Effectively reducing sensory eye dominance with a push-pull perceptual learning protocol

Monocular eye-cueing shifts eye balance in amblyopia

Here, we investigate the shift in eye balance in response to monocular cueing in adults with amblyopia. In normally sighted adults, biasing attention toward one eye, by presenting a monocular visual stimulus to it, can shift eye balance toward the stimulated eye, as measured by binocular rivalry. We investigated whether we can modulate eye balance by directing monocular stimulation/attention in adults with clinical binocular deficits associated with amblyopia and larger eye imbalances. In a dual-task paradigm, eight participants continuously reported ongoing rivalry percepts and simultaneously performed a task related to the cueing stimulus. Time series of eye balance dynamics, aligned to cue onset, are averaged across trials and participants. In different time series, we tested the effect of monocular cueing on the amblyopic and fellow eyes (compared to a binocular control condition) and the effect of an active versus passive task. Overall, we found a significant shift in eye balance toward the monocularly cued eye, when both the fellow eye or the amblyopic eye were cued, F(2, 14) = 27.649, p < 0.01, ω2 = 0.590. This was independent of whether, during the binocular rivalry, the cue stimulus was presented to the perceiving eye or the non-perceiving eye. Performing an active task tended to produce a larger eye balance change, but this effect did not reach significance. Our results suggest that the eye imbalance in adults with binocular deficits, such as amblyopia, can be transiently reduced by monocularly directed stimulation, at least through activation of bottom-up attentional processes.

Prediction of Robotic Anastomosis Competency Evaluation (RACE) metrics during vesico-urethral anastomosis using electroencephalography, eye-tracking, and machine learning

Residents learn the vesico-urethral anastomosis (VUA), a key step in robot-assisted radical prostatectomy (RARP), early in their training. VUA assessment and training significantly impact patient outcomes and have high educational value. This study aimed to develop objective prediction models for the Robotic Anastomosis Competency Evaluation (RACE) metrics using electroencephalogram (EEG) and eye-tracking data. Data were recorded from 23 participants performing robot-assisted VUA (henceforth 'anastomosis') on plastic models and animal tissue using the da Vinci surgical robot. EEG and eye-tracking features were extracted, and participants' anastomosis subtask performance was assessed by three raters using the RACE tool and operative videos. Random forest regression (RFR) and gradient boosting regression (GBR) models were developed to predict RACE scores using extracted features, while linear mixed models (LMM) identified associations between features and RACE scores. Overall performance scores significantly differed among inexperienced, competent, and experienced skill levels (P value < 0.0001). For plastic anastomoses, R2 values for predicting unseen test scores were: needle positioning (0.79), needle entry (0.74), needle driving and tissue trauma (0.80), suture placement (0.75), and tissue approximation (0.70). For tissue anastomoses, the values were 0.62, 0.76, 0.65, 0.68, and 0.62, respectively. The models could enhance RARP anastomosis training by offering objective performance feedback to trainees.

Collective plasticity of binocular interactions in the adult visual system

Binocular visual plasticity can be initiated via either bottom-up or top-down mechanisms, but it is unknown if these two forms of adult plasticity can be independently combined. In seven participants with normal binocular vision, sensory eye dominance was assessed using a binocular rivalry task, before and after a period of monocular deprivation and with and without selective attention directed towards one eye. On each trial, participants reported the dominant monocular target and the inter-ocular contrast difference between the stimuli was systematically altered to obtain estimates of ocular dominance. We found that both monocular light- and pattern-deprivation shifted dominance in favour of the deprived eye. However, this shift was completely counteracted if the non-deprived eye's stimulus was selectively attended. These results reveal that shifts in ocular dominance, driven by bottom-up and top-down selection, appear to act independently to regulate the relative contrast gain between the two eyes.

Effects of Monocular Flicker on Binocular Imbalance in Amblyopic and Nonamblyopic Adults

Purpose

This study aimed to evaluate the effects of monocular flicker stimulation on binocular imbalance in both amblyopic and nonamblyopic adults.

Methods

Seven amblyopic patients (28.3 ± 3.3 years; four females) and seven normally sighted participants (27.3 ± 4.1 years; five females) participated in the study. We used liquid crystal spectacles to create externally-generated monocular flicker (4, 7, 10, 15, or 20 Hz) and used the metric of log balance point (logBP) to determine whether imposed flicker could change the eyes' equilibrium interocular contrast ratio. Flicker was applied to either the fellow eye vs. the amblyopic eye or dominant eye (DE) vs. non-DE (non-DE) of amblyopic and nonamblyopic participants, respectively. We defined a logBP of 0 to indicate complete binocular balance and an increase in logBP relative to baseline to indicate a relative strengthening of the non-DE or amblyopic eye.

Results

Monocular flicker applied to the DE or fellow eye increased logBP, whereas when applied to the non-DE or amblyopic eye, reduced the logBP. These effects were more pronounced at low temporal frequencies than that at high temporal frequencies. The interaction between eye and temporal frequency was significant in both normals, F(4, 24) = 58.082, P < 0.001, η2 = 0.906, and amblyopes, F(1.923, 11.538) = 60.555, P < 0.001, η2 = 0.91.

Conclusions

Monocular flicker diminishes the contribution of the flickered eye in binocular combination, resulting in a relative dominance of the nonflickered eye in interocular interactions. Furthermore, a more pronounced temporally modulated effect was observed at lower temporal frequencies.

The Suppressive Basis of Ocular Dominance Changes Induced by Short-Term Monocular Deprivation in Normal and Amblyopic Adults

Purpose

We aimed to study the effect of short-term monocular deprivation on the suppressive interocular interactions in normals and amblyopes by using a dichoptic masking paradigm.

Methods

Nine adults with anisometropic or mixed amblyopia and 10 control adults participated in our study. The contrast sensitivity in discriminating a target Gabor dichoptically masked was measured before and after 2 hours of monocular deprivation. The mask consisted of bandpass-filtered noise. Both the target and the mask were horizontally oriented at the spatial frequency of 1.31 cpd. Deprivation was achieved using an opaque patch on the amblyopic eye of amblyopes and the dominant eye of controls.

Results

Results were similar in both controls and amblyopes. After 2 hours of monocular deprivation, the previously patched eye showed a significant increase in contrast sensitivity under dichoptic masking, which also suggested reduced suppressive effect from the nonpatched eye. Meanwhile, the contrast sensitivity of the nonpatched eye remained almost unchanged under dichoptic masking.

