Improving vision: neural compensation for optical defocus

Effects of brief and prolonged blur adaptation on visual search and discrimination

Adaptation to blurred or sharpened images has a large and rapid effect on perceived image focus and at longer durations has also been reported to impact acuity and blur sensitivity, but the dynamics and functional consequences of the adaptation remain poorly characterized. We tested the effects of blur adaptation on visual performance for two tasks and two adapting durations. Specifically, we measured the effects of brief (12 s) vs. prolonged (2 h) blur adaptation on visual search and discrimination performance. Our results show that adaptation improved search accuracies for novel blur levels after prolonged but not brief adapting duration, while neither duration improved blur discrimination. The improvements in visual search could reflect the role of adaptation in increasing the salience of novel properties in the visual environment.

Comparison of Unaided and Aided Visual Acuity in Adults With Down Syndrome

Purpose

Individuals with Down syndrome (DS) have reduced visual acuity (VA), even when wearing refractive correction. The relationship between refractive error and VA in adults with DS is explored.

Methods

Thirty adults with DS (age = 29 ± 10 years) were enrolled in a trial comparing clinical and objectively determined refractions. Monocular VA was recorded unaided and aided with best refraction. Vectors M, J0, and J45 were calculated from unaided wavefront aberration measures at the habitual pupil size. The square root of the sum of the squared vectors was calculated providing a single positive vector length representing unaided refractive error. Residual refractive error was determined after applying the best performing refraction. Linear regression determined correlation between refractive error and VAs.

Results

Unaided and aided VAs ranged from 0.22 to 1.42 logMAR and 0.06 to 0.82 logMAR, respectively. Unaided and residual refractive error represented as vector length ranged from 0.68 diopters (D) to 13.76 D and 0.05 D to 1.87 D, respectively. Unaided refractive error and VA were significantly positively correlated (r2 = 0.776, P < 0.001), but not residual refractive error and VA (r2 = 0.005, P = 0.721).

Conclusions

There was a positive correlation between unaided VA and refractive error magnitude in adults with DS; however, unaided VA was better than expected given the high levels of refractive error. Aided VA and residual refractive error were not correlated, despite overall low levels of remaining residual refractive error, suggesting that factors in addition to optical quality may be limiting VA in this population.

Translational Relevance

Understanding the relationship between refractive error and VA in individuals with DS may provide clinicians clearer expectations for the acuity end points before and after correction for this patient population.

Effects of long-term neural adaptation to habitual sspherical aberration on through-focus visual acuity in adults

We investigated how long-term visual experience with habitual spherical aberration (SA) influences subjective depth of focus (DoF). Nine healthy cycloplegic eyes with habitual SAs of different signs and magnitudes were enrolled. An adaptive optics (AO) visual simulator was used to measure through-focus high-contrast visual acuity after correcting all monochromatic aberrations and imposing + 0.5 μm and - 0.5 μm SAs for a 6-mm pupil. The positive (n = 6) and negative (n = 3) habitual SA groups ranged from 0.17 to 0.8 μm and from - 1.2 to - 0.12 μm for a 6-mm pupil, respectively. Although all optical conditions were identical, and the subjective DoFs were expected to be the same for all participants, the DoFs of individuals differed between the positive and negative habitual SA groups. For the positive habitual SA group, the mean DoF with positive AO-induced SA (2.14 D) was larger than that with negative AO-induced SA (1.88 D); for the negative habitual SA group, a smaller DoF was measured with positive AO-induced SA (1.94 D) than that with negative AO-induced SA (2.14 D). Subjective DoF tended to be larger when the induced SA in terms of sign and magnitude was closer to the participant's habitual SA. Our findings suggest that neural adaptation to habitual SA compensated for optical blur at multiple object distances, perceptually expanding DoF. As a result, the outcomes of optical treatments for presbyopia may differ due to the neural compensation mechanism influenced by an individual's visual experience with their habitual optics.

Foveal neural adaptation to optically induced contrast reduction

Contrast processing is suggested to interact with eye growth and myopia development. A novel contrast-reducing myopia control lens design decreases image contrast and was shown to slow myopia progression. Limited insights exist regarding neural visual processing following adaptation to image contrast reduction. This study investigated foveal neural contrast sensitivity in 29 young adults following a 30-minute adaptation to scattering using a Bangerter occlusion foil 0.8, +0.5-diopter defocus, and a clear lens control condition. Neural contrast sensitivity at its peak sensitivity of 6 cycles per degree was assessed before and after adaptation to the lens conditions, employing a unique interferometric system. Pre-adaptation measurements were averaged from six replicates and post-adaptation measurements by the first and last three of six replicates. The change in neural contrast sensitivity was largest for scattering across the first and last three post-adaptation measurements (+0.05 ± 0.01 logCS and +0.04 ± 0.01 logCS, respectively) compared with control and defocus (all +0.03 ± 0.01 logCS). For scattering, the observed increase of neural contrast sensitivity within the first three measurements differed significantly from the pre-adaptation baseline (p = 0.04) and was significantly higher compared with the control condition (p = 0.04). The sensitivity increases in the control and defocus conditions were not significant (all p > 0.05). As the adaptation effect diminished, no significant differences were found from baseline or between the conditions in the last three measurements (all p > 0.05). When post-adaptation neural contrast sensitivities were clustered into 25-second sequences, a significant effect was observed between the conditions, with only a significant relevant effect between control and scattering at 25 seconds (p = 0.04) and no further significant effects (all p > 0.05). The alteration in neural contrast sensitivity at peak sensitivity was most pronounced following adaptation to the scattering condition compared with defocus and control, suggesting that induced scattering might be considered for myopia control.

Neural adaptation to the eye's optics through phase compensation

How does the brain achieve a seemingly veridical and 'in-focus' perception of the world, knowing how severely corrupted visual information is by the eye's optics? Optical blur degrades retinal image quality by reducing the contrast and disrupting the phase of transmitted signals. Neural adaptation can attenuate the impact of blur on image contrast, yet vision rather relies on perceptually-relevant information contained within the phase structure of natural images. Here we show that neural adaptation can compensate for the impact of optical aberrations on phase congruency. We used adaptive optics to fully control optical factors and test the impact of specific optical aberrations on the perceived phase of compound gratings. We assessed blur-induced changes in perceived phase over three distinct exposure spans. Under brief blur exposure, perceived phase shifts matched optical theory predictions. During short-term (~1h) exposure, we found a reduction in blur-induced phase shifts over time, followed by after-effects in the opposite direction-a hallmark of adaptation. Finally, patients with chronic exposure to poor optical quality showed altered phase perception when tested under fully-corrected optical quality, suggesting long-term neural compensatory adjustments to phase spectra. These findings reveal that neural adaptation to optical aberrations compensates for alterations in phase congruency, helping restore perceptual quality over time.

