A dynamic model of cross-coupling between accommodation and convergence: simulations of step and frequency responses

Advanced Visualization Engineering for Vision Disorders: A Clinically Focused Guide to Current Technology and Future Applications

Head-mounted visualization technology, often in the form of virtual, augmented, and mixed reality (VAMR), has revolutionized how visual disorders may be approached clinically. In this manuscript, we review the available literature on VAMR for visual disorders and provide a clinically oriented guide to how VAMR technology has been deployed for visual impairments. The chief areas of clinical investigation with VAMR are divided include (1) vision assessment, (2) vision simulation, and (3) vision rehabilitation. We discuss in-depth the current literature of these areas in VAMR and upcoming/future applications to combat the detrimental impact of visual impairment worldwide.

How Do Most Young Moderate Hyperopes Avoid Strabismus?

Purpose

Uncorrected hyperopic children must overcome an apparent conflict between accommodation and vergence demands to focus and align their retinal images. This study tested hypotheses about simultaneous accommodation and vergence performance of young hyperopes to gain insight into ocular motor strategies used to maintain eye alignment.

Methods

Simultaneous eccentric photorefraction and Purkinje image tracking were used to assess accommodative and vergence responses of 26 adult emmetropes (AE) and 94 children (0-13 years) viewing cartoons. Children were habitually uncorrected (CU) (spherical equivalent refractive error [SE] -0.5 to +4 D), corrected and aligned (CCA), or corrected with a history of refractive esotropia (CCS). Accommodative and vergence accuracy, dissociated heterophoria, and vergence/accommodation ratios in the absence of retinal disparity cues were measured for 33- and 80-cm viewing distances.

Results

In binocular viewing, median accommodative lags for 33 cm were 1.0 D (AE), 1.33 D (CU), 1.25 D (CCA), and 1.0 D (CCS). Median exophorias at 80 and 33 cm were 1.2 and 4.5 pd (AE), 0.8 and 2.5 pd (CU), and 0 and 1.2 pd (CCA), respectively. Without disparity cues, most response vergence/accommodation ratios were between 1 and 2 meter angle/D (∼5-10 pd/D) (69% of AE, 44% of CU, 60% of CCA, and 50% of CCS).

Conclusions

Despite apparent conflict in motor coupling, uncorrected hyperopes were typically exophoric and achieved adultlike accuracy of both vergence and accommodation simultaneously, indicating ability to compensate for conflicting demands rather than bias to accurate vergence while tolerating inaccurate accommodation. Large lags and esophoria are therefore atypical. This analysis provides normative guidelines for clinicians and a deeper mechanistic understanding of how hyperopes avoid strabismus.

Accuracy and stability of accommodation and vergence responses during sustained near tasks in uncorrected hyperopes

This study investigated the accuracy and stability of accommodative and vergence functions in children with and without hyperopia while engaged in two sustained near tasks. The sustained accommodative and vergence characteristics of participants without refractive correction (n = 92, aged 5-10 years) with and without hyperopia (defined as cycloplegic retinoscopy ≥  + 1.00D and less than + 5.00D) were measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular measures of accommodation and eye position were recorded while participants engaged in 2 tasks at 25 cm for 15 min each: (1) reading small print on an Amazon Kindle and (2) watching an animated movie on liquid crystal display screen. Comprehensive visual assessment, including measurement of presenting visual acuity, amplitude of accommodation, and stereoacuity was conducted. The magnitude of accommodative and vergence responses was not related to refractive error (P > 0.05). However, there were inter-task differences in the accuracy and stability of the accommodative responses across refractive groups (P < 0.05). The relationship between accommodation and vergence was not significant in both tasks (P > 0.05). However, increased accommodative and vergence instabilities were associated with total accommodative response (P < 0.05). Despite having greater accommodative demand, uncorrected hyperopes accommodate comparably to emmetropic controls. However, uncorrected hyperopes have increased instabilities in their accommodative and vergence responses, which may adversely impact their visual experience.

The impact of Alzheimer's disease risk factors on the pupillary light response

Alzheimer's disease (AD) is the leading cause of dementia, and its prevalence is increasing and is expected to continue to increase over the next few decades. Because of this, there is an urgent requirement to determine a way to diagnose the disease, and to target interventions to delay and ideally stop the onset of symptoms, specifically those impacting cognition and daily livelihood. The pupillary light response (PLR) is controlled by the sympathetic and parasympathetic branches of the autonomic nervous system, and impairments to the pupillary light response (PLR) have been related to AD. However, most of these studies that assess the PLR occur in patients who have already been diagnosed with AD, rather than those who are at a higher risk for the disease but without a diagnosis. Determining whether the PLR is similarly impaired in subjects before an AD diagnosis is made and before cognitive symptoms of the disease begin, is an important step before using the PLR as a diagnostic tool. Specifically, identifying whether the PLR is impaired in specific at-risk groups, considering both genetic and non-genetic risk factors, is imperative. It is possible that the PLR may be impaired in association with some risk factors but not others, potentially indicating different pathways to neurodegeneration that could be distinguished using PLR. In this work, we review the most common genetic and lifestyle-based risk factors for AD and identify established relationships between these risk factors and the PLR. The evidence here shows that many AD risk factors, including traumatic brain injury, ocular and intracranial hypertension, alcohol consumption, depression, and diabetes, are directly related to changes in the PLR. Other risk factors currently lack sufficient literature to make any conclusions relating directly to the PLR but have shown links to impairments in the parasympathetic nervous system; further research should be conducted in these risk factors and their relation to the PLR.

Topical Review: Methodological Variables in Clinical and Laboratory Measurements of Fixation Disparity

SIGNIFICANCE

Fixation disparity is a small vergence error that does not disrupt fusion. Fixation disparity measures correlate with binocular symptoms. This article covers methodological differences between clinical fixation disparity measurement devices, findings when objective and subjective fixation disparities are compared, and the potential impact of binocular capture on fixation disparity measurements. Fixation disparity is a small vergence error that occurs in nonstrabismic individuals and does not disrupt fusion. This article reviews clinical fixation disparity variables and their clinical diagnostic value. Clinical devices that are used to measure these variables are described, as are studies in which the output from these devices has been compared. Methodological differences between the devices such as the location of the fusional stimulus, the rate at which judgments of dichoptic alignment are made, and the strength of the accommodative stimulus are all considered. In addition, the article covers theories of the neural origins of fixation disparity and control system models incorporating fixation disparity. Studies in which objective fixation disparities (oculomotor portion of fixation disparity assessed with an eye tracker) and subjective fixation disparities (sensory portion of fixation disparity assessed psychophysically with dichoptic Nonius lines) have been compared are also examined, and consideration is given to why some investigators find differences in these measures, whereas other investigators do not. The conclusion thus far is that there are likely complex interactions between vergence adaptation, accommodation, and the location of the fusional stimulus that lead to differences in objective and subjective fixation disparity measures. Finally, capture of the visual direction of monocular stimuli by adjacent fusional stimuli and the implications for fixation disparity measures are considered.

