Performance on the three-point Vernier alignment or acuity test as a function of age: measurement extended to ages 5 to 9 years

The Clinical Use of Vernier Acuity: Resolution of the Visual Cortex Is More Than Meets the Eye

Vernier acuity measures the ability to detect a misalignment or positional offset between visual stimuli, for example between two vertical lines when reading a vernier scale. It is considered a form of visual hyperacuity due to its detectable thresholds being considerably smaller than the diameter of a foveal cone receptor, which limits the spatial resolution of classical visual acuity. Vernier acuity relies heavily on cortical processing and is minimally affected by optical media factors, making it a useful indicator of cortical visual function. Vernier acuity can be measured, usually in seconds of arc, by freely available automated online tools as well as via analysis of steady state visual-evoked potentials, which allows measurement in non- or pre-verbal subjects such as infants. Although not routinely measured in clinical practice, vernier acuity is known to be reduced in amblyopia, glaucoma and retinitis pigmentosa, and has been explored as a measure of retinal or neural visual function in the presence of optical media opacities. Current clinical utility includes a home-based vernier acuity tool, preferential hyperacuity perimetry, which is used for screening for choroidal neovascularisation in age-related macular degeneration. This review will discuss the measurement of vernier acuity, provide a current understanding of its neuro-ophthalmic mechanisms, and finally explore its utility through a clinical lens, along with our recommendations for best practice.

Spatial and temporal aspects of visual backward masking in children and young adolescents

The development of visual functions is very diverse. Some visual functions mature within the first year of life, whereas maturation for other functions extends into adolescence. The reasons for these developmental differences are largely unknown. Here, we investigated spatiotemporal processing in children (7–9 years, n = 15), young adolescents (11–13 years, n = 26), and adults (18–33 years, n = 24) using the shine-through visual backward-masking paradigm. We found that children had significantly longer vernier durations than either young adolescents or adults. However, children’s spatial and temporal processing of complex masks was very similar to that of young adolescents and adults. We suggest that spatiotemporal processing related to visual backward masking is already fully developed at age 7, whereas the attentional processes related to target enhancement only mature in young adolescence.

Vernier acuity cards: examination of development and screening validity

PURPOSE

Because vernier acuity seems to be limited by the visual cortex, it possesses excellent potential as a clinical/screening tool to detect amblyopia in infants and toddlers. Thus, we developed the vernier acuity cards specifically for this age group. We compared developmental data gathered using this new test and the Teller Acuity Cards. In addition, we compared the clinical/screening validity of the two tests by testing children old enough to complete optotype acuity testing (6.2 ± 2.5 years).

METHODS

Vernier acuity and grating acuity were assessed in 98 children and 18 adults with normal vision (age range = 2.8 months to 35.8 years). The developmental time course of the two visual functions was compared. In addition, vernier acuity and grating acuity were measured in 43 children with amblyopia and 30 nonamblyopic children with an amblyogenic condition. Each child's grating acuity and vernier acuity were classified as normal/abnormal based on age-appropriate norms. These classifications were compared with amblyopia diagnoses by crowded HOTV or Early Treatment Diabetic Retinopathy Study (ETDRS) testing.

RESULTS

Vernier acuity and grating acuity follow different developmental time courses in normal infants and children. Vernier acuity is initially poorer than grating acuity but surpasses it by the age 5 years and is adult-like by the age 8 years. Compared with the Teller Acuity Cards, the vernier acuity cards yielded higher sensitivity (81 vs. 44%) and similar specificity (73 vs. 93%) and were more sensitive to all amblyopia subtypes/levels of severity.

CONCLUSIONS

The developmental time course of vernier acuity differed from that of grating acuity, implying that it is not mediated by the retina. Also, the impressive validity of the vernier acuity cards suggests that they are an effective tool for detecting amblyopia.