BCLA CLEAR Presbyopia: Management with contact lenses and spectacles

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Flicker adaptation improves acuity for briefly presented stimuli by reducing crowding

Adaptation to flickering/dynamic noise improves visual acuity for briefly presented stimuli (Arnold et al., 2016). Here, we investigate whether such adaptation operates directly on our ability to see detail or by changing fixational eye movements and pupil size or by reducing visual crowding. Following earlier work, visual acuity was measured in observers who were either unadapted or who had adapted to a 60-Hz flickering noise pattern. Participants reported the orientation of a white tumbling-T target (four-alternative forced choice [4AFC], ⊤⊣⊥⊢). The target was presented for 110 ms either in isolation or flanked by randomly oriented T's (e.g., ⊣⊤⊢) followed by an isolated (+) or flanked (+++) mask, respectively. We measured fixation stability (using an infrared eye tracker) while observers performed the task (with and without adaptation). Visual acuity improved modestly (around 8.4%) for flanked optotypes following adaptation to flicker (mean, -0.038 ± 0.063 logMAR; p = 0.015; BF10 = 3.66) but did not when measured with isolated letters (mean, -0.008 ± 0.055 logMAR; p = 0.5; BF10 = 0.29). The magnitude of acuity improvement was associated with individuals' (unadapted) susceptibility to crowding (the ratio of crowded to uncrowded acuity; r = -0.58, p = 0.008, BF10 = 7.70) but to neither fixation stability nor pupil size. Confirming previous reports, flicker improved acuity for briefly presented stimuli, but we show that this was only the case for crowded letters. These improvements likely arise from attenuation of sensitivity to a transient low spatial frequency (SF) image structure (Arnold et al., 2016; Tagoh et al., 2022), which may, for example, reduce masking of high SFs by low SFs. We also suggest that this attenuation could reduce backward masking and so reduce foveal crowding.

BCLA CLEAR Presbyopia: Evaluation and diagnosis

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

Peripheral Choroidal Response to Localized Defocus Blur: Influence of Native Peripheral Aberrations

Purpose

This study aims to examine the short-term peripheral choroidal thickness (PChT) response to signed defocus blur, both with and without native peripheral aberrations. This examination will provide insights into the role of peripheral aberration in detecting signs of defocus.

Methods

The peripheral retina (temporal 15°) of the right eye was exposed to a localized video stimulus in 11 young adults. An adaptive optics system induced 2D myopic or hyperopic defocus onto the stimulus, with or without correcting native peripheral ocular aberrations (adaptive optics [AO] or NoAO defocus conditions). Choroidal scans were captured using Heidelberg Spectralis OCT at baseline, exposure (10, 20, and 30 minutes), and recovery phases (4, 8, and 15 minutes). Neural network-based automated MATLAB segmentation program measured PChT changes from OCT scans, and statistical analysis evaluated the effects of different optical conditions over time.

Results

During the exposure phase, NoAO myopic and hyperopic defocus conditions exhibited distinct bidirectional PChT alterations, showing average thickening (10.0 ± 5.3 µm) and thinning (-9.1 ± 5.5 µm), respectively. In contrast, induced AO defocus conditions did not demonstrate a significant change from baseline. PChT recovery to baseline occurred for all conditions. The unexposed fovea did not show any significant ChT change, indicating a localized ChT response to retinal blur.

Conclusions

We discovered that the PChT response serves as a marker for detecting peripheral retinal myopic and hyperopic defocus blur, especially in the presence of peripheral aberrations. These findings highlight the significant role of peripheral oriented blur in cueing peripheral defocus sign detection.

Effects of Neural Adaptation to Habitual Spherical Aberration on Depth of Focus

We investigated how long-term visual experience with habitual spherical aberration (SA) influences subjective depth of focus (DoF). Nine healthy cycloplegic eyes with habitual SAs of different signs and magnitudes were enrolled. An adaptive optics (AO) visual simulator was used to measure through-focus high-contrast visual acuity after correcting all monochromatic aberrations and imposing +0.5 μm and -0.5 μm SAs for a 6-mm pupil. The positive (n=6) and negative (n=3) SA groups ranged from 0.17 to 0.8 μm and from -1.2 to -0.12 μm for a 6-mm pupil, respectively. For the positive habitual SA group, the median DoF with positive AO-induced SA (2.18D) was larger than that with negative AO-induced SA (1.91D); for the negative habitual SA group, a smaller DoF was measured with positive AO-induced SA (1.81D) than that with negative AO-induced SA (2.09D). The difference in the DoF of individual participants between the induced positive and negative SA groups showed a quadratic relationship with the habitual SA. Subjective DoF tended to be larger when the induced SA in terms of the sign and magnitude was closer to the participant's habitual SA, suggesting the importance of considering the habitual SA when applying the extended DoF method using optical or surgical procedures.

Contrast Adaptation in Pseudophakic Patients with Macular Disorders

PURPOSE

To learn whether contrast adaptation, induced by positive spherical defocus, is compromised by macular disorders such as age-related macular degeneration (AMD) or epiretinal membranes (ERM) and to gain further insight in the functionality of the pathological macula and the level of "functional reserve" often postulated for the indication of presbyopia correcting IOLs.

METHODS

In a pilot study, patients with macular disorders, AMD and ERM, (n = 10) and healthy volunteers (n = 10) were tested to quantify contrast adaption after +4 D defocus for 10 min, by performing an interocular contrast matching task. Subjects manually adjusted the perceived contrast of the test patch as seen by the test eye to match to the contrast of a target patch with a fixed Michelson contrast of 0.2 as seen by the contralateral untreated eye.

RESULTS

Patients with macular disorders subjectively matched the 0.2 target contrast with a contrast of 0.24 ± 0.06 (mean ± SD) before adaptation and with a contrast of 0.19 ± 0.04 after adaptation (p < 0.05). Accordingly, patients with macular disorders showed an induced contrast gain by adaptation of 0.05 (27%), which was not different from the control group, which showed an induced contrast gain by adaptation of 0.06 (35%).

CONCLUSION

Patients with mild and moderate macular disorders, such as AMD and ERM, show an induced contrast adaptation, i.e. a gain in contrast sensitivity, at 3.2 cpd, which is not different in level from the induced contrast adaptation in healthy subjects. Macular disorders do not prevent adaptation of the patient's visual system to low contrast or blurred retinal images. Therefore, the implantation of presbyopia correcting IOLs is not a strict exclusion criterion for these patients, but the progressive nature of the macular disorder must be taken into account.

Stability of the retinal image under normal viewing conditions and the implications for neural adaptation

Previous studies have demonstrated that the visual system adapts to the specific aberration pattern of an individual's eye. Alterations to this pattern can lead to reduced visual performance, even when the Root Mean Square (RMS) of the wavefront error remains constant. However, it is well-established that ocular aberrations are dynamic and can change with factors such as pupil size and accommodation. This raises an intriguing question: can the neural system adapt to continuously changing aberration patterns? To address this question, we measured the ocular aberrations in four subjects under various natural viewing conditions, which included changes in accommodative state and pupil size. We subsequently computed the associated Point Spread Functions (PSFs). For each subject, we examined the stability in the orientation of the PSFs and analyzed the cross-correlation between different PSFs. These findings were then compared to the characteristics of a distribution featuring PSF shapes akin to random variations. Our results indicate that the changes observed in the PSFs are not substantial enough to produce a PSF shape distribution resembling random variations. This lends support to the notion that neural adaptation is indeed a viable mechanism even in response to continuously changing aberration patterns.

Validation of the DYOP visual acuity test

PURPOSE

The dynamic optotype (DYOP) visual acuity (VA) test is based on motion detection rather than element resolution and has been proposed for routine clinical assessment. This investigation examined the validity, inter- and intra-session repeatability and subjective preference for the DYOP versus a static letter chart and examined its utility in detecting astigmatic defocus.

METHODS

VA of 103 participants was measured three times with the letter and DYOP charts and repeated within two weeks in 75 participants who also rated their subjective experience. The VA of 29 participants was measured using DYOP, letter, Landolt C, and Tumbling E charts, with habitual correction and astigmatism induced with +1.00, +2.00 or +3.00 cylinders at 45, 60, 90 and 180°.

