PremNandhini Satgunam

Contour Enhancement Benefits Older Adults with Simulated Central Field Loss

Purpose. Age-related macular degeneration is the leading cause of vision loss among Americans aged >65 years. Currently, no effective treatment can reverse the central vision loss associated with most age-related macular degeneration. Digital image-processing techniques have been developed to improve image visibility for peripheral vision; however, both the selection and efficacy of such methods are limited. Progress has been difficult for two reasons: the exact nature of image enhancement that might benefit peripheral vision is not well understood, and efficient methods for testing such techniques have been elusive. The current study aims to develop both an effective image enhancement technique for peripheral vision and an efficient means for validating the technique. Methods. We used a novel contour-detection algorithm to locate shape-defining edges in images based on natural-image statistics. We then enhanced the scene by locally boosting the luminance contrast along such contours. Using a gaze-contingent display, we simulated central visual field loss in normally sighted young (aged 18–30 years) and older adults (aged 58–88 years). Visual search performance was measured as a function of contour enhancement strength [“Original” (unenhanced), “Medium,” and “High”]. For preference task, a separate group of subjects judged which image in a pair “would lead to better search performance.” Results. We found that although contour enhancement had no significant effect on search time and accuracy in young adults, Medium enhancement resulted in significantly shorter search time in older adults (about 13% reduction relative to Original). Both age-groups preferred images with Medium enhancement over Original (2–7 times). Furthermore, across age-groups, image content types, and enhancement strengths, there was a robust correlation between preference and performance. Conclusions. Our findings demonstrate a beneficial role of contour enhancement in peripheral vision for older adults. Our findings further suggest that task-specific preference judgments can be an efficient surrogate for performance testing.

The influence of vergence adaptation on open-loop vergence dynamics

The objectives of this experiment were to measure the effect of sustained convergence on the open-loop vergence peak velocity and open-loop vergence amplitude, and to assess the correlation between changes in the phoria and changes in open-loop vergence peak velocity induced by sustained convergence. Subjects sustained convergence on a target that required 12 degrees of convergence for 5 minutes. Convergence and divergence movements of 4 degrees from the 12 degrees convergent position were measured before and after sustained convergence. Following sustained convergence, the open-loop vergence peak velocity and vergence amplitude both increased for convergence (regression slope=3.68, r=0.47). Vergence velocity and vergence amplitude both decreased for divergence (regression slope=1.76, r=0.36). After sustained convergence, a convergent shift in the phoria was noted in most cases. This shift correlated with changes in open-loop peak vergence velocity more for convergence (regression slope=1.1, r=0.33) than for divergence (regression slope=0.71, r=0.22). The results might be due to shifts in disparity detection brought about by the period of sustained convergence.

Television, computer and portable display device use by people with central vision impairment

Citation information: Woods RL & Satgunam P. Television, computer and portable display device use by people with central vision impairment. Ophthalmic Physiol Opt 2011, 31, 258–274. doi: 10.1111/j.1475‐1313.2011.00833.x

Statistical analysis of subjective preferences for video enhancement

Measuring preferences for moving video quality is harder than for static images due to the fleeting and variable nature of moving video. Subjective preferences for image quality can be tested by observers indicating their preference for one image over another. Such pairwise comparisons can be analyzed using Thurstone scaling (Farrell, 1999). Thurstone (1927) scaling is widely used in applied psychology, marketing, food tasting and advertising research. Thurstone analysis constructs an arbitrary perceptual scale for the items that are compared (e.g. enhancement levels). However, Thurstone scaling does not determine the statistical significance of the differences between items on that perceptual scale. Recent papers have provided inferential statistical methods that produce an outcome similar to Thurstone scaling (Lipovetsky and Conklin, 2004). Here, we demonstrate that binary logistic regression can analyze preferences for enhanced video.

Saccadic latencies for achromatic and chromatic targets.

