Age- and stereovision-dependent eye-hand coordination deficits in children with amblyopia and abnormal binocularity

Three-dimensional binocular eye-hand coordination in normal vision and with simulated visual impairment

Sensorimotor coupling in healthy humans is demonstrated by the higher accuracy of visually tracking intrinsically-rather than extrinsically-generated hand movements in the fronto-parallel plane. It is unknown whether this coupling also facilitates vergence eye movements for tracking objects in depth, or can overcome symmetric or asymmetric binocular visual impairments. Human observers were therefore asked to track with their gaze a target moving horizontally or in depth. The movement of the target was either directly controlled by the observer's hand or followed hand movements executed by the observer in a previous trial. Visual impairments were simulated by blurring stimuli independently in each eye. Accuracy was higher for self-generated movements in all conditions, demonstrating that motor signals are employed by the oculomotor system to improve the accuracy of vergence as well as horizontal eye movements. Asymmetric monocular blur affected horizontal tracking less than symmetric binocular blur, but impaired tracking in depth as much as binocular blur. There was a critical blur level up to which pursuit and vergence eye movements maintained tracking accuracy independent of blur level. Hand-eye coordination may therefore help compensate for functional deficits associated with eye disease and may be employed to augment visual impairment rehabilitation.

The functional impact of amblyopia

Amblyopia is the most common disorder managed in paediatric ophthalmic practice in industrialised countries. Reports on the impact of amblyopia on tasks relevant to the activities of children, or on skills pertinent to their education and quality of life, is leading to greater understanding of the functional disabilities associated with the condition. This review considers the extent to which amblyopia affects the ability to carry out everyday tasks, with particular attention to studies of motor skills and reading proficiency in children. Collectively, these studies show that amblyopia results in poorer outcomes on tests of skills required for proficiency in everyday tasks and which relate to childhood academic performance. However, the relative contributions that the documented vision anomalies inherent in amblyopia contribute to various functional disabilities is not fully determined. Recent reports have demonstrated improvement following treatment in standardised measures of fine motor skills involved in practical, everyday tasks. Including measurement of functional performance skills in amblyopia treatment trials is desirable to show treatment effect on crucial, real-world activities.

Binocular stereo acuity affects monocular three-dimensional shape perception in patients with strabismus

Background/aims

To evaluate the perception of three-dimensional (3D) shape in patients with strabismus and the contributions of stereopsis and monocular cues to this perception.

Methods

Twenty-one patients with strabismus with and 20 without stereo acuity as well as 25 age-matched normal volunteers performed two tasks: (1) identifying the closest vertices of 3D shapes from monocular shading (3D-SfS), texture (3D-SfT) or motion cues (3D-SfM) and from binocular disparity (3D-SfD), (2) discriminating 1D elementary features of these cues.

Results

Discrimination of the elementary features of luminance, texture and motion did not differ across groups. When the distances between reported and actual closest vertices were resolved into sagittal and frontoparallel plane components, sagittal components in 3D-SfS and frontoparallel components in 3D-SfT indicated larger errors in patients with strabismus without stereo acuity than in normal subjects. These patients could not discriminate one-dimensional elementary features of binocular disparity. Patients with strabismus with stereo acuity performed worse for both components of 3D-SfD and frontoparallel components of 3D-SfT compared with normal subjects. No differences were observed in the perception of 3D-SfM across groups. A comparison between normal subjects and patients with strabismus with normal stereopsis revealed no deficit in 3D shape perception from any cue.

Conclusions

Binocular stereopsis is essential for fine perception of 3D shape, even when 3D shape is defined by monocular static cues. Interaction between these cues may occur in ventral occipitotemporal regions, where 3D-SfS, 3D-SfT and 3D-SfD are processed in the same or neighbouring cortical regions. Our findings demonstrate the perceptual benefit of binocular stereopsis in patients with strabismus.

