Peripheral contrast sensitivity and attention in myopia

Meridional Attentional Asymmetries in Astigmatic Eyes

Purpose

To investigate the impact of attention orientation in young myopic adults with astigmatism.

Methods

The effect of attention on foveal meridional performance and anisotropy was measured in corrected myopes with various levels of astigmatism (with-the-rule astigmatism ≤ -0.75D, Axis: 180 ± 20) using orientation-based attention. Attention was manipulated by instructing subjects to attend to either the horizontal or the vertical line of a central pre-stimulus (a pulsed cross) along separate blocks of trials. For each attention condition, meridional acuity and reaction times were measured via an annulus Gabor target situated remotely from the cross and presented at random horizontally and vertically in a two-alternative forced-choice employing two interleaved staircase procedures (one-up/one-down). Attention modulations were estimated by the difference in performance between horizontal and vertical attention.

Results

Foveal meridional performance and anisotropy were strongly affected by the orientation of attention, which appeared critical for the enhancement of reaction times and resolution. Under congruent orienting of attention, foveal meridional anisotropy was correlated with the amount of defocus for both reaction time and resolution, demonstrating greater vertical performance than horizontal performance as myopia increased. Compatible with an attentional compensation of blur through optimal orienting of attention, vertical attention enhanced reaction times compared to horizontal attention and was accompanied by an increase in overall acuity when myopia increased. Increased astigmatism was associated with smaller attention effects and asymmetry, suggesting potential deficits in the compensation of blur in astigmatic eyes.

Conclusion

Collectively, attention to orientation plays a significant role in horizontal-vertical foveal meridional anisotropy and can modulate the asymmetry of foveal perception imposed by the optics of the eye in episodes of uncorrected vision. Further work is necessary to understand how attention and refractive errors interact during visual development. These results may have practical implications for methods to enhance vision with attention training in myopic astigmats.

Assessing the contrast sensitivity function in myopic parafovea: A quick contrast sensitivity functions study

Purpose

Compare peripheral contrast sensitivity functions (CSF) between myopes and emmetropes to reveal potential myogenic risks during emmetropization.

Materials and methods

This observational, cross-sectional, non-consecutive case study included data from 19 myopes (23.42 ± 4.03 years old) and 12 emmetropes (22.93 ± 2.91 years old) who underwent central and peripheral quick CSF (qCSF) measurements. Summary CSF metrics including the cut-off spatial frequency (cut-off SF), area under log CSF (AULCSF), low-, intermediate-, and high-spatial-frequency AULCSFs (l-, i-, and h-SF AULCSFs), and log CS at 19 SFs in the fovea and 15 peripheral locations (superior, inferior, temporal, and nasal quadrants at 6, 12, 18, and 24° eccentricities, excluding the physiological scotoma at 18°) were analyzed with 3-way and 4-way between-subjects analysis of variance (ANOVA) (α = 0.05).

Results

Three-way ANOVA showed that myopes had significantly increased AULCSF at 6° (mean difference, 0.08; 95% CI, 0.02–0.13; P = 0.007) and 12° (mean difference, 0.09; 95% CI, 0.03–0.14; P = 0.003). Log CS at all 19 SFs were higher in the myopia group compared to the normal group (mean differencesuperior, 0.02; 95% CI, 0.01–0.20; P = 0.02 and mean differenceinferior, 0.11; 95% CI, 0.02–0.21; P = 0.01) at 12°. The h-SF AULCSF at 6° (mean differenceinferior, 1.27; 95% CI, 0.32–2.22; P = 0.009) and i-SF AULCSF at 12° (mean differencesuperior, 5.31; 95% CI, 4.35–6.27; P < 0.001; mean differenceinferior, 1.14; 95% CI, 0.19–2.10; P = 0.02) were higher in myopia vs. normal group.

Conclusion

We found myopia increased contrast sensitivity in superior and inferior visual field locations at 6° parafoveal and 12° perifoveal regions of the retina. The observation of increased contrast sensitivities within the macula visual field in myopia might provide important insights for myopia control during emmetropization.

Do myopes have deficits in peripheral flicker sensitivity?

PURPOSE

Signals from the peripheral retina are important for myopia development. Unlike temporal vision, deficits in peripheral spatial visual functions of myopes have been investigated previously. This study investigated temporal contrast thresholds in emmetropes and myopes at different retinal eccentricities.

METHODS

Forty-four young adults (mean age 23 ± 3 years) including 21 emmetropes (Spherical Equivalent (SE): +0.01 ± 0.30D) and 23 myopes (SE: -3.98 ± 2.41D) participated in this prospective study. Flicker modulation thresholds (FMT) were determined monocularly (right eye) for 15 Hz flicker stimulus at 0°, nasal (23°, 10°) and temporal (-23°, -10°) retinal eccentricities along the horizontal meridian. FMTs were measured psychophysically using 5-adaptive interleaved staircases and threshold was taken as the average of the last 6 reversals.