Conclusions

We demonstrate that the ocular dominance changes induced by short-term monocular deprivation-namely, the strengthening of the deprived eye's contribution-are associated with the unilateral and asymmetric changes in suppressive interaction. The suppression from the nondeprived eye is reduced after short-term monocular deprivation. This provides a better understanding of how inverse patching (patching of the amblyopic eye) could, by reducing the suppressive drive from the normally sighted (nondeprived) eye, form the basis of a new treatment for the binocular deficit in amblyopia.

Integration and suppression interact in binocular vision

Contingent on stereo compatibility, two images presented dichoptically can lead to either binocular integration, thus generating stable stereopsis, or interocular suppression that induces binocular rivalry with bistable perception that alternates between the two images. The relationship between binocular integration and interocular suppression concerns how our brain processes binocular inputs to form unified visual awareness but remains unclear. Here, a series of psychophysical experiments were conducted to address this question, revealing that these collaborative and competitive binocular interactions are interconnected and would mediate one another according to their strength. Specifically, Experiments 1a and 1b showed that the presence of binocular rivalry inhibited peripheral stereopsis, significantly elevating the stereo threshold, with higher elevation resulting from increasing rivalry contrast. Experiments 2a and 2b showed that existing stereopsis with increasing binocular disparity balanced the dynamics of peripheral binocular rivalry, rendering more equivalent eye dominance. Based on these interactions, we suggest that binocular integration and interocular suppression may mediate one another through an overlapping mechanism for regulating eye dominance, with strong stereo percepts tending to reduce eye dominance and strong rivalry tending to increase eye dominance.

Measuring the reliability of binocular rivalry

Binocular rivalry is a widely used tool in sensory and cognitive neuroscience to investigate different aspects of vision and cognition. The dynamics of binocular rivalry (e.g., duration of perceptual dominance phases and mixed percept proportions) differ across individuals; based on rivalry dynamics, it is also possible to calculate an index of ocular dominance (by comparing the perceptual dominance of the images in the two eyes). In this study, we investigated the reliability of binocular rivalry dynamics using different methods for dichoptic stimulation and different rivalry stimuli. For the three main indices we defined (ocular dominance, phase durations and mixed percept proportions), we found a high test-retest reliability across sessions. Moreover, the test-retest reliability of the ocular dominance index was predictable from its internal consistency, supporting its stability over time. Phase durations and mixed percept proportions, in contrast, had worse test-retest reliability than expected based on internal consistency, indicating that these parameters are susceptible to state-dependent changes. Our results support the use of the ocular dominance index and binocular rivalry in the measurement of sensory eye dominance and its plasticity, but advise caution when investigating the association between phase durations or mixed percepts and stable characteristics like psychological traits or disorders.

Sensory eye dominance plasticity in the human adult visual cortex

Sensory eye dominance occurs when the visual cortex weighs one eye's data more heavily than those of the other. Encouragingly, mechanisms underlying sensory eye dominance in human adults retain a certain degree of plasticity. Notably, perceptual training using dichoptically presented motion signal-noise stimuli has been shown to elicit changes in sensory eye dominance both in visually impaired and normal observers. However, the neural mechanisms underlying these learning-driven improvements are not well understood. Here, we measured changes in fMRI responses before and after a five-day visual training protocol to determine the neuroplastic changes along the visual cascade. Fifty visually normal observers received training on a dichoptic or binocular variant of a signal-in-noise (left-right) motion discrimination task over five consecutive days. We show significant shifts in sensory eye dominance following training, but only for those who received dichoptic training. Pattern analysis of fMRI responses revealed that responses of V1 and hMT+ predicted sensory eye dominance for both groups, but only before training. After dichoptic (but not binocular) visual training, responses of V1 changed significantly, and were no longer able to predict sensory eye dominance. Our data suggest that perceptual training-driven changes in eye dominance are driven by a reweighting of the two eyes' data in the primary visual cortex. These findings may provide insight into developing region-targeted rehabilitative paradigms for the visually impaired, particularly those with severe binocular imbalance.

EEG Measurement for Suppression in Refractive Amblyopia and Push-pull Perception Efficacy

In order to evaluate refractive amblyopia suppression and understand the neural mechanism of amblyopia suppression and push-pull perception training, we recorded the EEG of refractive amblyopia children before, during, and after push-pull perception training. We compared the brain activity in different states through the steady-state visual evoked potentials (SSVEPs) response and power topography and compared them with normal children. We found that amblyopic and fellow eyes have different performances in fundamental and harmonic frequency responses. They also show different characteristics when be masked. Push-pull perception training improved the SSVEP performance of amblyopia children by reducing the SSVEP response difference between eyes and improving the intermodulation frequency response. The result of topography showed that push-pull perception reduced the alpha power of occipital and temporal lobes, which was conducive to improving binocular function. The changes of intermodulation response and occipital alpha power were significantly correlated with the clinical indicator. Thus, EEG is a potential method to measure amblyopia suppression and the efficacy of push-pull perception.

Recent Treatment Advances in Amblyopia

Occlusion therapy has a long history as the gold standard treatment for amblyopia. Over the past two decades, large multicenter randomized controlled trials and objective dose-monitoring studies have characterized the effects of refractive correction, patching, and atropine penalization, providing insights into the impact of factors such as age and treatment dose. More recent approaches, whose development has been accelerated by advances in technology, are designed to provide different stimulation to the amblyopic eye and the fellow eye. This review explores a variety of such dichoptic approaches, categorized according to whether they primarily feature requisite use of the amblyopic eye in the face of fellow-eye masking, integration of visual information from both eyes, or reduction of stimulus salience in the fellow eye. It is still unclear whether dichoptic treatments are superior to traditional, low-cost treatment methods or whether their therapeutic mechanisms are fundamentally different from those of established treatments. Expected final online publication date for the Annual Review of Vision Science, Volume 8 is September 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

New treatment for amblyopia based on rules of synaptic plasticity: a randomized clinical trial

Amblyopia resulting from early deprivation of vision or defocus in one eye reflects an imbalance of input from the eyes to the visual cortex. We tested the hypothesis that asynchronous stimulation of the two eyes might induce synaptic plasticity and rebalance input. Experiments on normal adults showed that repetitive brief exposure of grating stimuli, with the onset of each stimulus delayed by 8.3 ms in one eye, results in a shift in perceptual eye dominance. Clinical studies (Clinical trial registration number: ChiCTR2100049130), using popular 3D movies with similar asynchrony between the two eyes (amblyopic eye stimulated first) to treat anisometropic amblyopia, established that just 10.5 h of conditioning over <3 weeks produced improvement that met criteria for successful treatment. The benefits of asynchronous conditioning accumulate over 20-30 45 min sessions, and are maintained for at least 2 years. Finally, we demonstrate that asynchronous binocular treatment alone is more effective than patching only. This novel treatment is popular with children and is some 50 times more efficient than patching alone.

