The influence of ocular dominance on monovision--the interaction between binocular visual functions and the state of dominant eye's correction

PURPOSE: To examine the interaction between binocular visual functions and the correction of the dominant eye, i.e., for far vs. near vision in monovision. SUBJECTS AND METHODS: Ten healthy subjects without any ophthalmological disease were examined. After cycloplegia, the eyes of the subjects were corrected by soft contact lenses (difference in lens power between the lenses: 2.5 D) with an artificial pupil(diameter: 3.0 mm). Visual acuity at various distances, contrast sensitivity, and near stereoacuity were measured while the dominant eye determined by the hole-in-card test (sighting dominance) was corrected for far and near vision. RESULTS: Binocular visual acuity was better than 1.0(20/20) at all distances. When the dominant eye was corrected for distance, the binocular visual acuity at 0.7 m was better than the monocular visual acuity; contrast sensitivity was better within the spatial frequency range of 0.5-4.0 cycles per degree, and near stereoacuity by Titmus stereo tests improved. CONCLUSION: These results suggest that dominant eyes should be corrected for far vision for better binocular summation at middle distances, and near stereoacuity.     

单眼视设计的人工晶状体眼视功能临床研究

目的 探讨应用单眼视原理设计双眼白内障超声乳化联合植入单焦点人工晶状体术后的视功能情况.方法 对双眼年龄相关性白内障患者42例(84只眼),分为常规组21例(42只眼)及单眼视组21例(42只眼).常规行白内障超声乳化联合折叠式人工晶状体植入术.分别记录术前最佳矫正视力及术后1周单眼裸眼远、近视力及双眼裸眼远、近视力.采用SAS8.2统计软件对结果进行统计学分析.结果 (1)术前平均最佳矫正视力常规组4.44,单眼视组4.47(P ＞0.05),患者平均年龄常规组71岁,单眼视组69.5岁(P ＞0.05),差异无统计学意义.(2)术后1周单眼裸眼远视力常规组4.90,单眼视组:优势眼4.94(P ＞0.05),与常规组比较差异无统计学意义;非优势眼4.71(P < 0.05),与常规组比较差异有统计学意义.术后1周单眼近视力常规组4.36,单眼视组:优势眼4.37(P＞0.05),与常规组比较差异无统计学意义;非优势眼4.78(P < 0.05),与常规组比较差异有统计学意义.(3)术后1周双眼裸眼远视力常规组4.91,单眼视组4.91(P ＞0.05),与常规组比较差异无统计学意义;术后1周双眼近视力常规组4.42,单眼视组4.78(P < 0.05),与常规组比较差异有统计学意义.结论 单眼视设计的人工晶状体眼术后双眼远视力与常规设计人工晶状体眼相同,但近视力明显好于常规设计.按照单眼视原理设计人工晶状体可以较好的临床应用.     

Patterns of binocular suppression and accommodation in monovision

The binocular depth of focus of monovision wearers was compared to the sum of the two monocularly determined depths of focus. Observers fell into three groups based upon ocular sighting dominance. Complete binocular summation of the monocular depths of focus was observed in subjects without a preferred fixating eye. Subjects who preferred to fixate with one eye had difficulty suppressing blur of that eye while the binocular target was within the depth of focus of the nonpreferred eye. A third group showed partial summation of the two monocular depths of focus. Similar patterns of accommodative response, measured objectively with the SRI optometer, were observed in subjects wearing monovision corrections. Accommodative response to sinusoidal variations in blur was controlled primarily by the dominant sighting eye. These results demonstrate the effectiveness of interocular suppression of anisometropic blur in monovision correction and the influence of ocular dominance upon this suppression process.     

Adaptive gait changes in long‐term wearers of contact lens monovision correction

Introduction: The aim of the present study was to determine adaptive gait changes in long‐term wearers of monovision correction contact lenses by comparing gait parameters when wearing monovision correction to those observed when wearing binocular distance correction contact lenses. Methods: Gait and toe clearance parameters were measured in eleven participants (53.5 ± 4.6 years, median monovision wearing time 5 years) as they repeatedly walked up to and onto a raised surface with either monovision or distance correction. Results: Compared to distance correction, monovision resulted in a large reduction in stereoacuity from 17″ to 87″, a slower walking velocity (p = 0.001), a reduced horizontal toe clearance of the step edge (p = 0.035) and, for trials when monovision correction occurred first, a 33% greater variability in vertical toe clearance (p = 0.021). Variability in some gait data was large due to certain study design features and learning effects. Conclusion: A slower walking velocity with monovision correction suggests participants became more cautious, likely as a result of the significantly reduced stereoacuity. The decreased horizontal toe clearance and increased vertical toe clearance variability suggests that monovision correction may cause a greater likelihood of hitting step edges and tripping during everyday gait. Recommended study design features are suggested for future adaptive gait studies to increase the precision of the data and to attempt to minimize the effects of learning from somatosensory feedback.     

