Errors of monocular localization in strabismic amblyopia. Two-dimensional distortion]

Spatial distortions, i.e. spatial localization errors, and precision of localization were measured monocularly in the central visual field of 7 normal observers, 17 strabismic amblyopes and 2 anisometropic amblyopes. The task of the subjects was to construct circles of 2 degrees, 4 degrees and 6 degrees radius around a fixation point, using the dominant and the amblyopic eye in turn. Normal observers set distances on the vertical meridian smaller than distances on the horizontal meridian. Anisometropic amblyopes showed localization errors and variances similar to those of normal observers. The amblyopic eyes of strabismic observers with a large angle strabismus and deep amblyopia showed significant, individually different localization errors correlating with the depth of amblyopia. Strabismics with microstrabismus exhibited parallels between monocular localization and dichoptic retinal correspondence.     

Adaptive control of pursuit eye movements in humans

Defective spatial localization is an important feature of strabismic amblyopia. Based on our experience from testing adult strabismics under various test conditions, we developed a test for assessing vertical alignment in strabismic children. Patients had to align a vertical test line with the apices of two vertically arranged reference triangles, under the control of both the dominant eye and the amblyopic eye. Means and standard deviations of several judgements represent systematic errors and uncertainty of alignment. We tested 27 strabismic and 34 age-matched control children aged 4.5-10 years. Control children showed a scatter of mean systematic alignment around the correct position of up to 7 minarc. In the amblyopic eyes of strabismic children, uncertainty was consistently higher than in the eyes of the control children. Systematic errors outside the normal range frequently occurred. In children tested repeatedly during occlusion therapy, uncertainty decreased as visual acuity improved. In several cases we observed changes of systematic vertical alignment during therapy, sometimes unexpectedly in the sense of a change in the direction of mislocalization or an initial increase and later decrease of errors. Thus, children with strabismic amblyopia show spatial localization deficits which are similar to those of adult strabismic amblyopes. Both spatial uncertainty and systematic distortions are susceptible to change due to enforced use of the amblyopic eye during occlusion therapy.     

Preliminary report: monocular spatial localization in children with strabismic amblyopia

Defective spatial localization is an important feature of strabismic amblyopia. Based on our experience from testing adult strabismics under various test conditions, we developed a test for assessing vertical alignment in strabismic children. Patients had to align a vertical test line with the apices of two vertically arranged reference triangles, under the control of both the dominant eye and the amblyopic eye. Means and standard deviations of several judgements represent systematic errors and uncertainty of alignment. We tested 27 strabismic and 34 age-matched control children aged 4.5-10 years. Control children showed a scatter of mean systematic alignment around the correct position of up to 7 minarc. In the amblyopic eyes of strabismic children, uncertainty was consistently higher than in the eyes of the control children. Systematic errors outside the normal range frequently occurred. In children tested repeatedly during occlusion therapy, uncertainty decreased as visual acuity improved. In several cases we observed changes of systematic vertical alignment during therapy, sometimes unexpectedly in the sense of a change in the direction of mislocalization or an initial increase and later decrease of errors. Thus, children with strabismic amblyopia show spatial localization deficits which are similar to those of adult strabismic amblyopes. Both spatial uncertainty and systematic distortions are susceptible to change due to enforced use of the amblyopic eye during occlusion therapy.     

Comparison between anisometropic and strabismic amblyopia using functional magnetic resonance imaging

AIMS: To assess calcarine activation with functional magnetic resonance imaging (fMRI) in patients with anisometropic and strabismic amblyopia. METHODS: 14 amblyopes (eight anisometropic and six strabismic) were studied with fMRI using stimuli of checkerboards of various checker sizes and temporal frequencies. While T2* weighted MRI were obtained every 3 seconds for 6 minutes, patients viewed the stimuli monocularly with either the amblyopic or sound eye. RESULTS: Amblyopic eyes showed reduced calcarine activation compared with contralateral sound eyes in fMRI in all subjects. The calcarine activation from amblyopic eyes in anisometropic amblyopes was more suppressed at higher spatial frequencies, while that from amblyopic eyes in strabismic amblyopes was more suppressed at lower spatial frequencies. CONCLUSION: These results suggest that fMRI is a useful tool for the study of amblyopia in humans. The calcarine activation via amblyopic eyes because of anisometropia or strabismus has different temporospatial characteristics, which suggests differences in the neurophysiological mechanisms between two types of amblyopia.     

