Sharpening coarse-to-fine stereo vision by perceptual learning: asymmetric transfer across the spatial frequency spectrum

Can viewing a 3D movie improve visual function in children with a history of amblyopia and neurotypical children?: A pilot study

PURPOSE

The aim of this pilot study was to determine whether viewing an immersive 3D movie with large disparities in a cinema resulted in improved visual acuity (VA), stereoscopic depth perception (ST), and improved eye alignment in residual amblyopic children and children without amblyopia.

METHODS

A total of 24 children aged between 5 and 12 years with a history of anisometropic and/or strabismic amblyopia, that had been previously treated and who currently have residual amblyopia (N = 14), and in children with typical development without amblyopia (N = 10) viewed the movie in 3D Sing 2 in a cinema for 110 minutes. Visual acuity, stereoacuity and ocular deviation were assessed before viewing the movie, and three months later. Stereoacuity and ocular deviation were also measured immediately after viewing the movie.

RESULTS

We observed an improvement in visual acuity in the non-dominant (amblyopic) eye 3 months after viewing the movie in the amblyopic group (P<0.001). Stereopsis improved immediately after viewing the movie (P = 0.02), and after 3 months by ≈ 40% (P = 0.01). Moreover, improvements in stereopsis were also observed in children without amblyopia (P = 0.04). No significant changes in ocular deviation were observed in either group.

CONCLUSIONS

These pilot results suggest that brief exposure to large disparities by viewing a 3D movie in a cinema can help to improve stereopsis and visual acuity in children aged 5‒12 years with previously treated amblyopia, and provide a rationale for a randomized clinical trial.

Learning to see in depth

Stereopsis provides us with a vivid impression of the depth and distance of objects in our 3- dimensional world. Stereopsis is important for a number of everyday visual tasks, including (but not limited to) reaching and grasping, fine visuo-motor control, and navigating in our world. This review briefly discusses the neural substrate for normal binocular vision and stereopsis and its development in primates; outlines some of the issues and limitations of stereopsis tests and examines some of the factors that limit the typical development of stereopsis and the causes and consequences of stereo-deficiency and stereo-blindness. Finally, we review several approaches to improving or recovering stereopsis in both neurotypical individuals and those with stereo-deficiency and stereo-blindness and outline some emerging strategies for improving stereopsis.

Transfer of Perceptual Learning From Local Stereopsis to Global Stereopsis in Adults With Amblyopia: A Preliminary Study

It has long been debated whether the analysis of global and local stereoscopic depth is performed by a single system or by separate systems. Global stereopsis requires the visual system to solve a complex binocular matching problem to obtain a coherent percept of depth. In contrast, local stereopsis requires only a simple matching of similar image features. In this preliminary study, we recruited five adults with amblyopia who lacked global stereopsis and trained them on a computerized local stereopsis depth task for an average of 12 h. Three out of five (60%) participants recovered fine global stereoscopic vision through training. Those who recovered global stereopsis reached a learning plateau more quickly on the local stereopsis task, and they tended to start the training with better initial local stereopsis performance, to improve more on local stereopsis with training, and to have less severe amblyopia. The transfer of learning from local stereopsis to global stereopsis is compatible with an interacting two-stage model.

Broad and Long-Lasting Vision Improvements in Youth With Infantile Nystagmus After Home Training With a Perceptual Learning App

Current treatments for infantile nystagmus (IN), focused on dampening the oscillating eye movements, yield little to no improvement in visual functioning. It makes sense, however, to treat the visual impairments associated with IN with tailored sensory training. Recently, we developed such a training, targeting visual crowding as an important bottleneck in visual functioning with an eye-movement engaging letter discrimination task. This training improved visual performance of children with IN, but most children had not reached plateau performance after 10 supervised training sessions (3,500 trials). Here, we evaluate the effects of prolonged perceptual learning (14,000 trials) in 7-18-year-old children with IN and test the feasibility of tablet-based, at-home intervention. Results demonstrate that prolonged home-based perceptual training results in stable, long lasting visual acuity improvements at distance and near, with remarkably good transfer to reading and even stereopsis. Improvements on self-reported functional vision scores underline the clinical relevance of perceptual learning with e-health apps for individuals with IN.

General and Specific Effects of Stereo Learning

Technological advancements in virtual reality challenge the human vision, especially stereopsis, a function, which characterizes how two eyes coordinate to form a unified three-dimensional (3D) representation of the external world and is found to be deficient in 30% of the normal population. Although a few previous studies have consistently found that the perceptual learning of stereopsis significantly improved stereoacuity, an underlying mechanism of stereo learning remains heavily debated. Here, we trained subjects with normal stereo vision (assessed with the FLY Stereo Acuity Test) to judge stereopsis containing three types of binocular disparity orders (i.e., zero-, first-, and second-order), aiming to systematically examine the characteristics and plasticity of stereo learning. Thirty subjects were randomly assigned to the three training groups (each for the zero-, first-, or second-order disparity separately). The disparity thresholds were measured before and after training. The disparity threshold was measured in 10 additional control subjects only at the pre- and post-training phase. Stereoscopic images were displayed through a shutter goggle, which is synchronized to a monitor. We found that the training significantly improved the zero-, first-, and second-order disparity threshold by 52.42, 36.28, and 14.9% in the zero-order training condition; 30.44, 63.74, and 21.07% in the first-order training condition; and 30.77, 25.19, and 75.12% in the second-order training condition, respectively. There was no significant improvement in the control group. Interestingly, the greatest improvements in the first- and second-order disparity threshold were found in the corresponding disparity training group; on the contrary, the improvements in the zero-order disparity threshold were comparable across all the three disparity training groups. Our findings demonstrated both general (related to the zero-order disparity) and specific improvements (related to the first- and second-order disparity) in stereo learning, suggesting that stereo training occurs at different visual processing stages and its effects might depend on the specific training sites.

