover test achieve standard deviations between 0.5 and 0.8 deg. We addressed the question how this total noise is composed of variable errors related to the examiner (measurement noise), to the size of the heterophoria (heterophoria noise), and to the availability of sensory vergence cues (stimulus noise). We developed an automated alternating cover test (based on a combination of VOG and shutter glasses) which minimizes stimulus noise and has a defined measurement noise (sd=0.06 deg). In a within-subject design, 19 measures were taken within 1.5 min and multiple such blocks were repeated either across days or across 45 min. Blocks were separated by periods of binocular viewing. The standard deviation of the heterophoria across blocks from different days or from the same day (sd=0.33 deg) was 6 times larger than expected based on the standard deviation within the block. The results show that about 42% of the inter-block variance with the manual prism cover test was related to variability of the heterophoria and not to measurement noise or stimulus noise. The heterophoria noise across blocks was predominantly induced during the intermediate binocular viewing periods.

Central mesencephalic reticular formation control of the near response: lens accommodation circuits

To view a nearby target, the three components of the near response are brought into play: 1) the eyes are converged through contraction of the medial rectus muscles to direct both foveae at the target, 2) the ciliary muscle contracts to allow the lens to thicken, increasing its refractive power to focus the near target on the retina, and 3) the pupil constricts to increase depth of field. In this study, we utilized retrograde transsynaptic transport of the N2c strain of rabies virus injected into the ciliary body of one eye of macaque monkeys to identify premotor neurons that control lens accommodation. We previously used this approach to label a premotor population located in the supraoculomotor area. In the present report, we describe a set of neurons located bilaterally in the central mesencephalic reticular formation that are labeled in the same time frame as the supraoculomotor area population, indicating their premotor character. The labeled premotor neurons are mostly multipolar cells, with long, very sparsely branched dendrites. They form a band that stretches across the core of the midbrain reticular formation. This population appears to be continuous with the premotor near-response neurons located in the supraoculomotor area at the level of the caudal central subdivision of the oculomotor nucleus. The central mesencephalic reticular formation has previously been associated with horizontal saccadic eye movements, so these premotor cells might be involved in controlling lens accommodation during disjunctive saccades. Alternatively, they may represent a population that controls vergence velocity. NEW & NOTEWORTHY This report uses transsynaptic transport of rabies virus to provide new evidence that the central mesencephalic reticular formation (cMRF) contains premotor neurons controlling lens accommodation. When combined with other recent reports that the cMRF also contains premotor neurons supplying medial rectus motoneurons, these results indicate that this portion of the reticular formation plays an important role in directing the near response and disjunctive saccades when viewers look between targets located at different distances.

Measurement of fusional vergence: a systematic review

Background: Fusional amplitudes are important for clinical practice in diagnosing and managing binocular vision anomalies. Several measurement methods can be used to assess fusional amplitudes. However, those methods are not interchangeable, and measurement repeatability has been questioned. Objectives: To compare the normative values of tests for the measurement of fusional vergence and to investigate sources of heterogeneity of diagnostic accuracy including: age, variation in method of assessment, study design and size, type (convergent, divergent, vertical, cyclo) and severity of strabismus (constant/intermittent/latent). Data sources: Bibliographic databases were searched up to March 2018, including Cochrane registers, PubMed, Web of Science^TM, Google Scholar and Science Citation Index. Trial registers and conference proceedings were hand searched. Review methods: The review observed and reported according to the PRISMA guidelines and was registered with PROSPERO. The I² was used to show the percentage of observed total variation across studies that is due to real heterogeneity rather than chance. The results of the different studies and the overall effect (meta-analysis under the random effects model) are shown. Results: Eighty-one studies were included in the review. Heterogenous information about break vergence amplitudes is reported for the step vergence method (I² > 50%; p < 0.05) in children. Four parameters were reported consistently to affect measurements; age, method of assessment, order of testing and target size. For the smooth vergence technique break vergence values heterogeneity was not present in children and adults (I² = 0%; p > 0.05). Limitations: The results are based on cross-sectional studies that were performed independently of each other, with different examiners, methods of examination and different populations. Conclusions: The source of heterogeneity between studies for vergence break points measured with the step vergence method seems to be linked with age. Normal vergences reported in children had considerable heterogeneity compared with adults. In clinical practice, the population-based vergence ranges measured with the step vergence method in children should not be used as one single criterion. For the smooth vergence technique, normative population data can be used.