RESULTS

In both the groups (emmetropes and myopes), there was a naso-temporal asymmetry in FMTs with higher thresholds in the far temporal retina (Median; Interquartile range: 40.97%; 17.06) than the nasal retina (28.07%; 9.36) (p < 0.001). Flicker modulation thresholds were significantly higher in myopes (30.58%; 12.15) compared to emmetropes (26.77%; 7.74; p = 0.04) at far nasal retina (23°), while at other eccentricities there was no effect (p > 0.05). Further sub-analysis revealed only high myopes (34.48 %, 21.9) showed significantly higher FMT compared to emmetropes (26.77%; 7.74; p = 0.04).

CONCLUSION

Greater FMTs were seen in high myopes than that of emmetropes in the nasal retina. Further studies exploring the structural aspects of the myopic eye with FMT would provide a better understanding of role of flicker sensitivity in myopiogenesis.

Short-Term Peripheral Contrast Reduction Affects Central Chromatic and Achromatic Contrast Sensitivity

Peripheral retinal contrast reduction is suggested as a potential myopia control strategy. However, the underlying mechanism is yet unknown. Therefore, this study investigated the influence of peripheral contrast reduction on central chromatic and achromatic contrast sensitivity (CS). A total of 19 participants were included. Peripheral contrast reduction was induced via Bangerter foils of 0.4 and 0.8 density, each with a clear central zone of 8.0 mm diameter. Central achromatic and chromatic (for S-, M-, and L-cone types) CS was measured at 3 and 12 cpd in a 2-IFC psychophysical procedure. CS was tested monocularly at 0, 30, and 90 min of adaptation time, while the fellow eye was covered by an infrared filter. With the filter in place, pupil size was controlled to be smaller than the clear central aperture. Data were analyzed using linear mixed models. Cone-type CS showed significant differences among each other (all p < 0.05), except for the achromatic and L-cone type (p = 0.87). The minimum sensitivity was found with the S-cone type and the maximum with the M-cone type. Central achromatic and chromatic CS were equally affected by diffusion. The level of peripheral diffusion also influenced CS, while the 0.8 Bangerter foil led to a higher reduction in CS compared to the 0.4 Bangerter foil (p = 0.0008) and the control condition (p = 0.05). A significant reduction in CS occurred between 30 and 90 min of adaptation time (p < 0.0001). The current study found that peripheral contrast reduction impacted central achromatic and chromatic CS equally. It further showed that the amplitude of reduction was influenced by the level of diffusion, with the reduction becoming more pronounced over time.

Defective Temporal Window of the Foveal Visual Processing in High Myopia

Purpose

To investigate the temporal characteristics of visual processing at the fovea and the periphery in high myopia.

Methods

Eighteen low (LM, ≤ -0.50 and > -6.00 D) and 18 high myopic (HM, ≤ -6.00 D) participants took part in this study. The contrast thresholds in an orientation discrimination task under various stimulus onset asynchrony (SOA) masking conditions were measured at the fovea and a more peripheral area (7°) for the two groups. An elaborated perceptual template model (ePTM) was fit to the behavioral data for each participant.

Results

An analysis of variance with three factors (SOA, degree of myopia and eccentricity) was performed on the threshold data. The interaction between SOA and degree of myopia in the fovea was significant (F (4, 128) = 2.66, P = 0.036), suggesting that the masking effect had different temporal patterns between the two groups. The temporal profiles for the two groups were derived based on the ePTM model. The peak and the spread of the temporal window in the fovea were much lower and wider, respectively, in the HM group than that in the LM group (both Ps < 0.05). There was no significant difference in the peripheral temporal window between the two groups.

Conclusions

High myopia is associated with defective temporal processing in the fovea, captured by a flattened temporal window.

Is Peripheral Motion Detection Affected by Myopia?

Purpose

The current study was to investigate whether myopia affected peripheral motion detection and whether the potential effect interacted with spatial frequency, motion speed, or eccentricity.

Methods

Seventeen young adults aged 22–26 years participated in the study. They were six low to medium myopes [spherical equivalent refractions −1.0 to −5.0 D (diopter)], five high myopes (<-5.5 D) and six emmetropes (+0.5 to −0.5 D). All myopes were corrected by self-prepared, habitual soft contact lenses. A four-alternative forced-choice task in which the subject was to determine the location of the phase-shifting Gabor from the four quadrants (superior, inferior, nasal, and temporal) of the visual field, was employed. The experiment was blocked by eccentricity (20° and 27°), spatial frequency (0.6, 1.2, 2.4, and 4.0 cycles per degree (c/d) for 20° eccentricity, and 0.6, 1.2, 2.0, and 3.2 c/d for 27° eccentricity), as well as the motion speed [2 and 6 degree per second (d/s)].