RESULTS

The charts differed by a mean of 0.02 logMAR, with 81% of the measurements within one line of acuity. Inter-session, intraclass correlation coefficients, within-subject SD and repeatability were 0.03 logMAR, 0.95, 0.11 and 0.30 versus 0.01 logMAR, 0.92, 0.15 and 0.42 for the DYOP and letter charts, respectively. The DYOP was significantly more frustrating (1.79 vs.1.36), with 59% preferring the letter chart. The DYOP was least affected by induced astigmatism.

CONCLUSIONS

The DYOP and letter charts differed significantly in their mean values with wide limits of agreement. DYOP had better within-subject SD and narrower limits of agreement between sessions, though clinically insignificant, and performed significantly worse for the detection of uncorrected astigmatism. Thus, it is difficult to recommend this test for the clinical determination of refractive error.

Frequency of adapting events affects face aftereffects but not blur aftereffects

The dynamics of visual adaptation remain poorly understood. Recent studies have found that the strength of adaptation aftereffects in the perception of numerosity depends more strongly on the number of adaptation events than on the duration of the adaptation. We investigated whether such effects can be observed for other visual attributes. We measured blur (perceived focus-sharp vs blurred adapt) and face (perceived race- Asian vs. White adapt) aftereffects by varying the number of adaptation events (4 or 16) and the duration of each adaptation event (0.25 s or 1 s). We found evidence for an effect of event number on face but not on blur adaptation, though the effect for faces was significant for only one of the two face adapt conditions (Asian). Our results suggest that different perceptual dimensions may vary in how adaptation effects accrue, potentially because of differences in factors such as the sites (early or late) of the sensitivity changes or nature of the stimulus. These differences may impact how and how rapidly the visual system can adjust to different visual properties.

Brief Adaptation to Astigmatism Reduces Meridional Anisotropy in Contrast Sensitivity

Purpose

To investigate the effect of visual adaptation to orientation-dependent optical blur on meridional contrast sensitivity function in artificially imposed astigmatism.

Methods

The study adopted a top-up adapt-test paradigm. During the blur adaptation process, the 18 non-astigmatic young adult participants were briefly presented with natural scene images (first trial, 10 minutes; subsequent trials, 6 seconds). Contrast sensitivities for horizontal and vertical gratings at spatial frequencies ranging from 1 to 8 cycles per degree (cpd) were measured immediately before and after adaptation to +3.00 diopters cylinder (DC) with-the-rule or against-the-rule astigmatism. Meridional anisotropy was measured to quantify the contrast sensitivity difference between the two grating orientations.

Results

Adapting to astigmatic blur enhanced contrast sensitivity at the blurred power meridian but reduced contrast sensitivity at the least affected axis meridian. In with-the-rule conditions, contrast sensitivity for horizontal gratings was significantly increased, whereas that for vertical gratings was significantly decreased. Similarly, in against-the-rule conditions, contrast sensitivity for vertical gratings was significantly increased, whereas that for horizontal gratings was significantly decreased. These two factors together resulted in a substantial systematic reduction, averaging 34%, in meridional anisotropy of contrast sensitivity across the spatial frequency spectrum.

Conclusions

Astigmatism adaptation occurs in natural scene viewing. Brief exposure to astigmatic blur altered contrast sensitivity in the opposite direction at the two principal meridians, indicating that the mature visual system possesses functional plasticity to recalibrate the response characteristics of orientationally tuned cortical filters and thus promote substantial reductions of meridional anisotropy in astigmatic vision, to some extent counterbalancing the elongated oval shape of astigmatic blur.

Impact of temporal fluctuations in optical defocus on visual acuity: Empirical results and modeling outcomes

Optical defocus in human eyes is seldom steady during naturalistic steady-state viewing. It fluctuates by 0.3 to 0.5 diopters (D) from accommodative microfluctuations and by 1.5 to 2.5 D in dysfunctions such as spasm of near reflex, both with ≤2 Hz low-pass frequency spectra. This study observed losses in monocular visual acuity of cyclopleged adults who encountered varying amplitude (0.25-2.0 D) and temporal frequency (0.25-2.0 Hz) combinations of sinusoidal defoci induced using an electrically tunable lens. Visual acuity, recorded for 300-ms flashes of Sloan optotype presentation using the method of constant stimuli, deteriorated with defocus amplitude at a rate steeper for lower than higher temporal frequencies. A template matching model of acuity, incorporating optical and neural low-pass filters, neural noise, and a cross-correlated decision operator, showed the best match with empirical data when acuity was governed by the minimum defocus available during optotype display. This criterion minimized acuity loss for higher temporal frequencies due to the increased probability of zero-defocus encounters within the presentation duration. Other decision criteria such as defocus averaging across the entire or parts of the presentation duration yielded less satisfactory results. These results imply that vision loss in humans encountering broadband time-varying defocus is dictated by the dominant low frequencies, with higher frequencies largely compensated using the least defocus decision strategy.

Motion adaptation improves acuity (but perceived size doesn't matter)

Recognition acuity—the minimum size of a high-contrast object that allows us to recognize it—is limited by optical and neural elements of the eye and by processing within the visual cortex. The perceived size of objects can be changed by motion-adaptation. Viewing receding or looming motion makes subsequently viewed stimuli appear to grow or shrink, respectively. It has been reported that resulting changes in perceived size impact recognition acuity. We set out to determine if such acuity changes are reliable and what drives this phenomenon. We measured the effect of adaptation to receding and looming motion on acuity for crowded tumbling-T stimuli (). We quantified the role of crowding, individuals’ susceptibility to motion-adaptation, and potentially confounding effects of pupil size and eye movements. Adaptation to receding motion made targets appear larger and improved acuity (–0.037 logMAR). Although adaptation to looming motion made targets appear smaller, it induced not the expected decrease in acuity but a modest acuity improvement (–0.018 logMAR). Further, each observer's magnitude of acuity change was not correlated with their individual perceived-size change following adaptation. Finally, we found no evidence that adaptation-induced acuity gains were related to crowding, fixation stability, or pupil size. Adaptation to motion modestly enhances visual acuity, but unintuitively, this is dissociated from perceived size. Ruling out fixation and pupillary behavior, we suggest that motion adaptation may improve acuity via incidental effects on sensitivity—akin to those arising from blur adaptation—which shift sensitivity to higher spatial frequency-tuned channels.

Bi-directional Refractive Compensation for With-the-Rule and Against-the-Rule Astigmatism in Young Adults

Purpose

The purpose of this study was to investigate the short-term effect of imposing astigmatism on the refractive states of young adults.

Methods

Nineteen visually healthy low-astigmatic young adults (age = 20.94 ± 0.37 years; spherical-equivalent errors [M] = -1.47 ± 0.23 diopters [D]; cylindrical errors = -0.32 ± 0.05 D) were recruited. They were asked to wear a trial frame with treated and control lenses while watching a video for an hour. In three separate visits, the treated eye was exposed to one of three defocused conditions in random sequence: (1) with-the-rule (WTR) astigmatism = +3.00 DC × 180 degrees; (2) against-the-rule (ATR) astigmatism = +3.00 DC × 90 degrees; and (3) spherical defocus (SPH) = +3.00 DS. The control eye was fully corrected optically. Before and after watching the video, non-cycloplegic autorefraction was performed over the trial lenses. Refractive errors were decomposed into M, J0, and J45 astigmatism. Interocular differences in refractions (treated eye - control eye) were analyzed.