The Statistics of Eye Movements and Binocular Disparities during VR Gaming: Implications for Headset Design

The human visual system evolved in environments with statistical regularities. Binocular vision is adapted to these such that depth perception and eye movements are more precise, faster, and performed comfortably in environments consistent with the regularities. We measured the statistics of eye movements and binocular disparities in virtual-reality (VR) - gaming environments and found that they are quite different from those in the natural environment. Fixation distance and direction are more restricted in VR, and fixation distance is farther. The pattern of disparity across the visual field is less regular in VR and does not conform to a prominent property of naturally occurring disparities. From this we predict that double vision is more likely in VR than in the natural environment. We also determined the optimal screen distance to minimize discomfort due to the vergence-accommodation conflict, and the optimal nasal-temporal positioning of head-mounted display (HMD) screens to maximize binocular field of view. Finally, in a user study we investigated how VR content affects comfort and performance. Content that is more consistent with the statistics of the natural world yields less discomfort than content that is not. Furthermore, consistent content yields slightly better performance than inconsistent content.

Vergence and accommodation responses in the control of intermittent exotropia

PURPOSE

Individuals with different types of intermittent exotropia (IXT) may use neurally coupled accommodation and vergence responses differently from those without exotropia to achieve eye alignment. This study examined the relationship between simultaneously recorded accommodation and vergence responses in children and young adults with a range of types of IXT while aligned and deviated.

METHODS

Responses of 29 participants with IXT (4-31 years) and 24 age-matched controls were recorded using simultaneous eye-tracking and eccentric photorefraction while they watched a movie in binocular or monocular viewing at varying viewing distances. Gradient response AC/A ratios and fusional vergence ranges were also assessed. Eight participants had divergence or pseudo-divergence excess type IXT, 5 had convergence insufficiency and 16 had basic IXT.

RESULTS

Control and IXT participants accommodated similarly both in monocular and binocular-aligned conditions to visual targets at 80 and 33 cm. When deviated in binocular viewing, most participants with IXT exhibited changes in accommodation <0.5D relative to alignment. Gradient response AC/A ratios were similar for control [0.56 MA/D (IQR: 0.51 MA/D)] and IXT participants [0.42 MA/D (0.54 MA/D); p  = 0.60]. IXT participants showed larger vergence to accommodation ratios with changes from distance to near fixation [1.19 MA/D (1.45 MA/D)] than control participants [0.78 MA/D (0.60 MA/D); p = 0.02], especially among IXT participants with divergence or pseudo-divergence excess. Participants with IXT exhibited typical fusional divergence ranges beyond their dissociated position [8.86 Δ (7.10 Δ)] and typical fusional convergence ranges from alignment [18 Δ (15.75 Δ)].

CONCLUSIONS

This study suggests that control of IXT is typically neither driven by accommodative convergence alone nor associated with over-accommodation secondary to fusional convergence efforts. These simultaneous measurements confirmed that proximal vergence contributed significantly to IXT control, particularly for divergence or pseudo-divergence excess type IXT. For IXT participants in this study, achieving eye alignment did not conflict with having clear vision.

FIAT: A Device for Objective, Optical Measures of Accommodation in Phakic and Pseudophakic Eyes

Purpose

To present FIAT, a novel optical instrument and analysis package that is designed to elicit and optically record accommodation in human eyes.

Methods

FIAT employs a Shack-Hartmann wavefront sensor and a retro-illumination pupil camera that records from a single eye at video rates. It is effective at eliciting accommodation by offering the subject a full-field binocular view of an alternating distant target and a near-eye display. FIAT analysis software computes wave aberrations for each video frame over full- or subpupil sizes and computes accommodative dynamics and accommodative range.

Results

The system is validated by showing accurate refraction measurements in model eyes and human eyes with trial lenses. Robust accommodative responses are shown for young eyes, and a lack of accommodative response is shown for a known presbyopes. Accommodative stimulus-response curves from five phakic subjects over a range of ages show expected results. Results from two individuals with monofocal intraocular lenses are shown.

Conclusions

FIAT is an effective instrument for making accurate, objective measures of accommodation in phakic and pseudophakic eyes.

Translational Relevance

We present a device that can play an important role in the development and testing of accommodating intraocular lenses.

Vision-related symptoms, accommodative and binocular vision performance in young diabetics vs. normal controls

PURPOSE

To compare accommodative and binocular vision performance between young diabetic subjects and normal controls, and to investigate the correlation of accommodative/binocular indices with the severity of diabetes.

METHODS

Thirty young subjects with diabetes mellitus (DM) and 30 age-matched normal controls were recruited in this hospital-based cross-sectional study. DM was diagnosed by a haemoglobin A1c (HbA1c) higher than 6.5%. The status of vision-related symptoms was examined by the convergence insufficiency symptoms survey (CISS). All participants underwent a complete optometric examination including visual acuity measurement, objective and subjective refraction, accommodative and binocular vision assessments.

RESULTS

All study participants were between 18 and 40 years of age. There were no statistically significant differences in best-corrected visual acuity (BCVA), sphere, cylinder and spherical equivalent refraction (SE) between the diabetes and control groups. The median near point of convergence (NPC) was significantly more remote in diabetics compared with the control group. Mean accommodative amplitude (AA) and vergence facility (VF) and the median monocular accommodative facility (AF) were significantly lower in diabetic subjects compared with normal controls. In addition, the median accommodative lag in the diabetic group was significantly higher than the control group. A significantly higher percentage of the diabetic group were symptomatic (26.6%), compared with the controls (6.6%). The NPC and accommodative lag showed a significant positive correlation with the HbA1c level, while VF, AA and AF exhibited a significant negative correlation with HbA1c.

CONCLUSION

Aspects of accommodative and binocular vision performance are strongly affected by DM. There is also a significant correlation between accommodative and binocular disorders with the severity of DM. A significant percentage of young subjects with DM have severe vision-related symptoms.

A Deep Motion Sickness Predictor Induced by Visual Stimuli in Virtual Reality

In a virtual reality (VR) environment, where visual stimuli predominate over other stimuli, the user experiences cybersickness because the balance of the body collapses due to self-motion. Accordingly, the VR experience is accompanied by unavoidable sickness referred to as visually induced motion sickness (VIMS). In this article, our primary purpose is to simultaneously estimate the VIMS score by referring to the content and calculate the temporally induced VIMS sensitivity. To seek our goals, we propose a novel architecture composed of two consecutive networks: 1) neurological representation and 2) spatiotemporal representation. In the first stage, the network imitates and learns the neurological mechanism of motion sickness. In the second stage, the significant feature of the spatial and temporal domains is expressed over the generated frames. After the training procedure, our model can calculate VIMS sensitivity for each frame of the VR content by using the weakly supervised approach for unannotated temporal VIMS scores. Furthermore, we release a massive VR content database. In the experiments, the proposed framework demonstrates excellent performance for VIMS score prediction compared with existing methods, including feature engineering and deep learning-based approaches. Furthermore, we propose a way to visualize the cognitive response to visual stimuli and demonstrate that the induced sickness tends to be activated in a similar tendency, as done in clinical studies.

Effect of Vergence Facility Testing on Horizontal Fusional Reserves

SIGNIFICANCE

The effect of vergence adaptation on test sequences should be considered in clinical practice.

PURPOSE

This study aimed to compare the effect of vergence adaptation after different vergence facility (VF) testing methods on following horizontal fusional reserve measurement at near.

METHODS

This cross-sectional study was performed on 50 healthy subjects with a mean ± standard deviation age of 21.18 ± 1.41 years. The baseline horizontal fusional reserves were measured using base-in (BI) and base-out (BO) prisms (∆) at near. Then, VF was measured using 3∆BI/12∆BI flip prism at near, and then the measurement of fusional reserves was repeated. In the next step, fusional reserves were measured after VF testing using 8∆BI/8∆BO flip prism. The values of fusional reserves were compared with their baseline findings.