Comparison of binocular game and patching in treating mild to moderate anisometropic amblyopia: a study protocol for a randomized controlled trial

BACKGROUND

Amblyopia, as a neurodevelopmental preventable visual disorder, affects approximately 1.1 % in Asia. A binocular approach to treating amblyopia has been recently proposed. Whether the binocular playing game treatment is comparable to patching treatment needs further randomized clinical trials. To address this, the present research, designs, develops, and evaluates a new binocular game to treat amblyopia.

METHODS

This study has been designed as a non-inferiority, randomized, two parallel-group, controlled trial. Forty-four patients between 4 and 12 years diagnosed with amblyopia will be randomly assigned to the control and intervention groups. In the intervention group, amblyopia treatment is provided with red-green anaglyphic glasses and a red filter placed in front of the amblyopic eye, along with a game to be played for 30 min twice a day. Those in the control group will receive patch therapy according to amblyopia treatment study protocol. The primary outcome is to change visual acuity in the amblyopic eye from the baseline to 3 months after randomization.

ETHICS AND DISSEMINATION

The Ethics Committee of Mashhad University of Medical sciences' approval date was February 28, 2018, with a reference code of IR.MUMS.fm.REC.1396.783. Thus far, the recruitment of participants has not been completed and is scheduled to end in September 2021. The results will be disseminated in a peer-reviewed journal.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20180217038768N1 . Registered on 22 April 2019.

Attentional eye selection modulates sensory eye dominance

Brief periods of monocular deprivation significantly modify binocular visual processing. For example, patching one eye for a few hours alters the inter-ocular balance, with the previously patched eye becoming dominant once the patch is removed. However, the contribution of higher-level visual processing to this phenomenon is still unclear. Here, we compared changes in sensory eye dominance produced by three types of monocular manipulations in adult participants with normal binocular vision. One eye was covered for 150 min using either an opaque patch, a diffusing lens, or a prism that inverted the image. All three manipulations altered dominance duration and predominance during binocular rivalry (BR) in favour of the treated eye and the time courses of the changes were similar. These results indicate that modifications of luminance or contrast are not strictly necessary to drive shifts in eye dominance, as both were unaltered in the prism condition. Next, we found that shifts in eye dominance were dependent on attentional demands during the monocular treatment period, providing support for the role of attentional eye selection in modulating eye dominance. Finally, we found relatively rapid build-up of the ocular dominance shift after the onset of monocular treatment. Taken together, our results suggest that modifications to monocular input alter inter-ocular balance via selective attentional mechanisms that bias output towards the deprived eye. Eye-based attention may play an important role in conditions where normal input to one eye is disrupted, such as childhood amblyopia.

Evaluating the Acute Effect of Stereoscopic Recovery by Dichoptic Stimulation Using Electroencephalogram

Amblyopia is a common developmental disorder in adolescents and children. Stereoscopic loss is a symptom of amblyopia that can seriously affect the quality of patient's life. Recent studies have shown that the push-pull perceptual learning protocol had a positive effect on stereoscopic recovery. In this study, we developed a stereoscopic training method using a polarized visualization system according to the push-pull protocol. Dichoptic stimulation for 36 anisometropic and amblyopic subjects and 33 children with normal visual acuity (VA) has been conducted. Electroencephalogram (EEG) was used to evaluate the neurophysiological changes before, during, and after stimulation. For the anisometropic and amblyopic subjects, the statistical analysis demonstrated significant differences (p < 0.01) in the beta rhythm at the middle temporal and occipital lobes, while the EEG from the normal VA subjects indicated no significant changes when comparing the results before and after training. We concluded that the dichoptic training in our study can activate the middle temporal visual area and visual cortex. The EEG changes can be used to evaluate the training effects. This study also found that the beta band EEG acquired during visual stimulation at the dorsal visual stream can be potentially used for predicting acute training effect. The results facilitated the optimization of the individual training plan.

Abnormal sensory eye dominance in stereoanomalous subjects

Stereoanomalous (SA) subjects have normal visual acuity but reduced stereopsis and may have a prevalence of up to 30%. It has been suggested that, in SA subjects, an imbalance in interocular inhibition might underlie an asymmetry in sensory eye dominance (SED). Our study expands upon previous findings by examining binocular rivalry (BR) mean dominance durations, dichoptic masking (DM) thresholds and SED for a group of SA subjects compared to naïve controls. We examined BR dominance durations and DM thresholds for 15 stereonormal (SN) subjects and 10 SA subjects with normal or corrected-to-normal visual acuity. All subjects had visual acuity of 20/40 or better and less than or equal to two lines difference between eyes. Individuals who scored ≥6/9 on the Randot stereo test and <100 arcmin on the PacMan Stereo Acuity test were considered SN. We compared near-vertical and near-horizontal oriented sine-wave gratings for BR and DM in order to dissociate stereo-related mechanisms that rely on horizontal disparities from other eye-based integration mechanisms. Mean randot scores for SN subjects were 8.5/9 with a PacMan stereoacuity of 33 arcmin, and SA subjects scored 2.5/9 and 3,380 arcmin, respectively. The mean difference in SED was 0.19 for SN and 0.48 for SA when measured with a neutral density filter bar. The SA group showed a large interocular difference in BR durations that was significantly greater than normal (p = 0.004) and correlated with loss of stereoacuity. Moreover, the interocular difference for DM was similarly greater for SA subjects (p = 0.04) although a proportional difference in monocular sensitivity could partially account for this. We also found that both SN and SA subjects presented higher DM thresholds and, to some extent, sensitivity for vertical than horizontal orientations. SA subjects show an abnormal bias toward their dominant eye for both BR and DM. These data suggest that common mechanisms of monocular sensitivity and interocular inhibition may limit multiple binocular measures and provides a practical link to better understand the heterogeneity of stereopsis in amblyopia.