Differential changes of magnocellular and parvocellular visual function in early- and late-onset strabismic amblyopia

PURPOSE: Studies in nonhuman primates show that monocular visual deprivation starting at different ages has different effects on cells in the parvocellular and magnocellular laminae of the lateral geniculate nucleus. The present study used color and luminance contrast sensitivity (CS) measurements to look for differences in parvocellular- and magnocellular-related visual function in human subjects with strabismic amblyopia. METHODS: Fifteen subjects with early- and 14 with late-onset strabismic amblyopia and similar ranges of visual acuity were studied, together with 15 subjects with normal vision. Contrast sensitivities were measured to an equiluminant (L-M cone-modulated) grating with slow onset and an achromatic (L+M cone-modulated) 0.8-cpd grating with rapid onset using an adaptive METHOD: RESULTS: Luminance and color CS were lower in the amblyopic eyes than in the fellow eyes of all amblyopes. For luminance CS, this was due both to an increase in sensitivity of the fellow eye and to a reduction in sensitivity in the amblyopic eye. Color CS was greatly reduced in the amblyopic and fellow eyes of subjects with strabismic amblyopia of early- and late onset compared with subjects with normal vision. The reduction in color CS compared with luminance CS was significantly greater in eyes with late- rather than early-onset amblyopia. CONCLUSIONS: Parvocellular and magnocellular function are differentially affected in the amblyopic and fellow eyes of subjects with strabismic amblyopia. The difference is more marked in late-onset amblyopia than in early-onset amblyopia.     

The contrast sensitivity function and childhood amblyopia

We measured contrast sensitivity function and visual acuity in both eyes of strabismic and anisometropic amblyopic patients. There was a linear relationship between contrast sensitivity function and visual acuity in the amblyopic eye. As visual acuity decreased, the contrast sensitivity function decreased along the contrast sensitivity axis, and peak sensitivity shifted to lower spatial frequencies. After patching therapy, when visual acuity reached 20/20 in each eye, suggesting that the amblyopia was cured, there continued to be statistically significant difference in the contrast sensitivity functions between the eyes. The contrast sensitivity function from the previously amblyopic eye was depressed compared to the nonamblyopic eye. A comparison between patients with strabismic and anisometropic amblyopia showed that, when matched for visual acuity, the contrast sensitivity functions were similar for both the nonamblyopic and amblyopic eyes. However, a large difference was found between the amblyopic and nonamblyopic eyes of each group.     

屈光不正性、屈光参差性及斜视性弱视的位置辨别比较

目的比较屈光不正性、屈光参差性及斜视性弱视患者的位置辨别功能差异以及单眼弱视双眼间位置辨别差异。方法选取在广西视光中心就诊的139例(237眼)弱视患者,按弱视类型分为屈光不正性弱视组40例(80眼)、屈光参差性弱视组61例(82眼)、斜视性弱视组38例(75眼),检测3组弱视位置辨别功能并进行比较分析。结果 3组弱视位置辨别功能检测结果均集中在2～4级之间,中位数均为3级,3组位置辨别功能结果比较,差异无统计学意义(Hc=0.530,P>0.05)。单眼弱视双眼位置辨别功能比较,差异无统计学意义(MH=1.837,P>0.05)。单眼弱视眼与双眼弱视眼位置辨别功能比较,差异无统计学意义(Z=-0.588,P>0.05)。结论屈光不正性、屈光参差性及斜视性弱视儿童位置辨别功能不存在差异,单眼弱视双眼位置辨别功能无差异,单眼弱视眼与双眼弱视眼位置辨别功能相似。     

Monocular geometry is selectively distorted in the central visual field of strabismic amblyopes

