Lateral interactions in amblyopia

Comparative electrophysiological responses in anisometropic and strabismic amblyopic children

Purpose

To compare anisometropic hypermetropic amblyopic and strabismic amblyopic responses to pattern electroretinogram (PERG) and pattern visual evocated potential (PVEP).

Materials and methods

Fifty-six patients – 18 hypermetropic anisometropic amblyopic children (mean age 9.70±2.5 years), 19 strabismic amblyopic children (mean age 10.30±2.6 years) and 19 normal emetropic subjects (mean age 10.10±2.2 years) – were enrolled in this study. After routine ophthalmic examination, PERG and PVEP were recorded in response to checks reversed at the rate of two reversals/second stimulating macular area.

Results

The difference between hypermetropic anisometropic amblyopia and strabismus amblyopia with respect to P100/P50/N95 wave latencies (P=0.055/0.855/0.132) and P100/P50/N95 amplitudes (P=0.980/0.095/0.045) was not statistically significant. However, there was a significant statistical difference between strabismic amblyopia group and controls for P100/P50/N95 latencies (P=0.000/0.006/0.004).

Conclusion

Our findings indicated that despite clinical differences between anisometropic amblyopic and strabismic amblyopic patients, no differences were found in the responses of PVEP and PERG. The abnormal components of the PVEP and PERG in amblyopic subjects could reflect a retinal dysfunction in the visual pathway.

Developmental visual perception deficits with no indications of prosopagnosia in a child with abnormal eye movements

Visual categories are associated with eccentricity biases in high-order visual cortex: Faces and reading with foveally-biased regions, while common objects and space with mid- and peripherally-biased regions. As face perception and reading are among the most challenging human visual skills, and are often regarded as the peak achievements of a distributed neural network supporting common objects perception, it is unclear why objects, which also rely on foveal vision to be processed, are associated with mid-peripheral rather than with a foveal bias. Here, we studied BN, a 9 y.o. boy who has normal basic-level vision, abnormal (limited) oculomotor pursuit and saccades, and shows developmental object and contour integration deficits but with no indication of prosopagnosia. Although we cannot infer causation from the data presented here, we suggest that normal pursuit and saccades could be critical for the development of contour integration and object perception. While faces and perhaps reading, when fixated upon, take up a small portion of central visual field and require only small eye movements to be properly processed, common objects typically prevail in mid-peripheral visual field and rely on longer-distance voluntary eye movements as saccades to be brought to fixation. While retinal information feeds into early visual cortex in an eccentricity orderly manner, we hypothesize that propagation of non-foveal information to mid and high-order visual cortex critically relies on circuitry involving eye movements. Limited or atypical eye movements, as in the case of BN, may hinder normal information flow to mid-eccentricity biased high-order visual cortex, adversely affecting its development and consequently inducing visual perceptual deficits predominantly for categories associated with these regions.

A double dissociation of the acuity and crowding limits to letter identification, and the promise of improved visual screening

Here, we systematically explore the size and spacing requirements for identifying a letter among other letters. We measure acuity for flanked and unflanked letters, centrally and peripherally, in normals and amblyopes. We find that acuity, overlap masking, and crowding each demand a minimum size or spacing for readable text. Just measuring flanked and unflanked acuity is enough for our proposed model to predict the observer's threshold size and spacing for letters at any eccentricity. We also find that amblyopia in adults retains the character of the childhood condition that caused it. Amblyopia is a developmental neural deficit that can occur as a result of either strabismus or anisometropia in childhood. Peripheral viewing during childhood due to strabismus results in amblyopia that is crowding limited, like peripheral vision. Optical blur of one eye during childhood due to anisometropia without strabismus results in amblyopia that is acuity limited, like blurred vision. Furthermore, we find that the spacing:acuity ratio of flanked and unflanked acuity can distinguish strabismic amblyopia from purely anisometropic amblyopia in nearly perfect agreement with lack of stereopsis. A scatter diagram of threshold spacing versus acuity, one point per patient, for several diagnostic groups, reveals the diagnostic power of flanked acuity testing. These results and two demonstrations indicate that the sensitivity of visual screening tests can be improved by using flankers that are more tightly spaced and letter like. Finally, in concert with Strappini, Pelli, Di Pace, and Martelli (submitted), we jointly report a double dissociation between acuity and crowding. Two clinical conditions-anisometropic amblyopia and apperceptive agnosia-each selectively impair either acuity A or the spacing:acuity ratio S/A, not both. Furthermore, when we specifically estimate crowding, we find a double dissociation between acuity and crowding. Models of human object recognition will need to accommodate this newly discovered independence of acuity and crowding.