Results

After participants watched the video with monocular astigmatic defocus for an hour, the magnitude of the J0 astigmatism was significantly reduced by 0.25 ± 0.10 D in both WTR (from +1.53 ± 0.07 D to +1.28 ± 0.09 D) and 0.39 ± 0.15 D in ATR conditions (from -1.33 ± 0.06 D to -0.94 ± 0.18 D), suggesting an active compensation. In contrast, changes in J0 astigmatism were not significant in the SPH condition. No compensatory changes in J45 astigmatism or M were found under any conditions.

Conclusions

Watching a video for an hour with astigmatic defocus induced bidirectional, compensatory changes in astigmatic components, suggesting that refractive components of young adults are moldable to compensate for orientation-specific astigmatic blur over a short period.

Prediction of manifest refraction using machine learning ensemble models on wavefront aberrometry data

PURPOSE

To assess the performance of machine learning (ML) ensemble models for predicting patient subjective refraction (SR) using demographic factors, wavefront aberrometry data, and measurement quality related metrics taken with a low-cost portable autorefractor.

METHODS

Four ensemble models were evaluated for predicting individual power vectors (M, J0, and J45) corresponding to the eyeglass prescription of each patient. Those models were random forest regressor (RF), gradient boosting regressor (GB), extreme gradient boosting regressor (XGB), and a custom assembly model (ASB) that averages the first three models. Algorithms were trained on a dataset of 1244 samples and the predictive power was evaluated with 518 unseen samples. Variables used for the prediction were age, gender, Zernike coefficients up to 5th order, and pupil related metrics provided by the autorefractor. Agreement with SR was measured using Bland-Altman analysis, overall prediction error, and percentage of agreement between the ML predictions and subjective refractions for different thresholds (0.25 D, 0.5 D).

RESULTS

All models considerably outperformed the predictions from the autorefractor, while ASB obtained the best results. The accuracy of the predictions for each individual power vector component was substantially improved resulting in a ± 0.63 D, ±0.14D, and ±0.08 D reduction in the 95% limits of agreement of the error distribution for M, J0, and J45, respectively. The wavefront-aberrometry related variables had the biggest impact on the prediction, while demographic and measurement quality-related features showed a heterogeneous but consistent predictive value.

CONCLUSIONS

These results suggest that ML is effective for improving precision in predicting patient's SR from objective measurements taken with a low-cost portable device.

Visuo-Acoustic Stimulation's Role in Synaptic Plasticity: A Review of the Literature

Brain plasticity is the capacity of cerebral neurons to change, structurally and functionally, in response to experiences. This is an essential property underlying the maturation of sensory functions, learning and memory processes, and brain repair in response to the occurrence of diseases and trauma. In this field, the visual system emerges as a paradigmatic research model, both for basic research studies and for translational investigations. The auditory system remains capable of reorganizing itself in response to different auditory stimulations or sensory organ modification. Acoustic biofeedback training can be an effective way to train patients with the central scotoma, who have poor fixation stability and poor visual acuity, in order to bring fixation on an eccentrical and healthy area of the retina: a pseudofovea. This review article is focused on the cellular and molecular mechanisms underlying retinal sensitivity changes and visual and auditory system plasticity.

Brain Activation Induced by Myopic and Hyperopic Defocus From Spectacles

Purpose: To assess neural changes in perceptual effects induced by myopic defocus and hyperopic defocus stimuli in ametropic and emmetropic subjects using functional magnetic resonance imaging (fMRI).

Methods: This study included 41 subjects with a mean age of 26.0 ± 2.9 years. The mean spherical equivalence refraction was −0.54 ± 0.51D in the emmetropic group and −3.57 ± 2.27D in the ametropic group. The subjects were instructed to view through full refractive correction, with values of +2.00D to induce myopic defocus state and −2.00D to induce hyperopic defocus state. This was carried over in three random sessions. Arterial spin labeling (ASL) perfusion was measured using fMRI to obtain quantified regional cerebral blood flow (rCBF). Behavioral tests including distant visual acuity (VA) and contrast sensitivity (CS), were measured every 5 min for 30 min.

Results: Myopic defocus induced significantly greater rCBF increase in four cerebral regions compared with full correction: right precentral gyrus, right superior temporal gyrus, left inferior parietal lobule, and left middle temporal gyrus (P < 0.001). The differences were less significant in low myopes than emmetropes. In the hyperopic defocus session, the increased responses of rCBF were only observed in the right and left precentral gyrus. Myopic defocused VA and CS improved significantly within 5 min and reached a plateau shortly after.

Conclusion: This study revealed that myopic defocus stimuli can significantly increase blood perfusion in visual attention-related cerebral regions, which suggests a potential direction for future investigation on the relationship between retinal defocus and its neural consequences.

What are patients' beliefs about, and experiences of, adaptation to glasses and how does this affect their wearing habits?

PURPOSE

It is well known that some patients experience difficulties adapting to new glasses. However, little is known about what patients themselves understand of the adaptation process, and how this influences their attitudes and the decisions they make when adapting to a new pair of glasses. Nor is it understood whether these factors affect their wearing habits.

METHODS

We conducted four focus groups. Participants were 22 glasses wearers (mean ± SD age 43 ± 14 years, range 21-71 years) who reported they: (1) wore spectacle correction for distance vision (single vision, bifocal or progressive lenses); (2) had struggled to get used to a new pair of glasses and (3) sometimes chose not to wear their distance correction. Focus groups were audio recorded, transcribed verbatim and analysed thematically.

RESULTS

We identified three themes. Trust is about how participants' trust in their optometrist and themselves influences the likelihood of them adapting successfully to new glasses. Conflict describes how the advice patients have received about adapting to glasses can conflict with what they have experienced and how this conflict influences their expectations. Part of Me explores how participants' experiences and feelings about their glasses are important to adaptation and this includes physical, visual, emotional and behavioural aspects.

CONCLUSIONS

The traditional optometric perspective of adaptation to glasses is much narrower than that held by patients, and significantly underestimates the physical, behavioural and emotional adaptation that patients must go through in order to feel fully comfortable wearing their glasses. Patients should receive significantly more information about adaptation, including symptoms that may be experienced and why these happen, practical tips to aid adaptation, and when and how to raise concerns. Patients should also receive information about the day-to-day effects of blur adaptation to avoid them not wearing their glasses, including for vision-critical tasks such as driving.

Visual Adaptation to Scattering in Myopes

Myopes exhibit a larger capability of adaptation to defocus. Adaptation produces a boost in visual performance that can be characterized through different metrics. The ability of myopes to adapt to other sources of blur, such as diffusion, has not been studied so far. In this work, a group of 20 myopes with normal vision underwent high-contrast visual acuity (VA) measurements under different viewing conditions, wearing their refractive correction with or without a diffuser (Bangerter filter, BF). VA decreased immediately after wearing the BF of density 0.6, showing a significant relationship with the ocular refraction. After 40 minutes of binocular vision through the BF, a statistically significant increase (p = 0.02) in VA from 0.54 to 0.62 in decimal scale (from 0.3 to 0.2 logMAR) was obtained. No correlation with the refraction was observed. After removing the diffuser, VA returned to baseline. A control group (17 subjects) underwent the same experimental protocol but without diffuser filters. No significant changes in VA were found in this group. We describe a new type of contrast adaptation to blur in myopes caused by scattering, rather than by defocus. The effects of low scattering levels in vision might be relevant in the analysis of early stage of cataract, amblyopia treatments, and myopia understanding.

