Perceptual "blankout" of monocular homogeneous fields (Ganzfelder) is prevented with binocular viewing

Teleglaucoma Using a New Smartphone-Based Tool for Visual Field Assessment

PRCIS

COVID-19 underlines the importance of telemedical diagnostics. The smartphone-based campimetry (Sb-C) is a newly developed digital application allowing visual field testing using a head-mounted device and a smartphone. It enables visual field screening remotely from a clinic.

BACKGROUND

Sb-C is a newly developed tool for functional ophthalmic diagnosis. This study aimed to examine the comparability of the Sb-C and Octopus 900 to ensure ophthalmological care in times of social distancing.

METHODS

Total 93 eyes were included in the study. After an ophthalmological examination, the visual field was tested by the Octopus program G1 and by the smartphone-based campimeter. The Sb-C was performed using VR glasses and an iPhone 6. The software Sb-C was downloaded and installed as SmartCampiTracker app and is examining the 30-degree visual field with 59 test positions corresponding to the G pattern of Octopus G1. Sensitivities were recorded and saved on the app. In addition, test-retest reliability was tested on 6 ophthalmologically healthy participants.

RESULTS

The group comprised 48 women and 45 men (mean age: 62.52±12.2 y) including 19 controls, 17 patients with ocular hypertension, 11 preperimetric glaucomas, and 46 perimetric glaucomas. The mean sensitivity (MS) of all points of G1 perimetry was 23.13 dB (95% CI, 22.08-24.18). The MS of the Sb-C was 21.23 dB (95% CI, 20.37-22.08). The correlation between the mean MS measured by G1 perimetry and the Sb-C was strong ( r =0.815, P <0.05). The test-retest reliability showed a correlation of r =0.591 ( P <0.05) .

CONCLUSIONS

With some technical adjustments, the Sb-C shows promise for screening glaucoma and monitoring disease progression remotely from an ophthalmologic clinic.

Perimetric Comparison Between the IMOvifa and Humphrey Field Analyzer

PRCIS

IMO visual function analyzer (IMOvifa), a binocular perimeter, has similar output to the Humphrey Field Analyzer (HFA), but reduced the measurement time.

PURPOSE

The purpose of this study is to evaluate the performance of IMOvifa, a perimeter that performs binocular visual field (VF) testing, and to compare its results with standard automated perimetry.

METHODS

All patients underwent HFA 24-2 SITA-Fast and IMOvifa 24-2 AIZE-Rapid on the same day. Mean deviation (MD), pattern SD (PSD), foveal threshold, and visual field index (VFI) were compared between the 2 perimeters using Wilcoxon signed-rank tests, Pearson correlation, and Bland-Altman plot. Measurement time for performing VF for both eyes was also collected for each device.

RESULTS

In this cross-sectional study, 138 eyes (including 25 healthy, 48 glaucoma suspects, and 65 primary open angle glaucoma) of 69 patients were evaluated. Measurement time was significantly faster for IMOvifa compared with HFA (256 vs. 419 s, P <0.001). No significant differences were seen in MD and VFI between HFA and IMOvifa (both P >0.05). Significant differences were seen in mean PSD 3.2 (2.7, 3.6) dB for HFA versus 4.1 (3.5, 4.6) for IMOvifa ( P <0.001), and foveal threshold 33.9 (33.1, 34.6) dB for HFA versus 30.6 (29.3, 31.9) dB for IMOvifa ( P <0.001). Pearson r was strong for MD ( r =0.90, P <0.001), PSD ( r =0.78, P <0.001), and VFI ( r =0.94, P <0.001). The mean difference (95% limits of agreement) was -0.1 (-3.8, 3.5) dB for MD, -0.4 (-3.4, 2.5) dB for PSD, and 0.1 (-8.9, 9.1) dB for VFI, respectively.

CONCLUSIONS

IMOvifa reduced measurement time by 39%. MD, PSD, and VFI values for IMOvifa showed good agreement with HFA SITA-Fast strategy. This perimeter reduced fatigue for both patient and examiner. Additional studies are needed to determine whether it will be useful for routine VF testing.

Central Visual Field Sensitivity With and Without Background Light Given to the Nontested Fellow Eye in Glaucoma Patients

PRECIS

This study showed the difference of monocular visual sensitivity between with and without background light given to the nontested fellow eyes in glaucoma patients. Monocular sensitivity measurements of the worse eyes with fellow eye's background light conditions should carefully be considered when assessing the impact of functional impairment in glaucoma patients.

PURPOSE

The purpose of this study was to investigate the difference between monocular sensitivities measured with and without background light given to the nontested fellow eye in glaucoma patients using a new perimeter named "imo."

METHODS

In this cross-sectional study, we examined 102 eyes of 51 patients (mean age, 65.1±14.9 y) with open-angle glaucoma who were affected with at least 1 significant point in the central 10 degrees. We conducted a routine ophthalmic examination and visual field testing using the Humphrey Field Analyzer 24-2 and 10-2 programs. The eyes were assigned to "better" and "worse" categories based on the visual acuity and central visual thresholding. Subsequently, we compared the central visual sensitivities with and without background light given to the nontested fellow eye.

