An investigation of prism adaptation latency

Phoria Adaptation: The Ghost in the Machine

Importance: Phoria adaptation is a central tonus mechanism that provides plasticity to binocular alignment. However, its slow dissipation inevitably adulterates our clinical strabismus measurements.Purpose: To examine the role of phoria adaptation in normal binocular control, understand its neural substrate, and explore how it can alter our clinical measurements in common forms of strabismus.Methods: Investigation into the role of phoria adaptation in maintaining binocular alignment and its role in altering clinical strabismus measurement.Results: Phoria adaptation permeates all aspects of binocular alignment. It accounts for the stability of orthophoria, "latent" phorias, tenacious proximal fusion in intermittent exotropia, large fusional vertical amplitudes in congenital superior oblique muscle palsy, the "eating up" of prisms in accommodative esotropia, the smaller measured distance deviation in patients with high AC/A ratio or convergence excess, absence of physiologic skew deviation during head tilt, fusional divergence amplitudes, and spread of comitance. This binocular control system probably arises from a cerebellar learning mechanism that involves input via climbing fibers to the inferior olive, which provide a powerful timing and error signal to the cerebellar Purkinje cells to produce activity-dependent modification analogous to long-term potentiation.Conclusions: Phoria adaptation is generated by a central neural integrator that provides inertia, plasticity, and positional stability to human binocular vision.

Comparison of symmetrical prism adaptation to asymmetrical prism adaptation in those with normal binocular vision

This study sought to determine whether symmetrical compared to asymmetrical horizontal prisms (base-out or base-in) evoked different rates of phoria adaptation. Sixteen young adults with normal binocular vision participated in a symmetrical phoria adaptation experiment using a 3Δ base-out or 3Δ base-in binocular prism flipper and an asymmetrical phoria adaptation experiment using a 6Δ base-out or 6Δ base-in monocular wedge prism. The experiments were randomized and counterbalanced to reduce the influence of the prism stimulation order. Asymmetrical base-out prism adaptation was significantly faster than symmetrical prism adaptation for subjects with normal binocular vision. Asymmetrical phoria adaptation with base-in prism was not significantly different from symmetrical phoria adaptation implying that there are directional asymmetries (convergent versus divergent eye movements) in the slow fusional component of vergence. Data suggest that a potential interaction between the version system and the slow fusional vergence system may exist. Results have clinical relevance because patients with convergence or divergence insufficiency/excess may potentially show more pronounced differences between symmetrical and asymmetrical phoria adaptation compared to binocularly normal controls. These differences might also be relevant to clinical measurements such as vergence fusional range, which can be measured symmetrically (with Risley prisms in a phoroptor) or asymmetrically (with prism bar).

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.

Stereoacuity as an indicator of prism adaptation

PURPOSE

The purpose of this study was to determine whether stereoacuity can be used as an indicator of prism adaptation. In particular, we wanted to know whether the time required for stereoacuity to return to the initial level after viewing through a prism can be used to determine the degree of adaptation.

MATERIALS AND METHODS

Eighteen subjects participated in this study. Stereoacuity and dissociated phoria were determined using the TNO stereotest and the Maddox rod, respectively. Prism vergences were measured using a prism bar. For each participant, prism power equivalent to the blur point of base-in (BI) and base-out (BO) fusional vergence at 40 cm was divided and placed in front of both eyes. At 0, 3, 6, 9 and 12 min after prism introduction, the stereoacuity was measured, and at 0 and 12 min, the heterophoria was measured.

RESULTS

The repeated measures ANOVA showed a significant difference between the mean stereoacuity for BI and BO prisms at the different measurement times (p < 0.05). For BO prism, the initial value was different between 0 and 3 min after the prism introduction, whereas for BI prism, a difference in stereoacuity was found between the pre-prism value and the value at 0, 3 and 6 min. The size of the heterophoria with BO and BI prisms was different from 0 to 12 min (p < 0.05).

CONCLUSION

The time required for stereoacuity to return to baseline level was more than 3 min for BO, and more than 6 min for BI prism. In addition, the time required to return to baseline values was not similar for the stereoacuity and heterophoria. The recovery of stereoacuity is slower when adapting to divergence, as when looking from near to far. This implies that stereopsis responds faster to near targets than to distant one, and may precede complete phoria adaptation.

Vergence adaptation in clinical vergence testing

BACKGROUND

The purposes of this investigation were to determine whether vergence adaptation occurs after vergence range testing and vergence facility testing and to determine whether vergence adaptation correlates with the results of these tests.

METHODS

Thirty subjects participated in 3 testing sessions on different days. During each session 1 of the following was tested: base-out prism bar vergences, vergence facility (12 base-out/3 base-in binocular prism flippers for 1 minute), and 5 minutes viewing with 6 prism diopters of base-out prism. Before and after each test, the near phoria was measured using the modified Thorington method.