The influence of ocular dominance on monovision--the influence of strength of ocular dominance on visual functions

PURPOSE: Monovision is a method of correction for presbyopia. We have reported the advantage of conventional monovision (the dominant eye is corrected for distance). In this study, we investigated the influence of interocular imbalance of dominancy on the visual function. SUBJECTS AND METHODS: Ten healthy subjects without any ophthalmologic disease participated. After cycloplegia, the eyes of the subjects were corrected by soft contact lenses with an artificial pupil (diameter: 3.0mm). The dominant eye was corrected for distance, and the difference in lens power between the lenses was 2.5 D. The subjects were classified into two groups by strength of the imbalance of sensory dominance, which was determined by using binocular rivalry. Binocular visual functions (visual acuity at various distances, contrast sensitivity, near stereoacuity) were compared between the two groups. RESULTS: Subjects with strong imbalance of sensory dominance showed decreased near visual acuity as well as decreased binocular summation of contrast sensitivity at low spatial frequencies. On the other hand, near stereoacuity was not affected by the imbalance of sensory dominance. CONCLUSION: These results suggest that strong imbalance of sensory dominance interferes with binocular visual functions in monovision. Thus, the evaluation of ocular dominance is crucial for clinical applications of monovision.     

Effect of induced blur on visual acuity and stereoacuity

The acuities of three subjects with good visual acuity and stereoacuity were reduced by the addition of diffusing filters placed before one or both eyes; these subjects then underwent automated stereoacuity and visual acuity tests. Results were idiosyncratic and differed from subject to subject to such an extent that no general rule sufficed to describe the effect of different degrees of blur on visual acuity and stereoacuity. It had been thought that blur degraded stereoacuity more than visual acuity but most of the results from one subject indicated the opposite effect. The effects of monocular vs. binocular blur are discussed.     

Factors influencing interocular blur suppression

An Important feauture of monovision correction is the ability of the binocular system to suppress blur from the defocused eye (interocular blur suppression). We conducted a study with three subjects and found that interocular blur suppression improved with higher levels of monocular defocus (addition powers in monovision) but was not affected by the eye defocused (sighting dominant or non-domninant) or by pupil size. The selection and management of monovision patients may be assisted by an understading of the understanding of the underlying suppression preocesses.     

Comparison of suppression, stereoacuity, and interocular differences in visual acuity in monovision and acuvue bifocal contact lenses.

PURPOSE: The relationship between visual acuity and stereoacuity has been well documented: as binocular visual acuity increases, stereoacuity improves. We compared interocular differences in visual acuity and stereoacuity in two presbyopic soft contact lens modalities, monovision and a new soft bifocal contact lens, the Acuvue Bifocal. The Acuvue Bifocal is hypothesized to show a smaller interocular acuity difference, increased stereoacuity, and decreased suppression over monovision at distance and near. METHODS: Monovision patients wearing Acuvue or Surevue soft contact lenses were tested for visual acuity, stereoacuity, and suppression at distance and near. Stereoacuity was tested with the Randot Stereotest (near) and the BVAT (distance). Suppression was evaluated with the Acuity Suppression Vectogram (near) and the BVAT (distance). Patients were then fit with the Acuvue Bifocal in each eye. After wearing the lenses for 1 week, the same tests of visual acuity, stereoacuity, and suppression were performed. RESULTS: The mean interocular acuity difference (IAD) at distance with monovision was 0.712 logarithm of the minimum angle of resolution (logMAR) (SD = 0.275) and 0.188 logMAR (SD = 0.252) (p < 0.001) with the Acuvue Bifocal. At near, the mean IAD with monovision was 0.420 logMAR (SD = 0.183) and 0.137 logMAR (SD = 0.147) (p < 0.001) with the Acuvue Bifocal. Of the monovision subjects, 89% (17 of 19) demonstrated suppression at near while only 26% (5 of 19) did with the bifocal lenses (statistically significant at p < 0.001). Stereoacuity at near improved from a median of 200 sec arc with monovision to 50 sec arc with the bifocal lenses. CONCLUSIONS: In this study, correcting presbyopia with the Acuvue Bifocal versus monovision resulted in a statistically significant decrease in the interocular difference in visual acuity at distance and near. The decreased interocular difference in visual acuity improved certain aspects of binocularity as demonstrated by a decrease in suppression and an increase in stereoacuity.     