The purpose of this experiment was to compare saccadic latencies for supra-threshold achromatic and chromatic targets of equivalent contrast. Two experiments were performed. In the first experiment, subjects made saccades to horizontal and vertical chromatic (red, green, and blue) targets. The luminance of these targets was matched to the luminance of the white background. In the second experiment, subjects made saccades to horizontal and vertical achromatic targets whose luminance contrast was matched to the chromatic contrast of the targets in the first experiment using the CIE L*a*b* color space. In the first experiment, the saccadic latencies did not vary significantly (p = 0.074) for the different target colors. However, in the second experiment the mean latency for achromatic targets (268.6 ms +/- 53.1) varied significantly from the pooled latency for color targets (318.4 ms +/- 75.1).

Visual search performance of patients with vision impairment: effect of JPEG image enhancement

Citation information: Luo G, Satgunam P & Peli E. Visual search performance of patients with vision impairment: effect of JPEG image enhancement. Ophthalmic Physiol Opt 2012, 32, 421–428. doi: 10.1111/j.1475‐1313.2012.00908.x

Bitemporal hemianopia; its unique binocular complexities and a novel remedy.

Bitemporal hemianopic visual field impairment frequently leads to binocular vision difficulties. Patients with bitemporal hemianopia with pre‐existing exophoria complain of horizontal diplopia, sometimes combined with vertical deviation (with pre‐existing hyperphoria). The symptoms are a result of the phoria decompensating into a tropia (hemi‐slide) due to the lack of retinal correspondence between the remaining nasal fields of both eyes. We measured these effects using a dichoptic perimeter. We showed that aligning the eyes with prisms could prevent diplopia if the bitemporal hemianopia is incomplete. We also describe the successful use of a novel fusion aid – the ‘stereo‐typoscope’ – that utilizes midline stereopsis to prevent diplopia resulting from hemi‐sliding in patients with complete bitemporal hemianopia.

Torsional anomalous retinal correspondence effectively expands the visual field in hemianopia.

Purpose. Exotropia in congenital homonymous hemianopia has been reported to provide field expansion that is more useful when accompanied with harmonious anomalous retinal correspondence (HARC). Torsional strabismus with HARC provides a similar functional advantage. In a subject with hemianopia demonstrating a field expansion consistent with torsion, we documented torsional strabismus and torsional HARC. Methods. Monocular visual fields under binocular fixation conditions were plotted using a custom dichoptic visual field perimeter. The dichoptic visual field was also modified to measure perceived visual directions under dissociated and associated conditions across the central 50° diameter field. The field expansion and retinal correspondence of a subject with torsional strabismus (along with exotropia and right hypertropia) with congenital homonymous hemianopia was compared with that of another exotropic subject with acquired homonymous hemianopia without torsion and to a control subject with minimal phoria. Torsional rotations of the eyes were calculated from fundus photographs and perimetry. Results. Torsional anomalous retinal correspondence documented in the subject with congenital homonymous hemianopia provided a functional binocular field expansion up to 18°. Normal retinal correspondence was mapped for the full 50° visual field in the control subject and for the seeing field of the acquired homonymous hemianopia subject, limiting the functional field expansion benefit. Conclusions. Torsional strabismus with anomalous retinal correspondence, when occurring with homonymous hemianopia provides useful field expansion in the lower and upper fields. Dichoptic perimetry permits documentation of ocular alignment (lateral, vertical, and torsional) and perceived visual direction under binocular and monocular viewing conditions. Evaluating patients with congenital or early strabismus for HARC is useful when considering surgical correction, particularly in the presence of congenital homonymous hemianopia.