RESULTS

The results of negative fusional reserves after VF measurement using the 3∆BI/12∆BO prisms were significantly lower than the baseline values (blur [P = .03], break [P = .03], and recovery [P = .03]). There were no significant differences between the values of fusional reserves before and after VF testing using the 8∆BI/8∆BO prisms (P > .05). No correlation was observed between fusional reserves and VF responses (P > .05); however, the results revealed a positive correlation between the values of fusional reserves before and after VF testing using both methods (all P < .05). There was no significant difference in VF findings between the methods (P = .23).

CONCLUSIONS

The measurements of horizontal fusional reserves followed by VF testing were not affected except for the responses of negative fusional reserves, which decreased after VF determination using the 3∆BI/12∆BO method. Although the vergence adaptation does not seem clinically significant, it is recommended to evaluate horizontal fusional reserves before VF measurement or long-enough time after VF testing for the vergence system to return to its nonadapted state.

Waveguide-type see-through dual focus near-eye display with a polarization grating

Waveguide-type near-eye displays have useful properties such as compact form factor, lightweight and see-through capability. Conventional systems, however, support only a single image plane fixed at a certain distance, which may induce eye fatigue due to the vergence-accommodation conflict. In this paper, we propose a waveguide-type near-eye display with two image planes using a polarization grating. Two images with orthogonal polarizations propagate within the waveguide with different total internal reflection angles and form virtual images at different distances. The use of the polarization grating and two pairs of holographic optical elements enables dual image plane formation by a single waveguide with high transparency for the real scene. Optical experiments confirm the principle of the proposed optical system.

Recent understanding of binocular vision in the natural environment with clinical implications

Technological advances in recent decades have allowed us to measure both the information available to the visual system in the natural environment and the rich array of behaviors that the visual system supports. This review highlights the tasks undertaken by the binocular visual system in particular and how, for much of human activity, these tasks differ from those considered when an observer fixates a static target on the midline. The everyday motor and perceptual challenges involved in generating a stable, useful binocular percept of the environment are discussed, together with how these challenges are but minimally addressed by much of current clinical interpretation of binocular function. The implications for new technology, such as virtual reality, are also highlighted in terms of clinical and basic research application.

Binocular accommodative response with extended depth of focus under controlled convergences

Vergence and accommodation can be mismatched under virtual reality viewing conditions, and this mismatch has been thought to be one of the main causes of visual discomfort. The goal of this study was to investigate how optical conditions of the eyes affect accommodative responses to different convergence. Specifically, we hypothesized that extending the depth of focus (DoF) could weaken the control of the screen on accommodation, so that accommodation could be induced by convergence. To test this hypothesis, we extended the DoF using Zernike spherical aberrations (fourth and sixth orders) induced by a binocular adaptive optics (AO) vision simulator. Nine normal subjects between the ages of 21 and 34 (26 ± 5) years were recruited. Three optical conditions were generated: AO condition (aberration-free), monovision condition, and extended depth of focus (EDoF) condition. Binocular accommodative responses, along with binocular visual acuity and stereoacuity, were measured under all three optical conditions with varied binocular vergence levels. At 3 diopters of binocular convergence, the EDoF condition was the most efficient in inducing excessive accommodative response compared with the monovision condition and the AO condition. Visual acuity was impaired with EDoF as compared with the other two conditions. The average stereoscopic thresholds (at 0 vergence) under the EDoF condition were degraded compared with the AO condition but were superior to those of the monovision condition. Therefore, despite some compromise to visual performance, extending the DoF could allow for a more natural vergence–accommodation relationship, providing the potential for alleviating the vergence–accommodation conflict and associated visual fatigue symptoms in virtual reality.

The blur horopter: Retinal conjugate surface in binocular viewing

From measurements of wavefront aberrations in 16 emmetropic eyes, we calculated where objects in the world create best-focused images across the central 27∘ (diameter) of the retina. This is the retinal conjugate surface. We calculated how the surface changes as the eye accommodates from near to far and found that it mostly maintains its shape. The conjugate surface is pitched top-back, meaning that the upper visual field is relatively hyperopic compared to the lower field. We extended the measurements of best image quality into the binocular domain by considering how the retinal conjugate surfaces for the two eyes overlap in binocular viewing. We call this binocular extension the blur horopter. We show that in combining the two images with possibly different sharpness, the visual system creates a larger depth of field of apparently sharp images than occurs with monocular viewing. We examined similarities between the blur horopter and its analog in binocular vision: the binocular horopter. We compared these horopters to the statistics of the natural visual environment. The binocular horopter and scene statistics are strikingly similar. The blur horopter and natural statistics are qualitatively, but not quantitatively, similar. Finally, we used the measurements to refine what is commonly referred to as the zone of clear single binocular vision.

A covered eye fails to follow an object moving in depth

To clearly view approaching objects, the eyes rotate inward (vergence), and the intraocular lenses focus (accommodation). Current ocular control models assume both eyes are driven by unitary vergence and unitary accommodation commands that causally interact. The models typically describe discrete gaze shifts to non-accommodative targets performed under laboratory conditions. We probe these unitary signals using a physical stimulus moving in depth on the midline while recording vergence and accommodation simultaneously from both eyes in normal observers. Using monocular viewing, retinal disparity is removed, leaving only monocular cues for interpreting the object's motion in depth. The viewing eye always followed the target's motion. However, the occluded eye did not follow the target, and surprisingly, rotated out of phase with it. In contrast, accommodation in both eyes was synchronized with the target under monocular viewing. The results challenge existing unitary vergence command theories, and causal accommodation-vergence linkage.

Spasm of Near Reflex: Objective Assessment of the Near-Triad

Purpose

To characterize binocular steady-state accommodation, pupil and convergence responses (near triad) in spasm of near reflex (SNR) before and after optical and pharmacological intervention. To identify the putative source of SNR in the neural control schema of accommodation-vergence interaction using controls-engineering modeling.

Methods

Near-triad of 15 patients with SNR (9 to 23 years) was recorded using an infrared photorefractor at 2m viewing distance for 120s during clinical presentation, after optical fogging intended to relieve spasm, with cycloplegia, post-cycloplegia and long-term follow-up visits. Data were also collected without cycloplegia in 15 age-matched controls. Schor (1999) model was used to computationally simulate accommodation and vergence responses of controls and SNR.

Results

Both eyes of SNR exhibited significant myopia and refraction fluctuations (<1.0Hz) during clinical presentation [median (25^th to 75^th IQR) refraction: −1.7D (−3.2 to −0.8D); root mean squared (RMS) deviation: 1.1D (0.5 to 1.5D)], relative to controls [0.8D (−0.03 to 1.4D); 0.2D (0.1 to 0.3D)] (p < 0.001). These decreased after optical fogging, largely eliminated with cycloplegia and partially re-appeared in the post-cycloplegia and follow-up visits. SNR responses could be modeled by increasing the gain and decay time of tonic accommodation, vis-à-vis, controls. Pupil and convergence responses in SNR were similar to controls at all visits (p > 0.1).

Conclusions

Exaggerated fluctuations of steady-state accommodation may be a signature feature of SNR, even while their pupil and convergence responses may remain unaffected. These fluctuations may arise from the tonic accommodation controller, the properties of which could be potentially altered after optical fogging to relieve the disorder.

A Normative Study of Objective Measures of Disparity Vergence and Saccades in Children 9 to 17 Years Old

SIGNIFICANCE

This study establishes normative data for objective outcome measures of vergence and saccade eye movements for the pediatric population. These data should facilitate future clinical trial design.