Factors influencing success and failure in monovision

This study compared the visual performance of 70 successful and 18 failed monovision (MV) wearers, measured before contact lens dispensing. Compared with successful MV wearers, the failed group showed greater levels of ghosting at distance and near, lost more stereoacuity at 6 m, and lost slightly more near visual acuity. The failed MV group was also older on average than the successful group. Both groups showed worse visual acuity at distance and near with MV than at spectacle baseline, as well as worse stereoacuity at 6 m and 40 cm. Discriminant analysis indicated that distance ghosting, distance stereoacuity, and age were predictive of both success and failure (78% sensitivity; 82% specificity). An investigation, before lens fitting, of other effects of monocular blur on binocular function, as well as an assessment of personal characteristics such as motivation and the nature of visual demands, may further improve the accuracy of prediction of patient success with MV found in this study.     

Binocular visual function of myopic pseudophakic monovision

Purpose

To compare binocular visual function of myopic pseudophakic patients with myopic monovision to patients without monovision.

Study design

Randomized comparative study

Methods

Sixty patients were randomized to one of two groups: patients whose refraction was targeted to -2.75 diopters (D) in the dominant eye and -1.75D in the nondominant eye (myopic monovision group), and patients whose refraction was targeted to -2.75D bilaterally (non-monovision group). Binocular uncorrected and corrected visual acuity at various distances was measured using an all-distance vision tester, and contrast visual acuity and near stereoacuity were examined.

Results

In the myopic monovision group mean refraction was -2.74D in the dominant eyes and -1.94D in the nondominant eyes, and in the non-monovision group it was -2.96D bilaterally. Mean binocular uncorrected distance (UDVA) and intermediate visual acuity (UIVA) from 0.5 m to 5.0 m were significantly better in the myopic monovision group than in the non-monovision group (P≤ 0.0134), while binocular uncorrected near visual acuity (UNVA) at 0.3 m did not differ significantly between groups. The distribution of UIVA and UDVA was significantly better in the myopic monovision group (P≤ 0.0035). Corrected visual acuity at any distance, photopic and mesopic contrast visual acuity, and stereoacuity did not differ significantly between groups.

Conclusion

Patients with myopic monovision exhibited significantly better binocular UIVA and UDVA than those without monovision, while UNVA, corrected visual acuity, contrast sensitivity, and stereoacuity were comparable between groups, suggesting that this method is useful for patients who want to see near and intermediate distances without spectacles.

     

The effect of monocularly and binocularly induced astigmatic blur on depth discrimination is orientation dependent.

PURPOSE: Naturally occurring astigmatism varies according to the age of the person. Although uncorrected astigmatism may be associated with meridional amblyopia, there is little information of its effect on stereopsis. The purpose of this study was to determine the effect of astigmatism on depth discrimination and whether this was dependent on the axis of the astigmatism. METHODS: Astigmatic blur was induced in four healthy subjects (mean age, 31.5 years; range, 22 to 42 years) using plain cylinders (-8.75 D to +11.5 D) for orientation control and Jackson cross-cylinders (0 to 12 D) for spherical neutrality. Horizontal, vertical, and oblique astigmatism was induced with five monocular and three binocular axis steps. Depth discrimination was recorded at near using Frisby, TNO, and Titmus stereoacuity tests and at distance (4 m) using the variable distance stereoacuity test. Visual acuity was recorded at 0.4 m and 4 m. RESULTS: Visual acuity and depth discrimination degraded with increasing astigmatic blur. The effect of monocular astigmatic blur on depth discrimination and visual acuity was not dependent on the axis of orientation. For binocular astigmatic blur, the reduction in depth discrimination was dependent on the axis of the induced astigmatism (p < 0.01). The maximum effect occurred with orthogonal-oblique orientations (x45 left; x135 right), followed by against-the-rule (ATR) astigmatism; with-the-rule (WTR) astigmatism had the least effect (p < 0.001). CONCLUSIONS: The lesser effect of WTR compared with ATR astigmatic blur on depth discrimination may reflect the contribution of horizontal compared with nonhorizontal disparity processing in stereopsis. The pronounced effect of oblique astigmatic blur may be because of the effects on horizontal and nonhorizontal disparity and interocular differential image blur.     

Comparison of multifocal and monovision soft contact lens corrections in patients with low-astigmatic presbyopia.