Strabismic amblyopia is associated with a distorted perception of visual space. The aim of our study was to investigate the monocular space perception of strabismic observers at several locations in the central and peripheral visual field. We tested nine observers with strabismic and/or anisometropic amblyopia, two strabismic subjects with alternating fixation and two normal control subjects. The task was to align a light stimulus with two vertically arranged reference marks. Testing conditions included three separations of the references along the vertical meridian (10 degrees, 20 degrees and 40 degrees) as well as several presentation sites of the vertical references in the nasal and temporal peripheral visual field (5 degrees, 10 degrees and 20 degrees from fixation). Performance with the amblyopic eye was clearly impaired as compared to the nonamblyopic eye. For alignment along the vertical meridian, all amblyopic eyes showed increased uncertainty in their position judgements. Most of the squinting eyes of amblyopes also displayed a systematic lateral displacement of the test stimulus in relation to the reference marks, in the most extreme case up to almost 7 degrees. Usually, larger errors were found with wider separations of the reference marks. In the peripheral field, the differences between the amblyopic and the nonamblyopic eye diminished or disappeared. Thus, monocular geometry appears to be selectively impaired in the central visual field of the deviated eye of strabismic amblyopes. These spatial distortions might be related to the different states of binocular correspondence in the central vs. peripheral visual field, shown by some strabismic amblyopes.     

Adaptation of visual distortions in children with strabismic amblyopia following strabismus surgery and occlusion therapy

BACKGROUND: Reduced visual acuity and deficient binocularity are well-known symptoms of amblyopia. Distortions of visual space perception were reported more recently in strabismic amblyopia. This study investigated whether strabismus surgery and occlusion therapy have an influence on these deficits in amblyopic children. MATERIALS AND METHODS: Two aspects of vertical alignment of amblyopic eyes, namely spatial distortion and spatial uncertainty, were investigated prospectively in 13 children (mean age 6 years 9 months) before and after strabismus surgery and in 12 children (mean age 6 years 11 months) during 6 months of occlusion therapy. RESULTS: A different impact of the two types of therapeutic intervention was observed: a slight (statistically not significant) increase of uncertainty was the only change noticed postoperatively after 1 week, spatial distortions were not affected. During occlusion treatment, both clear shifts of alignment and a decrease of uncertainty occurred. CONCLUSIONS: The geometry of visual space of amblyopic children showed modifications due to altered visual experience during treatment, most obviously during occlusion therapy. These changes are evidence for unknown features of plasticity of the amblyopic visual system initiated by treatment.     

Long-term changes in visual acuity and refractive error in amblyopes.

PURPOSE: To report long-term changes in visual acuity and refractive error for strabismic, anisometropic, and isoametropic amblyopes. METHODS: Records of patients with strabismic amblyopia, anisometropic amblyopia, and isoametropic amblyopia who were treated from 1983 to 1993 were reviewed. Excluded were patients having ocular or neurological diseases, developmental delay, and follow-up <4 years after treatment cessation. Data included best-correctable visual acuity and spherical equivalent refractive error of the amblyopic and the nonamblyopic eye at pretreatment, posttreatment, and long-term follow-up. RESULTS: Records for 61 patients met the inclusion criteria. For strabismic amblyopia (n = 22), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.36 and 0.05 logarithm of the minimum angle of resolution (logMAR) units after a mean treatment time of 1 year. At long-term follow-up (mean = 9.3 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR and visual acuity in the nonamblyopic eye improved 0.10 logMAR units. For anisometropic amblyopia (n = 26), mean visual acuity in amblyopic and nonamblyopic eyes improved 0.30 and 0.02 logMAR units, respectively, after a mean treatment period of 1.1 year. At the long-term follow-up visit (mean = 7.1 years after treatment), visual acuity in the amblyopic eye regressed 0.09 logMAR unit and in the nonamblyopic eye improved 0.03 logMAR unit. Repeated-measures analysis of variance showed no significant effect of type of amblyopia on visual acuity of the amblyopic eye and a significant effect of visit due to treatment but not regression. The changes in visual acuity in the nonamblyopic eye from the pretreatment to the follow-up visit were significant and interacted with type, the changes being larger in strabismic amblyopia. For strabismic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +2.15 D and +1.85 D, respectively, initially to +0.45 D and +0.58 D, respectively, at the follow-up visit. For anisometropic amblyopia, the mean refractive error in amblyopic and nonamblyopic eyes changed from +1.04 D and +0.12 D, respectively, initially to +0.23 D and -0.94 D, respectively, at the follow-up visit. The effect of visit on amblyopic and nonamblyopic refractive errors was significant. For isoametropic amblyopia (n = 13), visual acuity in both right and left eyes initially was 0.39 logMAR unit and improved to 0.14 logMAR unit in each eye after a mean follow-up of 8.9 years. Refractive error in the right and the left eyes changed from -1.22 D and -1.14 D, respectively, to -2.68 D and -2.56 D, respectively, at follow-up. These differences were all significant. CONCLUSIONS: After treatment and with long-term follow up, visual acuity regresses but not significantly in the amblyopic eye in strabismic amblyopia and anisometropic amblyopia. At the same time, visual acuity in the nonamblyopic eye improves slightly. Visual acuity also improves significantly over time in isoametropic amblyopia. The refractive error of both amblyopic and nonamblyopic eyes tends to show a myopic shift regardless of the type of amblyopia.     