PURPOSE

This study was designed to establish normative data for objective measures of disparity vergence and saccades in children between the ages 9 and 17 years using an objective binocular eye movement tracking system.

METHODS

Participants (aged 9 to 17 years) had a vision examination including refraction, accommodative, and binocular vision testing. Eligibility criteria included 20/25 visual acuity with best correction, normal accommodation, and binocular vision. The ISCAN RK-826PCI binocular tracking system (ISCAN, Woburn, MA) was used to objectively record horizontal, symmetrical disparity vergence, and saccadic eye movements. Parameters assessed included peak velocity, time to peak velocity, latency, and response amplitude for both disparity vergence and saccades.

RESULTS

One hundred eighteen participants were recruited (54.94% female; mean age, 13.5 years), and 77.1% (91/118) of the participants completed the assessment with usable data. A sample of the normative data included peak velocity (°/s), which had a mean ± standard deviation of 25.4 ± 2.9, 22.0 ± 3.0, 225 ± 16.7, and 332.5 ± 20.5 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively. The mean ± standard deviation for the latency (seconds) measures were 0.28 ± 0.1, 0.28 ± 0.16, 0.23 ± 0.05, and 0.23 ± 0.05 for 4° convergence, 4° divergence, 5° saccades, and 10° saccades, respectively.

CONCLUSIONS

Normative data enable researchers to have benchmark results for comparison with patient populations with binocular dysfunction. These objective disparity vergence measures can serve as outcome measures in future clinical trials to assess the effectiveness of therapeutic interventions by determining whether post-treatment results are similar to normal data.

Approximated super multi-view head-mounted display to reduce visual fatigue

To reduce the visual fatigue of the head-mounted displays, we propose an approximated super multi-view technique in which multiple viewpoints are generated two-dimensionally with an interval smaller than the pupil diameter using the time multiplexing technique, and left and right virtual images are two-dimensionally shifted in synchronization with the viewpoint generation. The proposed technique enlarges the depth of field of eyes to provide the accommodation-invariant feature so that the vergence-accommodation conflict is mitigated. We constructed an experimental system by using two LED arrays for the viewpoint generation and one LCD panel vibrated by two stepping motors. The proposed technique was then experimentally validated.

The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data

Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures.Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031.Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD.Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.

Receiver operating characteristic curve analysis of clinical signs for screening of convergence insufficiency in young adults

Convergence insufficiency (CI) is a dysfunction of binocular vision that is associated with various signs and symptoms in near work. However, CI screening is performed less frequently in adults than in children. We aimed to evaluate the ability of screening tests to discriminate CI from other binocular vision anomalies and normal binocular vision in young adults. One hundred eighty-four university students (age, 18-28 years) who underwent an eye examination due to ocular discomfort were included. Near point of convergence (NPC), phoria, accommodative amplitude, fusional vergence, the ratio of accommodative convergence to accommodation, relative accommodation, binocular accommodative facility, vergence facility, and the values corresponding to Sheard's and Percival's criteria were evaluated. Receiver operating characteristic (ROC) curve analysis for each test was also performed. The prevalence of CI ranged from 10.3% to 21.2%, depending on the signs and the presence of CI associated with accommodative disorders. Assessments based on NPC, Sheard's criterion, and Percival's criterion showed high discriminative ability, with the ability being higher between the CI and normal binocular vision groups than between the CI and non-CI groups. Sheard's criterion showed the highest diagnostic performance in discriminating CI with three signs from the non-CI group. The cut-off values were 7.2 cm for NPC, -0.23 to 1.00 for Sheard's criterion, and -4.00 to -2.33 for Percival's criterion. Our results suggest that the use of Sheard's criterion with NPC shows high performance for screening of CI.

A differential role for the posterior cerebellum in the adaptive control of convergence eye movements

INTRODUCTION

The vergence oculomotor system possesses two robust adaptive mechanisms; a fast "dynamic" and a slow "tonic" system that are both vital for single, clear and comfortable binocular vision. The neural substrates underlying these vergence adaptive mechanisms in humans is unclear.

METHODS

We investigated the role of the posterior cerebellum in convergence adaptation using inhibitory continuous theta-burst repetitive transcranial magnetic stimulation (cTBS) within a double-blind, sham controlled design while eye movements were recorded at 250hz via infrared oculography.

RESULTS

In a preliminary experiment we validated our stimulation protocols by reproducing results from previous work on saccadic adaptation during the classic double-step adaptive shortening paradigm. Following this, across a series of three separate experiments we observed a clear dissociation in the effect of cTBS on convergence adaptation. Dynamic adaptation was substantially reduced while tonic adaptation was unaffected. Baseline dynamic fusional vergence response were also unaffected by stimulation.

CONCLUSIONS

These results indicate a differential role for the posterior cerebellum in the adaptive control of convergence eye movements and provide initial evidence that repetitive transcranial magnetic stimulation is a viable tool to investigate the neurophysiology of vergence control. The results are discussed in the context of the current models of implicit motor adaptation of vergence and their application to clinical populations and technology design in virtual and augmented head mounted display architectures.

SIGNIFICANCE STATEMENT

The cerebellum plays a critical role in the adaptive control of motor systems. Vergence eye movements shift our gaze in depth allowing us to see in 3D and exhibit two distinct adaptive mechanisms that are engaged under a range of conditions including reading, wearing head-mounted displays and using a new spectacle prescription. It is unclear what role the cerebellum plays in these adaptive mechanisms. To answer this, we temporarily disrupted the function of the posterior cerebellum using non-invasive brain stimulation and report impairment of only one adaptive mechanism, providing evidence for neural compartmentalization. The results have implications for vergence control models and applications to comfort and experience studies in head-mounted displays and the rehabilitation of clinical populations exhibiting vergence dysfunctions.

Objective Assessment of Disparity Vergence after Treatment of Symptomatic Convergence Insufficiency in Children

SIGNIFICANCE

This first report of the use of objective measures of disparity vergence as outcome measures for symptomatic convergence insufficiency in children provides additional information that is not accessible with clinical tests. The study results also demonstrate that objective measures of vergence could be used in future randomized clinical trials of binocular vision disorders with children.

PURPOSE

This study was designed to evaluate changes in objective measures of disparity vergence after office-based vergence/accommodative therapy (OBVAT) for convergence insufficiency in children 12 to 17 years old.

METHODS

In this prospective trial, we recruited 10 participants with normal binocular vision and 12 with convergence insufficiency. All participants with convergence insufficiency were treated with 12 weeks of OBVAT. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, and accuracy. Changes in clinical measures (near point of convergence, positive fusional vergence at near) and symptoms were evaluated.

RESULTS

There was a statistically significant increase in peak velocity and more accurate response amplitude to 4° symmetrical convergence step stimuli after OBVAT compared with baseline measurements. Near point of convergence, positive fusional vergence, and symptoms also statistically significantly improved after OBVAT. Ten of the 12 participants met clinical success criteria.

CONCLUSIONS

In this prospective study on the treatment of symptomatic convergence insufficiency in children in which both clinical and objective eye movement measurements were used to evaluate the results of treatment, significant changes were found in symptoms and both clinical and objective measures of disparity vergence after completion of OBVAT in children with symptomatic convergence insufficiency.