(Disparity-Driven) Accommodation Response Contributes to Perceived Depth

When looking at objects at various distances in the physical space, the accommodation and vergence systems adjust their parameters to provide a single and clear vision of the world. Subtended muscle activity provides oculomotor cues that can contribute to the perception of depth and distance. While several studies have outlined the role of vergence in distance perception, little is known about the contribution of its concommitant accommodation component. It is possible to unravel the role of each of these physiological systems by placing observers in a situation where there is a conflict between accommodation and vergence distances. We thus sought to determine the contribution of each response system to perceived depth by simultaneously measuring vergence and accommodation while participants judged the depth of 3D stimuli. The distance conflict decreased depth constancy for stimulus displayed with negative disparity steps (divergence). Although vergence was unaffected by the stimulus distance, accommodation responses were significantly reduced when the stimulus was displayed with negative disparities. Our results show that biases in perceived depth follow undershoots in the disparity-driven accommodation response. These findings suggest that accommodation responses (i.e., from oculomotor information) can contribute to perceived depth.

Activity of near-response cells during disconjugate saccades in strabismic monkeys

Infantile strabismus is a common disorder characterized by a chronic misalignment of the eyes, impairment of binocular vision, and oculomotor abnormalities. Nonhuman primates with strabismus, induced in infancy, show a pattern of abnormalities similar to those of strabismic children. This allows strabismic nonhuman primates to serve as an ideal animal model to examine neural mechanisms associated with aberrant oculomotor behavior. Here, we test the hypothesis that impairment of disparity vergence and horizontal saccade disconjugacy in exotropia and esotropia are associated with disrupted tuning of near- and far-response neurons in the supraoculomotor area (SOA). In normal animals, these neurons carry signals related to vergence position and/or velocity. We hypothesized that, in strabismus, these neurons modulate inappropriately in association with saccades between equidistant targets. We recorded from 62 SOA neurons from 4 strabismic animals (2 esotropes and 2 exotropes) during visually guided saccades to a target that stepped to different locations on a tangent screen. Under these same conditions, SOA neurons in normal animals show no detectable modulation. In our strabismic subjects, we found that a subset of SOA neurons carry weak vergence velocity signals during saccades. In addition, a subset of SOA neurons showed clear modulation associated with slow fluctuations of horizontal strabismus angle in the absence of a saccade. We suggest that abnormal SOA activity contributes to fixation instability but plays only a minor role in the horizontal disconjugacy of saccades that do not switch fixation from one eye to the other. NEW & NOTEWORTHY The present study is the first to investigate the activity of neurons in the supraoculomotor area (SOA) during horizontally disconjugate saccades in a nonhuman primate model of infantile strabismus. We report that fluctuations of horizontal strabismus angle, during fixation of static targets on a tangent screen, are associated with contextually inappropriate modulation of SOA activity. However, firing rate modulation during saccades is too weak to make a major contribution to horizontal disconjugacy.

A Subset of Palisade Endings Only in the Medial and Inferior Rectus Muscle in Monkey Contain Calretinin

Purpose

To further chemically characterize palisade endings in extraocular muscles in rhesus monkeys.

Methods

Extraocular muscles of three rhesus monkeys were studied for expression of the calcium-binding protein calretinin (CR) in palisade endings and multiple endings. The complete innervation was visualized with antibodies against the synaptosomal-associated protein of 25 kDa and combined with immunofluorescence for CR. Six rhesus monkeys received tracer injections of choleratoxin subunit B or wheat germ agglutinin into either the belly or distal myotendinous junction of the medial or inferior rectus muscle to allow retrograde tracing in the C-group of the oculomotor nucleus. Double-immunofluorescence methods were used to study the CR content in retrogradely labeled neurons in the C-group.