Visuospatial interpolation in typically developing children and in people with Williams Syndrome

Visuospatial interpolation is the estimation of object position or contour shape computed from known "anchor" positions. We characterized the developmental profile of interpolation by measuring positional thresholds as a function of inter-element separation without (Experiment 1) and with (Experiment 2) the context of illusory contours in typically developing children, typical adults and individuals with Williams Syndrome (WS), a genetic disorder that causes impaired global visuospatial abilities. We found that typically developing children and WS individuals had more difficulty integrating information across distant elements than typical adults. However, illusory contours improved thresholds in all participant groups in a similar way. Our results suggest that in WS individuals, and in typically developing children, the grouping mechanisms that enable long-range spatial integration are immature. We hypothesize that WS individuals and young children can use stimulus-driven grouping cues for bottom-up integration, but have immature mechanisms for top-down integration of spatial information.

A psychophysical study of human binocular interactions in normal and amblyopic visual systems

During infancy and childhood, spatial contrast sensitivity and alignment sensitivity undergo maturation, and during this period the visual system has considerable plasticity. The purpose of this study was to compare the nature of interocular interactions of these spatial functions in normally sighted children and adults, and to study the extent to which interocular interactions are impaired in anisometropic amblyopia. Spatial functions were measured under three viewing conditions: monocular (fellow eye occluded), dichoptic (uniform stimulus presented to the fellow eye but with a peripheral fusion lock), and binocular. Measurements were made in each eye during monocular and dichoptic viewing. In the contrast sensitivity task, Gabor stimuli were presented in one of two temporal intervals. For the alignment task, a three-element Gabor stimulus was used. The task of the subject was to indicate the direction of displacement of the middle patch with respect to the outer patches. The findings indicate that in children, binocular contrast sensitivity was better than monocular (binocular summation) but so too was dichoptic sensitivity (dichoptic summation). The magnitude of binocular/dichoptic summation was significantly greater in children than in normally sighted adults for contrast sensitivity, but not for alignment sensitivity. In anisometropic amblyopes, however, we find that for the group as a whole the amblyopic eye does not benefit when the fellow eye views a dichoptic stimulus, compared to dark occlusion of that eye. In addition, we found considerable inter-individual variation within the amblyopic group. Implications of these findings for techniques used in vision therapy are discussed.

A comparison of the effects of ageing upon vernier and bisection acuity

While most positional acuity tasks exhibit an age-related decline in performance, the effect of ageing upon vernier acuity continues to be the subject of some debate. In the present study we employed a stimulus design that enabled the simultaneous determination of bisection and vernier acuities in 36 subjects, aged between 22 and 84 years. This approach provided a means for directly testing the hypothesis that ageing affects bisection acuity but not vernier acuity by ensuring that differences in stimulus configuration and in the subject's task were kept to an absolute minimum. Optimum thresholds increased as a function of age for both bisection and vernier tasks. Inter-subject threshold variability also increased with age. Issues surrounding the comparison of absolute vernier thresholds across different studies are discussed and two important methodological factors are identified: the precise statistical method used to estimate thresholds, and the magnitude, in angular terms, of the smallest spatial offset of the elements of the vernier stimulus which can be displayed. Comparison with previously published data indicates that the discrepancy between this study and most previous investigations with respect to the effect of age upon vernier performance can be at least partly accounted for by differences in the minimum displayable vernier offset. Vernier thresholds do increase with age. The increased variability of vernier thresholds in older subjects would appear to limit the diagnostic value of the test as a means of enabling normal ageing to be distinguished from visual loss due to pathology of the eye or visual system.

Late maturation of visual hyperacuity

We used a visual evoked-potential measure to study the development of two components of pattern vision, vernier acuity and grating acuity, in humans from early infancy through adolescence. These two visual functions develop at similar rates and have nearly the same absolute values between 1 month and 6 years of age. After age 6, grating acuity is constant at the adult level, but vernier acuity continues to improve, becoming a hyperacuity. Vernier acuity reaches asymptotic levels around age 14 years. These results suggest that adultlike vernier hyperacuity is not limited by spatial resolution or sensitivity of small receptive fields, but rather that the limitation is imposed by higher-level processing. Sensitivity, connections in visual cortical areas, or both therefore retain plasticity throughout childhood and into adolescence.