Sensory Eye Dominance: Relationship Between Eye and Brain

Eye dominance refers to the preference to use one eye more than the fellow eye to accomplish a task. However, the dominant eye revealed can be task dependent especially when the tasks are as diverse as instructing the observer to sight a target through a ring, or to report which half-image is perceived more of during binocular rivalry stimulation. Conventionally, the former task is said to reveal motor eye dominance while the latter task reveals sensory eye dominance. While the consensus is that the motor and sensory-dominant eye could be different in some observers, the reason for it is still unclear and has not been much researched. This review mainly focuses on advances made in recent studies of sensory eye dominance. It reviews studies conducted to quantify and relate sensory eye dominance to other visual functions, in particular to stereopsis, as well as studies conducted to explore its plasticity. It is recognized that sensory eye dominance in observers with clinically normal vision shares some similarity with amblyopia at least at the behavioral level, in that both exhibit an imbalance of interocular inhibition. Furthermore, sensory eye dominance is probably manifested at multiple sites along the visual pathway, perhaps including the level of ocular dominance columns. But future studies with high-resolution brain imaging approaches are required to confirm this speculation in the human visual system.

Binocular game versus part-time patching for treatment of anisometropic amblyopia in Chinese children: a randomised clinical trial

AIMS

To compare amblyopic-eye visual acuity (VA) and binocularity improvement of a binocular game with part-time patching in the treatment of Chinese children with anisometropic amblyopia.

METHODS

103 Chinese children aged 3-13 years with anisometropic amblyopia were recruited in a randomised clinical trial. Eligible participants were randomly assigned to the binocular, patching and combined groups. Primary outcome was amblyopic-eye VA improvement at 3 months. Secondary outcomes included reduction of suppression and change of stereoacuity.

RESULTS

Of 85 completed participants, 44 (52%) were women and mean (SD) age was 5.99 (2.33) years. At 3 months, mean (95% CI) amblyopic-eye VA improved 0.18 (0.10-0.26), 0.28 (0.19-0.36) and 0.30 (0.21-0.39) logarithm of the minimum angle of resolution in the binocular, patching and combined groups, respectively. After adjusting for baseline VA, the difference was statistically significant (F=6.29, p=0.003), favouring as follows: the combined group, the patching group and the binocular group. After treatment, Titmus (x² _binocular=9.75, p=0.007; x² _combined=9.35, p=0.009) and dynamic stereoacuity (x² _binocular=12.56, p=0.01; x² _combined=12.66, p=0.01) improved only in the binocular and combined groups. Among groups, only Titmus improvement differed significantly (F=49.55, p<0.001). Changes of other types of stereoacuity and interocular suppression were similar.

CONCLUSIONS

The binocular game used in this study could improve amblyopic-eye VA and binocularity in Chinese children with anisometropic amblyopia, but it was less effective than patching in amblyopic-eye VA improvement and showed no superiority in binocularity over patching. It remains unclear whether the low treatment response of this binocular game was due to limitations of the study or its low treatment effect.

Effect of Interocular Contrast Difference on Stereopsis in Observers With Sensory Eye Dominance

Purpose

We investigated how sensory eye dominance (SED) affects stereopsis when the half-images of random-dot-stereo stimuli had different interocular contrast.

Methods

We measured crossed and uncrossed stereo disparity thresholds and reaction time to seeing random-dot-stereograms with variable interocular contrast differences (ICD), where ICD = (log10 [CLE] - log10 [CRE]) = -0.4, -0.2, 0, 0.2, or 0.4 log unit. The mean contrast of the stimuli, (log10 [CLE] + log10 [CRE])/2, remained constant at 1.2 log unit to ensure that the measured effect was solely due to ICD. We also measured SED using, respectively, dichoptic horizontal sine wave gratings with different phases (revealing SEDcombo) and dichoptic vertical and horizontal gratings (revealing SEDinhibition).

Results

Both measures of SEDinhibition and SEDcombo revealed the observers had the same eye as dominant although the magnitudes differed. The observers had lower stereo thresholds and shorter stereo reaction time on stimuli with unequal interocular contrast when the non-sensory-dominant eye viewed the higher contrast half-image, suggesting a stimulus-compensating effect. We then estimated the ICD of random-dot-stereo half-images (compensating stimuli) that would lead to minimum stereo threshold (SEDstereo-threshold) and reaction time (SEDstereo-RT) based on the stereo performance and ICD relationship, and found that they were significantly smaller than SEDinhibition and SEDcombo.

Conclusions

By linking SEDinhibition and SEDcombo with the effect of ICD on stereopsis, we provided further support for the notion that the stimulus-compensating effect is mediated by the interocular inhibitory and interocular gain control mechanisms. Furthermore, the interocular contrast for SEDstereo-threshold and SEDstereo-RT can be potentially applied for improving stereopsis in individuals with SED.

Psychophysical Tests Do Not Identify Ocular Dominance Consistently

Classical sighting or sensory tests are used in clinical practice to identify the dominant eye. Several psychophysical tests were recently proposed to quantify the magnitude of dominance but whether their results agree was never investigated. We addressed this question for the two most common psychophysical tests: The perceived-phase test, which measures the cyclopean appearance of dichoptically presented sinusoids of different phase, and the coherence-threshold test, which measures interocular differences in motion perception when signal and noise stimuli are presented dichoptically. We also checked for agreement with three classical tests (Worth 4-dot, Randot suppression, and Bagolini lenses). Psychophysical tests were administered in their conventional form and also using more dependable psychophysical methods. The results showed weak correlations between psychophysical measures of strength of dominance with inconsistent identification of the dominant eye across tests: Agreement on left-eye dominance, right-eye dominance, or nondominance by both tests occurred only for 11 of 40 observers (27.5%); the remaining 29 observers were classified differently by each test, including 14 cases (35%) of opposite classification (left-eye dominance by one test and right-eye dominance by the other). Classical tests also yielded conflicting results that did not agree well with classification based on psychophysical tests. The results are discussed in the context of determination of ocular dominance for clinical decisions.

A new counterintuitive training for adult amblyopia

Objectives

The aim of this study was to investigate whether short-term inverse occlusion, combined with moderate physical exercise, could promote the recovery of visual acuity and stereopsis in a group of adult anisometropic amblyopes.

Methods

Ten adult anisometropic patients underwent six brief (2 h) training sessions over a period of 4 weeks. Each training session consisted in the occlusion of the amblyopic eye combined with physical exercise (intermittent cycling on a stationary bike). Visual acuity (measured with ETDRS charts), stereoacuity (measured with the TNO test), and sensory eye dominance (measured with binocular rivalry) were tested before and after each training session, as well as in follow-up visits performed 1 month, 3 months, and 1 year after the end of the training.

Results

After six brief (2 h) training sessions, visual acuity improved in all 10 patients (0.15 ± 0.02 LogMar), and six of them also recovered stereopsis. The improvement was preserved for up to 1 year after training. A pilot experiment suggested that physical activity might play an important role for the recovery of visual acuity and stereopsis.