Contrast sensitivity and higher-order aberrations in Keratoconus subjects

This study analyzes the relationship between contrast-sensitivity and higher-order aberrations (HOA) in mild and subclinical-keratoconus in subjects with good visual-acuity (VA). Keratoconus group (including subclinical-keratoconus) and controls underwent autokeratometry, corneal-tomography, autorefraction and HOA measurement. Contrast-sensitivity was tested using a psychophysical two-alternative forced-choice Gabor patches in three blocks (6, 9, 12 cycles/deg). Controls were compared to the keratoconus group and to a keratoconus subgroup with VA of 0.00 LogMar group ("keratoconus-0.00VA"). Spearman correlation tested association between HOA and contrast-sensitivity. Twenty-two keratoconus subjects (38 eyes: 28 keratoconus, 10 subclinical-keratoconus, 20 keratoconus-0.00VA) and 35 controls were included. There was a significant difference between control and keratoconus, and between control and keratoconus-0.00VA, for keratometry, cylinder, thinnest and central corneal thickness (p < 0.001). Controls showed lower HOA and higher contrast-sensitivity for all spatial-frequencies (p < 0.001). Most HOA were negatively correlated with contrast-sensitivity for all spatial-frequencies for keratoconus group and for 9 and 12 cycles/deg for keratoconus-0.00VA. Keratoconus subjects with good VA showed reduction in contrast-sensitivity and increased HOAs compared to controls. HOA and contrast-sensitivity are inversely correlated in subjects with mild keratoconus despite good VA. This suggests that the main mechanism underlying the decreased vision quality in keratoconus is the increase of HOA.

Joint effect of defocus blur and spatial attention

Defocus blur and spatial attention both act on our ability to see clearly over time. However, it is currently unknown how these two factors interact because studies on spatial resolution only focused on the separate effects of attention and defocus blurs. In this study, eleven participants performed a resolution acuity task along the diagonal 135˚/315˚ with horizontal, at 8˚ eccentricity for clear and blurred Landolt C images under various manipulations of covert endogenous attention. All the conditions were interleaved and viewed binocularly on a visual display. We observed that attention not just improves the resolution of clear stimuli, but also modulates the resolution of defocused stimuli for compensating the loss of resolution caused by retinal blur. Our results show, however, that as the degree of attention decreases, the differences between clear and blurred images largely diminish, thus limiting the benefit of an image quality enhancement. It also appeared that attention tends to enhance the resolution of clear targets more than blurred targets, suggesting potential variations in the gain of vision correction with the level of attention. This demonstrates that the interaction between spatial attention and defocus blur can play a role in the way we see things. In view of these findings, the development of adaptive interventions, which adjust the eye's defocus to attention, may hold promise.

Blur Detection Sensitivity Increases in Children Using Orthokeratology

Purpose

To investigate changes in blur detection sensitivity in children using orthokeratology (Ortho-K) and explore the relationships between blur detection thresholds (BDTs) and aberrations and accommodative function.

Methods

Thirty-two children aged 8–14 years old who underwent Ortho-K treatment participated in and completed this study. Their BDTs, aberrations, and accommodative responses (ARs) were measured before and after a month of Ortho-K treatment. A two forced-choice double-staircase procedure with varying extents of blur in three images (Tumbling Es, Lena, and Street View) was used to measure the BDTs. The participants were required to judge whether the images looked blurry. The BDT of each of the images (BDT_Es, BDT_Lena, and BDT_Street) was the average value of the last three reversals. The accommodative lag was quantified by the difference between the AR and the accommodative demand (AD). Changes in the BDTs, aberrations, and accommodative lags and their relationships were analyzed.

Results

After a month of wearing Ortho-K lenses, the children’s BDT_Es and BDT_Lena values decreased, the aberrations increased significantly (for all, P ≤0.050), and the accommodative lag decreased to a certain extent [T(31) = 2.029, P = 0.051]. Before Ortho-K treatment, higher-order aberrations (HOAs) were related to BDT_Lena (r = 0.463, P = 0.008) and the accommodative lag was related to BDT_Es (r = −0.356, P = −0.046). After one month, no significant correlations were found between the BDTs and aberrations or accommodative lags, as well as between the variations of them (for all, P ≥ 0.069).

Conclusion

Ortho-K treatment increased the children’s level of blur detection sensitivity, which may have contributed to their good visual acuity.

Functional reallocation of sensory processing resources caused by long-term neural adaptation to altered optics

The eye’s optics are a major determinant of visual perception. Elucidating how long-term exposure to optical defects affects visual processing is key to understanding the capacity for, and limits of, sensory plasticity. Here, we show evidence of functional reallocation of sensory processing resources following long-term exposure to poor optical quality. Using adaptive optics to bypass all optical defects, we assessed visual processing in neurotypically-developed adults with healthy eyes and with keratoconus – a corneal disease causing severe optical aberrations. Under fully-corrected optical conditions, keratoconus patients showed altered contrast sensitivity, with impaired sensitivity for fine spatial details and better-than-typical sensitivity for coarse spatial details. Both gains and losses in sensitivity were more pronounced in patients experiencing poorer optical quality in their daily life and mediated by changes in signal enhancement mechanisms. These findings show that adult neural processing adapts to better match the changes in sensory inputs caused by long-term exposure to altered optics.

Orientation-specific long-term neural adaptation of the visual system in keratoconus

Eyes with the corneal ectasia keratoconus have performed better than expected (e.g. visual acuity) given their elevated levels of higher-order aberrations that cause rotationally asymmetric retinal blur. Adapted neural processing has been suggested as an explanation but has not been measured across multiple meridional orientations. Using a custom Maxwellian-view laser interferometer to bypass ocular optics, sinusoidal grating neural contrast sensitivity was measured in six eyes (three subjects) with keratoconus and four typical eyes (two subjects) at six spatial frequencies and eight orientations using a two-interval forced-choice paradigm. Total measurement duration was 24 to 28 hours per subject. Neural contrast sensitivity functions of typical eyes agreed with literature and generally showed the oblique effect on a linear-scale and rotational symmetry on a log-scale (rotational symmetry was quantified as the ratio of the minor and major radii of an ellipse fit to all orientations within each spatial frequency; typical eye mean 0.93, median 0.93; where a circle = 1). Mean sensitivities of eyes with keratoconus were 20% to 60% lower (at lower and higher spatial frequencies respectively) than typical eyes. Orientation-specific neural contrast sensitivity functions in keratoconus showed substantial rotational asymmetry (ellipse radii ratio: mean 0.84; median 0.86) and large meridional reductions. The visual image quality metric VSX was used with a permutation test to combine the asymmetric optical aberrations of the eyes with keratoconus and their measured asymmetric neural functions, which illustrated how the neural sensitivities generally mitigated the detrimental effects of the optics.

Advancing Digital Workflows for Refractive Error Measurements

Advancements in clinical measurement of refractive errors should lead to faster and more reliable measurements of such errors. The study investigated different aspects of advancements and the agreement of the spherocylindrical prescriptions obtained with an objective method of measurement ("Aberrometry" (AR)) and two methods of subjective refinements ("Wavefront Refraction" (WR) and "Standard Refraction" (StdR)). One hundred adults aged 20-78 years participated in the course of the study. Bland-Altman analysis of the right eye measurement of the spherocylindrical refractive error (M) identified mean differences (±95% limits of agreement) between the different types of measurements of +0.36 D (±0.76 D) for WR vs. AR (t-test: p < 0.001), +0.35 D (± 0.84 D) for StdR vs. AR (t-test: p < 0.001), and 0.0 D (± 0.65 D) for StdR vs. WR (t-test: p < 0.001). Monocular visual acuity was 0.0 logMAR in 96% of the tested eyes, when refractive errors were corrected with measurements from AR, indicating that only small differences between the different types of prescriptions are present.

