Catherine M. Suttle

Eye–Hand Coordination Skills in Children with and without Amblyopia

PURPOSE To investigate whether binocular information provides benefits for programming and guidance of reach-to-grasp movements in normal children and whether these eye-hand coordination skills are impaired in children with amblyopia and abnormal binocularity. METHODS Reach-to-grasp performance of the preferred hand in binocular versus monocular (dominant or nondominant eye occluded) conditions to different objects (two sizes, three locations, and two to three repetitions) was quantified by using a 3D motion-capture system. The participants were 36 children (age, 5-11 years) and 11 adults who were normally sighted and 21 children (age, 4-8 years) who had strabismus and/or anisometropia. Movement kinematics and error rates were compared for each viewing condition within and between subject groups. RESULTS The youngest control subjects used a mainly programmed (ballistic) strategy and collided with the objects more often when viewing with only one eye, while older children progressively incorporated visual feedback to guide their reach and, eventually, their grasp, resulting in binocular advantages for both movement components resembling those of adult performance. Amblyopic children were the worst performers under all viewing conditions, even when using the dominant eye. They spent almost twice as long in the final approach to the objects and made many (1.5-3 times) more errors in reach direction and grip positioning than their normal counterparts, these impairments being most marked in those with the poorest binocularity, regardless of the severity or cause of their amblyopia. CONCLUSIONS The importance of binocular vision for eye-hand coordination normally increases with age and use of online movement guidance. Restoring binocularity in children with amblyopia may improve their poor hand action control.

Morphology of transient VEPs to luminance and chromatic pattern onset and offset

Characteristics of the visual evoked response to chromatic and luminance-modulated stimuli reflect the activity of underlying neural mechanisms, although selective neuronal activity depends upon stimulus parameters. In the present study, the behaviour of the transient visual evoked response to low spatial and temporal frequency chromatic stimuli is investigated at a range of colour luminance ratios. Our results show that the response to pattern-offset may be used in addition to the pattern-onset response as part of the signature of the evoked response to luminance-modulated or isoluminant chromatic stimuli.

Interocular interactions during acuity measurement in children and adults, and in adults with amblyopia

The binocular interactions that occur during dichoptic and binocular viewing were investigated using a letter acuity task in normally sighted children (age range 6-14 years) and adults, and in adults with anisometropic amblyopia. Our aims were to investigate the nature of binocular interactions that occur in each group, and the extent to which the characteristics of binocular interactions differ across the groups. The non-tested eye was occluded during monocular (baseline) viewing, and was allowed to view a uniform stimulus with fusion lock in dichoptic viewing. In adults and children with normal vision, acuity under dichoptic viewing was unchanged relative to monocular baseline in the dominant eyes, while acuity of the non-dominant eye improved under dichoptic viewing relative to baseline. The magnitude of dichoptic change in the non-dominant eyes was similar in the two normally sighted groups, but the dichoptic advantage was found to decrease with increasing age within the children tested. Binocular acuity was better than monocular acuity in normal subjects, and a decrease in binocular summation with age was noted within the age range of the children tested. In contrast, the amblyopic observers showed no change in acuity with viewing conditions. The results demonstrate development of interocular interactions during childhood, and wide inter-individual variation in pattern of interocular interactions among anisometropic amblyopic adults.

Transient pattern visual evoked potentials in children with Down's syndrome.

Visual acuity and contrast sensitivity are lower in children with Downs syndrome than in those developing normally. In many cases, this difference might be accounted for by the relatively high incidence of ocular abnormalities (including refractive error and strabismus) in Downs syndrome. However, abnormal spatial vision persists in children with Downs syndrome in the absence of ocular abnormality, suggesting that abnormal retino‐cortical visual processing explains reduced visual function in this group. The aim of the present study was to assess retino‐cortical function in children with Downs syndrome by recording transient visual evoked potentials (VEPs) in response to pattern stimuli. Responses from children with Downs syndrome were compared with those recorded from children developing normally. Response latency is similar in the two groups, but morphology differs, with the N75 component being clearly present in the normal responses, but diminished or undetectable in responses from children with Downs syndrome. Our findings may suggest a cortical abnormality specific to the source of the N75 component of pattern‐reversal achromatic VEPs.

Sensory ocular dominance based on resolution acuity, contrast sensitivity and alignment sensitivity

Background:  Ocular dominance is the superiority or preference of one eye over the other in terms of sighting, sensory function (for example, visual acuity) or persistence in binocular rivalry. There is poor agreement between sighting and sensory dominance and findings are equivocal on the possible neural basis of ocular dominance and its significance. Thus, there are questions on the meaning and importance of ocular dominance. Despite the lack of clarity in this area, ocular dominance is used clinically, for example, as the basis for decisions on monovision in contact lens wear and on treatment of anomalies of binocular vision.