Results

Mixed-model analysis of variances showed no significant difference in the thresholds of peripheral motion detection between three refractive groups at either 20° (F[2,14] = 0.145, p = 0.866) or 27° (F[2,14] = 0.475, p = 0.632). At 20°, lower motion detection thresholds were associated with higher myopia (p < 0.05) mostly for low spatial frequency and high-speed targets in the nasal and superior quadrants, and for high spatial frequency and high-speed targets in the temporal quadrant in myopic viewers. Whereas at 27°, no significant correlation was found between the spherical equivalent and the peripheral motion detection threshold under all conditions (all p > 0.1). Spatial frequency, speed, and quadrant of the visual field all showed significant effect on the peripheral motion detection threshold.

Conclusion

There was no significant difference between the three refractive groups in peripheral motion detection. However, lower motion detection thresholds were associated with higher myopia, mostly for low spatial frequency targets, at 20° in myopic viewers.

Contrast sensitivity and visual acuity in subjects wearing multifocal contact lenses with high additions designed for myopia progression control

OBJECTIVES

To assess the visual performance of multifocal contact lenses (MFCLs) with high addition powers designed for myopia control.

METHODS

Twenty-four non-presbyopic adults (mean age 24 years, range 18-36 years) were fitted with soft MFCLs with add powers of +2.0 D (Add2) and +4.0 D (Add4) (RELAX, SwissLens) and single vision lenses (SVCL; Add0) in a counterbalanced order. In this double-masked study, half of the participants were randomly fitted with 3 mm-distance central zone MFCLs while the other half received 4.5 mm-distance central zone MFCLs. Visual acuity was measured at distance (3.0 m) and at near (0.4 m). Central and peripheral contrast sensitivity was evaluated at distance using the Gabor patch test. The area under the logarithmic contrast sensitivity function curve (ALCSF) was calculated and compared between the groups (i.e. different additions powers used).

RESULTS

Near and distance visual acuities were not affected by the lenses, neither Add2 nor Add4, when compared to Add0, however, CZ3 significantly reduced distance visual acuity with Add4 when compared to CZ4.5 (-0.08 logMAR vs. for CZ3 and -0.18 logMAR for CZ4.5, p = 0.013). MFCLs impaired central ALCSF only when Add2 was used (15.99 logCS for Add2 and 16.36 logCS for SVCLs, p = 0.021). Peripheral ALCSF was statistically lower for both addition powers of the MFCLs when compared to SVCLs (12.70 for Add2 and Add4, 13.73 for SVCLs, p = 0.009). The above effects were the same for both central zones used.

CONCLUSIONS

MFCLs with CZ3 diameter and high add power (Add4) slightly reduced distance visual acuity when compared to CZ4.5 but no reduction in this parameter was found with medium add power (Add2). Central contrast sensitivity was impaired only by MFCLs with the lower add power (Add2). Both add powers in the MFCLs reduced peripheral contrast sensitivity to a similar extent.

Refractive error is associated with intracranial volume

Myopia is part of the spectrum of refractive error. Myopia is associated with psychometric intelligence and, the link between brain anatomy and myopia has been hypothesized. Here we aimed to identify the associations between brain structures and refractive error in developed young adults. In a study cohort of 1,319 normal educated young adults, the refractive error showed a significant negative correlation with total intracranial volume and total cerebrospinal fluid (CSF) volume but not with total gray matter volume (GMV) or total white matter volume (WMV). Time spent studying was associated with refractive error but could not explain the aforementioned associations with brain volume parameters. The R² values of the simple regression between spherical equivalent and outcome variables for each sex in non-whole brain imaging analyses were less than 0.05 in all cases and thus were weak. Psychometric intelligence was not associated with refractive error or total CSF volume, but it weakly positively correlated with total GMV and total WMV in this study population. Thus, refractive error appears to be primarily (weakly) associated with the volume of the cranium, whereas psychometric intelligence was associated with the volume of the brain.

[Secondary diseases in high myopia]

BACKGROUND

Eyes with high myopia (axial length ≥ 26.5 mm) do not just have a different size. Due to morphological and structural changes there is a considerably increased risk for many different secondary diseases.

OBJECTIVE

Determination of the incidence and mortality in high myopia, discussion of effects and clinical signs, presentation of treatment recommendations and counselling.

MATERIAL AND METHODS

A systematic search of the literature was carried out and a discussion on basic principles and epidemiological investigations is presented.

RESULTS

Findings due to high myopia are not in a closed state but undergo continuous changes. Choroidal neovascularization (adjusted prevalence 2.5-5%), staphyloma, foveoschisis and peripheral retinal degeneration are examples of problems contributing to the increased rate of visual impairment and blindness related to myopia. High myopia is associated with a clearly increased risk of retinal detachment after lens surgery (hazard ratio 6.1) and particularly more frequently in younger people. The associated primary open-angle glaucoma (odds ratio 2.46) is often recognized too late due to relatively low values of intraocular pressure.

CONCLUSION

Understanding of atrophic areas and staphyloma has benefited from recent advances in imaging (e.g. magnetic resonance imaging, optical coherence tomography and wide-field imaging) that complement and explain histological findings. Knowledge of the associated risk profile is of major clinical relevance.