RESULTS

The mean sensitivity (MS) in the central 5 points of the visual field of the worse eyes was better when measured with background light than without background light (P=0.037) given to the nontested fellow eye. No significant difference was seen among the MS in the visual field of the better eyes. After dividing the patients into low (n=25) and high sensitivity (n=26) groups, only the low sensitivity group in worse eyes had higher MS with background light than without background light (P<0.05) given to the nontested fellow eye.

CONCLUSIONS

Monocular sensitivities measured with background light given to the nontested fellow eye were higher than those without background light in the worse eye group of glaucoma patients. Monocular MS measurements of the worse eyes with fellow eye's background light conditions and their related indices should thus carefully be considered when assessing the impact of functional impairment in glaucoma patients.

Effect of Sensitivity Disparity Between the Two Eyes on Pointwise Monocular Sensitivity Under Binocular Viewing in Patients With Glaucoma

PRCIS

A difference between monocular sensitivities measured with and without occlusion was observed in glaucoma. Monocular sensitivity without occlusion could have been affected differently by binocular interaction due to the sensitivity disparity between both eyes.

PURPOSE

To investigate the influence of sensitivity disparity between both eyes on visual field results under binocular viewing in glaucoma.

MATERIALS AND METHODS

Thirteen glaucoma patients tested by Humphrey Field Analyzer (HFA) and imo were reviewed retrospectively. On the basis of their HFA results, we defined the eye with a better HFA-MD as "the better eye" and the fellow eye with a worse HFA-MD as "the worse eye." Depending on the pointwise pattern deviation (PD) of both eyes, all evaluated test points were classified into 4 groups: normal PD in both eyes (N/N), normal PD in the better eye but abnormal in the worse eye (N/A), abnormal PD in the better eye but normal in the worse eye (A/N), and abnormal PD in both eyes (A/A). Using imo, which can measure sensitivity with and without occluding the nontested eye, the better eye's sensitivities with and without occlusion were compared in each group using weighted data. The weight was derived by applying the inverse probability weighting.

RESULTS

Monocular sensitivity without occlusion was higher than that with occlusion in N/N (P<0.01) and the opposite was observed in A/A (P<0.05). No significant sensitivity difference between both conditions was seen in N/A or A/N. In N/A, the points showing a higher sensitivity without occlusion decreased as the sensitivity difference between both eyes increased.

CONCLUSIONS

A difference between sensitivities measured with and without occlusion was observed in glaucoma. Owing to the sensitivity disparity between both eyes, monocular sensitivity without occlusion could have been affected differently by binocular interaction.

Comparison of central visual sensitivity between monocular and binocular testing in advanced glaucoma patients using imo perimetry

BACKGROUND/AIM

This study aimed to compare central visual sensitivity under monocular and binocular conditions in patients with glaucoma using the new imo static perimetry.

METHODS

Fifty-one consecutive eyes of 51 patients with open-angle glaucoma who were affected with at least one significant point in the central 10° were examined in this cross-sectional study. Monocular and binocular random single-eye tests were performed using the imo perimeter and the Humphrey field analyser (HFA) 24-2 and 10-2 tests. The eyes were assigned to 'better' and 'worse' categories based on the visual acuity and central visual thresholding. Central visual sensitivity results obtained by monocular, binocular random single-eye tests and binocular simultaneous both eye test were compared.

RESULTS

The average mean deviation with the HFA 24-2 was -5.5 (-1.5, -14.6) dB (median, (IQR)) in the better eyes and -18.0 (-12.9, -23.8) dB in the worse eyes. The mean sensitivity in the central 4 points of the visual field (VF) of the worse eyes was lower when measured under the binocular eye condition than under the monocular condition. Conversely, this value of the better eyes was greater when measured under the binocular eye condition than under the monocular condition.

CONCLUSIONS

The central sensitivity of the better eyes was better and that of the worse eyes poorer with binocular testing than with monocular testing in patients with glaucoma. Although monocular VF testing is still the most straightforward means to monocularly monitor glaucoma at clinical settings, binocular testing, such as provided with imo perimetry, may be a useful clinical tool to predict the effect of VF impairments on a patient's quality of visual life.

Comparison of monocular sensitivities measured with and without occlusion using the head-mounted perimeter imo

Purpose

Using a head-mounted perimeter imo that can measure monocular sensitivity with both eyes open, we investigated the difference between monocular sensitivities measured with and without occlusion of the fellow eye and if the difference was influenced by eccentricity.

Methods

Using the perimeter imo, monocular sensitivities with/without occlusion and binocular sensitivity were measured and compared. Three test conditions for monocular sensitivity without occlusion were: with/without a fusional fixation target, and a binocular random single eye test in which the target was randomly presented to either eye and the examinee was not aware of the tested eye. Within the central 25° visual field (VF), 29 points located at the fovea and on the 45°, 135°, 225°, and 315° meridians with 3° intervals were tested. Differences among the four monocular sensitivities with/without occlusion were further evaluated at the fovea, within and beyond the central 5° VF.

Results

Sixteen visually normal volunteers (mean age, 28.6 ± 4.6 years) were included in this study. Except at the fovea, monocular sensitivities measured without occlusion were significantly higher than those with occlusion (P < 0.01). No significant difference was seen among the three monocular sensitivities without occlusion (P = 0.82).

