The absence of lateral congruency between sighting dominance and the eye with better visual acuity

Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial

Objectives

This study evaluated the safety of topical lipoic acid choline ester (UNR844, 1.5%) ophthalmic solution and its efficacy in improving distance-corrected near visual acuity (DCNVA) in subjects with presbyopia.

Subjects and methods

This was a prospective, randomized, double-masked, and multicentre clinical trial. Subjects with a diagnosis of presbyopia (n = 75) were randomized 2:1 to UNR844 or placebo. On days 1–7, all subjects were dosed unilaterally (twice a day, b.i.d.) in their non-dominant eye to ensure safety and tolerability prior to days 8–91 when dosing was changed to bilateral (b.i.d.). Clinical assessments, including DCNVA and adverse events (AEs), were recorded at each study visit. Patients who completed the study were recruited into a non-interventional follow-up study that monitored them until 7 months after their final UNR844 exposure. The primary endpoints were safety and the mean change in DCNVA from baseline in the study eye.

Results

UNR844 administration (n = 50) produced no safety concerns and was well-tolerated, with no clinically-relevant changes in best-corrected distance visual acuity, pupil size, intraocular pressure, or discontinuations due to adverse events. DCNVA improved in the study eye in the UNR844 group compared to placebo during the 91 days of treatment [UNR844 vs. placebo, mean change in LogMAR (SD); −0.159 (0.120) vs. −0.079 (0.116)]. Bilateral DCNVA improved, with 53.1% UNR844 vs. 21.7% placebo subjects gaining ≥10 letters. Improvements in DCNVA were sustained at 5 and 7 months after UNR844 dosing ceased.

Conclusions

These results support further development of UNR844 ophthalmic solution for the treatment of presbyopia.

Psychophysical Tests Do Not Identify Ocular Dominance Consistently

Classical sighting or sensory tests are used in clinical practice to identify the dominant eye. Several psychophysical tests were recently proposed to quantify the magnitude of dominance but whether their results agree was never investigated. We addressed this question for the two most common psychophysical tests: The perceived-phase test, which measures the cyclopean appearance of dichoptically presented sinusoids of different phase, and the coherence-threshold test, which measures interocular differences in motion perception when signal and noise stimuli are presented dichoptically. We also checked for agreement with three classical tests (Worth 4-dot, Randot suppression, and Bagolini lenses). Psychophysical tests were administered in their conventional form and also using more dependable psychophysical methods. The results showed weak correlations between psychophysical measures of strength of dominance with inconsistent identification of the dominant eye across tests: Agreement on left-eye dominance, right-eye dominance, or nondominance by both tests occurred only for 11 of 40 observers (27.5%); the remaining 29 observers were classified differently by each test, including 14 cases (35%) of opposite classification (left-eye dominance by one test and right-eye dominance by the other). Classical tests also yielded conflicting results that did not agree well with classification based on psychophysical tests. The results are discussed in the context of determination of ocular dominance for clinical decisions.

A comparison of tests for quantifying sensory eye dominance

Clinicians rely heavily on stereoacuity to measure binocular visual function, but stereo-vision represents only one aspect of binocularity. Lab-based tests of sensory eye dominance (SED) are commonplace, but have not been translated to wider clinical practice. Here we compare several methods of quantifying SED in a format suitable for clinical use. We tested 30 participants with ostensibly normal vision on eight tests. Seven tests (#1-7) were designed to quantify SED in the form of an interocular balance-point (BP). In tests #1-6, we estimated a contrast-BP, the interocular difference in contrast required for observers to be equally likely to base their judgement on either eye, whereas in test #7 we measured binocular rivalry (interocular ratio of sensory dominance duration). We compare test-retest reliability (intra-observer consistency) and test-validity (inter-observer discriminatory power) and compare BP to stereoacuity (test #8). The test that best preserved inter-observer differences in contrast balance while maintaining good test-retest reliability was a polarity judgement using superimposed opposite-contrast polarity same-identity optotypes. A reliable and valid measure of SED can be obtained rapidly (20 trials) using a simple contrast-polarity judgement. Tests that use polarity-rivalrous stimuli elicit more reliable judgments than those that do not. SIGNIFICANCE STATEMENT: Although sensory eye dominance is central to understanding normal and disordered binocular vision, there is currently no consensus as to the best way to measure it. Here we compare several candidate measures of sensory eye dominance and conclude that a reliable measure of SED can be achieved rapidly using a judgement of stimulus contrast-polarity.

Individual differences in sensory eye dominance reflected in the dynamics of binocular rivalry

Normal binocular vision emerges from the combination of neural signals arising within separate monocular pathways. It is natural to wonder whether both eyes contribute equally to the unified cyclopean impression we ordinarily experience. Binocular rivalry, which occurs when the inputs to the two eyes are markedly different, affords a useful means for quantifying the balance of influence exerted by the eyes (called sensory eye dominance, SED) and for relating that degree of balance to other aspects of binocular visual function. However, the precise ways in which binocular rivalry dynamics change when the eyes are unbalanced remain uncharted. Relying on widespread individual variability in the relative predominance of the two eyes as demonstrated in previous studies, we found that an observer's overall tendency to see one eye more than the other was driven both by differences in the relative duration and frequency of instances of that eye's perceptual dominance. Specifically, larger imbalances between the eyes were associated with longer and more frequent periods of exclusive dominance for the stronger eye. Increases in occurrences of dominant eye percepts were mediated in part by a tendency to experience "return transitions" to the predominant eye - that is, observers often experienced sequential exclusive percepts of the dominant eye's image with an intervening mixed percept. Together, these results indicate that the often-observed imbalances between the eyes during binocular rivalry reflect true differences in sensory processing, a finding that has implications for our understanding of the mechanisms underlying binocular vision in general.