Temporal instability in the perception of strabismic amblyopia

Amblyopia is a developmental disorder of spatial vision resulting from an abnormal visual stimulation in early childhood. The aim of our study was to investigate the spatial and temporal distortions that occur in strabismic and anisometropic amblyopic vision. The main focus was on the temporal instability of amblyopic perception of low and high spatial frequencies. Our results indicate that temporal instability is perceived mainly by strabismic and strabismic-anisometropic amblyopes and occurs only at high spatial frequencies. We found two categories of temporal distortions in high spatial frequency patterns: a) the whole pattern is perceived as jittering, b) single lines or parts in a pattern are perceived as moving. Our data suggest that strabismus, in addition to amblyopia, is needed to elicit significant temporal distortions.     

Contour integration in amblyopic monkeys

Amblyopia is characterized by losses in a variety of aspects of spatial vision, such as acuity and contrast sensitivity. Our goal was to learn whether those basic spatial deficits lead to impaired global perceptual processing in strabismic and anisometropic amblyopia. This question is unresolved by the current human psychophysical literature. We studied contour integration and contrast sensitivity in amblyopic monkeys. We found deficient contour integration in anisometropic as well as strabismic amblyopic monkeys. Some animals showed poor contour integration in the fellow eye as well as in the amblyopic eye. Orientation jitter of the elements in the contour systematically decreased contour-detection ability for control and fellow eyes, but had less effect on amblyopic eyes. The deficits were not clearly related to basic losses in contrast sensitivity and acuity for either type of amblyopia. We conclude that abnormal contour integration in amblyopes reflects disruption of mechanisms that are different from those that determine acuity and contrast sensitivity, and are likely to be central to V1.     

Deficits of spatial localization in children with strabismic amblyopia

Background Besides loss of visual acuity and binocularity, spatial localization deficits (comprising both increased spatial uncertainty and spatial distortions) are an important feature of strabismic amblyopia. Although they have been extensively investigated in adult amblyopes, there are still many open questions concerning their substrate and relationship to clinical parameters. Our aim was to develop a procedure for assessing vertical alignment, which enabled us to find out whether children with strabismic amblyopia had similar spatial localization deficits, and their relation to the childrens clinical condition.Methods Vertical alignment was assessed in children by comparing the visual direction in space of three loci along the vertical meridian, separated by 5 deg of visual angle. We tested alignment in the amblyopic and dominant eyes of 32 strabismic and in both eyes of 35 control children from 4.5 to 10 years, together with a careful orthoptic examination.Results In the amblyopic eyes, increased uncertainty and systematic distortions outside the normal range occurred. Large angles of deviation and pathological fixation patterns were necessary, but not sufficient conditions for gross spatial deficits to occur. The fellow dominant eyes showed spatial localization similar to normal eyes.Conclusions Children with strabismic amblyopia exhibited localization deficits and relationship to clinical data similar to those in adult amblyopes. These data are important for further investigations about the substrate, plasticity and the clinical relevance of perceptual distortions.     