Conclusions

Except at the fovea, monocular sensitivities measured with and without occlusion significantly differed. This indicates that without occlusion, binocular interaction is activated and affects not only binocular sensitivity but also monocular sensitivity.

Variability in monocular and binocular fixation during standard automated perimetry

The aim of this cross-sectional study was to use standard automated perimetry to compare fixation variability among the dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Thirty-five eyes of 35 healthy young participants underwent standard automated perimetry (Humphrey 24–2 SITA-Standard) in dominant eye fixation, non-dominant eye fixation, and binocular fixation conditions. Fixation variability during foveal threshold and visual field measurement, which was recorded using a wearable eye-tracking glass and calculated using the bivariate contour ellipse area (deg²), was compared among the three fixation conditions. Further, the association of bivariate contour ellipse area with ocular position and fusional amplitude during binocular fixation was analysed. There were no significant differences in bivariate contour ellipse area during foveal threshold measurement among the dominant eye fixation (1.75 deg²), non-dominant eye fixation (1.45 deg²), and binocular fixation (1.62 deg²) conditions. In contrast, the bivariate contour ellipse area during visual field measurement in binocular fixation (2.85 deg²) was significantly lower than the bivariate contour ellipse area in dominant eye fixation (4.62 deg²; p = 0.0227) and non-dominant eye fixation (5.24 deg²; p = 0.0006) conditions. There was no significant difference in bivariate contour ellipse area during visual field measurement between dominant eye fixation and non-dominant eye fixation conditions. There was no significant correlation between bivariate contour ellipse area and either ocular position or fusional amplitude during both foveal threshold and visual field measurements. Thus, fixation variability might be improved in binocular fixation conditions during a long-duration test, such as visual field measurement.

Yarbus's Conceptions on the General Mechanisms of Color Perception

In the last series of papers published during 1975 to 1980, Alfred Yarbus tried to formulate general conceptions concerning the basic principles of retinal image processing in the human visual system. The original ideas of Yarbus were based on the results of his numerous and various experiments carried out with extraordinary inventiveness and great skill. Being concentrated primarily on the problems of color vision, Alfred Yarbus dreamed of elaborating a comprehensive model that would simulate visual information processing at the monocular precognitive level in the visual system of humans with normal trichromatic color perception. In this article, the most important of Yarbus' experimental paradigms, findings, statements, and conclusions are systematized and considered in relation to the classical theories of color perception and, in particular, fundamental theses of the Nyberg school. The perceptual model developed by Alfred Yarbus remained incomplete. Nevertheless, it is already evident that some intrinsic contradictions make it inadequate in terms of comprehensive modeling. However, certain partial advantages deserve more thorough appreciation and further investigation.

Melanopsin-driven increases in maintained activity enhance thalamic visual response reliability across a simulated dawn

Twice a day, at dawn and dusk, we experience gradual but very high amplitude changes in background light intensity (irradiance). Although we perceive the associated change in environmental brightness, the representation of such very slow alterations in irradiance by the early visual system has been little studied. Here, we addressed this deficit by recording electrophysiological activity in the mouse dorsal lateral geniculate nucleus under exposure to a simulated dawn. As irradiance increased we found a widespread enhancement in baseline firing that extended to units with ON as well as OFF responses to fast luminance increments. This change in baseline firing was equally apparent when the slow irradiance ramp appeared alone or when a variety of higher-frequency artificial or natural visual stimuli were superimposed upon it. Using a combination of conventional knockout, chemogenetic, and receptor-silent substitution manipulations, we continued to show that, over higher irradiances, this increase in firing originates with inner-retinal melanopsin photoreception. At the single-unit level, irradiance-dependent increases in baseline firing were strongly correlated with improvements in the amplitude of responses to higher-frequency visual stimuli. This in turn results in an up to threefold increase in single-trial reliability of fast visual responses. In this way, our data indicate that melanopsin drives a generalized increase in dorsal lateral geniculate nucleus excitability as dawn progresses that both conveys information about changing background light intensity and increases the signal:noise for fast visual responses.

Visual Percepts in the Cases of Binocular and Monocular Viewing Stabilized Test Objects, Ganzfeld Stimuli, and Prolonged Afterimages

A thorough analysis of the literature on retinal image stabilization, as well as our own experimental data, present evidence that Yarbus's concept, implying inevitable and irreversible fading of a visible image evoked by stabilized retinal stimulus of any size, color, and luminance in 1 to 3 s after its onset, is not valid in a general case. It has been demonstrated that, even with Yarbus's stabilization techniques, the lifetime of visible images varies from fractions of a second to the whole stimulus duration-up to 30 min in our experiments-depending on many factors: monocular or binocular viewing, stimulus parameters, characteristics of subjects, and so forth. The dynamics of perceived images is determined mainly by the processes at the higher levels of the visual system. In the cases of such unusual visual stimuli as stabilized retinal images, it is problematic for the visual brain to find their proper interpretations in terms of everyday natural experience. Usually, the responses of retinal units are determined by three types of coexisting images: (a) the optical projections of external objects, (b) shadows of the blood vessels and other internal eye structures, (c) virtual patterns caused by the traces of previous stimuli. A task of the visual system is to recognize and visualize only external objects separating their projections from all the entoptic images of the two remaining types. To implement separation, visual brain employs a number of approaches--in particular, the eye movements that cause sliding over the retina but only the projection of the external objects. This means that the peculiar phenomena observed in the cases of stabilized retinal images can be determined not by invariability of such stimuli per se but rather by the fact that stabilization eliminates a powerful cue helping to identify the retinal images belonging to the external objects, thereby increasing the probability to treat them as the entoptic ones which should be ignored or canceled rather than perceived. However, the probability of canceling--image fading--can be essentially reduced in conditions of concordant, large, bright, and sharp binocular stimuli.