Conclusions

Our results suggest a noninvasive training strategy for adult human amblyopia based on an inverse-occlusion procedure combined with physical exercise.

On Sensory Eye Dominance Revealed by Binocular Integrative and Binocular Competitive Stimuli

Purpose

Two core processes underlie 3-D binocular vision. The first, a binocular combination/summation process, integrates similar feature signals from the two eye channels to form a binocular representation. The second, a binocular inhibitory process, suppresses interocular conflicting signals or falsely matched binocular representations to establish single vision. Having an intrinsic interocular imbalance within one or both processes can cause sensory eye dominance (SED), related to imbalances of combination (SEDcombo) and/or inhibition (SEDinhibition). While much has recently been revealed about SEDcombo and SEDinhibition, the relationship between them is still unknown.

Methods

We measured observers' foveal SEDcombo and SEDinhibition, respectively, with a pair of dichoptic horizontal sine wave gratings with different phases and binocular rivalry stimulus with vertical and horizontal gratings. We then measured horizontal and vertical monocular contrast thresholds using sinusoidal grating stimuli, and stereo thresholds using random-dot stereograms.

Results

There exists a strong correlation between SEDcombo and SEDinhibition. An observer's interocular difference in contrast threshold was not always consistent with his/her SEDcombo and SEDinhihition, suggesting a partial binocular origin for the underlying imbalances. We also found stereo thresholds significantly increased with the magnitudes of SEDcombo, as well as with the magnitude of SEDinhibition.

Conclusions

Our findings suggest a common origin for interocular imbalance in the two different binocular processes and that both types of sensory eye dominance are significant factors in impeding stereopsis.

Home use of binocular dichoptic video content device for treatment of amblyopia: a pilot study

PURPOSE

To evaluate the efficacy of the BinoVision home system as measured by improvement of visual acuity in the patient's amblyopic eye.

METHODS

An open-label prospective pilot-trial of the system was conducted with amblyopic children aged 4-8 years at the pediatric ophthalmology unit, Tel-Aviv Medical Center, January 2014 to October 2015. Participants were assigned to the study or sham group for treatment with BinoVision for 8 or 12 weeks. Patients were instructed to watch animated television shows and videos at home using the BinoVision device for 60 minutes, 6 days a week. The BinoVision program incorporates elements at different contrast and brightness levels for both eyes, weak eye tracking training by superimposed screen images, and weak eye flicker stimuli with alerting sound manipulations. Patients were examined at 4, 8, 12, 24, and 36 weeks.

RESULTS

A total of 27 children were recruited (14 boys), with 19 in the treatment group. Median age was 5 years (range, 4-8 years). Mean visual acuity improved by 0.26 logMAR lines in the treatment group from baseline to 12 weeks. Visual acuity was improved compared to baseline during all study and follow-up appointments (P < 0.01), with stabilization of visual acuity after cessation of treatment. The sham group completed 4 weeks of sham protocol with no change in visual acuity (P = 0.285). The average compliance rate was 88% ± 16% (50% to 100%) in treatment group.

CONCLUSIONS

This pilot trial of 12 weeks of amblyopia treatment with the BinoVision home system demonstrated significant improvement in patients' visual acuity.

Individual differences in sensory eye dominance reflected in the dynamics of binocular rivalry

Normal binocular vision emerges from the combination of neural signals arising within separate monocular pathways. It is natural to wonder whether both eyes contribute equally to the unified cyclopean impression we ordinarily experience. Binocular rivalry, which occurs when the inputs to the two eyes are markedly different, affords a useful means for quantifying the balance of influence exerted by the eyes (called sensory eye dominance, SED) and for relating that degree of balance to other aspects of binocular visual function. However, the precise ways in which binocular rivalry dynamics change when the eyes are unbalanced remain uncharted. Relying on widespread individual variability in the relative predominance of the two eyes as demonstrated in previous studies, we found that an observer's overall tendency to see one eye more than the other was driven both by differences in the relative duration and frequency of instances of that eye's perceptual dominance. Specifically, larger imbalances between the eyes were associated with longer and more frequent periods of exclusive dominance for the stronger eye. Increases in occurrences of dominant eye percepts were mediated in part by a tendency to experience "return transitions" to the predominant eye - that is, observers often experienced sequential exclusive percepts of the dominant eye's image with an intervening mixed percept. Together, these results indicate that the often-observed imbalances between the eyes during binocular rivalry reflect true differences in sensory processing, a finding that has implications for our understanding of the mechanisms underlying binocular vision in general.

The Best of Both Worlds: Adaptation During Natural Tasks Produces Long-Lasting Plasticity in Perceptual Ocular Dominance

In human vision, one eye is usually stronger than the other. This is called ocular dominance. Extremely imbalanced ocular dominance can be found among certain patient groups, for example, in patients with amblyopia. Here, we introduce a novel method to rebalance ocular dominance. We developed an altered-reality system that subjects used to interact with the natural world, the appearance of which was changed through a real-time image process. Several daily adaptation sessions lasting 3 hr each reduced sensory ocular dominance in adults who were not diagnosed with amblyopia and improved vision in patients with amblyopia. Surprising additional strengthening was found over the subsequent 2 months, when subjects experienced natural vision only. Our method effectively trains subjects to use both eyes in the wide variety of everyday tasks. The transfer of this training to everyday vision likely produced the continuing growth in effects during the months after the training. These findings are promising for the application of this method in future clinical research on amblyopia.

Persistent Biases in Binocular Rivalry Dynamics within the Visual Field

Binocular rivalry is an important tool for measuring sensory eye dominance-the relative strength of sensory processing in an individual's left and right eye. By dichoptically presenting images that lack corresponding visual features, one can induce perceptual alternations and measure the relative visibility of each eye's image. Previous results indicate that observers demonstrate reliable preferences for several image features, and that these biases vary within the visual field. However, evidence about the persistence of these biases is mixed, with some suggesting they affect only the onset (i.e., first second) of rivalry, and others suggesting lasting effects during prolonged viewing. We directly investigated individuals' rivalry biases for eye and color within the visual field and interestingly found results that mirrored the somewhat contradictory pattern in the literature. Each observer demonstrated idiosyncratic patterns of biases for both color and eye within the visual field, but consistent, prolonged biases only for the eye of presentation (sensory eye dominance, SED). Furthermore, the strength of eye biases predicted one's performance on a stereoacuity task. This finding supports the idea that binocular rivalry and other binocular visual functions m ay rely on shared mechanisms, and emphasizes the importance of SED as a measure of binocular vision.