RESULTS

There was no correlation between the amplitude of the vergence ranges and the amplitude of vergence facility. Significant vergence adaptation as indicated by an esophoric shift of approximately 3 prism diopters occurred in all testing sessions. The amplitude of vergence adaptation did not correlate with either the amplitude of the blur vergence range or vergence facility. There was a significant correlation between the amplitude of vergence adaptation and the amplitude of the break vergence range.

CONCLUSIONS

The lack of correlation between the blur vergence range and the vergence facility is not likely because of vergence adaptation. The lack of correlation between the break vergence range and the vergence facility may be in part caused by vergence adaptation.

The forced vergence cover test and phoria adaptation

Phoria adaptation (PA) provides innervation to help maintain the correct vergence posture for binocularly viewing objects. Once fusion is disrupted, such as is required for measuring a (dissociated) phoria, this innervation is slowly depleted. Thus, extended periods of monocular occlusion can be required to dissipate PA and reveal the full extent of the phoria. Two versions of a forced vergence modification of the alternating cover test (CT) have been proposed to rapidly show the full phoria. We evaluated the ability of these forced vergence CTs (FVCT-1 and FVCT-2) to deplete the PA induced by a 15 min adaptation period to base out prism. In both experiments, the CT followed by the FVCT was performed before and after the adaptation period. In Experiment 1 (n = 13), the FVCT-1 was evaluated at 40 cm. Experiment 2 (n = 32) evaluated the FVCT-2 at 4 m. In Experiments 1 and 2, the difference between pre- and post-adaptation CTs showed significant PA occurred during the adaptation period (7.8(Delta), p < 0.0005, and 5.4(Delta), p < 0.0005 respectively). In Experiment 1, the FVCT-1 did not reveal a larger phoria than the CT before (mean difference: 0.4(Delta), p = 0.34) or after (no difference for all subjects) the adaptation period. Thus, the FVCT-1 did not alter PA. In Experiment 2, the FVCT-2 did show a shift in the phoria compared to the CT. However, this shift was found to be equivalent before and after the adaptation period (mean difference in shift: 0.22(Delta), 95% CI: -0.52 to 0.96(Delta)). Thus, the FVCT-2 shifts the phoria a constant amount independent of the amount of PA present. We conclude that neither FVCT's behaviour is dependent on the PA present. Thus, these procedures are unlikely to be effective clinical procedures for revealing the full magnitude of the phoria.

Stereoacuity is affected by induced phoria but returns toward baseline during vergence adaptation

PURPOSE

In normal binocular single vision adaptation to an induced deviation occurs over a period of several minutes. This study investigates the effect on stereoacuity during vergence adaptation.

METHODS

Stereoacuity, using the Frisby near stereotest, was measured in 20 participants aged 20.2 +/- 1.9 years with normal binocular single vision. Measurements were taken immediately on inducing a phoria with 12(Delta) base-out prisms (split), and after 3, 6, and 9 minutes of adaptation. A measure of stereoacuity was also taken with the same size prisms that were used concomitantly to control for the reduced visual acuity.

RESULTS

Stereoacuity was found to decrease following introduction of the 12(Delta) base-out prismatic glasses (9.4 +/- 2.5 arcsec compared with 24.4 +/- 21.4 arcsec) and then increase over the 9 minute period of adaptation (ANOVA, p = 0.0002). Using post-hoc tests with Bonferroni correction, the decrease of stereoacuity on introduction of the prism was significant (p = 0.0039), and although an increase in stereoacuity appeared to occur after 3 and 6 minutes of wearing the 12(Delta) glasses (14.9 +/- 4.3 arcsec, 12.3 +/- 4.5 arcsec), this did not return to the baseline value until 9 minutes, when the stereoacuity had increased to 12.6 +/- 10.6 arcsec (p = 0.1982).

CONCLUSIONS

In these participants, inducing a deviation with base-out prisms negatively affected near stereoacuity. However, as adaptation occurred, the level of stereoacuity was seen to increase back toward the baseline measurement.

The role of vergence adaptation in recovery of binocular single vision (BSV) following sensory strabismus

Vergence adaptation is an important element of comfortable binocular single vision and probably contributes to the high incidence of orthophoria or small angles of heterophoria in the normal population. Where binocular single vision has been absent for a period of time, restoration of good visual acuity appears to enable the vergence adaptation mechanism to become active again. A case is presented in which a moderate to large angle of deviation rapidly 'disappeared' once good visual acuity was restored and the disparate images could be fused. Known factors concerning vergence adaptation are discussed in relation to such clinical cases.