(Disparity-Driven) Accommodation Response Contributes to Perceived Depth

When looking at objects at various distances in the physical space, the accommodation and vergence systems adjust their parameters to provide a single and clear vision of the world. Subtended muscle activity provides oculomotor cues that can contribute to the perception of depth and distance. While several studies have outlined the role of vergence in distance perception, little is known about the contribution of its concommitant accommodation component. It is possible to unravel the role of each of these physiological systems by placing observers in a situation where there is a conflict between accommodation and vergence distances. We thus sought to determine the contribution of each response system to perceived depth by simultaneously measuring vergence and accommodation while participants judged the depth of 3D stimuli. The distance conflict decreased depth constancy for stimulus displayed with negative disparity steps (divergence). Although vergence was unaffected by the stimulus distance, accommodation responses were significantly reduced when the stimulus was displayed with negative disparities. Our results show that biases in perceived depth follow undershoots in the disparity-driven accommodation response. These findings suggest that accommodation responses (i.e., from oculomotor information) can contribute to perceived depth.

Is blur sensitivity altered in children with progressive myopia?

School aged children with progressive myopia show large accommodative lags to blur only cue which is suggestive of a large depth of focus (DOF). While DOF measures are lacking in this age group, their blur detection and discrimination capacities appear to be similar to their non-myopic peers. Accordingly, the current study quantified DOF and blur detection ability in progressive myopic children showing large accommodative lags compared to their non-myopic peers and adults. Blur sensitivity measures were taken from 12 children (8-13 years, 6 myopes and 6 emmetropes) and 6 adults (20-35 years). DOF was quantified using step changes in the lens induced defocus while the subjects viewed a high contrast target through a Badal lens at either 2 or 4D demand. Blur detection thresholds (BDT) were tested using a similar high contrast target in a 2-alternate forced-choice paradigm (2AFC) at both the demands. In addition to the large accommodative lags, micro fluctuations and DOF were significantly larger in myopic children compared to the other groups. However, BDTs were similar across the three groups. When limited to blur cues, the findings of a large DOF coupled with large response lags suggests that myopes are less sensitive to retinal defocus. However, in agreement to a previous study, refractive error had no influence on their BDTs suggesting that the reduced sensitivity to the defocus in a myopic eye appears to be compensated by some form of an adjustment in the higher visual processes to preserve the subjective percept even with a poor retinal image quality.

Patterns of Pupillary Activity During Binocular Disparity Resolution

This study examined the dynamic coordination between disconjugate, vergence eye movements, and pupil size in 52 normal subjects during binocular disparity stimulation in a virtual reality display. Eye movements and pupil area were sampled with a video-oculographic system at 100 Hz during performance of two tasks, (1) fusion of a binocular disparity step (±1.5° of visual angle in the horizontal plane) and (2) pursuit of a sinusoidally varying binocular disparity stimulus (0.1 Hz, ±2.6° of visual angle in the horizontal plane). Pupil size data were normalized on the basis of responses to homogeneous illumination increments ranging from 0.42 to 65.4 cd/m². The subjects produced robust vergence eye movements in response to disparity step shifts and high fidelity sinusoidal vergence responses (R² relative to stimulus profile: 0.933 ± 0.088), accompanied by changes in pupil area. Trajectory plots of pupil area as a function of vergence angle showed that the pupil area at zero vergence is altered between epochs of linear vergence angle—pupil area relations. Analysis with a modified Gath-Geva clustering algorithm revealed that the dynamic relationship between the ocular vergence angle and pupil size includes two different transient, synkinetic response patterns. The near response pattern, pupil constriction during convergence and pupil dilation during divergence, occurred ~80% of the time across subjects. An opposite, previously undescribed synkinetic pattern was pupil constriction during divergence and pupil dilatation during convergence; it occurred ~15% of the time across subjects. The remainder of the data were epochs of uncorrelated activity. The pupil size intercepts of the synkinetic segments, representing pupil size at initial tropia, had different relationships to vergence angle for the two main coordinated movement types. Hippus-like movements of the pupil could also be accompanied by vergence movements. No pupil coordination was observed during a conjugate pursuit task. In terms of the current dual interaction control model (1), findings suggest that the synkinetic eye and pupillary movements are produced by a dynamic switch of the influence of vergence related information to pupil control, accompanied by a resetting of the pupil aperture size at zero-vergence.

Super multi-view near-eye display to solve vergence-accommodation conflict

A super multi-view (SMV) technique is applied to near-eye displays to solve the vergence-accommodation conflict that causes visual fatigue. The proposed SMV near-eye display employs a high-speed spatial light modulator (SLM), a two-dimensional (2D) light source array, and an imaging optics for each eye. The imaging optics produces a virtual image of the SLM and real images of the light sources to generate a 2D array of viewpoints. The SMV images are generated using a time-multiplexing technique: the multiple light sources sequentially emit light while the SLM synchronously displays corresponding parallax images. A monocular experimental system was constructed using a ferroelectric liquid crystal display and an LED array. A full-parallax SMV image generation with 21 viewpoints was demonstrated and a comparison of full-parallax and horizontal parallax SMV images provided.

FocusAR: Auto-focus Augmented Reality Eyeglasses for both Real World and Virtual Imagery

We describe a system which corrects dynamically for the focus of the real world surrounding the near-eye display of the user and simultaneously the internal display for augmented synthetic imagery, with an aim of completely replacing the user prescription eyeglasses. The ability to adjust focus for both real and virtual stimuli will be useful for a wide variety of users, but especially for users over 40 years of age who have limited accommodation range. Our proposed solution employs a tunable-focus lens for dynamic prescription vision correction, and a varifocal internal display for setting the virtual imagery at appropriate spatially registered depths. We also demonstrate a proof of concept prototype to verify our design and discuss the challenges to building an auto-focus augmented reality eyeglasses for both real and virtual.

Creating correct blur and its effect on accommodation

Blur occurs naturally when the eye is focused at one distance and an object is presented at another distance. Computer-graphics engineers and vision scientists often wish to create display images that reproduce such depth-dependent blur, but their methods are incorrect for that purpose. They take into account the scene geometry, pupil size, and focal distances, but do not properly take into account the optical aberrations of the human eye. We developed a method that, by incorporating the viewer's optics, yields displayed images that produce retinal images close to the ones that occur in natural viewing. We concentrated on the effects of defocus, chromatic aberration, astigmatism, and spherical aberration and evaluated their effectiveness by conducting experiments in which we attempted to drive the eye's focusing response (accommodation) through the rendering of these aberrations. We found that accommodation is not driven at all by conventional rendering methods, but that it is driven surprisingly quickly and accurately by our method with defocus and chromatic aberration incorporated. We found some effect of astigmatism but none of spherical aberration. We discuss how the rendering approach can be used in vision science experiments and in the development of ophthalmic/optometric devices and augmented- and virtual-reality displays.

Adaptation of reflexive fusional vergence is directionally biased

Divergence is known to differ from convergence across a wide range of clinical parameters. We have postulated that a limited neural substrate results in reduced fusional divergence velocities and subsequently a reduced capacity to adapt tonic vergence to uncrossed disparities. We further investigated this hypothesis by characterizing the degree of plasticity in reflexive fusional vergence to repetitive end-point errors using a disparity-based double-step paradigm. 10 adults completed 4 study visits where reflexive fusional convergence or divergence was measured (250 Hz infrared oculography) to a 2° disparity step and then lengthened or shortened via a repeated double-step (2° ± 1.5°). Stimuli were presented dichoptically at 40 cm. Adaptive modification of vergence responses was similar between directions for the shortening conditions, suggesting a common neural mechanism responds to overshooting errors. In comparison, adaptive lengthening of convergence was slower, but of equal magnitude, suggesting a second neural mechanism with a longer time constant for undershooting errors. Divergence response velocities were slower at baseline and did not increase after adaptive lengthening. Instead, increases in divergence response amplitudes were a result of increased response duration, implying saturation of the reflexive, preprogrammed response. Adaptive responses serving to increase or decrease reflexive fusional vergence recruitment were asymmetric. Adaptive lengthening of convergence and divergence identified further directional asymmetries. The results support the hypothesis that the neural substrate underlying divergence is attenuated, resulting in reduced reflexive plasticity when compared to convergence. The clinical and technological implications of these results are discussed.

