Amblyopia: Out of the Dark, Into the Light

Plasticity of the visual cortex and treatment of amblyopia

Over the last 50 years, research into the developmental plasticity of the visual cortex has led to a growing understanding of first the causes and then of the underlying cellular mechanisms of amblyopia or 'lazy eye', the commonest childhood disorder of vision. While it is widely believed that amblyopia cannot be treated successfully after the age of about 7, recent animal studies have demonstrated that visual cortex plasticity can be restored or enhanced later in life, paving the way for new strategies for the treatment of amblyopia that attempt to remove molecular brakes on plasticity. In addition, both animal and human work has established that amblyopia is not simply a monocular deficit, and therefore the most promising new non-invasive approaches force the two eyes to cooperate as opposed to conventional procedures that severely penalise the good eye.

Visual system plasticity in mammals: the story of monocular enucleation-induced vision loss

The groundbreaking work of Hubel and Wiesel in the 1960’s on ocular dominance plasticity instigated many studies of the visual system of mammals, enriching our understanding of how the development of its structure and function depends on high quality visual input through both eyes. These studies have mainly employed lid suturing, dark rearing and eye patching applied to different species to reduce or impair visual input, and have created extensive knowledge on binocular vision. However, not all aspects and types of plasticity in the visual cortex have been covered in full detail. In that regard, a more drastic deprivation method like enucleation, leading to complete vision loss appears useful as it has more widespread effects on the afferent visual pathway and even on non-visual brain regions. One-eyed vision due to monocular enucleation (ME) profoundly affects the contralateral retinorecipient subcortical and cortical structures thereby creating a powerful means to investigate cortical plasticity phenomena in which binocular competition has no vote.In this review, we will present current knowledge about the specific application of ME as an experimental tool to study visual and cross-modal brain plasticity and compare early postnatal stages up into adulthood. The structural and physiological consequences of this type of extensive sensory loss as documented and studied in several animal species and human patients will be discussed. We will summarize how ME studies have been instrumental to our current understanding of the differentiation of sensory systems and how the structure and function of cortical circuits in mammals are shaped in response to such an extensive alteration in experience. In conclusion, we will highlight future perspectives and the clinical relevance of adding ME to the list of more longstanding deprivation models in visual system research.