PURPOSE: The purpose of this study was to assess visual performance and patient satisfaction with two presbyopic soft contact lens modalities. METHODS: A crossover study of 38 patients with presbyopia was conducted. Patients were randomized first into either multifocal (Bausch & Lomb SofLens Multifocal) or monovision (SofLens 59) for 1 month. Visual performance was measured with high- and low-contrast visual acuity at distance and near and near stereoacuity. Patients' satisfaction was measured by the National Eye Institute Refractive Error Quality of Life Instrument questionnaire and by recording the patient's final lens preference. RESULTS: Patients maintained at least 20/20 binocular vision with both multifocal (MF) and monovision (MV) contact lenses under high-contrast conditions at distance and near. Under low-contrast conditions, patients lost less than a line of vision from the best spectacle correction to either multifocal or monovision contact lens correction at distance (pMF = 0.001, pMV = 0.006). Under low-contrast conditions at near, multifocal wearers lost five to six letters and monovision wearers lost two letters of vision (pMF < 0.001, pMV = 0.03, pMF/MV = 0.005). The average stereoacuity decreased by 79 s arc with monovision vs. multifocal contact lenses (p = 0.002). On the NEI-RQL, patients reported worse clarity of vision (pMF = 0.01, pMV < 0.001), more symptoms (pMF = 0.09, pMV = 0.01), and an improvement in their appearance with contact lens wear (pMF < 0.001, pMV < 0.001). Seventy-six percent of patients reported that they preferred multifocal contact lenses, and 24% preferred monovision contact lenses (p = 0.001). CONCLUSION: The majority of our patients preferred multifocals to monovision, most likely because the Bausch & Lomb SofLens Multifocal provides excellent visual acuity without compromising stereoacuity to the same degree as monovision.     

The effect of binocular and monocular distractors on saccades in participants with normal binocular vision

We tested the effect of visual distractors presented monocularly and binocularly on saccade latency and accuracy to determine whether differences occur in saccadic planning with binocular or monocular visual input. For five participants with normal binocular single vision (BSV), saccade latency and accuracy were compared with distractors presented to the dominant eye, non-dominant eye or to both eyes. Eye movements of the dominant eye were recorded using a Skalar infra-red recorder. In the presence of normal BSV, the effect of distractors is significantly larger for saccade latency and accuracy with binocular distractor presentation than for monocular presentations, with no difference between distrators presented to the dominant or non-dominant eye. The implications of these results are discussed with regard to saccade programming.     

Binocular interactions in visual evoked cortical potentials with two light-emitting-diodes

Binocular interaction for a central field was studied with transient scalp visual evoked cortical potentials (VECPs) using two light-emitting-diodes. VECPs were obtained for binocular and monocular visions with dominant and non-dominant eyes, and arithmetical sums of monocular VECPs with dominant and non-dominant eyes were calculated. Amplitude and latency of remarkable initial three peaks were tested with the multivariate analysis of variance. Significant differences were noted among the four VECPs. Pairwise comparisons showed that (1) the amplitude of the first peak for the binocular VECPs was larger than that for the monocular VECPs but smaller than that for the sum-VECPs; the latency of the first peaks for the binocular VECPs were earlier than that for the monocular VECPs with the non-dominant eye; (2) the amplitude of the first negative peak for the sum-VECPs was larger than that for the binocular VECPs, and the peak latency for the sum-VECPs showed later than that for the binocular VECPs; (3) the amplitude of the second positive peak for the binocular VECPs and monocular VECPs with the dominant eye was larger than that with the non-dominant eye, but smaller for the binocular VECPS than that for the sum-VECPs; the latency for the binocular VECPs showed earlier than that for the monocular VECPs with the dominant eye and for the sum-VECPs. Binocular suppression was noted in amplitude for the three peaks and binocular facilitation was noted in latency for the latter two peaks. This revised version was published online in July 2006 with corrections to the Cover Date.     

The effects of blur and size on monocular and stereoscopic localization

Monocular localization of non-abutting stimuli and stereoscopic localization of the same second-order targets are performed with the same precision (Wilcox, L.M. & Hess, R.F. (1996) Is the site of non-linear filtering in stereopsis before or after binocular combination? Vision Research, 36, 391-399). Further, both tasks show a similar dependence on the scale of the stimulus. Since prior studies used Gaussian-enveloped stimuli, modifications of stimulus scale produced concurrent changes in edge blur. The experiments reported here assess the relative contributions of size and blur to the observed dependence on envelope scale for both monocular localization and stereoacuity. Stereoacuity for first-order targets was found to be an order of magnitude better than stereoacuity for second-order targets and monocular acuity for both first- and second-order targets. Further, while first-order stereopsis was found to depend solely on blur, second-order stereoacuity and monocular acuity were affected by both size and blur. These results suggest that while stereoacuity for first-order stimuli may be determined by a correlative process limited by early additive noise, stereoacuity for second-order stimuli and monocular acuity for non-abutting targets are more likely limited by stimulus-dependent spatial subsampling.     