Quantitative measurement of fixation stability during RareBit perimetry and Humphrey visual field testing

PURPOSE

To compare fixation stability and fixation loss between the Humphrey Field Analyzer (HVF, static fixation target) and the RareBit computer-based perimeter (RBP, kinetic fixation target) during visual field testing.

METHODS

Fourteen healthy volunteer subjects wore an ASL Mobile Gaze Tracker as they completed HVF 10-2 and RareBit central field tests in a random order. Fixation stability, defined as the average distance from the fixation target to the subject's gaze location, was calculated using data from the processed video capture. Fixation loss, defined as eye closure or a deviation of >20 degrees from the fixation target, was also measured. All subjects were surveyed regarding test preference.

RESULTS

Use of the RBP kinetic target was associated with 18% improved fixation stability compared with the HVF static target (P=0.02). Nine of 14 study subjects demonstrated better fixation with RBP compared with HVF. Subjects demonstrated decreased fixation loss during RBP (0.9 s) compared with HVF (10.0 s) (P=0.002). Eighty-six percent of study subjects preferred RBP over HVF.

CONCLUSIONS

Use of the RBP kinetic fixation target is associated with consistent fixation stability and decreased fixation loss compared with the HVF static target. This improvement in fixation stability may result from decreased perception interference (Ganzfeld, Troxler, and binocular rivalry effects), and may help account for the greater comfort reported with RBP compared with HVF.

Psychophysical scaling: Judgments of attributes or objects?

Psychophysical scaling models of the form R = f(I), with R the response and I some intensity of an attribute, all assume that people judge the amounts of an attribute. With simple biases excepted, most also assume that judgments are independent of space, time, and features of the situation other than the one being judged. Many data support these ideas: Magnitude estimations of brightness (R) increase with luminance (I). Nevertheless, I argue that the general model is wrong. The stabilized retinal image literature shows that nothing is seen if light does not change over time. The classification literature shows that dimensions often combine to produce emergent properties that cannot be described by the elements in the stimulus. These and other effects cannot be adjusted for by simply adding variables to the general model because some factors do not combine linearly. The proposed alternative is that people initially judge the entire stimulus - the object in terms of its environment. This agrees with the constancy literature that shows that objects and their attributes are identified through their relations to other aspects of the scene. That the environment determines judgments is masked in scaling studies where the standard procedure is to hold context constant. In a typical brightness study (where different lights are presented on the same background on different trials) the essential stimulus might be the intensity of the light or a difference between the light and the background. The two are perfectly confounded. This issue is examined in the case of audition. Judgments of the loudness of a tone depend on how much that tone differs from the previous tone in both pitch and loudness. To judge loudness (and other attributes) people first seem to process the stimulus object in terms of differences between it and other aspects in the situation; only then do they assess the feature of interest. Psychophysical judgments will therefore be better interpreted by theories of attention that are based in biology or psychology than those (following Fechner) that are based in classical physics.

A limited role for suppression in the central field of individuals with strabismic amblyopia

Background

Although their eyes are pointing in different directions, people with long-standing strabismic amblyopia typically do not experience double-vision or indeed any visual symptoms arising from their condition. It is generally believed that the phenomenon of suppression plays a major role in dealing with the consequences of amblyopia and strabismus, by preventing images from the weaker/deviating eye from reaching conscious awareness. Suppression is thus a highly sophisticated coping mechanism. Although suppression has been studied for over 100 years the literature is equivocal in relation to the extent of the retina that is suppressed, though the method used to investigate suppression is crucial to the outcome. There is growing evidence that some measurement methods lead to artefactual claims that suppression exists when it does not.

Methodology/Results

Here we present the results of an experiment conducted with a new method to examine the prevalence, depth and extent of suppression in ten individuals with strabismic amblyopia. Seven subjects (70%) showed no evidence whatsoever for suppression and in the three individuals who did (30%), the depth and extent of suppression was small.

Conclusions

Suppression may play a much smaller role in dealing with the negative consequences of strabismic amblyopia than previously thought. Whereas recent claims of this nature have been made only in those with micro-strabismus our results show extremely limited evidence for suppression across the central visual field in strabismic amblyopes more generally. Instead of suppressing the image from the weaker/deviating eye, we suggest the visual system of individuals with strabismic amblyopia may act to maximise the possibilities for binocular co-operation. This is consistent with recent evidence from strabismic and amblyopic individuals that their binocular mechanisms are intact, and that, just as in visual normals, performance with two eyes is better than with the better eye alone in these individuals.