Human infants can generate vergence responses to retinal disparity by 5 to 10 weeks of age

Vergence is defined as a binocular eye movement during which the two eyes move in opposite directions to align to a target in depth. In adults, fine vergence control is driven primarily by interocular retinal image disparity. Although infants have not typically been shown to respond to disparity until 3 to 5 months postpartum, they have been shown to align their eyes from hours after birth. It remains unclear what drives these responses in young infants. In this experiment, 5- to 10-week-old human infants were presented with a dynamic random noise stimulus oscillating in disparity at 0.1 Hz over an amplitude of 2° for 30 s. Fourier transforms of the horizontal eye movements revealed significant disparity-driven responses at the frequency of the stimulus in over half of the tested infants. Because the stimulus updated dynamically, this experiment precluded the possibility of independent monocular fixations to a sustained target. These data demonstrate cortical binocular function in humans by five weeks, the youngest age tested here, which is as much as two months younger than previously believed.

Vergence and Strabismus in Neurodegenerative Disorders

Maintaining proper eye alignment is necessary to generate a cohesive visual image. This involves the coordination of complex neural networks, which can become impaired by various neurodegenerative diseases. When the vergence system is affected, this can result in strabismus and disorienting diplopia. While previous studies have detailed the effect of these disorders on other eye movements, such as saccades, relatively little is known about strabismus. Here, we focus on the prevalence, clinical characteristics, and treatment of strabismus and disorders of vergence in Parkinson’s disease, spinocerebellar ataxia, Huntington disease, and multiple system atrophy. We find that vergence abnormalities may be more common in these disorders than previously thought. In Parkinson’s disease, the evidence suggests that strabismus is related to convergence insufficiency; however, it is responsive to dopamine replacement therapy and can, therefore, fluctuate with medication “on” and “off” periods throughout the day. Diplopia is also established as a side effect of deep brain stimulation and is thought to be related to stimulation of the subthalamic nucleus and extraocular motor nucleus among other structures. In regards to the spinocerebellar ataxias, oculomotor symptoms are common in many subtypes, but diplopia is most common in SCA3 also known as Machado–Joseph disease. Ophthalmoplegia and vergence insufficiency have both been implicated in strabismus in these patients, but cannot fully explain the properties of the strabismus, suggesting the involvement of other structures as well. Strabismus has not been reported as a common finding in Huntington disease or atypical parkinsonian syndromes and more studies are needed to determine how these disorders affect binocular alignment.

Enhancement of Visual Comfort and Sense of Presence on Stereoscopic 3D Images

Conventional stereoscopic 3D (S3D) displays do not provide accommodation depth cues of the 3D image or video contents being viewed. The sense of content depths is thus limited to cues supplied by motion parallax (for 3D video), stereoscopic vergence cues created by presenting left and right views to the respective eyes, and other contextual and perspective depth cues. The absence of accommodation cues can induce two kinds of accommodation vergence mismatches (AVM) at the fixation and peripheral points, which can result in severe visual discomfort. With the aim of alleviating discomfort arising from AVM, we propose a new visual comfort enhancement approach for processing S3D visual signals to deliver a more comfortable 3D viewing experience at the display. This is accomplished via an optimization process whereby a predictive indicator of visual discomfort is minimized, while still aiming to maintain the viewer's sense of 3D presence by performing a suitable parallax shift, and by directed blurring of the signal. Our processing framework is defined on 3D visual coordinates that reflect the nonuniform resolution of retinal sensors and that uses a measure of 3D saliency strength. An appropriate level of blur that corresponds to the degree of parallax shift is found, making it possible to produce synthetic accommodation cues implemented using a perceptively relevant filter. By this method, AVM, the primary contributor to the discomfort felt when viewing S3D images, is reduced. We show via a series of subjective experiments that the proposed approach improves visual comfort while preserving the sense of 3D presence.

Are high lags of accommodation in myopic children due to motor deficits?

Children with a progressing myopia exhibit an abnormal pattern of high accommodative lags coupled with high accommodative convergence (AC/A) and high accommodative adaptation. This is not predicted by the current models of accommodation and vergence. Reduced accommodative plant gain and reduced sensitivity to blur have been suggested as potential causes for this abnormal behavior. These etiologies were tested by altering parameters (sensory, controller and plant gains) in the Simulink model of accommodation. Predictions were then compared to the static and dynamic blur accommodation (BA) measures taken using a Badal optical system on 12 children (6 emmetropes and 6 myopes, 8-13years) and 6 adults (20-35years). Other critical parameters such as CA/C, AC/A, and accommodative adaptation were also measured. Usable BA responses were classified as either typical or atypical. Typical accommodation data confirmed the abnormal pattern of myopia along with an unchanged CA/C. Main sequence relationship remained invariant between myopic and nonmyopic children. An overall reduction was noted in the response dynamics such as peak velocity and acceleration with age. Neither a reduced plant gain nor reduced blur sensitivity could predict the abnormal accommodative behavior. A model adjustment reflecting a reduced accommodative sensory gain (ASG) coupled with an increased AC cross-link gain and reduced vergence adaptive gain does predict the empirical findings. Empirical measures also showed a greater frequency of errors in accommodative response generation (atypical responses) in both myopic and control children compared to adults.

3D Displays

Creating realistic three-dimensional (3D) experiences has been a very active area of research and development, and this article describes progress and what remains to be solved. A very active area of technical development has been to build displays that create the correct relationship between viewing parameters and triangulation depth cues: stereo, motion, and focus. Several disciplines are involved in the design, construction, evaluation, and use of 3D displays, but an understanding of human vision is crucial to this enterprise because in the end, the goal is to provide the desired perceptual experience for the viewer. In this article, we review research and development concerning displays that create 3D experiences. And we highlight areas in which further research and development is needed.

Viewing 3D TV over two months produces no discernible effects on balance, coordination or eyesight

With the rise in stereoscopic 3D media, there has been concern that viewing stereoscopic 3D (S3D) content could have long-term adverse effects, but little data are available. In the first study to address this, 28 households who did not currently own a 3D TV were given a new TV set, either S3D or 2D. The 116 members of these households all underwent tests of balance, coordination and eyesight, both before they received their new TV set, and after they had owned it for 2 months. We did not detect any changes which appeared to be associated with viewing 3D TV. We conclude that viewing 3D TV does not produce detectable effects on balance, coordination or eyesight over the timescale studied. Practitioner Summary: Concern has been expressed over possible long-term effects of stereoscopic 3D (S3D). We looked for any changes in vision, balance and coordination associated with normal home S3D TV viewing in the 2 months after first acquiring a 3D TV. We find no evidence of any changes over this timescale.