The time course of the onset and recovery of axial length changes in response to imposed defocus

The human eye is capable of responding to the presence of blur by changing its axial length, so that the retina moves towards the defocused image plane. We measured how quickly the eye length changed in response to both myopic and hyperopic defocus and how quickly the eye length changed when the defocus was removed. Axial length was measured at baseline and every 10 minutes during 1 hour of exposure to monocular defocus (right eye) with the left eye optimally corrected for two defocus conditions (+3 D and −3 D) and a control condition. Recovery was measured for 20 minutes after blur removal. A rapid increase in axial length was observed after exposure (~2 minutes) to hyperopic defocus (+7 ± 5 μm, p < 0.001) while the reduction in axial length with myopic defocus was slower and only statistically significant after 40 minutes (−8 ± 9 μm, p = 0.017). The eye length also recovered toward baseline levels during clear vision more rapidly following hyperopic than myopic defocus (p < 0.0001). These findings provide evidence that the human eye is able to detect and respond to the presence and sign of blur within minutes.

Cerebral Blood Flow Alterations in High Myopia: An Arterial Spin Labeling Study

Objective

The aim of this study was to explore cerebral blood flow (CBF) alterations in subjects with high myopia (HM) using three-dimensional pseudocontinuous arterial spin labeling (3D-pcASL).

Methods

A total of sixteen patients with bilateral HM and sixteen age- and sex-matched healthy controls (HCs) were recruited. All subjects were right-handed. Image data preprocessing was performed using SPM8 and the DPABI toolbox. Clinical parameters were acquired in the HM group. Two-sample t-tests and Pearson correlation analysis were applied in this study.

Results

Compared to HCs, patients with HM exhibited significantly increased CBF in the bilateral cerebellum, and no decreases in CBF were detected in the brain. However, no relationship was found between the mean CBF values in the different brain areas and the disease duration (P > 0.05).

Conclusions

Using ASL analysis, we detected aberrant blood perfusion in the cerebellum in HM patients, contributing to a better understanding of brain abnormalities and brain plasticity through a different perspective.

Blur adaptation: clinical and refractive considerations

The human visual system is amenable to a number of adaptive processes; one such process, or collection of processes, is the adaptation to blur. Blur adaptation can be observed as an improvement in vision under degraded conditions, and these changes occur relatively rapidly following exposure to blur. The potential important future directions of this research area and the clinical implications of blur adaptation are discussed.

Contrast adaptation appears independent of the longitudinal chromatic aberration of the human eye

As ocular chromatic aberration was suspected to cue contrast adaptation in human vision, the purpose of this study was to investigate contrast adaptation under monochromatic light conditions. Single and complex frequency adaptation stimuli were used, and monochromatic conditions were achieved using band pass filters with short (470±2  nm), medium (530±2  nm), and long (630±2  nm) transmission wavelengths. Post-adaptational contrast sensitivity was shown to be significantly decreased for all wavelength conditions for the single frequency stimulus. A significant difference of contrast adaptation between short and long wavelengths was found. Consistently, adaptation led to a significant decrease in contrast sensitivity for the complex frequency stimulus. To conclude, contrast adaptation under mesopic illumination occurs independently of the longitudinal chromatic aberration of the eye; it can be inferred that this mechanism can be used to distinguish between the sign of optical defocus in poly- and monochromatic light conditions.

The effects of auditory satellite navigation instructions and visual blur on road hazard perception

The distracting effects of mobile telephone use while driving are well known, however the effects of other sources of distraction, such as auditory navigation devices, are less well understood. Whether the effects of auditory distraction might interact with other sensory impairments, such as vision impairment, is of interest given that visual impairment is relatively common within the population, particularly as a result of uncorrected refractive error. In this experiment, 20 current drivers (mean age of 29.4 ± 3.2 years), binocularly viewed video recordings of traffic scenes presented as part of the Hazard Perception Test and responded to potential hazards within the traffic scenes. Half of the presented scenes included auditory navigation instructions as an auditory distractor. Additionally, some of the scenes were viewed through optical lenses to induce different levels of refractive blur (+0.50 DS, +1.00 DS and +2.00 DS). Hazard perception response times increased significantly (p < 0.05) with increasing blur. Participants were significantly slower in reacting to hazards for the +1.00 DS and +2.00 DS blur conditions compared to the control condition (with no blur). There was also a significant increase in response times to hazards in the presence of the auditory navigation instructions. The combined effect of blur and auditory instructions was additive, with the worst performance being in the presence of both blur and auditory instructions. These results suggest that the delivery of auditory navigation guidance for those with visual impairments, such as blur, which are relatively common in the population, should be further investigated.

Response to short-term deprivation of the human adult visual cortex measured with 7T BOLD

Sensory deprivation during the post-natal ‘critical period’ leads to structural reorganization of the developing visual cortex. In adulthood, the visual cortex retains some flexibility and adapts to sensory deprivation. Here we show that short-term (2 hr) monocular deprivation in adult humans boosts the BOLD response to the deprived eye, changing ocular dominance of V1 vertices, consistent with homeostatic plasticity. The boost is strongest in V1, present in V2, V3 and V4 but absent in V3a and hMT+. Assessment of spatial frequency tuning in V1 by a population Receptive-Field technique shows that deprivation primarily boosts high spatial frequencies, consistent with a primary involvement of the parvocellular pathway. Crucially, the V1 deprivation effect correlates across participants with the perceptual increase of the deprived eye dominance assessed with binocular rivalry, suggesting a common origin. Our results demonstrate that visual cortex, particularly the ventral pathway, retains a high potential for homeostatic plasticity in the human adult.

The world around us changes all the time, and the brain must adapt to these changes. This process, known as neuroplasticity, peaks during development. Abnormal sensory input early in life can therefore cause lasting changes to the structure of the brain. One example of this is amblyopia or ‘lazy eye’. Infants who receive insufficient input to one eye – for example, because of cataracts – can lose their sight in that eye, even if the cataracts are later removed. This is because the brain reorganizes itself to ignore messages from the affected eye.

Does the adult visual system also show neuroplasticity? To explore this question, Binda, Kurzawski et al. asked healthy adult volunteers to lie inside a high-resolution brain scanner with a patch covering one eye. At the start of the experiment, roughly half of the brain’s primary visual cortex responded to sensory input from each eye. But when the volunteers removed the patch two hours later, this was no longer the case.

Some areas of the visual cortex that had previously responded to stimuli presented to the non-patched eye now responded to stimuli presented to the patched eye instead. The patched eye had also become more sensitive to visual stimuli. Indeed, these changes in visual sensitivity correlated with changes in brain activity in a pathway called the ventral visual stream. This pathway processes the fine details of images. Groups of neurons within this pathway that responded to stimuli presented to the patched eye were more sensitive to fine details after patching than before.

Visual regions of the adult brain thus retain a high degree of neuroplasticity. They adapt rapidly to changes in the environment, in this case by increasing their activity to compensate for a lack of input. Notably, these changes are in the opposite direction to those that occur as a result of visual deprivation during development. This has important implications because lazy eye syndrome is currently considered untreatable in adulthood.