Determining mechanisms of visual loss in glaucoma using Rarebit perimetry

PURPOSE

Evidence for ganglion cell visual dysfunction in human glaucoma is often indirect, being either measured at the cellular level in animal models or being inferred from the pooled responses of a large number of ganglion cells in human observers. Rarebit perimetry (RBP) uses repeated, intense (150 cd/m2) stimuli-whose size is close to the spatial scale of a ganglion cell-to search for small retinal areas with zero sensitivity. Decreasing the stimulus luminance to 64 cd/m2 in normal observers does not alter the percentage of RBP stimuli detected [the mean hit rate (MHR)], and so we hypothesized that a similar response robustness should occur in glaucoma if the elements detecting the RBP target show no signs of visual dysfunction.

METHODS

Nineteen glaucoma subjects and 19 age-matched controls were tested with a customized RBP test at 13 stimulus luminances (10 to 150 cd/m2, 0.14 log unit intervals). A four-parameter (threshold, spread, false positive proportion, and miss rate) cumulative Gaussian psychometric function was fitted to the response rate data from a glaucoma-affected region (glaucoma subjects; MHR >50% and <80%) and from the corresponding region in an age-matched normal control. Our hypothesis would predict that only the miss rates should differ between groups.

RESULTS

Glaucoma subjects showed significantly higher miss rates (0.18 vs. 0.04, p < 0.001), lower false positive proportions (0.009 vs. 0.025, p = 0.004), greater spreads (0.30 vs. 0.19, p = 0.002), and elevated thresholds [1.57 log(cd/m2) vs. 1.13 log(cd/m2), p < 0.001].

CONCLUSIONS

Responses to RBP stimuli are not robust to decreasing luminances in glaucoma. Our results more directly imply the presence of ganglion cell visual dysfunction in human glaucoma than studies using larger targets where contrast sensitivity losses could result through ganglion cell death alone. Such dysfunction may not be detected by Rarebit's MHR given that dysfunctional elements may still respond to the very intense RBP stimulus.

Peripheral fading with monocular and binocular viewing

This study measured the fading times of peripheral targets as a function of whether viewing was monocular or binocular, and of brightness contrast. Data from a binocularly normal group showed Troxler fading to be significantly faster with monocular (i.e., patched) than with binocular viewing. In contrast, one-eyed observers showed significantly longer fading times than the two-eyed observers viewing monocularly and equivalent times to their binocular viewing. A control experiment showed that these findings were not due to worse fixation stability, larger pupil sizes, or an unusually large blinking rate in the enucleated group. The enucleated group actually exhibited a slight miosis, equivalent fixation stability, and a normal blinking rate. In both experiments, the times to fading of all observers were a function of brightness contrast. We conclude that in binocularly normal observers patching or closing one eye does not produce monocular vision but rather a condition of weak binocular rivalry, and that the absence of inhibitory binocular interactions in the enucleated group may explain, in part, their resistance to fading and their superior performance in other contrast-defined tasks.

Principles of modern low vision rehabilitation

Low vision rehabilitation is a new emerging subspecialty drawing from the traditional fields of ophthalmology, optometry, occupational therapy, and sociology, with an ever-increasing impact on our customary concepts of research, education, and services for the visually impaired patient. A multidisciplinary approach and coordinated effort are necessary to take advantage of new scientific advances and achieve optimal results for the patient. Accordingly, the intent of this paper is to outline the principles and details of a modern low vision rehabilitation service. All rehabilitation attempts must start with a first hand interview (the intake) for assessing functionality and priority tasks for rehabilitation, as well as assessing the patient's all-important cognitive skills. The assessment of residual visual functions follows the intake and offers a unique opportunity to measure, evaluate, and document accurately the extent of functional loss sustained by the patient from disease. An accurate assessment of residual visual functions includes assessment of visual acuity, contrast sensitivity, binocularity, refractive errors, perimetry, oculomotor functions, cortical visual integration, and light characteristics affecting visual functions. Functional vision assessment in low vision rehabilitation measures how well one uses residual visual functions to perform routine tasks, using different items under various conditions, throughout the day. Of the many functional vision skills known, reading skills is an obligatory item for all low vision rehabilitation assessments. Results of assessment guide rehabilitation professionals in developing rehabilitation plans for the individual and recommending appropriate low vision devices. The outcome from assessing residual visual functions is detection of visual functions that can be improved with the use of optical devices. Methods for prescribing devices such as image relocation with prisms to a preferred retinal locus, field displacement to primary gaze position, field expansion, and manipulation of light are practiced today in addition to, or instead of, magnification. Correction of refractive errors, occlusion therapy, enhancement of oculomotor skills, and field restitution are additional methods now available for prescribing devices leading to rehabilitation of visual functions. The outcome from assessing residual functional vision is detection of functional vision that can be improved with the use of vision therapy training. After restoration of optimal residual visual functions is achieved with optical devices, one can follow with training programs for restoration of lost vision-related skills. If an optical dispensary is available where prescribing of low vision devices routinely take place, this will help ensure familiarity and specialization of the dispensary and staff with low vision devices and their special dispensing requirements. The dispensing of low vision devices is an opportunity to introduce the device to the patient, train the patient in the correct use of the device for the task selected, and create a direct and continuous connection with the patient until the next encounter. Following assessment, prescribing, and dispensing of devices, a low vision practitioner, ophthalmologist or optometrist, is responsible for recommending and prescribing vision therapy training to improve residual functional vision. An attempt to present a template for a comprehensive modern low vision rehabilitation practice is made here by summarizing scientific developments in the field and stressing the multidisciplinary involvement required for this kind of practice. It is hoped that this paper and other initiatives from colleagues, the public, and government will promote and raise awareness of modern low vision rehabilitation for the benefit of all.