Neuroimaging Evidence for 2 Types of Plasticity in Association with Visual Perceptual Learning

Visual perceptual learning (VPL) is long-term performance improvement as a result of perceptual experience. It is unclear whether VPL is associated with refinement in representations of the trained feature (feature-based plasticity), improvement in processing of the trained task (task-based plasticity), or both. Here, we provide empirical evidence that VPL of motion detection is associated with both types of plasticity which occur predominantly in different brain areas. Before and after training on a motion detection task, subjects' neural responses to the trained motion stimuli were measured using functional magnetic resonance imaging. In V3A, significant response changes after training were observed specifically to the trained motion stimulus but independently of whether subjects performed the trained task. This suggests that the response changes in V3A represent feature-based plasticity in VPL of motion detection. In V1 and the intraparietal sulcus, significant response changes were found only when subjects performed the trained task on the trained motion stimulus. This suggests that the response changes in these areas reflect task-based plasticity. These results collectively suggest that VPL of motion detection is associated with the 2 types of plasticity, which occur in different areas and therefore have separate mechanisms at least to some degree.

Training of binocular rivalry suppression suggests stimulus-specific plasticity in monocular and binocular visual areas

The plasticity of the human brain, as shown in perceptual learning, is generally reflected by improved task performance after training. Here, we show that perceptual suppression can be increased through training. In the first experiment, binocular rivalry suppression of a specific orientation was trained, leading to a relative reduction in sensitivity to the trained orientation. In a second experiment, two orthogonal orientations were suppressed in alternating training blocks, in the left and right eye, respectively. This double-training procedure lead to reduced sensitivity for the orientation that was suppression-trained in each specific eye, implying that training of feature suppression is specific for the eye in which the oriented grating was presented during training. Results of a control experiment indicate that the obtained effects are indeed due to suppression during training, instead of being merely due to the repetitive presentation of the oriented gratings. Visual plasticity is essential for a person's visual development. The finding that plasticity can result in increased perceptual suppression reported here may prove to be significant in understanding human visual development. It emphasizes that for stable vision, not only the enhancement of relevant signals is crucial, but also the reliable and stable suppression of (task) irrelevant signals.

Space perception of strabismic observers in the real world environment

PURPOSE

Space perception beyond the near distance range (>2 m) is important for target localization, and for directing and guiding a variety of daily activities, including driving and walking. However, it is unclear whether the absolute (egocentric) localization of a single target in the intermediate distance range requires binocular vision, and if so, whether having subnormal stereopsis in strabismus impairs one's ability to localize the target.

METHODS

We investigated this by measuring the perceived absolute location of a target by observers with normal binocular vision (n = 8; mean age, 24.5 years) and observers with strabismus (n = 8; mean age, 24.9 years) under monocular and binocular conditions. The observers used the blind walking-gesturing task to indicate the judged location of a target located at various viewing distances (2.73-6.93 m) and heights (0, 30, and 90 cm) above the floor. Near stereopsis was assessed with the Randot Stereotest.

RESULTS

Both groups of observers accurately judged the absolute distance of the target on the ground (height = 0 cm) either with monocular or binocular viewing. However, when the target was suspended in midair, the normal observers accurately judged target location with binocular viewing, but not with monocular viewing (mean slant angle, 0.8° ± 0.5° vs. 7.4° ± 1.4°; P < 0.001, with a slant angle of 0° representing accurate localization). In contrast, the strabismic observers with poorer stereo acuity made larger errors in target localization in both viewing conditions, though with fewer errors during binocular viewing (mean slant angle, 2.7° ± 0.4° vs. 9.2° ± 1.3°; P < 0.0025). Further analysis reveals the localization error, that is, slant angle, correlates positively with stereo threshold during binocular viewing (r(2) = 0.479, P < 0.005), but not during monocular viewing (r(2) = 0.0002, P = 0.963).

CONCLUSIONS

Locating a single target on the ground is sufficient with monocular depth information, but binocular depth information is required when the target is suspended in midair. Since the absolute binocular disparity information of the single target is weak beyond 2 m, we suggest the visual system localizes the single target using the relative binocular disparity information between the midair target and the visible ground surface. Consequently, strabismic observers with residual stereopsis localize a target more accurately than their counterparts without stereo ability.

Interocular Shift of Visual Attention Enhances Stereopsis and Visual Acuities of Anisometropic Amblyopes beyond the Critical Period of Visual Development: A Novel Approach

Aims. Increasing evidence shows that imbalanced suppressive drive prior to binocular combination may be the key factor in amblyopia. We described a novel binocular approach, interocular shift of visual attention (ISVA), for treatment of amblyopia in adult patients. Methods. Visual stimuli were presented anaglyphically on a computer screen. A square target resembling Landolt C had 2 openings, one in red and one in cyan color. Through blue-red goggles, each eye could only see one of the two openings. The patient was required to report the location of the opening presented to the amblyopic eye. It started at an opening size of 800 sec of arc, went up and down in 160 sec of arc step, and stopped when reaching the 5th reversals. Ten patients with anisometropic amblyopia older than age 14 (average age: 26.7) were recruited and received ISVA treatment for 6 weeks, with 2 training sessions per day. Results. Both Titmus stereopsis (z = -2.809, P = 0.005) and Random-dot stereopsis (z = -2.317, P = 0.018) were significantly improved. Average improvement in best corrected visual acuity (BCVA) was 0.74 line (t = 5.842, P < 0.001). Conclusions. The ISVA treatment may be effective in treating amblyopia and restoring stereoscopic function.

Age-related declines of stability in visual perceptual learning

One of the biggest questions in learning is how a system can resolve the plasticity and stability dilemma. Specifically, the learning system needs to have not only a high capability of learning new items (plasticity) but also a high stability to retain important items or processing in the system by preventing unimportant or irrelevant information from being learned. This dilemma should hold true for visual perceptual learning (VPL), which is defined as a long-term increase in performance on a visual task as a result of visual experience. Although it is well known that aging influences learning, the effect of aging on the stability and plasticity of the visual system is unclear. To address the question, we asked older and younger adults to perform a task while a task-irrelevant feature was merely exposed. We found that older individuals learned the task-irrelevant features that younger individuals did not learn, both the features that were sufficiently strong for younger individuals to suppress and the features that were too weak for younger individuals to learn. At the same time, there was no plasticity reduction in older individuals within the task tested. These results suggest that the older visual system is less stable to unimportant information than the younger visual system. A learning problem with older individuals may be due to a decrease in stability rather than a decrease in plasticity, at least in VPL.