Visual adaptation and the amplitude spectra of radiological images

We examined how visual sensitivity and perception are affected by adaptation to the characteristic amplitude spectra of X-ray mammography images. Because of the transmissive nature of X-ray photons, these images have relatively more low-frequency variability than natural images, a difference that is captured by a steeper slope of the amplitude spectrum (~ − 1.5) compared to the ~ 1/f (slope of − 1) spectra common to natural scenes. Radiologists inspecting these images are therefore exposed to a different balance of spectral components, and we measured how this exposure might alter spatial vision. Observers (who were not radiologists) were adapted to images of normal mammograms or the same images sharpened by filtering the amplitude spectra to shallower slopes. Prior adaptation to the original mammograms significantly biased judgments of image focus relative to the sharpened images, demonstrating that the images are sufficient to induce substantial after-effects. The adaptation also induced strong losses in threshold contrast sensitivity that were selective for lower spatial frequencies, though these losses were very similar to the threshold changes induced by the sharpened images. Visual search for targets (Gaussian blobs) added to the images was also not differentially affected by adaptation to the original or sharper images. These results complement our previous studies examining how observers adapt to the textural properties or phase spectra of mammograms. Like the phase spectrum, adaptation to the amplitude spectrum of mammograms alters spatial sensitivity and visual judgments about the images. However, unlike the phase spectrum, adaptation to the amplitude spectra did not confer a selective performance advantage relative to more natural spectra.

Symmetric visual response to positive and negative induced spherical defocus under monochromatic light conditions

The purpose of the study was to investigate the sign-dependent response to real and simulated spherical defocus on the visual acuity under monochromatic light conditions. The investigation included 15 myopic participants with a mean spherical equivalent error of -2.98 ± 2.17 D. Visual acuity (VA) was tested with and without spherical defocus using the source method (simulated defocus) and the observer method (lens-induced defocus) in a range of ±3.0 D in 1.0 D steps. VA was assessed using Landolt C's, while the threshold was determined with an adaptive staircase procedure. Monochromatic light conditions were achieved using band pass filters with a wavelength of 450 ± 2 nm, 530 ± 2 nm and 630 ± 2 nm. Results showed that the reduction of VA was significantly different under blue lighting conditions, when compared to the green and red light conditions. No significant difference in the reduction of the VA was found between the positive and the negative sign of defocus for all lighting conditions. The agreement for the VA between the source and observer method was significantly dependent on the wavelength as well as on the level of defocus. To conclude, under monochromatic light conditions, myopes show a symmetric sign-dependency regarding the influence of spherical defocus on visual acuity. The observed results indicate that the human visual system is capable of integrating the chromatic differences in refraction to distinguish between the signs of defocus.

Eye Movements and Road Hazard Detection: Effects of Blur and Distractors

PURPOSE

To examine the effects of optical blur, auditory distractors, and age on eye movement patterns while performing a driving hazard perception test (HPT).

METHODS

Twenty young (mean age 27.1 ± 4.6 years) and 20 older (73.3 ± 5.7 years) drivers with normal vision completed a HPT in a repeated-measures counterbalanced design while their eye movements were recorded. Testing was performed under two visual (best-corrected vision and with +2.00DS blur) and two distractor (with and without auditory distraction) conditions. Participants were required to respond to road hazards appearing in the HPT videos of real-world driving scenes and their hazard response times were recorded.

RESULTS

Blur and distractors each significantly delayed hazard response time by 0.42 and 0.76 s, respectively (p < 0.05). A significant interaction between age and distractors indicated that older drivers were more affected by distractors than young drivers (response with distractors delayed by 0.96 and 0.60 s, respectively). There were no other two- or three-way interaction effects on response time. With blur, for example, both groups fixated significantly longer on hazards before responding compared to best-corrected vision. In the presence of distractors, both groups exhibited delayed first fixation on the hazards and spent less time fixating on the hazards. There were also significant differences in eye movement characteristics between groups, where older drivers exhibited smaller saccades, delayed first fixation on hazards, and shorter fixation duration on hazards compared to the young drivers.

CONCLUSIONS

Collectively, the findings of delayed hazard response times and alterations in eye movement patterns with blur and distractors provide further evidence that visual impairment and distractors are independently detrimental to driving safety given that delayed hazard response times are linked to increased crash risk.

Role of parafovea in blur perception

The blur experienced by our visual system is not uniform across the visual field. Additionally, lens designs with variable power profile such as contact lenses used in presbyopia correction and to control myopia progression create variable blur from the fovea to the periphery. The perceptual changes associated with varying blur profile across the visual field are unclear. We therefore measured the perceived neutral focus with images of different angular subtense (from 4° to 20°) and found that the amount of blur, for which focus is perceived as neutral, increases when the stimulus was extended to cover the parafovea. We also studied the changes in central perceived neutral focus after adaptation to images with similar magnitude of optical blur across the image or varying blur from center to the periphery. Altering the blur in the periphery had little or no effect on the shift of perceived neutral focus following adaptation to normal/blurred central images. These perceptual outcomes should be considered while designing bifocal optical solutions for myopia or presbyopia.

Blur Adaptation to Central Retinal Disease

Purpose

The long-term, low-resolution vision experienced by individuals affected by retinal disease that causes central vision loss (CVL) may change their perception of blur through adaptation. This study used a short-term adaptation paradigm to evaluate adaptation to blur and sharpness in patients with CVL.

Methods

A variation of Webster's procedure was used to measure the point of subjective neutrality (PSN). The image that appeared normal after adaptation to each of seven blur and sharpness levels (PSN) was measured in 12 patients with CVL (20/60 to 20/320) and 5 subjects with normal sight (NS). Patients with CVL used a preferred retinal locus to view the images. Small control studies investigated the effects of long-term and medium-term (1 hour) defocus and diffusive blur.

Results

Adaptation was reliably measured in patients with CVL and in the peripheral vision of NS subjects. The shape of adaptation curves was similar in patients with CVL and both central and peripheral vision of NS subjects. No statistical correlations were found between adaptation and age, visual acuity, retinal eccentricity, or contrast sensitivity. Long-term blur experience by a non-CVL myopic participant caused a shift in the adaptation function. Conversely, medium-term adaptation did not cause a shift in the adaptation function.

Conclusions

Blur and sharp short-term adaptation occurred in peripheral vision of normal and diseased retinas. In most patients with CVL, neither adaptation nor blur perception was affected by long-term attention to peripheral low-resolution vision. The impact of blur/sharp adaptation on the benefit of image enhancement techniques for patients with CVL is discussed.

Illusory Increases in Font Size Improve Letter Recognition

Visual performance of human observers depends not only on the optics of the eye and early sensory encoding but also on subsequent cortical processing and representations. In two experiments, we demonstrated that motion adaptation can enhance as well as impair visual acuity. Observers who experienced an expanding motion aftereffect exhibited improved letter recognition, whereas observers who experienced a contracting motion aftereffect showed impaired letter recognition. We conclude that illusory enlargement and shrinkage of a visual stimulus can modulate visual acuity.

Effect of induced high myopia on functional MRI signal changes

PURPOSE

The current study evaluated the effect of lens-induced high myopia (IHM) on the activity of the occipital visual cortex during two visual stimuli presentations to the subjects. This was done by measuring the Blood Oxygenation Level Dependent (BOLD) signal using functional MRI (fMRI).

METHODS

BOLD contrast fMRI was performed with a 1.5T MRI scanner on 12 emmetropic subjects (refractive error <±0.25Diopter) with no history of neurologic disorder. IHM conditions were applied to subjects by three convex lenses of +5D, +7D and +10D. Visual stimuli with 0.34cpd and 1.84cpd spatial frequencies (SF) were presented as a block paradigm to the participants in three IHM states and normal vision state during fMRI data acquisition. Resultant fMRI data were compared among different refractive states.