Psychophysics of Electrical Stimulation of Striate Cortex in Macaques

Macaques indicated their detection of onset or alteration of 0.2-ms pulses applied in various configurations through electrodes implanted in striate cortex. When microelectrodes were introduced and left in place, the threshold for detection of 100-Hz pulses nearly doubled within 24 h. However, for chronically implanted platinum-alloy macroelectrodes detection thresholds usually remained stable for many months, independently of location within striate cortex or its immediately subjacent white matter. Thresholds were unaffected by the visual conditions, such as light versus darkness, or movement of the eyes; but in one animal blind after acute glaucoma thresholds for loci in striate cortex were permanently decreased by about 50%. Learning to respond to electrical stimulation of the optic tract produced no tendency to respond to such stimulation of striate cortex. Onset of stimulation at a given locus could be detected even in the face of continuous supraliminal stimulation at four surrounding loci on a 3-mm radius. The surround stimulation did alter the threshold of the central locus, but such stimuli could not summate if they were subliminal by some 10%. Cessation of stimulation that had been continuing for 1 min to 1 h could be detected if it were being applied at a level 20–75% above that needed for detection of stimulus onset. Continuous stimulation had a pronounced “priming” effect, in that modulation of frequency or intensity of such stimulation by as little as 5% could be detected (e.g., 20 μA in a background of 500 μA, or <2-ms interpulse interval with pulses at 50 Hz). Using pulses inserted in various phase relations to ongoing pulses at 2–5 Hz, it could be determined that stimulus pulses were surrounded by a strong facilitatory period for about 30 ms, which was then replaced by refractoriness. Given the congruence of macaque and human visual anatomy and psychophysics, these results further encourage efforts to develop a cortical prosthesis for the blind.

Characteristics of the normative database for the Humphrey matrix perimeter

PURPOSE

The Humphrey Matrix (Carl Zeiss Meditec, Dublin CA; Welch-Allyn, Skaneateles, NY) is a high-spatial-resolution perimeter that uses frequency-doubling stimuli. It incorporates an efficient test strategy that assumes that age, eccentricity, and test procedure type have only small effects on sensitivity. The results used to create the normative database for the perimeter were examined, to see whether these assumptions were met and to examine the form of the normative data.

METHOD

Visual fields were measured (Matrix 30-2, 24-2, 10-2 and Macula patterns) in >275 subjects judged to be normal by a battery of clinical procedures. The right eye was always tested first.

RESULTS

Sensitivity decreased by approximately 0.7 dB per age decade across all eccentricities; sensitivity decreased with eccentricity, typically by <5 dB at the most peripheral points tested. Although there was no systematic difference in sensitivity between the 30-2 and 24-2 tests, the Macula test sensitivities were typically 1 dB higher than for the 10-2 test. Sensitivity in the left eye was slightly lower than in the right, with the difference being significantly greater in the temporal visual field. In most test locations, the 95% confidence interval of normal sensitivity was approximately 6 dB below the median sensitivity.

CONCLUSIONS

The performance of the test strategy in the Matrix perimeter is appropriately matched to the response characteristics of the normal population. The finding of a spatially nonuniform difference in sensitivity between left and right eyes is attributable to light-adaptation differences between the eyes. This effect is accounted for in the perimeter's normative database.

Detailed Analyses of Ganzfeld Phenomena as Perceptual Events in Stimulus-Reductive Situations

Experiment 1 reexamined in detail conscious experiences in Ganzfeld situations with homogeneous light (red, green, or blue). Subjects were instructed to report everything, including phenomena attributed to the external world (colour, brightness, space) and those of the self (somatosensory experience, body movement, and emotion). The reports were richer in the red-light condition. Naïve subjects reported a larger variety of events than sophisticated subjects. In Experiment 2 pupillary responses were recorded while the subjects were exposed to a Ganzfeld at two different levels of illumination. Pupillary size for high illumination decreased with time and then recovered to the initial level, while for low illumination it remained constant. Subjective brightness correlated with pupillary size. Experiment 3 revealed a temporal pattern of spatial events. The findings obtained are discussed in relation to the ontogenetic process of visual space perception and emotion.

Providing a homogeneous visual field with an integrating sphere

Homogeneous visual fields are widely used in visual perception and psychophysical studies. An integrating sphere can be guaranteed to provide a homogeneous diffuse source of illumination. We report here on a custom built integrating sphere, which provides a uniformly illuminated, unpatterned visual field. The apparatus allows for superior subject comfort over other methods. Binocular viewing is facilitated and the apparatus is highly adaptable to various experimental situations requiring a homogeneous visual field.

The effect of ocular dominance on visual field testing

PURPOSE

During standard automated perimetry (SAP), some patients experience visual disturbances in the tested eye while the other eye is covered with an opaque occluder. It is possible that a binocular interaction producing an inhibitory response in the nonoccluded eye, such as rivalry or Ganzfeld blankout, may be the causative factor, particularly when the dominant eye is occluded. The objective of this experiment was to determine whether subjective visual disturbances occurring during conventional perimetric test conditions were related to ocular dominance and to investigate the effect of these disturbances on measurements made during threshold visual field analysis.