Identification of contrast-defined letters benefits from perceptual learning in adults with amblyopia

Amblyopes show specific deficits in processing second-order spatial information (e.g. Wong, Levi, & McGraw (2001). Is second-order spatial loss in amblyopia explained by the loss of first-order spatial input? Vision Research, 41, 2951-2960). Recent work suggests there is a significant degree of plasticity in the visual pathway that processes first-order spatial information in adults with amblyopia. In this study, we asked whether or not there is similar plasticity in the ability to process second-order spatial information in adults with amblyopia. Ten adult observers with amblyopia (five strabismic, four anisometropic and one mixed) were trained to identify contrast-defined (second-order) letters using their amblyopic eyes. Before and after training, we determined observers' contrast thresholds for identifying luminance-defined (first-order) and contrast-defined letters, separately for the non-amblyopic and amblyopic eyes. Following training, eight of the 10 observers showed a significant reduction in contrast thresholds for identifying contrast-defined letters with the amblyopic eye. Five of these observers also showed a partial transfer of improvement to their fellow untrained non-amblyopic eye for identifying contrast-defined letters. There was a small but statistically significant transfer to the untrained task of identifying luminance-defined letters in the same trained eye. Similar to first-order spatial tasks, adults with amblyopia benefit from perceptual learning for identifying contrast-defined letters in their amblyopic eyes, suggesting a sizeable degree of plasticity in the visual pathway for processing second-order spatial information.     

CSF interocular interactions in childhood ambylopia

Contrast sensitivity functions (CSF's) were measured in the amblyopic and dominant eyes of 17 strabismic and 28 anisometropic children and in 19 similar age normal controls. A three-alternative forced-choice procedure was used to measure CSF's with the VCTS 6500. The results revealed reduced contrast sensitivity (CS) in both the amblyopic and dominant eyes of strabismic and anisometropic amblyopes compared to normal controls. Statistically significant intereye correlations of CS at each spatial frequency were found in all groups and in the presence of deep amblyopia, suggesting continued interocular interactions and binocularity. A separate longitudinal study of 7 of the amblyopes showed that, during the course of occlusion therapy, both the amblyopic and the dominant eyes improved in CSF. The results suggest that the amblyopic eye may influence CS in the dominant eye through interocular interactions. This process may serve to minimize CSF differences between the eyes and maximize binocular vision.     

Sparse-sampling of gratings in the visual cortex of strabismic amblyopes

Strabismic amblyopes show losses in positional acuity that cannot be explained by their resolution or contrast sensitivities. One hypothesis for these losses is a reduction in the density of cortical neurons that are driven by the amblyopic eye (cortical undersampling). The question this study addressed was whether the foveal representation of the amblyopic eye is undersampled in the cortex of strabismic amblyopes. In order to assess spatial sampling psychophysically, we recorded the perceived orientation of a stationary grating as a function of grating orientation and frequency in three strabismic amblyopes. To ensure high retinal contrast, the grating was imaged on the fovea of each observer using a laser interferometer. We found that the strabismic amblyopes misperceived the orientation of the grating at spatial frequencies that are a factor of two to six lower than the sampling frequency of the foveal cones. Since the retina and LGN in strabismic amblyopes are presumably normal, this result suggests sparse cortical sampling in the foveal representation of the amblyopic eye. Undersampling by cortical neurons may contribute to the spatial distortions present in strabismic amblyopic eyes.     

The lateral geniculate nucleus in human strabismic amblyopia.

Cell shrinkage in monkey lateral geniculate nucleus (LGN) layers supplied by the amblyopic eye have been described in experimental amblyopia caused by visual deprivation, anisometropia, and strabismus. A human brain from a strabismic amblyope became available for study and the authors compared cell sizes in LGN layers receiving input from the normal and the amblyopic eye. Significant cell shrinkage was present in layers connected with the amblyopic eye, and was most evident in the ipsilateral LGN. These findings support the validity of the monkey model for the study of strabismic amblyopia by showing, for the first time, changes in the brain from a human strabismic amblyope that are similar to those previously described in monkeys.