Adaptation of horizontal eye alignment in the presence of prism in young children

Young children experience decreased convergence and increased accommodation demands relative to adults, as a result of their small interpupillary distance and hyperopic refraction. Those with typical amounts of hyperopic refractive error must accommodate more than an emmetrope to achieve focused retinal images, which may also drive additional convergence through the neural coupling. Adults and older children have demonstrated vergence adaptation to a variety of visual stimuli. Can vergence adaptation help younger children achieve alignment in the presence of these potentially conflicting demands? Purkinje image eye tracking and eccentric photorefraction were used to record simultaneous vergence and accommodation responses in adults and young children (3-6 years). To assess vergence adaptation, heterophoria was monitored before, during, and after adaptation induced by both base-in and base-out prisms. Adaptation was observed in both adults and young children with no significant effect of age, F(1, 34) = 0.014, p = 0.907. Changes in accommodation between before, during, and after adaptation were less than 0.5 D in binocular viewing. Typically developing children appear capable of vergence adaptation, which might play an important role in the maintenance of eye alignment under their changing visual demands.

Dynamic lens and monovision 3D displays to improve viewer comfort

Stereoscopic 3D (S3D) displays provide an additional sense of depth compared to non-stereoscopic displays by sending slightly different images to the two eyes. But conventional S3D displays do not reproduce all natural depth cues. In particular, focus cues are incorrect causing mismatches between accommodation and vergence: The eyes must accommodate to the display screen to create sharp retinal images even when binocular disparity drives the eyes to converge to other distances. This mismatch causes visual discomfort and reduces visual performance. We propose and assess two new techniques that are designed to reduce the vergence-accommodation conflict and thereby decrease discomfort and increase visual performance. These techniques are much simpler to implement than previous conflict-reducing techniques. The first proposed technique uses variable-focus lenses between the display and the viewer's eyes. The power of the lenses is yoked to the expected vergence distance thereby reducing the mismatch between vergence and accommodation. The second proposed technique uses a fixed lens in front of one eye and relies on the binocularly fused percept being determined by one eye and then the other, depending on simulated distance. We conducted performance tests and discomfort assessments with both techniques and compared the results to those of a conventional S3D display. The first proposed technique, but not the second, yielded clear improvements in performance and reductions in discomfort. This dynamic-lens technique therefore offers an easily implemented technique for reducing the vergence-accommodation conflict and thereby improving viewer experience.

Unmasking the linear behaviour of slow motor adaptation to prolonged convergence

Adaptation to changing environmental demands is central to maintaining optimal motor system function. Current theories suggest that adaptation in both the skeletal-motor and oculomotor systems involves a combination of fast (reflexive) and slow (recalibration) mechanisms. Here we used the oculomotor vergence system as a model to investigate the mechanisms underlying slow motor adaptation. Unlike reaching with the upper limbs, vergence is less susceptible to changes in cognitive strategy that can affect the behaviour of motor adaptation. We tested the hypothesis that mechanisms of slow motor adaptation reflect early neural processing by assessing the linearity of adaptive responses over a large range of stimuli. Using varied disparity stimuli in conflict with accommodation, the slow adaptation of tonic vergence was found to exhibit a linear response whereby the rate (R(2)  = 0.85, P < 0.0001) and amplitude (R(2)  = 0.65, P < 0.0001) of the adaptive effects increased proportionally with stimulus amplitude. These results suggest that this slow adaptive mechanism is an early neural process, implying a fundamental physiological nature that is potentially dominated by subcortical and cerebellar substrates.

[Evaluation of Motion Sickness Induced by 3D Video Clips]

The use of stereoscopic images has been spreading rapidly. Nowadays, stereoscopic movies are nothing new to people. Stereoscopic systems date back to 280 A.D. when Euclid first recognized the concept of depth perception by humans. Despite the increase in the production of three-dimensional (3D) display products and many studies on stereoscopic vision, the effect of stereoscopic vision on the human body has been insufficiently understood. However, symptoms such as eye fatigue and 3D sickness have been the concerns when viewing 3D films for a prolonged period of time; therefore, it is important to consider the safety of viewing virtual 3D contents as a contribution to society. It is generally explained to the public that accommodation and convergence are mismatched during stereoscopic vision and that this is the main reason for the visual fatigue and visually induced motion sickness (VIMS) during 3D viewing. We have devised a method to simultaneously measure lens accommodation and convergence. We used this simultaneous measurement device to characterize 3D vision. Fixation distance was compared between accommodation and convergence during the viewing of 3D films with repeated measurements. Time courses of these fixation distances and their distributions were compared in subjects who viewed 2D and 3D video clips. The results indicated that after 90 s of continuously viewing 3D images, the accommodative power does not correspond to the distance of convergence. In this paper, remarks on methods to measure the severity of motion sickness induced by viewing 3D films are also given. From the epidemiological viewpoint, it is useful to obtain novel knowledge for reduction and/or prevention of VIMS. We should accumulate empirical data on motion sickness, which may contribute to the development of relevant fields in science and technology.

Stereoscopic 3D Visual Discomfort Prediction: A Dynamic Accommodation and Vergence Interaction Model

The human visual system perceives 3D depth following sensing via its binocular optical system, a series of massively parallel processing units, and a feedback system that controls the mechanical dynamics of eye movements and the crystalline lens. The process of accommodation (focusing of the crystalline lens) and binocular vergence is controlled simultaneously and symbiotically via cross-coupled communication between the two critical depth computation modalities. The output responses of these two subsystems, which are induced by oculomotor control, are used in the computation of a clear and stable cyclopean 3D image from the input stimuli. These subsystems operate in smooth synchronicity when one is viewing the natural world; however, conflicting responses can occur when viewing stereoscopic 3D (S3D) content on fixed displays, causing physiological discomfort. If such occurrences could be predicted, then they might also be avoided (by modifying the acquisition process) or ameliorated (by changing the relative scene depth). Toward this end, we have developed a dynamic accommodation and vergence interaction (DAVI) model that successfully predicts visual discomfort on S3D images. The DAVI model is based on the phasic and reflex responses of the fast fusional vergence mechanism. Quantitative models of accommodation and vergence mismatches are used to conduct visual discomfort prediction. Other 3D perceptual elements are included in the proposed method, including sharpness limits imposed by the depth of focus and fusion limits implied by Panum's fusional area. The DAVI predictor is created by training a support vector machine on features derived from the proposed model and on recorded subjective assessment results. The experimental results are shown to produce accurate predictions of experienced visual discomfort.

Transfer Function Model of Physiological Mechanisms Underlying Temporal Visual Discomfort Experienced When Viewing Stereoscopic 3D Images

When viewing 3D images, a sense of visual comfort (or lack of) is developed in the brain over time as a function of binocular disparity and other 3D factors. We have developed a unique temporal visual discomfort model (TVDM) that we use to automatically predict the degree of discomfort felt when viewing stereoscopic 3D (S3D) images. This model is based on physiological mechanisms. In particular, TVDM is defined as a second-order system capturing relevant neuronal elements of the visual pathway from the eyes and through the brain. The experimental results demonstrate that the TVDM transfer function model produces predictions that correlate highly with the subjective visual discomfort scores contained in the large public databases. The transfer function analysis also yields insights into the perceptual processes that yield a stable S3D image.

Agreement between clinical and laboratory methods assessing tonic and cross-link components of accommodation and vergence

BACKGROUND

Several tests are available to optometrists for investigating accommodation and vergence. This study sought to investigate the agreement between clinical and laboratory methods and to clarify which components are actually measured when tonic and cross-link of accommodation and vergence are assessed.

METHODS

Tonic vergence, tonic accommodation, accommodative vergence (AC/A) and vergence accommodation (CA/C) were measured using several tests. Clinical tests were compared to the laboratory assessment, the latter being regarded as an absolute reference. The repeatability of each test and the degree of agreement between the tests were quantified using Bland-Altman analysis.