METHOD

Ocular dominance was determined by questioning and objective testing on 55 normal subjects. Each subject underwent program 24-2 Full Threshold SAP on a Humphrey Field Analyzer, and an opaque black patch was used to occlude the nontested eye. After testing, patients were asked to report symptoms of visual disturbance characteristic of rivalry or blankout, and the relationship between ocular dominance and visual disturbances was investigated. To determine whether symptoms of rivalry or blankout had affected visual field quantification, comparisons of short-term fluctuation, mean deviation, and false-negative errors were performed between eyes with and without visual disturbances.

RESULTS

A total of 24 of 55 subjects reported visual disturbances consistent with rivalry or blankout (44%). Sixteen subjects complained of the phenomenon in one eye, and eight complained of the phenomenon in both eyes. Of the 16 experiencing disturbances in one eye only, nine cases occurred during occlusion of the dominant eye. The association between ocular dominance and visual disturbances was not found to be significant (p > 0.10). No significant differences in short-term fluctuation (p = 0.78), mean deviation (p = 0.64), or false-negative errors (p = 0.10) were found between eyes with and without visual disturbances.

CONCLUSIONS

Patients undergoing standard automated perimetry with opaque patch occlusion of the nontested eye often experience visual disturbances consistent with rivalry or blankout, although these disturbances do not cause increased within-test variability or reduced sensitivity as quantified by visual field global indices. In terms of summary visual field indices, ocular dominance does not appear to affect visual field test results.

How patterns of bleached rods and cones become visual perceptual experiences: a proposal

In an attempt to increase information about how mammalian visual systems create a perceptual experience out of a retinal photochemical bleach pattern, this article brings together recent rat physiological data acquired with large electrodes, an old cat behavioral experiment, and two complex human behaviors: reading and the reversible blindness people experience when the scene being viewed is stabilized on the retinal surface. The outcome suggests this juxtaposition of disparate data sets has been logical, reasonable, and informative. The link between rats and reading is the fact that both rat and human retinas convert bleach patterns into ganglion cell volleys 3 times a second. The probable trigger for these episodic retinal volleys is a more or less abrupt change in the pattern of bleached rods and cones, and we claim the absence of this trigger when the image is stabilized is responsible for the blindness. The cat behavioral experiment correlates performance on visual discrimination tasks with the number of nerve fibers remaining after lesions of the optic tract. The analysis of the result, which shows that as few as 2% of the normal number of nerve fibers supports perfect performance of such tasks, prompts the concept of a second dynamic visual system, operating in parallel with the anatomical nervous system pictured in the textbooks. The dynamic visual system model, which brings into the foreground important old facts that have been neglected and integrates them with new data, offers a synthesis that may be useful in interpreting classical visual behavioral phenomena.

Neural dynamics of binocular brightness perception

How does the visual cortex combine information from both eyes to generate perceptual representations of object surfaces? Important clues about this process may be derived from data about the perceived brightness of surface regions under binocular viewing conditions, including data about binocular brightness summation in response to Ganzfelds, the U-shaped data of Fechner's paradox that violates binocular brightness summation, and the effects of different combinations of monocular and binocular contours and surface luminance differences on threshold sensitivity to monocular flashes of light. How to reconcile these apparently contradictory data properties has been a severe challenge to previous models, and none has explained them all. The present article quantitatively simulates them all by further developing the FACADE vision model. Key model processes discount the illuminant and compute image contrasts in each monocular channel using shunting on-center off-surround networks; binocularly fuse these discounted monocular signals using shunting on-center off-surround networks with nonlinear excitatory and inhibitory signals; and use these binocularly fused activities to trigger filling-in of a binocular surface representation that represents perceived surface brightness. Previous models that have suggested explanations of subsets of these data are discussed.

Nonlinear combination of luminance excursions during flicker, simultaneous contrast, afterimages and binocular fusion

The changes in apparent brightness or color, induced into a test spot by a surround, can be greatly enhanced either by flickering the test spot between two luminances, or by binocularly fusing a pair of test spots of different luminances. Simultaneous contrast, in which a white surround makes a grey spot look darker, is greatly enhanced if the spot (not the surround) flickers between black and white. Colour contrast is likewise enhanced by chromatic flicker: on a blue surround, a grey spot looks slightly yellowish, but a yellow/blue flickering spot looks strongly yellow. Temporal successive contrasts, or negative afterimages, are also enhanced by flickering the test field. The negative afterimage of a half-white, half-black rectangle looked dark grey and light grey when projected on a grey test field, but it looked almost black and almost white when projected on a test field that flickered between black and white. Coloured negative afterimages were also enhanced by projecting them on a chromatic flickering test field. We examined the combination rules for pairs of luminances which were presented either successively as flicker or else dichoptically (and fused binocularly). The brightness averaging functions for spatial increments (light spots) on dark surrounds were quasi-linear for binocular fusion but quadratic for flicker. For spatial decrements (dark spots) on white surrounds, the brightness averaging functions were strongly nonlinear winner-take-all for both binocular fusion and flicker. We also found temporal analogues of Fechner's [(1860). Elements of psychophysics. New York: Holt, Rinehart, Winston, 1966] paradox and Levelt's [(1965). British Journal of Psychology, 56, 1-13] dichoptic contour effect. We conclude that the visual rules for combining luminance excursions, whether in flicker or binocular fusion, favour disproportionately the spot with the higher contrast.