Correlation between visual function and visual ability in patients with uveitis

AIM: To investigate the correlation between tests of visual function and perceived visual ability recorded with a quality of life questionnaire for patients with uveitis. METHODS: 132 patients with various types of uveitis were studied. High (monocular and binocular) and low (binocular) contrast logMAR letter acuities were recorded using a Bailey-Lovie chart. Contrast sensitivity (binocular) was determined using a Pelli-Robson chart. Vision related quality of life was assessed using the Vision Specific Quality of Life (VQOL) questionnaire. RESULTS: VQOL declined with reduced performance on the following tests: binocular high contrast visual acuity (p = 0.0011), high contrast visual acuity of the better eye (p = 0.0012), contrast sensitivity (p = 0.005), binocular low contrast visual acuity (p = 0.0065), and high contrast visual acuity of the worse eye (p = 0.015). Stepwise multiple regression analysis revealed binocular high contrast visual acuity (p <0.01) to be the only visual function adequate to predict VQOL. The age of the patient was also significantly associated with perceived visual ability (p <0.001). CONCLUSIONS: Binocular high contrast visual acuity is a good measure of how uveitis patients perform in real life situations. Vision quality of life is worst in younger patients with poor binocular visual acuity.     

改良单眼视LASIK手术矫正老视的疗效

目的 评价Custom-Q引导的改良单眼视准分子激光角膜磨镶术(LASIK)治疗患有近视、散光的老视患者的疗效.方法 前瞻性系列病例研究.收集2009年6月至2010年2月在华西医院近视中心实施改良单眼视LASIK手术的老视患者10例,主视眼屈光度全矫,实施传统LASIK切削;非主视眼保留-1.50 D球镜度数,实施“Custom-Q”引导的非球面性切削,实现改良的单眼视,分别于术后1周、1个月、3个月、6个月及1年进行随访,观察非主视眼和双眼的远、近视力,通过问卷调查,评估患者手术前后用眼舒适度、眼镜的依赖程度及术后满意度.分别对结果进行单因索方差分析、配对t检验和Wilcoxon秩和检验.结果 ①视力:与术前相比,术后非主视眼单眼的裸眼远、近视力差异均有统计学意义(P＜0.01),双眼同时视的裸眼远、近视力差异均有统计学意义(P均＜0.01).②稳定性:非主视眼的单眼和双眼裸眼视力在术后各时间点,差异均无统计学意义.③安全性:术中、术后无严重并发症发生,非主视眼最佳矫正视力术后较术前差异无统计学意义.④满意度:术后主观评分8.40±0.88,问卷调查显示用眼舒适度和眼镜依赖度评分术前和术后差异具有统计学意义(Z=-2.527、-2.609,P＜0.05).结论 运用Custom-Q改良的高级单眼视可用于矫正患有近视、散光的老视人群,可同时获得较好的远、近视力,患者满意度较高.     

双眼相位整合平衡点检测在单眼弱视患者眼间抑制定量评估中的应用

目的采用双眼相位整合的测量范式定量评估单眼弱视患者的眼间抑制情况,并探讨患者眼间抑制度与其他视功能的相关性。方法前瞻性临床对照研究。收集在安徽医科大学第一附属医院眼科门诊就诊的未治疗过的单眼弱视患者51例,正常对照者25例,采用计算机程序呈现的双眼整合的测量范式进行双眼相位整合平衡点检测,比较单眼弱视患者和正常对照者双眼平衡点的差异,并将弱视患者检测结果与弱视眼视力、立体视锐度及屈光参差程度进行相关性分析。结果弱视组双眼平衡点（BP）值为0.227±0.016,正常对照组BP值为0.984±0.020,两组间差异有统计学意义（t=27.316,P<0.01）;弱视眼视力（r=-0.339,P<0.05）、立体视功能（Titmus：r=-0.421,P<0.01;RDS：r=-0.548,P<0.01;Fishy：r=-0.553,P<0.01）与BP值之间均存在显著的相关关系,屈光参差程度与BP值之间无明显相关性（r=-0.086,P>0.05）。结论双眼相位整合平衡点检测可定量评估弱视患者弱视眼的受抑制程度,有一定的临床应用前景。     

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.