Training-induced recovery of low-level vision followed by mid-level perceptual improvements in developmental object and face agnosia

Long-term deprivation of normal visual inputs can cause perceptual impairments at various levels of visual function, from basic visual acuity deficits, through mid-level deficits such as contour integration and motion coherence, to high-level face and object agnosia. Yet it is unclear whether training during adulthood, at a post-developmental stage of the adult visual system, can overcome such developmental impairments. Here, we visually trained LG, a developmental object and face agnosic individual. Prior to training, at the age of 20, LG's basic and mid-level visual functions such as visual acuity, crowding effects, and contour integration were underdeveloped relative to normal adult vision, corresponding to or poorer than those of 5–6 year olds (Gilaie-Dotan, Perry, Bonneh, Malach & Bentin, 2009). Intensive visual training, based on lateral interactions, was applied for a period of 9 months. LG's directly trained but also untrained visual functions such as visual acuity, crowding, binocular stereopsis and also mid-level contour integration improved significantly and reached near-age-level performance, with long-term (over 4 years) persistence. Moreover, mid-level functions that were tested post-training were found to be normal in LG. Some possible subtle improvement was observed in LG's higher-order visual functions such as object recognition and part integration, while LG's face perception skills have not improved thus far. These results suggest that corrective training at a post-developmental stage, even in the adult visual system, can prove effective, and its enduring effects are the basis for a revival of a developmental cascade that can lead to reduced perceptual impairments.

Linking structure and function: development of lateral spatial interactions in macaque monkeys

Lateral spatial interactions among elements of a scene, which either enhance or degrade visual performance, are ubiquitous in vision. The neural mechanisms underlying lateral spatial interactions are a matter of debate, and various hypotheses have been proposed. Suppressive effects may be due to local inhibitory interactions, whereas facilitatory effects are typically ascribed either to the function of long-range horizontal projections in V1 or to uncertainty reduction. We investigated the development of lateral spatial interactions, facilitation and suppression, and compared their developmental profiles to those of potential underlying mechanisms in the visual system of infant macaques. Animals ranging in age from 10 weeks to 3 years were tested with a lateral masking paradigm. We found that suppressive interactions are present from very early in postnatal life, showing no change over the age range tested. However, facilitation develops slowly over the first year after birth. Our data suggest that the early maturation of suppressive interactions is related to the relatively mature receptive field properties of neurons in early visual cortical areas near birth in infant macaques, whereas the later maturation of facilitation is unlikely to be explained by development of local or long-range connectivity in primary visual cortex. Instead our data favor a late developing feedback or top-down cognitive process to explain the origin of facilitation.

Normalization as a canonical neural computation

There is increasing evidence that the brain relies on a set of canonical neural computations, repeating them across brain regions and modalities to apply similar operations to different problems. A promising candidate for such a computation is normalization, in which the responses of neurons are divided by a common factor that typically includes the summed activity of a pool of neurons. Normalization was developed to explain responses in the primary visual cortex and is now thought to operate throughout the visual system, and in many other sensory modalities and brain regions. Normalization may underlie operations such as the representation of odours, the modulatory effects of visual attention, the encoding of value and the integration of multisensory information. Its presence in such a diversity of neural systems in multiple species, from invertebrates to mammals, suggests that it serves as a canonical neural computation.

Treatment of children with amblyopia by perceptual learning

Recent studies have shown that perceptual learning has the potential to treat amblyopia. In this study we tested whether a recent perceptual learning technique that improved visual functions in adults can be applied to improve the vision of children after the conventional treatment of patching has failed. A prospective clinical pilot study was carried out in children who were non-compliant with patching or in whom patching had failed despite good compliance. Each child underwent a complete eye examination before and after treatment. The treatment was based on a perceptual learning technique that was similar to the adult study [Polat, U., Ma-Naim, T., Belkin, M., & Sagi, D. (2004). Improving vision in adult amblyopia by perceptual learning. Proceedings of the National Academy of Sciences of the United States of America, 101(17), 6692-6697]. Between blocks, children played a computer game to engage and maintain their attention in order to increase compliance. Each child received two treatment sessions a week, with a total of not more than 40 sessions. Each session lasted for about 1h and included a total practice time of about 30min. The age of the children (n=5) was between 7 and 8years (mean 7.3years). For the whole group, the average improvement in visual acuity was 1.5 Snellen lines or 2.12 ETDRS lines. The training improved the contrast sensitivity, which reached the normal range after treatment. Thus, the perceptual learning technique can be successfully used to treat children with amblyopia even after the conventional treatment of patching fails.