Brightness fading during Ganzfeld adaptation

The time course and extent of brightness fading in a Ganzfeld were determined for adapting luminances ranging from 0.01 to 100 cd/m2. Magnitude estimation and interocular brightness matching were used. During Ganzfeld adaptation, perceived brightness decreased slowly and leveled off, on average, after 5-7 min (adapting time increasing with luminance). On average, the total brightness loss was equivalent to a 1.2 log unit reduction in luminance, independent of adapting luminance. The residual brightness perceived at the final plateau was generally higher than the brightness of the Eigengrau, suggesting a partially sustained luminance channel.

Baseline alterations in blue-on-yellow normal perimetric sensitivity

BACKGROUND

the extent of any learning and fatigue effects in blue-on-yellow (B-Y) perimetry is unknown. The within- and between-eye changes in B-Y normal sensitivity at a single visit and between visits was investigated as a function of previous experience in white-on-white (W-W) perimetry and of subject age.

METHODS

Sixty-one normal subjects 22 young (range 20-34 years) and 39 elderly (range 51-80 years)-- assigned to one of four groups based upon perimetric experience and age underwent B-Y perimetry on four separate occasions using Program 30-2 of a modified Humphrey Field Analyser 640. Perimetry was performed for both eyes on three consecutive days and again one week later. Global, hemifield and annular mean sensitivities and global short-term fluctuation were calculated for each eye at each visit.

RESULTS

Mean sensitivity was higher in the first eye examined and increased over the 3 days. The increase in mean sensitivity was similar for each eye and was independent of perimetric experience and age. Short-term fluctuation decreased over the 3 days, regardless of eye and experience, but was more pronounced for the younger age group. The extent of all improvements varied considerably between subjects.

CONCLUSIONS

Improvements in B-Y perimetric performance occurred as the familiarity with the test increased, regardless of previous W-W experience. Failure to account for such improvement could reduce the efficiency of B-Y perimetry.

Models of binocular luminance interaction evaluated using visually evoked potential and psychophysical measures: a tribute to M. Russell Harter

We determined subjects' responses to sine-wave modulated lights employing visually evoked potentials (VEPs) and psychophysical thresholds in a series of experiments. The stimuli had the same temporal frequency and mean luminance in each eye but the phase difference between the two eyes was varied so that phase was either the same (dioptic) or different (dichoptic) in the two eyes. The data were fit by a model which had two binocular pathways, one which summed monocular nonlinear elements and a second which had a nonlinearity following the combination of monocular linear elements. In the second channel the outputs of the monocular linear elements were summed at low luminance while at higher luminance levels they were subtracted. Based on variations in the threshold data with temporal frequency, the pathway which summed nonlinear monocular elements was identified with the magnocellular (M) pathway, and the pathway which combined monocular linear elements prior to a binocular nonlinear element was identified with the parvocellular (P) pathway.

Visual aftereffects and the consequences of visual system lesions on their perception in the rhesus monkey

This study examined the consequences of visual system lesions on visual aftereffects produced by achromatic stimuli of various luminance contrasts and chromatic stimuli of various wavelength compositions. The effects of repeated exposure to such adapting stimuli were assessed using probes whose luminance contrast and wavelength composition were systematically varied using both detection and discrimination paradigms. Interocular tests revealed that both peripheral and central mechanisms contribute to the visual aftereffects produced by the adapting stimulus arrays used in this study. Contrary to the hypothesis according to which the midget system of the retina is the conveyor of visual afterimages, we found that blocking this system with lesions of parvocellular lateral geniculate nucleus, through which the midget cells make their way to the striate cortex in primates, did not eliminate the visual aftereffects. It appears therefore that the parasol system of the retina, which courses through the magnocellular layers of the lateral geniculate nucleus to cortex, can convey the necessary signals for the generation of visual aftereffects. Lesions of areas V4 and MT did not have significant effects on the visual aftereffects studied suggesting that the central factors that contribute to the visual aftereffects occur either already in area V1 or are conveyed to higher centers through regions other than areas V4 and MT.

Visual disturbance of the uncovered eye in patients wearing an eye patch

We questioned 104 consecutive eye casualty patients about any visual disturbance experienced while wearing an eye patch as part of their treatment. Many (31%) reported momentary loss of vision in the uncovered eye. Some experienced this while driving. It was more common (p < 0.0008) if the 'dominant eye' had been patched (47%) rather than the 'non-dominant eye' (16%). In a separate experiment, a number of co-operative subjects were provided with a translucent-coloured occluder to be worn over each eye in turn. They reported a recurring coloured interference in the uncovered eye sparing the monocular crescent. We propose that the loss of vision in the unpatched eye is due to binocular rivalry suppression by the patched eye. This visual disturbance may be a cause of anxiety or risk for the patient. Patched patients should be warned this may occur, and advised to avoid driving or operating machinery.