Crowding between first- and second-order letters in amblyopia

Stimuli Characteristics and Psychophysical Requirements for Visual Training in Amblyopia: A Narrative Review

Active vision therapy using perceptual learning and/or dichoptic or binocular environments has shown its potential effectiveness in amblyopia, but some doubts remain about the type of stimuli and the mode and sequence of presentation that should be used. A search was performed in PubMed, obtaining 143 articles with information related to the stimuli used in amblyopia rehabilitation, as well as to the neural mechanisms implied in such therapeutic process. Visual deficits in amblyopia and their neural mechanisms associated are revised, including visual acuity loss, contrast sensitivity reduction and stereopsis impairment. Likewise, the most appropriate stimuli according to the literature that should be used for an efficient rehabilitation of the amblyopic eye are described in detail, including optotypes, Gabor’s patches, random-dot stimuli and Vernier’s stimuli. Finally, the properties of these stimuli that can be modified during the visual training are discussed, as well as the psychophysical method of their presentation and the type of environment used (perceptual learning, dichoptic stimulation or virtual reality). Vision therapy using all these revised concepts can be an effective option for treating amblyopia or accelerating the treatment period when combining with patching. It is essential to adapt the stimuli to the patient’s individual features in both monocular and binocular training.

Foveal visual acuity is worse and shows stronger contour interaction effects for contrast-modulated than luminance-modulated Cs

Contrast-modulated (CM) stimuli are processed by spatial mechanisms that operate at larger spatial scales than those processing luminance-modulated (LM) stimuli and may be more prone to deficits in developing, amblyopic, and aging visual systems. Understanding neural mechanisms of contour interaction or crowding will help in detecting disorders of spatial vision. In this study, contour interaction effects on visual acuity for LM and CM C and bar stimuli are assessed in normal foveal vision. In Experiment 1, visual acuity is measured for all-LM and all-CM stimuli, at ~3.5× above their respective modulation thresholds. In Experiment 2, visual acuity is measured for Cs and bars of different type (LM C with CM bars and vice versa). Visual acuity is degraded for CM compared with LM Cs (0.46 ± 0.04 logMAR vs. 0.18 ± 0.04 logMAR). With nearby bars, CM acuity is degraded further (0.23 ± 0.01 logMAR or ~2 lines on an acuity chart), significantly more than LM acuity (0.11 ± 0.01 logMAR, ~1 line). Contour interaction for CM stimuli extends over greater distances (arcmin) than it does for LM stimuli, but extents are similar with respect to acuities (~3.5× the C gap width). Contour interaction is evident when the Cs and bars are defined differently: it is stronger when an LM C is flanked by CM bars (0.17 ± 0.03 logMAR) than when a CM C is flanked by LM bars (0.08 ± 0.02 logMAR). Our results suggest that contour interaction for foveally viewed acuity stimuli involves feature integration, such that the outputs of receptive fields representing Cs and bars are combined. Contour interaction operates at LM and CM representational stages, it can occur across stage, and it is enhanced at the CM stage. Greater contour interaction for CM Cs and bars could hold value for visual acuity testing and earlier diagnosis of conditions for which crowding is important, such as in amblyopia.

Low-level processing deficits underlying poor contrast sensitivity for moving plaids in anisometropic amblyopia

Many studies using random dot kinematograms have indicated a global motion processing deficit originated from extrastriate cortex, specifically middle temporal area (MT) and media superior temporal area (MST), in patients with amblyopia. However, the nature of this deficit remains unclear. To explore whether the ability of motion integration is impaired in amblyopia, contrast sensitivity for moving plaids and their corresponding component gratings were measured over a range of stimulus durations and spatial and temporal frequencies in 10 control subjects and 13 anisometropic amblyopes by using a motion direction discrimination task. The results indicated a significant loss of contrast sensitivity for moving plaids as well as for moving gratings at intermediate and high spatial frequencies in amblyopic eyes (AEs). Additionally, we found that the loss of contrast sensitivity for moving plaids was statistically equivalent to that for moving component gratings in AEs, that is, the former could be almost completely accounted for by the latter. These results suggest that the integration of motion information conveyed by component gratings of moving plaids may be intact in anisometropic amblyopia, and that the apparent deficits in contrast sensitivity for moving plaids in anisometropic amblyopia can be almost completely attributed to those for gratings, that is, low-level processing deficits.