A 1-Year Review of Amblyopia and Strabismus Research

PURPOSE

This current review highlights some of the literature published in the past year from April 2013 to May 2014.

DESIGN

Literature Review.

METHODS

The present review is based on an extended search for pertinent articles on amblyopia and strabismus published during the specified period.

RESULTS

Many articles are often not very comparable to one another because of a lack of randomized clinical trials with most of the studies being retrospective in nature. There is often disagreement on some terminology. Typically, the definition of binocular vision is rarely related to the tests used for evaluating it.

CONCLUSIONS

The authors conclude that adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment, but also for social anxiety levels that may be associated with improvements in their quality of life and disability levels.

Perceptual learning: toward a comprehensive theory

Visual perceptual learning (VPL) is long-term performance increase resulting from visual perceptual experience. Task-relevant VPL of a feature results from training of a task on the feature relevant to the task. Task-irrelevant VPL arises as a result of exposure to the feature irrelevant to the trained task. At least two serious problems exist. First, there is the controversy over which stage of information processing is changed in association with task-relevant VPL. Second, no model has ever explained both task-relevant and task-irrelevant VPL. Here we propose a dual plasticity model in which feature-based plasticity is a change in a representation of the learned feature, and task-based plasticity is a change in processing of the trained task. Although the two types of plasticity underlie task-relevant VPL, only feature-based plasticity underlies task-irrelevant VPL. This model provides a new comprehensive framework in which apparently contradictory results could be explained.

Two-stage model in perceptual learning: toward a unified theory

Training or exposure to a visual feature leads to a long-term improvement in performance on visual tasks that employ this feature. Such performance improvements and the processes that govern them are called visual perceptual learning (VPL). As an ever greater volume of research accumulates in the field, we have reached a point where a unifying model of VPL should be sought. A new wave of research findings has exposed diverging results along three major directions in VPL: specificity versus generalization of VPL, lower versus higher brain locus of VPL, and task-relevant versus task-irrelevant VPL. In this review, we propose a new theoretical model that suggests the involvement of two different stages in VPL: a low-level, stimulus-driven stage, and a higher-level stage dominated by task demands. If experimentally verified, this model would not only constructively unify the current divergent results in the VPL field, but would also lead to a significantly better understanding of visual plasticity, which may, in turn, lead to interventions to ameliorate diseases affecting vision and other pathological or age-related visual and nonvisual declines.

A push-pull treatment for strengthening the 'lazy eye' in amblyopia

Almost all individuals exhibit sensory eye dominance, one neural basis of which is unequal interocular inhibition. Sensory eye dominance can impair binocular functions that depend on both excitatory and inhibitory mechanisms. We developed a 'push-pull' perceptual learning protocol that simultaneously affects the excitatory and inhibitory networks to reduce sensory eye dominance and improve stereopsis in adults with otherwise normal vision. The push-pull protocol provides a promising clinical paradigm for treating the extreme sensory eye dominance in amblyopia ('lazy eye'). The prevailing standard of care does not directly treat sensory eye dominance; instead, selected excitatory functions in the amblyopic eye are stimulated while the strong eye is patched, on the assumption that recovery of the weak eye's excitatory functions rebalances the eyes. Patching the strong eye does not directly address interocular inhibition; in contrast, the push-pull protocol by design excites the weak eye, while completely inhibiting the strong eye's perception to recalibrate the interocular balance of excitatory and inhibitory interactions. Here, we show that three adult amblyopes who trained on the push-pull protocol gained longstanding improvements in interocular balance and stereopsis. Our findings provide a proof-of-concept and evidence that push-pull learning leads to long-term plasticity.

Response feedback triggers long-term consolidation of perceptual learning independently of performance gains

Visual perceptual learning (VPL) is defined as a long-term performance enhancement on a visual task, and is typically thought of as a manifestation of plasticity in visual processing. It is thought that neural representations relevant to a recently learned task are consolidated over the course of hours or days and made robust against the effects of deterioration and interference. However, recent work has shown that when these representations are reactivated by further task exposure, they become plastic again and are vulnerable to deterioration effects. Here we used a perceptual learning paradigm in combination with performance feedback (knowledge of task accuracy provided to the observer in real-time) to investigate behavioral factors that influence consolidation. Subjects were trained to detect two coherent motion directions embedded in noise over several days. It was found that without feedback, performance improvements accrued during training rapidly deteriorated upon exposure to novel, neighboring motion directions. However, when one of the two directions was consistently paired with feedback during training, the paired direction was resilient against the effects of deterioration. This benefit coincides with a gradual inhibition of learning for the unpaired stimuli. Furthermore, this stabilizing effect operates independently of the magnitude of performance gains during training and suggests a useful behavioral marker for the study of consolidation processes.

Further support for the importance of the suppressive signal (pull) during the push-pull perceptual training

We previously designed a push-pull perceptual training protocol that effectively reduces sensory eye dominance (SED) and enhances binocular depth detection in human adults (Xu, He, & Ooi, 2010a). During the training, an attention cue precedes a pair of binocular competitive stimulus to induce dominance of the weak eye and suppression of the strong eye. To verify that the success of the protocol is due to the suppression of the signals evoked by the stimulus in the strong eye, rather than to the attention cueing per se, we employed two new push-pull training protocols that did not involve attention cueing. Instead, we used the specific configurations of the boundary contours of the binocular competitive stimulus to render the strong eye suppressed. The first, MBC push-pull protocol has a half-image with grating feature but no boundary contour in the strong eye. The second, BBC push-pull protocol has a half-image with both grating feature and boundary contour in the strong eye. For both protocols, the weak eye receives a half-image with strong grating feature and boundary contour. These boundary contour configurations ensure that the weak eye remains dominant while the strong eye is suppressed during training. Each observer was trained with both protocols at two parafoveal (2°) retinal locations. We found that both protocols significantly reduce SED and binocular depth threshold. This confirms the basis of the push-pull protocol is the suppression of the strong eye, rather than the attention cueing per se. We further found that the learning effect (SED reduction) is more effective in the BBC push-pull protocol where the suppressed half-image in the strong eye carries both grating feature and boundary contour information, than in the MBC push-pull protocol where the boundary contour information is absent from the strong eye's half-image. This suggests that the learning effect depends in part on the availability of the image attributes for processing (suppression) during the push-pull perceptual training.

