Treated amblyopes remain deficient in spatial vision: a contrast sensitivity and external noise study

To evaluate residual spatial vision deficits in treated amblyopia, we recruited five clinically treated amblyopes (mean age=10.6 years). Contrast sensitivity functions (CSF) in both the previously amblyopic eyes (pAE; visual acuity=0.944+/-0.019 MAR) and fellow eyes (pFE; visual acuity=0.936+/-0.021 MAR) were measured using a standard psychophysical procedure for all the subjects. The results indicated that the treated amblyopes remained deficient in spatial vision, especially at high spatial frequencies, although their Snellen visual acuity had become normal in the pAEs. To identify the mechanisms underlying spatial vision deficits of treated amblyopes, threshold vs external noise contrast (TvC) functions--the signal contrast necessary for the subject to maintain a threshold performance level in varying amounts of external noise ("TV snow")--were measured in both eyes of four of the subjects in a sine-wave grating detection task at several spatial frequencies. Two mechanisms of amblyopia were identified: increased internal noise at low to medium spatial frequencies, and both increased internal noise and increased impact of external noise at high spatial frequencies. We suggest that, in addition to visual acuity, other tests of spatial vision (e.g., CSF, TvC) should be used to assess treatment outcomes of amblyopia therapies. Training in intermediate and high spatial frequencies may be necessary to fully recover spatial vision in amblyopia in addition to the occlusion therapy.