RESULTS

The values obtained for each test were found to be stable across repetitions; however, in most cases, significant differences were observed between tests supposed to measure the same oculomotor component. Tonic and cross-link components cannot be easily assessed because proximal and instrumental responses interfere with the assessment. Other components interfere with oculomotor assessment. Specifically, accommodative divergence interferes with tonic vergence estimation and the type of accommodation considered in the AC/A ratio affects its magnitude. Results on clinical tonic accommodation and clinical CA/C show that further investigation is needed to clarify the limitations associated with the use of difference of Gaussian as visual targets to open the accommodative loop.

CONCLUSIONS

Although different optometric tests of accommodation and vergence rely on the same basic principles, the results of this study indicate that clinical and laboratory methods actually involve distinct components. These differences, which are induced by methodological choices, must be taken into account, when comparing studies or when selecting a test to investigate a particular oculomotor component.

Stereo vision and strabismus

Binocular stereopsis, or stereo vision, is the ability to derive information about how far away objects are, based solely on the relative positions of the object in the two eyes. It depends on both sensory and motor abilities. In this review, I briefly outline some of the neuronal mechanisms supporting stereo vision, and discuss how these are disrupted in strabismus. I explain, in some detail, current methods of assessing stereo vision and their pros and cons. Finally, I review the evidence supporting the clinical importance of such measurements.

Disparity-driven vs blur-driven models of accommodation and convergence in binocular vision and intermittent strabismus

PURPOSE

To propose an alternative and practical model to conceptualize clinical patterns of concomitant intermittent strabismus, heterophoria, and convergence and accommodation anomalies.

METHODS

Despite identical ratios, there can be a disparity- or blur-biased "style" in three hypothetical scenarios: normal; high ratio of accommodative convergence to accommodation (AC/A) and low ratio of convergence accommodation to convergence (CA/C); low AC/A and high CA/C. We calculated disparity bias indices (DBI) to reflect these biases and provide early objective data from small illustrative clinical groups that fit these styles.

RESULTS

Normal adults (n = 56) and children (n = 24) showed disparity bias (adult DBI 0.43 [95% CI, 0.50-0.36], child DBI 0.20 [95% CI, 0.31-0.07]; P = 0.001). Accommodative esotropia (n = 3) showed less disparity-bias (DBI 0.03). In the high AC/A-low CA/C scenario, early presbyopia (n = 22) showed mean DBI of 0.17 (95% CI, 0.28-0.06), compared to DBI of -0.31 in convergence excess esotropia (n=8). In the low AC/A-high CA/C scenario near exotropia (n = 17) showed mean DBI of 0.27. DBI ranged between 1.25 and -1.67.

CONCLUSIONS

Establishing disparity or blur bias adds to AC/A and CA/C ratios to explain clinical patterns. Excessive bias or inflexibility in near-cue use increases risk of clinical problems.

The rate of change of vergence-accommodation conflict affects visual discomfort

Stereoscopic (S3D) displays create conflicts between the distance to which the eyes must converge and the distance to which the eyes must accommodate. Such conflicts require the viewer to overcome the normal coupling between vergence and accommodation, and this effort appears to cause viewer discomfort. Vergence-accommodation coupling is driven by the phasic components of the underlying control systems, and those components respond to relatively fast changes in vergence and accommodative stimuli. Given the relationship between phasic changes and vergence-accommodation coupling, we examined how the rate of change in the vergence-accommodation conflict affects viewer discomfort. We used a stereoscopic display that allows independent manipulation of the stimuli to vergence and accommodation. We presented stimuli that simulate natural viewing (i.e., vergence and accommodative stimuli changed together) and stimuli that simulate S3D viewing (i.e., vergence stimulus changes but accommodative stimulus remains fixed). The changes occurred at 0.01, 0.05, or 0.25 Hz. The lowest rate is too slow to stimulate the phasic components while the highest rate is well within the phasic range. The results were consistent with our expectation: somewhat greater discomfort was experienced when stimulus distance changed rapidly, particularly in S3D viewing when the vergence stimulus changed but the accommodative stimulus did not. These results may help in the generation of guidelines for the creation and viewing of stereo content with acceptable viewer comfort.

Effect of the accommodation-vergence conflict on vergence eye movements

With the broader use of stereoscopic displays, a flurry of research activity about the accommodation-vergence conflict has emerged to highlight the implications for the human visual system. In stereoscopic displays, the introduction of binocular disparities requires the eyes to make vergence movements. In this study, we examined vergence dynamics with regard to the conflict between the stimulus-to-accommodation and the stimulus-to-vergence. In a first experiment, we evaluated the immediate effect of the conflict on vergence responses by presenting stimuli with conflicting disparity and focus on a stereoscopic display (i.e. increasing the stereoscopic demand) or by presenting stimuli with matched disparity and focus using an arrangement of displays and a beam splitter (i.e. focus and disparity specifying the same locations). We found that the dynamics of vergence responses were slower overall in the first case due to the conflict between accommodation and vergence. In a second experiment, we examined the effect of a prolonged exposure to the accommodation-vergence conflict on vergence responses, in which participants judged whether an oscillating depth pattern was in front or behind the fixation plane. An increase in peak velocity was observed, thereby suggesting that the vergence system has adapted to the stereoscopic demand. A slight increase in vergence latency was also observed, thus indicating a small decline of vergence performance. These findings offer a better understanding and document how the vergence system behaves in stereoscopic displays. We describe what stimuli in stereo-movies might produce these oculomotor effects, and discuss potential applications perspectives.

Accommodation and vergence response gains to different near cues characterize specific esotropias

AIM

To describe preliminary findings of how the profile of the use of blur, disparity, and proximal cues varies between non-strabismic groups and those with different types of esotropia.

DESIGN

This was a case control study.

METHODOLOGY

A remote haploscopic photorefractor measured simultaneous convergence and accommodation to a range of targets containing all combinations of binocular disparity, blur, and proximal (looming) cues. Thirteen constant esotropes, 16 fully accommodative esotropes, and 8 convergence excess esotropes were compared with age- and refractive error-matched controls and 27 young adult emmetropic controls. All wore full refractive correction if not emmetropic. Response AC/A and CA/C ratios were also assessed.

RESULTS

Cue use differed between the groups. Even esotropes with constant suppression and no binocular vision (BV) responded to disparity in cues. The constant esotropes with weak BV showed trends for more stable responses and better vergence and accommodation than those without any BV. The accommodative esotropes made less use of disparity cues to drive accommodation (p = 0.04) and more use of blur to drive vergence (p = 0.008) than controls. All esotropic groups failed to show the strong bias for better responses to disparity cues found in the controls, with convergence excess esotropes favoring blur cues. AC/A and CA/C ratios existed in an inverse relationship in the different groups. Accommodative lag of > 1.0 D at 33 cm was common (46%) in the pooled esotropia groups compared with 11% in typical children (p = 0.05).

CONCLUSION

Esotropic children use near cues differently from matched non-esotropic children in ways characteristic to their deviations. Relatively higher weighting for blur cues was found in accommodative esotropia compared to matched controls.

Why do only some hyperopes become strabismic?

Children with hyperopia greater than +3.5 diopters (D) are at increased risk for developing refractive esotropia. However, only approximately 20% of these hyperopes develop strabismus. This review provides a systematic theoretical analysis of the accommodation and vergence oculomotor systems with a view to understanding factors that could either protect a hyperopic individual or precipitate a strabismus. The goal is to consider factors that may predict refractive esotropia in an individual and therefore help identify the subset of hyperopes who are at the highest risk for this strabismus, warranting the most consideration in a preventive effort.