Understanding attentional modulation of binocular rivalry: a framework based on biased competition

Starting from early scientific explorations of binocular rivalry, researchers have wondered about the degree to which an observer can exert voluntary attentional control over rivalry dynamics. The answer to this question would not only reveal the extent to which we may determine our own conscious visual experience, but also advance our understanding of the neural mechanisms underlying binocular rivalry. Classic studies, intriguingly, reached contradictory conclusions, ranging from an absence of attentional control, as advocated by Breese, to nearly complete control of rivalry dynamics, as reported by Helmholtz. Recent investigations have revisited this question, but the results have continued to echo the conflicting findings of earlier studies, seemingly precluding a comprehensive understanding of attentional effects on rivalry. Here, we review both classic and modern studies, and propose a unifying framework derived from the biased competition theory of attention. The key assumption of this theory is that the nature of stimulus conflict determines the limits of attentional modulation. For example, a condition in which unresolved stimulus conflict transpires through many levels of visual processing should be very susceptible to attentional control. When applied to binocular rivalry, this framework predicts strong attentional modulations under conditions of unresolved stimulus conflict (e.g., initial selection) and conditions where conflict is resolved at higher levels of visual processing (e.g., stimulus rivalry). Additionally, the efficacy of attentional control over rivalry can be increased by utilization of demanding, behaviorally relevant tasks, and likely through perceptual training paradigms. We show that this framework can help facilitate the understanding and synthesis of a diverse set of results on attentional control over rivalry, and we propose several directions for future research on this interesting topic.

A binocular perimetry study of the causes and implications of sensory eye dominance

Sensory eye dominance (SED) reflects an imbalance of interocular inhibition in the binocular network. Extending an earlier work (Ooi & He, 2001) that measured global SED within the central 6°, the current study measured SED locally at 17 locations within the central 8° of the binocular visual field. The eccentricities (radius) chosen for this, "binocular perimetry", study were 0° (fovea), 2° and 4°. At each eccentricity, eight concentric locations (polar angle: 0°, 45°, 90°, 135°, 180°, 225°, 270°, and 315°) were tested. The outcome, an SED map, sets up comparison between local SED and other visual functions [monocular contrast threshold, binocular disparity threshold, reaction time to detect depth, the dynamics of binocular rivalry and motor eye dominance]. Our analysis shows that an observer's SED varies gradually across the binocular visual field both in its sign and magnitude. The strong eye channel revealed in the SED measurement does not always have a lower monocular contrast threshold, and does not need to be the motor dominant eye. There exists significant correlation between SED and binocular disparity threshold, and between SED and the response time to detect depth of a random-dot stereogram. A significant correlation is also found between SED and the eye that predominates when viewing an extended duration binocular rivalry stimulus. While it is difficult to attribute casual factors based on correlation analyses, these observations agree with the notion that an imbalance of interocular inhibition, which is largely revealed as SED, is a significant factor impeding binocular visual perception.

Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision

Stereopsis, the perception of depth based on the disparity of the images projected to the retinas of the two eyes, is an important process in our three-dimensional world; however, 3-5% of the population is stereoblind or has seriously impaired stereovision. Here we provide evidence for the recovery of stereopsis through perceptual learning, the repetitive practice of a demanding visual task, in human adults long deprived of normal binocular vision. We used a training paradigm that combines monocular cues that were correlated perfectly with the disparity cues. Following perceptual learning (thousands of trials) with stereoscopic gratings, five adults who initially were stereoblind or stereoanomalous showed substantial recovery of stereopsis, both on psychophysical tests with stimuli that contained no monocular cues and on clinical testing. They reported that depth "popped out" in daily life, and enjoyed 3D movies for the first time. After training, stereo tests with dynamic random-dot stereograms and band-pass noise revealed the properties of the recovered stereopsis: It has reduced resolution and precision, although it is based on perceiving depth by detecting binocular disparity. We conclude that some human adults deprived of normal binocular vision can recover stereopsis at least partially.

Push-pull training reduces foveal sensory eye dominance within the early visual channels

A push-pull training protocol is applied to reduce sensory eye dominance in the foveal region. The training protocol consists of cueing the weak eye to force it to become dominant while the strong eye is suppressed when a pair of dichoptic orthogonal grating stimulus is subsequently presented to it (Ooi & He, 1999). We trained with four pairs of dichoptic orthogonal gratings (0°/90°, 90°/0°, 45°/135° and 135°/45° at 3cpd) to affect the interocular inhibitory interaction tuned to the four trained orientations (0°, 45°, 90° and 135°). After a 10-day training session, we found a significant learning effect (reduced sensory eye dominance) at the trained orientations as well as at two other untrained orientations (22.5° and 67.5°). This suggests that the four pairs of oriented training stimuli are sufficient to produce a learning effect at any other orientation. The nearly complete transfer of the learning effect across orientation is attributed to the fact that the trained and untrained orientations are close enough to fall in the same orientation tuning function of the early visual cortical neurons (∼37.5°). Applying the same notion of transfer of learning within the same feature channel, we also found a large transfer effect to an untrained spatial frequency (6cpd), which is 1 octave higher than the trained spatial frequency (3cpd). Furthermore, we found that stereopsis is improved, as is the competitive ability between the two eyes, after the push-pull training. Our data analysis suggests that these improvements are correlated with the reduced sensory eye dominance after the training, i.e., due to a more balanced interocular inhibition. We also found that the learning effect (reduced SED and stereo threshold) can be retained for more than a year after the termination of the push-pull training.

Perceptual learning to reduce sensory eye dominance beyond the focus of top-down visual attention

Perceptual learning is an important means for the brain to maintain its agility in a dynamic environment. Top-down focal attention, which selects task-relevant stimuli against competing ones in the background, is known to control and select what is learned in adults. Still unknown, is whether the adult brain is able to learn highly visible information beyond the focus of top-down attention. If it is, we should be able to reveal a purely stimulus-driven perceptual learning occurring in functions that are largely determined by the early cortical level, where top-down attention modulation is weak. Such an automatic, stimulus-driven learning mechanism is commonly assumed to operate only in the juvenile brain. We performed perceptual training to reduce sensory eye dominance (SED), a function that taps on the eye-of-origin information represented in the early visual cortex. Two retinal locations were simultaneously stimulated with suprathreshold, dichoptic orthogonal gratings. At each location, monocular cueing triggered perception of the grating images of the weak eye and suppression of the strong eye. Observers attended only to one location and performed orientation discrimination of the gratings seen by the weak eye, while ignoring the highly visible gratings at the second, unattended, location. We found SED was not only reduced at the attended location, but also at the unattended location. Furthermore, other untrained visual functions mediated by higher cortical levels improved. An automatic, stimulus-driven learning mechanism causes synaptic alterations in the early cortical level, with a far-reaching impact on the later cortical levels.