Global motion perception is related to motor function in 4.5-year-old children born at risk of abnormal development

Global motion perception is often used as an index of dorsal visual stream function in neurodevelopmental studies. However, the relationship between global motion perception and visuomotor control, a primary function of the dorsal stream, is unclear. We measured global motion perception (motion coherence threshold; MCT) and performance on standardized measures of motor function in 606 4.5-year-old children born at risk of abnormal neurodevelopment. Visual acuity, stereoacuity and verbal IQ were also assessed. After adjustment for verbal IQ or both visual acuity and stereoacuity, MCT was modestly, but significantly, associated with all components of motor function with the exception of fine motor scores. In a separate analysis, stereoacuity, but not visual acuity, was significantly associated with both gross and fine motor scores. These results indicate that the development of motion perception and stereoacuity are associated with motor function in pre-school children.

The Davida Teller Award Lecture, 2016: Visual Brain Development: A review of "Dorsal Stream Vulnerability"-motion, mathematics, amblyopia, actions, and attention

Research in the Visual Development Unit on "dorsal stream vulnerability' (DSV) arose from research in two somewhat different areas. In the first, using cortical milestones for local and global processing from our neurobiological model, we identified cerebral visual impairment in infants in the first year of life. In the second, using photo/videorefraction in population refractive screening programs, we showed that infant spectacle wear could reduce the incidence of strabismus and amblyopia, but many preschool children, who had been significantly hyperopic earlier, showed visuo-motor and attentional deficits. This led us to compare developing dorsal and ventral streams, using sensitivity to global motion and form as signatures, finding deficits in motion sensitivity relative to form in children with Williams syndrome, or perinatal brain injury in hemiplegia or preterm birth. Later research showed that this "DSV" was common across many disorders, both genetic and acquired, from autism to amblyopia. Here, we extend DSV to be a cluster of problems, common to many disorders, including poor motion sensitivity, visuo-motor spatial integration for planning actions, attention, and number skills. In current research, we find that individual differences in motion coherence sensitivity in typically developing children are correlated with MRI measures of area variations in parietal lobe, fractional anisotropy (from TBSS) of the superior longitudinal fasciculus, and performance on tasks of mathematics and visuo-motor integration. These findings suggest that individual differences in motion sensitivity reflect decision making and attentional control rather than integration in MT/V5 or V3A. Its neural underpinnings may be related to Duncan's "multiple-demand" (MD) system.

Motor skills of children with unilateral visual impairment in the Infant Aphakia Treatment Study

AIM

To assess motor functioning in children aged 4 years 6 months enrolled in the Infant Aphakia Treatment Study, and to determine contributions of visual acuity and stereopsis to measured motor skills.

METHOD

One hundred and four children (53% female) with unilateral aphakia randomized to intraocular lens or contact lens treatment were evaluated at 4 years 6 months (age range 4y 6mo-4y 11mo) for monocular recognition visual acuity, motor skills, and stereopsis by a traveling examiner masked to treatment condition. Motor skills were assessed with the Movement Assessment Battery for Children--Second Edition (MABC-2). Visual acuity was operationalized as log10 of the minimum angle of resolution (logMAR) value for treated eye, best logMAR value for either eye, and intraocular logMAR difference.

RESULTS

Student's t-tests showed no significant differences in MABC-2 scores between the intraocular lens and contact lens groups. The mean total score was low (6.43; 18th centile) compared with the normative reference group. Motor functioning was not related to visual acuity in the treated eye or to intraocular logMAR difference, but was predicted in a regression model by the better visual acuity of either eye (usually the fellow eye), even after accounting for the influence of age at surgery, examiner, orthotropic ocular alignment, and stereopsis.

INTERPRETATION

Children with unilateral congenital cataract may have delayed motor functioning at 4 years 6 months, which may adversely affect their social and academic functioning.