RESULTS

Data analysis showed that IHM did not cause a significant change in the visual cortex activity throughout the presentation of 0.34cpd SF visual stimulus and BOLD signal intensity remained approximately constant (p=0.17). Although, fMRI responses to visual stimuli with spatial frequency of 1.84cpd demonstrated that visual cortex activity was significantly reduced in IHM states compared to normal vision (p=0.01), the results showed no significant differences between three different values of IHM.

CONCLUSIONS

This study shows severe blurring caused by lens induced high myopia can decrease BOLD signal intensity depending on the visual stimulus pattern details. However in the low and moderate range of spatial frequencies, blur increment from +5D up to +10D is not associated with further reduction in the BOLD signal of the occipital visual cortex.

Effects of multifocal soft contact lenses used to slow myopia progression on quality of vision in young adults

PURPOSE

To assess the effects of multifocal soft contact lenses (MF SCLs) used for myopia control on visual acuity (VA) and subjective quality of vision.

METHODS

Twenty-four young adult myopes had baseline high and low-contrast VAs and refractions measured and quality of vision assessed by the Quality of Vision (QoV) questionnaire with single vision SCLs. Additional VA and QoV questionnaire data were collected immediately after subjects were fitted with Proclear MF SCLs and again after a 2-week adaptation period of daily lens wear. Data were collected for two MF SCL designs, incorporating +1.50 and +3.00 D peripheral near additions, with a week washout period allowed between the two lens trials.

RESULTS

High- and low-contrast VAs were initially reduced with both MF SCL designs, but subsequently improved to be not significantly reduced in the case of high-contrast VA by the end of the 2-week adaptation period. The quality of vision was also reduced, more so with the +3.00 D MF SCL. Quality of Vision (QoV) scores describing frequency, severity and bothersome nature of visual symptoms indicated symptoms worsening rather than resolving over the 2-week period, particularly so with the +3.00 D MF SCL.

CONCLUSION

Low and high add MF SCLs adversely affected vision on initial insertion, with sustained effects on low-contrast VA and QoV scores but not high-contrast VA. Thus, high-contrast VA is not a suitable surrogate for quality of vision. In prescribing MF SCLs for myopia control, clinicians should educate patients about these effects on vision.

Neural adaptation to peripheral blur in myopes and emmetropes

In the presence of optical blur at the fovea, blur adaptation can improve visual acuity (VA) and perceived image quality over time. However, little is known regarding blur adaptation in the peripheral retina. Here, we examined neural adaptation to myopic defocus at the fovea and parafovea (10° temporal retina) in both emmetropes and myopes. During a 60-min adaptation period, subjects (3 emmetropes and 3 myopes) watched movies with +2 diopters of defocus blur through a 6-mm artificial pupil in two separate, counter-balanced sessions for each retinal location. VA was measured at 10-min intervals under full aberration-corrected viewing using an adaptive optics (AO) vision simulator. By correcting subjects' native optical aberrations with AO, we bypassed the influence of the individual subjects' optical aberrations on visual performance. Overall, exhibited a small but significant improvement after the 60-min of adaptation at both the fovea (mean±SE VA improvement: -0.06±0.04 logMAR) and parafovea (mean±SE VA improvement: -0.07±0.04 logMAR). Myopic subjects exhibited significantly greater improvement in parafoveal VA (mean±SE VA improvement: 0.10±0.02 logMAR), than that of emmetropic subjects (mean±SE VA improvement: 0.04±0.03 logMAR). In contrast, there was no significant difference in foveal VA between the two refractive-error groups. In conclusion, our results reveal differences in peripheral blur adaptation between refractive-error groups, with myopes displaying a greater degree of adaptation.

Soft multifocal simultaneous image contact lenses: a review

Soft multifocal simultaneous image contact lenses have boomed in recent years due to the growing number of presbyopic patients demanding visual solutions, allowing them to maintain their current standard of living. The concept of 'simultaneous image' is based on blur interpretation and/or blur tolerance of superimposed multiple images on the retina formed by various powers of a contact lens. This is the basis for a specific type of multifocal contact lens developed for the compensation of presbyopia. Manufacturers have released a great variety of soft simultaneous image lens designs to meet different patient needs but their fitting is still unsatisfactory in some cases. Some presbyopes discontinue wearing contact lenses due to some limitations in visual quality and comfort that can be overcome with an appropriate contact lens selection based on a comprehensive pre-fitting evaluation. This paper aims to review the different types of soft multifocal contact lenses that are currently available for presbyopic correction and to define the steps and factors crucial for their fitting, such as pupil, aberrations, accommodation and centring. A discussion about useful tools to achieve a customised fitting leading to a successful outcome, such as the defocus curve, power profile and questionnaires, is performed.

The effect of interrupted defocus on blur adaptation

PURPOSE

Blur adaptation occurs when an observer is exposed to continuous defocus. However, it is unclear whether adaptation requires constant defocus, or whether the effect can still be achieved when the adaptation period is interrupted by short periods of clear vision.

METHODS

The study included 12 emmetropes and 12 myopes. All observers wore full refractive correction throughout the experiment. 1D and 3D of myopic defocus was introduced using spherical convex lenses. An automated system was used to place the blurring lens before the RE for varying periods of blurred and clear vision during adaptation. Participants watched a DVD at 3 m during each 15 min trial. Visual acuity was measured using Test Chart 2000 before and after adaptation.

RESULTS

Blur adaptation occurs to varying degrees depending on the periods of incremental blur exposure. Significant improvements in defocused visual acuity occur with continuous blur, equal blur and clear periods, as well as for longer blur periods. However, longer clear periods showed reduced adaptation and this trial is significantly different to the other three trials for both defocus levels (p < 0.001). No refractive group differences were observed for neither 1D nor 3D defocus (p = 0.58 and p = 0.19 respectively).

CONCLUSIONS

Intervening periods of clear vision cause minimal disruption to improvements in defocused visual acuity after adaptation, indicating that blur adaptation is a robust phenomenon. However, when the exposure to clear vision exceeds the defocused periods, adaptation is inhibited. This gives insight into the effects of real-world tasks on adaptation to blur.

Myopes experience greater contrast adaptation during reading

In this study, we investigated whether reading influences contrast adaptation differently in young adult emmetropic and myopic participants at the spatial frequencies created by text rows and character strokes. Pre-adaptation contrast sensitivity was measured for test gratings with spatial frequencies of 1cdeg(-1) and 4cdeg(-1), presented horizontally and vertically. Participants then adapted to reading text corresponding to the horizontal "row frequency" of text (1cdeg(-1)), and vertical "stroke frequency" of the characters (4cdeg(-1)) for 180s. Following this, post-adaptation contrast sensitivity was measured. Twenty young adults (10 myopes, 10 emmetropes) optimally corrected for the viewing distance participated. There was a significant reduction in logCS post-text adaptation (relative to pre-adaptation logCS) at the row frequency (1cdeg(-1) horizontal) but not at the stroke frequency (4cdeg(-1) vertical). logCS changes due to adaptation at 1cdeg(-1) horizontal were significant in both emmetropes and myopes. Comparing the two refractive groups, myopic participants showed significantly greater adaptation compared to emmetropic participants. Reading text on a screen induces contrast adaptation in young adult observers. Myopic participants were found to exhibit greater contrast adaptation than emmetropes at the spatial frequency corresponding to the text row frequency. No contrast adaptation was observed at the text stroke frequency in either participant group. The greater contrast adaptation experienced by myopes after reading warrants further investigation to better understand the relationship between near work and myopia development.