Volume Perimetry: measurement in depth of visual field loss

Purpose. Volume scotomas are three-dimensional regions of space that are not visible to the observer. Volume perimetry maps volume scotomas. Volume scotomas predicted from combining monocular visual fields assume known fixation locus (mainly foveal). However, fixation loci are not always known, especially with central field loss (CFL). Here we demonstrate methods for measuring and calculating volume scotomas and discuss their practical implications. Methods. Three patients (bitemporal hemianopia, binasal scotoma, and CFL) were evaluated. Slices through the volume scotomas were measured at three distances: at the plane of fixation, at a plane anterior to fixation (representing anterior volume perimetry), and at a plane posterior to fixation (representing posterior volume perimetry). For anterior volume perimetry, patients fixated on a screen 100 cm away through a beamsplitter that reflected the perimetric stimulus (at 50 cm). For posterior volume perimetry, patients fixated on a near target (50 cm), while perimetric stimuli were presented on a screen 150 cm beyond fixation. At the plane of fixation, monocular visual fields under binocular viewing conditions were measured using a computerized dichoptic perimeter. Results. Posterior and anterior volume scotomas were documented in patients with bitemporal hemianopia and binasal scotomas, respectively. The CFL patient demonstrated both anterior and posterior volume scotomas. Scotoma magnitude was considered to determine its effect on visual function. Conclusions. Direct measurement of volume scotomas can be performed. Anterior and posterior volume visual fields can vary substantially from conventional binocular perimetry measured at the fixation plane, revealing blind areas not otherwise identified. These volume scotomas are likely to impair functional vision such as driving (for bitemporal hemianopes) and near work with small hand tools (for binasal scotomas). Patients with CFL will have impaired functional vision for both distance and near tasks. Consideration of volume scotomas can help provide more effective vision rehabilitation and counseling.

Corneal Transplantation in Disease Affecting Only One Eye: Does It Make a Difference to Habitual Binocular Viewing?

Background Clarity of the transplanted tissue and restoration of visual acuity are the two primary metrics for evaluating the success of corneal transplantation. Participation of the transplanted eye in habitual binocular viewing is seldom evaluated post-operatively. In unilateral corneal disease, the transplanted eye may remain functionally inactive during binocular viewing due to its suboptimal visual acuity and poor image quality, vis-à-vis the healthy fellow eye. Methods and Findings This study prospectively quantified the contribution of the transplanted eye towards habitual binocular viewing in 25 cases with unilateral transplants [40yrs (IQR: 32–42yrs) and 25 age-matched controls [30yrs (25–37yrs)]. Binocular functions including visual field extent, high-contrast logMAR acuity, suppression threshold and stereoacuity were assessed using standard psychophysical paradigms. Optical quality of all eyes was determined from wavefront aberrometry measurements. Binocular visual field expanded by a median 21% (IQR: 18–29%) compared to the monocular field of cases and controls (p = 0.63). Binocular logMAR acuity [0.0 (0.0–0.0)] almost always followed the fellow eye’s acuity [0.00 (0.00 –-0.02)] (r = 0.82), independent of the transplanted eye’s acuity [0.34 (0.2–0.5)] (r = 0.04). Suppression threshold and stereoacuity were poorer in cases [30.1% (13.5–44.3%); 620.8arc sec (370.3–988.2arc sec)] than in controls [79% (63.5–100%); 16.3arc sec (10.6–25.5arc sec)] (p<0.001). Higher-order wavefront aberrations of the transplanted eye [0.34μ (0.21–0.51μ)] were higher than the fellow eye [0.07μ (0.05–0.11μ)] (p<0.001) and their reduction with RGP contact lenses [0.09μ (0.08–0.12μ)] significantly improved the suppression threshold [65% (50–72%)] and stereoacuity [56.6arc sec (47.7–181.6arc sec)] (p<0.001). Conclusions In unilateral corneal disease, the transplanted eye does participate in gross binocular viewing but offers limited support to fine levels of binocularity. Improvement in the transplanted eye’s optics enhances its participation in binocular viewing. Current metrics of this treatment success can expand to include measures of binocularity to assess the functional benefit of the transplantation process in unilateral corneal disease.