Itay Ben-Zion

A Review of Primary Congenital Glaucoma in the Developing World

Primary congenital glaucoma is the most common type of infantile glaucoma, yet it remains a relatively rare disease. Treatment is principally surgical, and management lasts a lifetime. In the developing world, delayed diagnosis, limited treatment, and inadequate follow-up lead to a heavier burden on the patient and community. We highlight the epidemiology and genetics of the disease, its current management and prognosis, and the limitations facing both providers and patients in the developing world. Further efforts are necessary to provide effective, timely screening of children and allocate adequate resources to allow health care workers to reduce the rate of avoidable blindness in developing countries.

The Limits of Shape Recognition following Late Emergence from Blindness

Visual object recognition develops during the first years of life. But what if one is deprived of vision during early post-natal development? Shape information is extracted using both low-level cues (e.g., intensity- or color-based contours) and more complex algorithms that are largely based on inference assumptions (e.g., illumination is from above, objects are often partially occluded). Previous studies, testing visual acuity using a 2D shape-identification task (Lea symbols), indicate that contour-based shape recognition can improve with visual experience, even after years of visual deprivation from birth. We hypothesized that this may generalize to other low-level cues (shape, size, and color), but not to mid-level functions (e.g., 3D shape from shading) that might require prior visual knowledge. To that end, we studied a unique group of subjects in Ethiopia that suffered from an early manifestation of dense bilateral cataracts and were surgically treated only years later. Our results suggest that the newly sighted rapidly acquire the ability to recognize an odd element within an array, on the basis of color, size, or shape differences. However, they are generally unable to find the odd shape on the basis of illusory contours, shading, or occlusion relationships. Little recovery of these mid-level functions is seen within 1 year post-operation. We find that visual performance using low-level cues is relatively robust to prolonged deprivation from birth. However, the use of pictorial depth cues to infer 3D structure from the 2D retinal image is highly susceptible to early and prolonged visual deprivation.

Trends in the incidence and causes of severe visual impairment and blindness in children from Israel.

PURPOSE To describe trends in the incidence and causes of legal childhood blindness in Israel, one of the few countries worldwide that maintain a national registry of the blind. METHODS We performed a historical cohort study of annual reports of the National Registry of the Blind (NRB) between 1999 and 2013. All data regarding demographic information, year of registration and cause of blindness of children 0-18 years of age registered for blind certification were obtained from the annual reports of the NRB. Causes of legal blindness analyzed were optic atrophy, retinitis pigmentosa, retinopathy of prematurity (ROP), albinism, other retinal disorders, cataract, and glaucoma. The main outcome measure was the incidence of new cases of certified legal blindness. RESULTS The incidence of newly registered legally blind children in Israel almost halved from 7.7 per 100,000 in 1999 to 3.1 per 100,000 in 2013. The decline was mainly attributable to a decreased incidence of blindness resulting from retinitis pigmentosa and ROP. The incidence of registered cases due to cerebral visual impairment increased. CONCLUSIONS During the past decade the incidence of severe childhood visual impairment and blindness declined in Israel. A continuous decline in consanguineous marriages among the Jewish and Arab populations in Israel may have contributed to the decrease in the rate of vision loss due to retinitis pigmentosa in children.

Lack of Automatic Imitation in Newly Sighted Individuals

Viewing a hand action performed by another person facilitates a response-compatible action and slows a response-incompatible one, even when the viewed action is irrelevant to the task. This automatic imitation effect is taken as the clearest evidence for a direct mapping between action viewing and motor performance. But there is an ongoing debate whether this effect is innate or experience dependent. We tackled this issue by studying a unique group of newly sighted children who suffered from dense bilateral cataracts from early infancy and were surgically treated only years later. The newly sighted children were less affected by viewing task-irrelevant actions than were control children, even 2 years after the cataract-removal surgery. This strongly suggests that visually guided motor experience is necessary for the development of automatic imitation. At the very least, our results indicate that if imitation is based on innate mechanisms, these are clearly susceptible to long periods of visual deprivation.