Results

A subgroup of palisade and multiple endings was found to express CR, only in the medial and inferior rectus muscle. In contrast, the en plaque endings lacked CR. Accordingly, within the tracer-labeled neurons of the C-group, a subgroup expressed CR.

Conclusions

The study indicates that two different neuron populations targeting nontwitch muscle fibers are present within the C-group for inferior rectus and medial rectus, respectively, one expressing CR, one lacking CR. It is possible that the CR-negative neurons represent the basic population for all extraocular muscles, whereas the CR-positive neurons giving rise to CR-positive palisade endings represent a specialized, perhaps more excitable type of nerve ending in the medial and inferior rectus muscles, being more active in vergence. The malfunction of this CR-positive population of neurons that target nontwitch muscle fibers could play a significant role in strabismus.

Evaluation of binocular function among pre- and early-presbyopes with asthenopia

PURPOSE

Individuals approaching presbyopia may exhibit ocular symptoms as they contend with visual demands of near work, coupled with natural age-related changes in accommodation. Therefore, accommodation and vergence of 30- to 40-year-old, myopic, soft contact lens wearing subjects with symptoms of asthenopia and no history of using multifocal lenses were evaluated.

PATIENTS AND METHODS

In this prospective, observational study, 253 subjects with asthenopia were evaluated by 25 qualified practitioners, each at a different clinical site. Subjects were 30-40 years in age, had symptoms of soreness, eyestrain, tired eyes, or headaches with near work, regularly performed 2-3 consecutive hours of near work, and were undiagnosed with presbyopia. Amplitude of accommodation (AC) and near point convergence (NPC) were measured with a Royal Air Force binocular gauge. Triplicate push up and push down AC and NPC measures were recorded, and average AC values were compared to those calculated using the Hofstetter formula (HF).

RESULTS

The average AC push up/push down value was significantly better than the HF prediction for this age range (8.04±3.09 vs 6.23±0.80 D), although 22.5% of subjects had mean AC below their HF value (5.36±0.99 D). The average NPC push up/push down value was 12.0±4.69 cm. The mean binocular AC value using the push up measure was significantly better than the push down measure (8.5±3.4 vs 7.6±3.0 D). The mean NPC value using the push up measure was significantly worse than the push down measure (13.0±5.0 vs 11.0±4.7 cm). The most frequent primary diagnosis was ill-sustained accommodation (54%), followed by accommodative insufficiency (18%), and accommodative infacility (12%).

CONCLUSION

Based upon a standardized assessment of accommodation and vergence, ill-sustained accommodation was the most frequent diagnosis among this population.

Response of supraoculomotor area neurons during combined saccade-vergence movements

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

Joint Learning of Binocularly Driven Saccades and Vergence by Active Efficient Coding

This paper investigates two types of eye movements: vergence and saccades. Vergence eye movements are responsible for bringing the images of the two eyes into correspondence, whereas saccades drive gaze to interesting regions in the scene. Control of both vergence and saccades develops during early infancy. To date, these two types of eye movements have been studied separately. Here, we propose a computational model of an active vision system that integrates these two types of eye movements. We hypothesize that incorporating a saccade strategy driven by bottom-up attention will benefit the development of vergence control. The integrated system is based on the active efficient coding framework, which describes the joint development of sensory-processing and eye movement control to jointly optimize the coding efficiency of the sensory system. In the integrated system, we propose a binocular saliency model to drive saccades based on learned binocular feature extractors, which simultaneously encode both depth and texture information. Saliency in our model also depends on the current fixation point. This extends prior work, which focused on monocular images and saliency measures that are independent of the current fixation. Our results show that the proposed saliency-driven saccades lead to better vergence performance and faster learning in the overall system than random saccades. Faster learning is significant because it indicates that the system actively selects inputs for the most effective learning. This work suggests that saliency-driven saccades provide a scaffold for the development of vergence control during infancy.