Examining the evidence base used by optometrists in Australia and New Zealand

Background:  The optometrists role in primary eye care is expanding to include not only diagnosis but also management and co-management of a range of eye diseases and visual disorders. This role calls for evidence-based practice, including an ability to source and reliably assess the various forms of evidence, on which eye care might be based. It is not known whether optometrists registered to practise in Australasia use high or low quality evidence as a basis for their clinical decisions. Methods:  The present study addressed this question by surveying 3,589 optometrists registered to practise in Australia and New Zealand. A 16-item questionnaire was made available for completion online. Results:  Responses from the 279 optometrists who completed the questionnaire (response rate 7.8 per cent) indicate that, after the patients history, symptoms and signs, optometrists in our sample place most weight on knowledge and information gained via undergraduate and postgraduate education, including continuing education, as a basis for clinical decision-making. Conclusion:  These findings highlight the need for current, critically evaluated content in optometric education and suggest that optometrists currently prefer to receive information and knowledge from an educator rather than sourcing and assessing the material independently.Background:  The optometrists role in primary eye care is expanding to include not only diagnosis but also management and co‐management of a range of eye diseases and visual disorders. This role calls for evidence‐based practice, including an ability to source and reliably assess the various forms of evidence, on which eye care might be based. It is not known whether optometrists registered to practise in Australasia use high or low quality evidence as a basis for their clinical decisions.

The correlation dimension: a useful objective measure of the transient visual evoked potential?

Visual evoked potentials (VEPs) may be analyzed by examination of the morphology of their components, such as negative (N) and positive (P) peaks. However, methods that rely on component identification may be unreliable when dealing with responses of complex and variable morphology; therefore, objective methods are also useful. One potentially useful measure of the VEP is the correlation dimension. Its relevance to the visual system was investigated by examining its behavior when applied to the transient VEP in response to a range of chromatic contrasts (42%, two times psychophysical threshold, at psychophysical threshold) and to the visually unevoked response (zero contrast). Tests of nonlinearity (e.g., surrogate testing) were conducted. The correlation dimension was found to be negatively correlated with a stimulus property (chromatic contrast) and a known linear measure (the Fourier-derived VEP amplitude). It was also found to be related to visibility and perception of the stimulus such that the dimension reached a maximum for most of the participants at psychophysical threshold. The latter suggests that the correlation dimension may be useful as a diagnostic parameter to estimate psychophysical threshold and may find application in the objective screening and monitoring of congenital and acquired color vision deficiencies, with or without associated disease processes.

Vitamin and mineral deficiencies in the developed world and their effect on the eye and vision.

Vitamin and mineral deficiencies are common in developing countries, but also occur in developed countries. We review micronutrient deficiencies for the major vitamins A, cobalamin (B12), biotin (vitamin H), vitamins C and E, as well as the minerals iron, and zinc, in the developed world, in terms of their relationship to systemic health and any resulting ocular disease and/or visual dysfunction. A knowledge of these effects is important as individuals with consequent poor ocular health and reduced visual function may present for ophthalmic care.

A psychophysical study of human binocular interactions in normal and amblyopic visual systems.

During infancy and childhood, spatial contrast sensitivity and alignment sensitivity undergo maturation, and during this period the visual system has considerable plasticity. The purpose of this study was to compare the nature of interocular interactions of these spatial functions in normally sighted children and adults, and to study the extent to which interocular interactions are impaired in anisometropic amblyopia. Spatial functions were measured under three viewing conditions: monocular (fellow eye occluded), dichoptic (uniform stimulus presented to the fellow eye but with a peripheral fusion lock), and binocular. Measurements were made in each eye during monocular and dichoptic viewing. In the contrast sensitivity task, Gabor stimuli were presented in one of two temporal intervals. For the alignment task, a three-element Gabor stimulus was used. The task of the subject was to indicate the direction of displacement of the middle patch with respect to the outer patches. The findings indicate that in children, binocular contrast sensitivity was better than monocular (binocular summation) but so too was dichoptic sensitivity (dichoptic summation). The magnitude of binocular/dichoptic summation was significantly greater in children than in normally sighted adults for contrast sensitivity, but not for alignment sensitivity. In anisometropic amblyopes, however, we find that for the group as a whole the amblyopic eye does not benefit when the fellow eye views a dichoptic stimulus, compared to dark occlusion of that eye. In addition, we found considerable inter-individual variation within the amblyopic group. Implications of these findings for techniques used in vision therapy are discussed.

A Longitudinal Study of Visual Evoked Responses to Tritan Stimuli in Human Infants

The principal goal of this study was to assess the development of the S-cone pathway in human infants. For comparison, development of the L-M opponent pathway was also assessed. Visual evoked responses were measured to chromatic (tritan and red-green) and luminance-modulated (yellow-black) sinusoidal gratings of 0.2 cpd, viewed binocularly at a distance of 40 cm. For each type of chromatic stimulus, responses were recorded at a range of color ratios around the adult isoluminant point, as determined using standard flicker photometry criteria. Presentation was by abrupt pattern-onset with a stimulus duration of 100 ms and an interstimulus interval of 400 ms. Responses were recorded from Oz, referred to Cz, by averaging 30 sweeps. Infants were examined between the ages of 4 weeks and 3 months. Reliable visual evoked responses were recorded to isoluminant tritan stimuli from as early as 4 weeks of age, and to red-green stimuli from 6 weeks. Responses to the luminance-modulated stimuli were evident in all infants at 4 weeks of age (the earliest age examined). Our results provide evidence that the rate of development for pathways mediating information about tritan stimuli, red-green stimuli, and luminance-modulated stimuli is similar.