Scaffolding depth cues and perceptual learning in VR to train stereovision: a proof of concept pilot study

Stereopsis is a valuable feature of human visual perception, which may be impaired or absent in amblyopia and/or strabismus but can be improved through perceptual learning (PL) and videogames. The development of consumer virtual reality (VR) may provide a useful tool for improving stereovision. We report a proof of concept study, especially useful for strabismic patients and/or those with reduced or null stereoacuity. Our novel VR PL strategy is based on a principled approach which included aligning and balancing the perceptual input to the two eyes, dichoptic tasks, exposure to large disparities, scaffolding depth cues and perception for action. We recruited ten adults with normal vision and ten with binocular impairments. Participants played two novel PL games (DartBoard and Halloween) using a VR-HMD. Each game consisted of three depth cue scaffolding conditions, starting with non-binocular and binocular cues to depth and ending with only binocular disparity. All stereo-anomalous participants improved in the game and most (9/10) showed transfer to clinical and psychophysical stereoacuity tests (mean stereoacuity changed from 569 to 296 arc seconds, P < 0.0001). Stereo-normal participants also showed in-game improvement, which transferred to psychophysical tests (mean stereoacuity changed from 23 to a ceiling value of 20 arc seconds, P = 0.001). We conclude that a VR PL approach based on depth cue scaffolding may provide a useful method for improving stereoacuity, and the in-game performance metrics may provide useful insights into principles for effective treatment of stereo anomalies.This study was registered as a clinical trial on 04/05/2010 with the identifier NCT01115283 at ClinicalTrials.gov.

Essential Infantile Esotropia: A Course of Treatment From Our Experience

Background: Essential infantile esotropia (EIE) is the most common type of childhood esotropia. Although its classical approach is surgical, less invasive techniques have been proposed as an adjunct or alternative to traditional surgery. Among them, chemodenervation with botulinum toxin (BT) has been investigated, showing variable and sometimes conflicting results. Objectives: To compare the outcomes of bilateral BT injection and traditional surgery in a pediatric population with EIE in order to optimize and standardize the therapeutic approach. Other purposes are to evaluate whether early intervention may prevent the onset of vertical ocular deviation (which is part of the clinical picture of EIE) and/or influence the development of fine stereopsis, and also to assess changes in refractive status over time among the enrolled population. Methods: A retrospective consecutive cohort study was conducted in 86 children aged 0-48 months who underwent correction of EIE. The primary intervention in naïve subjects was either bilateral BT injection (36 subjects, "BT group") or strabismus surgery (50 subjects, "surgery group"). Results: Overall, BT chemodenervation (one or two injections) was effective in 13 (36.1%) subjects. With regard to residual deviation angle, the outcomes at least 5 years after the last intervention were overlapping in children receiving initial treatment with either injection or surgery; however, the success rate of primary intervention in the surgery group was higher, and the average number of interventions necessary to achieve orthotropia was smaller. Both early treatment with chemodenervation and surgery at a later age were not found to prevent the onset of vertical ocular deviation, whereas, surprisingly, the percentage of subjects developing fine stereopsis was higher in the surgery group. Finally, with regard to the change in refractive status over time, most of the subjects increased their initial hyperopia, whereas 10% became myopic. Conclusions: Our data suggest that a single bilateral BT injection by age 2 years should be considered as the first-line treatment of EIE without vertical component; whereas, traditional surgery should be considered as the first-line treatment for all other cases and in subjects unresponsive to primary single BT injection.

Dressmakers show enhanced stereoscopic vision

The ability to estimate the distance of objects from one’s self and from each other is fundamental to a variety of behaviours from grasping objects to navigating. The main cue to distance, stereopsis, relies on the slight offsets between the images derived from our left and right eyes, also termed disparities. Here we ask whether the precision of stereopsis varies with professional experience with precise manual tasks. We measured stereo-acuities of dressmakers and non-dressmakers for both absolute and relative disparities. We used a stereoscope and a computerized test removing monocular cues. We also measured vergence noise and bias using the Nonius line technique. We demonstrate that dressmakers’ stereoscopic acuities are better than those of non-dressmakers, for both absolute and relative disparities. In contrast, vergence noise and bias were comparable in the two groups. Two non-exclusive mechanisms may be at the source of the group difference we document: (i) self-selection or the fact that stereo-vision is functionally important to become a dressmaker, and (ii) plasticity, or the fact that training on demanding stereovision tasks improves stereo-acuity.

Monocular blur alters the tuning characteristics of stereopsis for spatial frequency and size

Our sense of depth perception is mediated by spatial filters at different scales in the visual brain; low spatial frequency channels provide the basis for coarse stereopsis, whereas high spatial frequency channels provide for fine stereopsis. It is well established that monocular blurring of vision results in decreased stereoacuity. However, previous studies have used tests that are broadband in their spatial frequency content. It is not yet entirely clear how the processing of stereopsis in different spatial frequency channels is altered in response to binocular input imbalance. Here, we applied a new stereoacuity test based on narrow-band Gabor stimuli. By manipulating the carrier spatial frequency, we were able to reveal the spatial frequency tuning of stereopsis, spanning from coarse to fine, under blurred conditions. Our findings show that increasing monocular blur elevates stereoacuity thresholds 'selectively' at high spatial frequencies, gradually shifting the optimum frequency to lower spatial frequencies. Surprisingly, stereopsis for low frequency targets was only mildly affected even with an acuity difference of eight lines on a standard letter chart. Furthermore, we examined the effect of monocular blur on the size tuning function of stereopsis. The clinical implications of these findings are discussed.