Lisa Asper

Strabismic amblyopia. Part 1. Psychophysics.

This is a two‐part survey of current literature concerning strabismic amblyopia. The aim of this review is to bring the optometric practitioner up to date on the status of scientific research into strabismic amblyopia.

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.

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.

Viewing distance and eyestrain symptoms with prolonged viewing of smartphones

This paper investigates viewing distances and eyestrain symptoms in young adults reading from a smartphone for 60 minutes.

Context and crowding in perceptual learning on a peripheral contrast discrimination task: context-specificity in contrast learning.

Perceptual learning is an improvement in sensitivity due to practice on a sensory task and is generally specific to the trained stimuli and/or tasks. The present study investigated the effect of stimulus configuration and crowding on perceptual learning in contrast discrimination in peripheral vision, and the effect of perceptual training on crowding in this task. 29 normally-sighted observers were trained to discriminate Gabor stimuli presented at 9° eccentricity with either identical or orthogonally oriented flankers with respect to the target (ISO and CROSS, respectively), or on an isolated target (CONTROL). Contrast discrimination thresholds were measured at various eccentricities and target-flanker separations before and after training in order to determine any learning transfer to untrained stimulus parameters. Perceptual learning was observed in all three training stimuli; however, greater improvement was obtained with training on ISO-oriented stimuli compared to CROSS-oriented and unflanked stimuli. This learning did not transfer to untrained stimulus configurations, eccentricities or target-flanker separations. A characteristic crowding effect was observed increasing with viewing eccentricity and decreasing with target-flanker separation before and after training in both configurations. The magnitude of crowding was reduced only at the trained eccentricity and target-flanker separation; therefore, learning for contrast discrimination and for crowding in the present study was configuration and location specific. Our findings suggest that stimulus configuration plays an important role in the magnitude of perceptual learning in contrast discrimination and suggest context-specificity in learning.

The development of crowding and interocular interactions in a resolution acuity task.

PURPOSE To investigate the impact of interocular similarities of a surround stimulus on foveal resolution acuity in the normally developing visual system. METHODS Liquid crystal shutter goggles synchronized with the monitor frame rate were used to present a Landolt C and surround bars to one or both eyes, in monocular, dichoptic, half-binocular, and binocular viewing conditions. Resolution acuity was measured under each condition in 56 normally sighted children (7 to 14 years of age) and 22 adults (21 to 38 years of age). The effect of the surround bars (crowding) was tested in a subgroup of nine children, and 10 adults. RESULTS Across all age groups resolution acuity was significantly better in the binocular condition than in the other three viewing conditions (binocular summation), and was significantly better in the half-binocular (with target presented to the test eye and bars presented to both eyes) than in the dichoptic condition (target presented to test eye and bars presented to the nontested eye only). In children, but not in adults, resolution acuity was significantly better without than with bars. CONCLUSIONS The interocular similarities may explain the better visual resolution in the half-binocular condition than in the dichoptic condition for all age groups tested. The results suggest that interocular interactions underpinning resolution acuity under these viewing conditions are developed in early childhood. The foveal crowding effect was found to be apparent at the beginning of school age, and diminished with maturation.

Enhancement of Resolution Acuity in a Half-Binocular Viewing Condition

PURPOSE To investigate the effect of interocular stimulus similarity on foveal resolution acuity. METHODS Liquid crystal shutter goggles synchronized with the monitor refresh rate were used to present a Landolt C and surround bars to one or both eyes, in four viewing conditions (monocular, dichoptic, half-binocular, and binocular). Resolution acuity was measured in each condition in 22 normally sighted adults. RESULTS Resolution acuity was significantly better in the binocular condition than in the other three viewing conditions (binocular summation) and was significantly better in the half-binocular condition (with target presented to the test eye and bars presented to both eyes) than in the dichoptic condition (target presented to the test eye and bars presented to the nontested eye only). CONCLUSIONS Monocular resolution acuity depends in part on interocular similarities of the stimulus surrounding the central target. This finding may have implications in the design of stimuli for vision-training therapies.

The Effects of Vertical Yoked Prisms on Gait

PURPOSE To investigate the influence of base down (BD) and base up (BU) yoked prism wear on gait. METHODS Gait was assessed in 31 young healthy adults (mean age, 24.0 ± 5.1 years) during and after wearing 5 prism diopter ((Δ)) BU yoked prisms, 5(Δ) BD yoked prisms, and plano (PL) (zero power; control condition) lenses, worn in a pseudorandom order. Velocity; cadence; step length; double support phase; step width; and variability in step time, step width, step length, and swing time were measured as participants walked at a freely chosen walking speed along a 5.3-m electronic mat placed in the center of a 7.5-m walkway. Gait parameters were analyzed for each viewing condition before, during, and after prism wear. RESULTS BD yoked prisms, when compared with PL, led to slower velocity, lower cadence, decreased step length, and increased step time variability (P ≤ 0.001) These gait parameters did not significantly differ between BU yoked prisms and PL lenses (P > 0.05). Measurements taken immediately on removal did not differ from those taken after a time delay of 5 minutes. CONCLUSIONS BD yoked prisms affected gait in young healthy adults walking across an unobstructed path at their freely chosen walking speed, in that participants adopted a slower, apparently more cautious gait pattern; BU yoked prisms did not significantly affect gait. The effect of BD prism on gait may be due in part to a perception of increased height.

Negligible impact on posture from 5-diopter vertical yoked prisms.

PURPOSE Yoked prisms are used by some optometrists to adjust posture, but evidence to support this practice is sparse and low level. The aim of this research was to investigate whether vertical yoked prisms have an impact on posture in healthy adults. METHODS Posture was assessed objectively in 20 healthy adults, by recording a range of joint angles or body segment locations at the ankle, hip, torso, neck, and head during participant observation of a straight-ahead target, and subsequently with eyes closed. Recording occurred before, during, and after wearing goggles with control plano lenses, and 5-diopter (D) base-up and 5-D base-down yoked prisms. In each viewing condition, the goggles were worn for 30 minutes. Interaction effects of lens/prism condition by time on joint angles and body orientation were determined. RESULTS In the eyes-open and eyes-closed conditions, no significant lens/prism × time interaction effects were found at the torso, neck, hip, or ankle (P > 0.1). However, in both eyes-open and eyes-closed conditions a significant lens/prism × time interaction was found at the head (P = 0.031 and 0.006, respectively), with head extended (tilted backward) by up to 2.5 degrees more while viewing with base-down prisms than with plano lenses. CONCLUSIONS In healthy adults, 5-D base-down yoked prisms were not associated with a change in body posture. A small effect on head orientation and not at other locations suggests a minimal effect on posture. Research in a larger sample and in individuals with abnormal posture is needed to verify this.

Optical treatment of amblyopia: a systematic review and meta-analysis: Optical treatment of amblyopia

Despite evidence that amblyopia can often be treated by optical treatment alone, many practitioners still do not use an optical‐correction‐only phase in amblyopia treatment and some investigators omit this important step in their research. This paper aims to systematically review the evidence for the optical treatment of strabismic, refractive and combined‐mechanism amblyopia and to quantify the evidence via a meta‐analysis.