The other side of amblyopia

Amblyopia is defined as a loss of letter recognition visual acuity in the affected eye; however, studies in both nonhuman primates and man have shown that other important aspects of vision, including color, motion, and contour perception, are also abnormal. The anatomical changes that occur in the lateral geniculate nucleus and visual cortex following monocular visual deprivation affect both eyes and follow very different patterns with deprivation that begins at different ages and differ markedly in the magnocellular and parvocellular pathways. The interactions between the eyes and the requirements for recovery are very different following onset at different ages and differ for magnocellular and parvocellular pathways. Electrophysiological and psychophysical studies in man show different patterns of change in patients with strabismic amblyopia of early and late onset and abnormalities of color and motion processing that affect both amblyopic and fellow eyes and differ with age of onset. Abnormal visual experience also has more general effects on development, with amblyopic children showing abnormalities of eye-hand coordination when using either their amblyopic or fellow eyes, and abnormalities of reading. Differential effects of abnormal visual experience and treatment on magnocellular and parvocellular pathways may account for some of the visual deficits and treatment failures seen in amblyopia.

Contribution of binocular vision to the performance of complex manipulation tasks in 5-13years old visually-normal children

Individual studies have shown that visuomotor coordination and aspects of binocular vision, such as stereoacuity and dynamic vergence control, continue to improve in normally developing children between birth and early teenage years. However, no study has systematically addressed the relationship between the development of binocular vision and fine manipulation skills. Thus, the aim of this cross-sectional study was to characterize performance of complex manipulation tasks during binocular and monocular viewing. Fifty-two children, between 5 and 13years old, performed 2 manipulation tasks: peg-board and bead-threading under randomized viewing conditions. Results showed that binocular viewing was associated with a significantly greater improvement in performance on the bead-threading task in comparison to the peg-board task and the youngest children showed the greatest decrement in task performance under the monocular viewing condition when performing the bead-threading task. Thus, the role of binocular vision in performance of fine manipulation skills is both task- and age-dependent. These findings have implications for assessment of visuomotor skills in children with abnormal binocular vision, which occurs in 2-3% of otherwise typically developing children.

Perceptual Visual Distortions in Adult Amblyopia and Their Relationship to Clinical Features

PURPOSE

Develop a paradigm to map binocular perceptual visual distortions in adult amblyopes and visually normal controls, measure their stability over time, and determine the relationship between strength of binocular single vision and distortion magnitude.

METHODS

Perceptual visual distortions were measured in 24 strabismic, anisometropic, or microtropic amblyopes (interocular acuity difference ≥ 0.200 logMAR or history of amblyopia treatment) and 10 controls (mean age 27.13 ± 10.20 years). The task was mouse-based target alignment on a stereoscopic liquid crystal display monitor, measured binocularly five times during viewing dichoptically through active shutter glasses, amblyopic eye viewing cross-hairs, fellow eye viewing single target dots (16 locations within central 5°), and five times nondichoptically, with all stimuli visible to either eye. Measurements were repeated over time (1 week, 1 month) in eight amblyopic subjects, evaluating test-retest reliability. Measurements were also correlated against logMAR visual acuity, horizontal prism motor fusion range, Frisby/Preschool Randot stereoacuity, and heterophoria/heterotropia prism cover test measurement.

RESULTS

Sixty-seven percent (16/24) of amblyopes had significant perceptual visual distortions under dichoptic viewing conditions compared to nondichoptic viewing conditions and dichoptic control group performance. Distortions correlated with the strength of motor fusion (r = -0.417, P = 0.043) and log stereoacuity (r = 0.492, P = 0.015), as well as near angle of heterotropic/heterophoric deviation (r = 0.740, P < 0.001), and, marginally, amblyopia depth (r = 0.405, P = 0.049). Global distortion index (GDI, mean displacement) remained, overall, consistent over time (median change in GDI between baseline and 1 week = -0.03°, 1 month = -0.08°; x-axis Z = 4.4256, P < 0.001; y-axis Z = 5.0547, P < 0.001).

CONCLUSIONS

Perceptual visual distortions are stable over time and associated with poorer binocular function, greater amblyopia depth, and larger angles of ocular deviation. Assessment of distortions may be relevant for recent perceptual learning paradigms specifically targeting binocular vision.