Making perceptual learning practical to improve visual functions

Task-specific improvement in performance after training is well established. The finding that learning is stimulus-specific and does not transfer well between different stimuli, between stimulus locations in the visual field, or between the two eyes has been used to support the notion that neurons or assemblies of neurons are modified at the earliest stage of cortical processing. However, a debate regarding the proposed mechanism underlying perceptual learning is an ongoing issue. Nevertheless, generalization of a trained task to other functions is an important key, for both understanding the neural mechanisms and the practical value of the training. This manuscript describes a structured perceptual learning method that previously used (amblyopia, myopia) and a novel technique and results that were applied for presbyopia. In general, subjects were trained for contrast detection of Gabor targets under lateral masking conditions. Training improved contrast sensitivity and diminished the lateral suppression when it existed (amblyopia). The improvement was transferred to unrelated functions such as visual acuity. The new results of presbyopia show substantial improvement of the spatial and temporal contrast sensitivity, leading to improved processing speed of target detection as well as reaction time. Consequently, the subjects, who were able to eliminate the need for reading glasses, benefited. Thus, here we show that the transfer of functions indicates that the specificity of improvement in the trained task can be generalized by repetitive practice of target detection, covering a sufficient range of spatial frequencies and orientations, leading to an improvement in unrelated visual functions. Thus, perceptual learning can be a practical method to improve visual functions in people with impaired or blurred vision.

Crowding between first- and second-order letters in amblyopia

To test whether first- and second-order stimuli are processed independently in amblyopic vision, we measured thresholds for identifying a target letter flanked by two letters for all combinations of first- and second-order targets and flankers. We found that (1) the magnitude of crowding is greater for second- than for first-order letters for target and flankers of the same order type; (2) substantial but asymmetric cross-over crowding occurs such that stronger crowding is found for a second-order letter flanked by first-order letters than for the converse; (3) the spatial extent of crowding is independent of the order type of the letters. Our findings are consistent with the hypothesis that crowding results from an abnormal integration of target and flankers beyond the stage of feature detection, which takes place over a large distance in amblyopic vision.

Spatial and temporal crowding in amblyopia

Spatial crowding is a well-known deficit in amblyopia. We have previously reported evidence suggesting that the inability to isolate stimuli in space in crowded displays (spatial crowding) is a largely independent component of the amblyopic deficit in visual acuity, which is typically found in strabismic amblyopia [Bonneh, Y., Sagi, D., & Polat, U. (2004a). Local and non-local deficits in amblyopia: Acuity and spatial interactions. Vision Research, 44, 3009-3110]. Here, we extend this result to the temporal domain by measuring visual acuity (VA) for a single pattern in a rapid serial visual presentation (RSVP-VA, N=15) for fast ("crowded") and slow ("uncrowded") presentations. We found that strabismic amblyopes but not anisometropic amblyopes or normal controls exhibited a significant difference between VA under the fast and slow conditions. We further compared the "temporal crowding" measure to two measures of spatial crowding: (1) static Tumbling-E acuity in multi-pattern crowded displays (N=26) and (2) Gabor alignment with lateral flankers (N=20). We found that all three measures of crowding (one temporal and two spatial) were highly correlated across subjects while being largely independent of the visual acuity for a single isolated pattern, with both spatial and temporal crowding being high and correlated in strabismus and low in anisometropia. This suggests that time and space are related in crowding, at least in amblyopia.

Global contour processing in amblyopia

The purpose of the experiments described here was to investigate global image processing using methods that require global processing while eliminating or compensating for low level abnormalities: visibility, shape perception and positional uncertainty. In order to accomplish this we used a closed figure made up of Gabor patches either in noise or on a blank field. The stimuli were circular or elliptical contours, formed by N equally spaced Gabor patches. We performed two separate experiments: In one experiment we fixed N and varied the aspect ratio using a staircase to determine the threshold aspect ratio; in the second experiment we held the aspect ratio constant (at twice the threshold aspect ratio) and varied N in order to measure the threshold number of elements required to judge the shape. Our results confirm and extend previous studies showing that humans with naturally occurring amblyopia show deficits in contour processing. Our results show that the deficits depend strongly on spatial scale (target size and spatial frequency). The deficit in global contour processing is substantially greater in noise (where contour-linking is required) than on a blank field. The magnitude of the deficits is modest when low-level deficits (reduced visibility, increased positional uncertainty, and abnormal shape perception) are minimized, and does not seem to depend much on acuity, crowding or stereoacuity. The residual deficits reported here cannot be simply ascribed to reduced visibility or increased positional uncertainty, and we therefore conclude that these are genuine deficits in global contour segregation and integration.

Visual processing in amblyopia: animal studies

In the past five years, substantial progress has been made in our knowledge of the neural basis of amblyopia. Recent advances based on animal models are described, along with new psychophysical data showing perceptual deficits in amblyopic animals that are not explained by simple losses in contrast sensitivity. Studies of contour integration and integration of motion and form signals in the presence of noise show that 1) there are fundamental losses in temporal as well as spatial vision, 2) the losses extend to the fellow eye in many cases, 3) amblyopic animals are especially impaired in the presence of background noise, and 4) these losses must depend on a process downstream from area V1 in the extrastriate cortex.

Location coding by the human visual system: multiple topological adaptations in a case of strabismic amblyopia

Amblyopia, a major cause of vision loss, is a developmental disorder of visual perception commonly associated with strabismus (squint). Although defined by a reduction in visual acuity, severe distortions of perceived visual location are common in strabismic amblyopia. These distortions can help us understand the cortical coding of visual location and its development in normal vision, as well as in amblyopia. The history of retinotopic mapping in the visual cortex highlights the potential impact of amblyopia. Theories of amblyopia include topological disarray of receptors in primary visual cortex, undersampling from the amblyopic eye compared with normal eyes, and the presence of anomalous retinal correspondence or multiple cortical representations of the strabismic fovea. We examined the distortions in a strabismic amblyope, using a pop-out localization task, in which normal observers made errors dependent on the visual context of the stimulus. The localization errors of the strabismic amblyope were abnormal. We found that none of the available theories could fully explain this one patient's localization performance. Instead, the observed behavior suggests that multiple adaptations of the underlying cortical topology are possible simultaneously in different parts of the visual field.

Spatial interactions in amblyopia: Effects of stimulus parameters and amblyopia type

Adults with amblyopia were recently shown to perform abnormally in tasks requiring integration of local features into global percepts. Moreover, spatial interactions in amblyopic patients, though often found to be abnormal, showed marked variability. Here we measured collinear lateral interactions using Gabor patches in a large number of amblyopic (N=75) and normal subjects (N=25), testing four spatial frequencies (1.5, 3, 6, 9 cpd). We used the lateral masking paradigm, in which the contrast-detection threshold is measured in the presence of high-contrast flankers at different distances from a central target. Whereas in normal subjects spatial interaction patterns were evident across all spatial frequencies, amblyopic subjects showed abnormal spatial interactions and increasing deficiencies with increasing spatial frequencies. These abnormalities depended on the axis of astigmatism (in meridional amblyopia) and were more pronounced in strabismic than in anisometropic amblyopia. Spatial interactions were independent on the contrast-detection thresholds. Thus, adults with amblyopia might perform as well as normal observers for some stimulus parameters and abnormally for others. Our results indicate a close relationship between abnormal visual input to the visual cortex during development and abnormal functionality of the collinear spatial interactions in adults with amblyopia.

Local and non-local deficits in amblyopia: acuity and spatial interactions

Amblyopic vision is thought to be limited by abnormal long-range spatial interactions, but their exact mode of action and relationship to the main amblyopic deficit in visual acuity is largely unknown. We studied this relationship in a group (N=59) of anisometropic (N=21) and strabismic (or combined, N=38) subjects, using (1) a single and multi-pattern (crowded) computerized static Tumbling-E test with scaled spacing of two pattern widths (TeVA), in addition to an optotype (ETDRS chart) acuity test (VA) and (2) contrast detection of Gabor patches with lateral flankers (lateral masking) along the horizontal and vertical axes as well as in collinear and parallel configurations. By correlating the different measures of visual acuity and contrast suppression, we found that (1) the VA of the strabismic subjects could be decomposed into two uncorrelated components measured in TeVA: acuity for isolated patterns and acuity reduction due to flanking patterns. The latter comprised over 60% of the VA magnitude, on the average and accounted for over 50% of its variance. In contrast, a slight reduction in acuity was found in the anisometropic subjects, and the acuity for a single pattern could account for 70% of the VA variance. (2) The lateral suppression (contrast threshold elevation) in a parallel configuration along the horizontal axis was correlated with the VA (R2=0.7), as well as with the crowding effect (TeVA elevation, R2=0.5) for the strabismic group. Some correlation with the VA was also found for the collinear configuration in the anisometropic group, but less suppression and no correlation were found for all the vertical configurations in all the groups. The results indicate the existence of a specific non-local component of the strabismic deficit, in addition to the local acuity deficit in all amblyopia types. This deficit might reflect long-range lateral inhibition, or alternatively, an inaccurate and scattered top-down attentional selection mechanism.