Association of Visual Acuity with Ocular Dominance in 2045 Myopic Patients

PURPOSE

Previous studies of the relationship between visual acuity (VA) and ocular dominance have produced conflicting results. We hypothesized that (1) the discrepancies were related mostly to sample size and interocular visual acuity difference (IOVAD); (2) in large samples of individuals with marked IOVADs, the eye with the better uncorrected distance visual acuity (UDVA) would be dominant. These hypotheses were tested in a large group of myopic patients.

METHODS

This prospective study of cycloplegic refraction involved 2045 myopic refractive surgery candidates. Patients with amblyopia or strabismus were excluded. Ocular dominance was assessed using the hole-in-the-card test.

RESULTS

In 2045 patients, the dominant eye had significantly better UDVA (p = 0.028) and was less astigmatic (p = 0.000) than the nondominant eye. In 426 patients with marked interocular difference in the UDVA (≥0.2 logMAR), the dominant eye not only had significant UDVA (p = 0.022) but also significantly less myopic (p = 0.028) and had a shorter axial length (AL; p = 0.001). In patients with smaller differences in UDVA (0.1 logMAR, n = 411) or no difference (n = 1208), the dominant and nondominant eyes did not differ significantly with respect to UDVA, myopic power, and AL (p > 0.05).

CONCLUSIONS

The present study showed that the dominant eyes had significantly better UDVA than the nondominant eyes, especially in individuals with marked differences in UDVA. These results supported our hypothesis regarding the relationship between better VA and ocular dominance.

The effect of cataract surgery on ocular dominance

Purpose

The aim of this study is to assess whether eye dominance may change after cataract surgery.

Methods

This is a prospective case series. Cataract surgery candidates were examined prior to surgery for best-corrected visual acuity, eye dominance, and handedness. Patients with ocular conditions that may affect visual acuity were excluded from the study. A month following surgery, best-corrected visual acuity and eye dominance examinations were repeated.

Results

The study included 33 patients with a mean age of 70.5±9.4 years. Eighteen patients (54.5%) had right eye dominance. Following surgery, seven patients (21.2%) had a change in eye dominance. The change in dominance was linked to improved visual acuity in the operated eye and to a younger age, although with no statistical significance.

Conclusion

This is the first study reported in the literature to show that ocular dominance is a plastic characteristic following cataract surgeries. The results may change the importance given to eye dominance measurement prior to surgeries that rely on this examination, such as monovision surgeries.

Sighting versus sensory ocular dominance

Purpose

An indication of the laterality of ocular dominance (OD) informs the clinical decision making process when considering certain ophthalmic refractive and surgical interventions. Can predictive reliance be assured regardless of OD technique or is the indication of a dominant eye method-dependent?

Methods

Two alternative OD test formats were administered to a group of 72 emmetropic healthy young adult subjects: the ‘hole-in-card’ test for sighting dominance and the ‘+1.50D blur’ test for sensory dominance. Both techniques were chosen as being likely familiar to the majority of ophthalmic clinicians; to promote and expedite application during the examination routine neither test required specialist training nor equipment.

Results

Right eye dominance was indicated in 71% of cases by the sighting test but in only 54% of subjects using the sensory test. The laterality of OD indicated for the individual subject by each technique was in agreement on only 50% of occasions.

Conclusions

Reasons are considered for the poor intra-individual agreement between OD tests, along with an item of procedural advice for the clinician.

Relative contributions of the two eyes to perceived egocentric visual direction in normal binocular vision

Perceived egocentric direction (EVD) is based on the sensed position of the eyes in the orbit and the oculocentric visual direction (eye-centered, OVD). Previous reports indicate that in some subjects eye-position information from the two eyes contributes unequally to the perceived EVD. Findings from other studies indicate that the retinal information from the two eyes may not always contribute equally to perceived OVD. The goal of this study was to assess whether these two sources of information covary similarly within the same individuals. Open-loop pointing responses to an isolated target presented randomly at several horizontal locations were collected from 13 subjects during different magnitudes of asymmetric vergence to estimate the contribution of the position information from each eye to perceived EVD. For the same subjects, the direction at which a horizontally or vertically disparate target with different interocular contrast or luminance ratios appeared aligned with a non-disparate target estimated the relative contribution of each eye's retinal information. The results show that the eye-position and retinal information vary similarly in most subjects, which is consistent with a modified version of Hering's law of visual direction.

Laterality of amblyopia

PURPOSE

To determine the frequency of unilateral amblyopia in right versus left eyes among children younger than 18 years.

DESIGN

Analysis of data collected in randomized clinical trials conducted by the Pediatric Eye Disease Investigator Group.

METHODS

The laterality of the amblyopic eye was analyzed in 2635 subjects younger than 18 years who participated in 9 multicenter prospective, randomized treatment trials. Eligibility criteria for these clinical trials included unilateral amblyopia associated with strabismus, anisometropia, or both, with visual acuity between 20/40 and 20/400. Logistic regression was used to assess the association of baseline and demographic factors with the laterality of amblyopia.

RESULTS

Among subjects with anisometropic amblyopia (with or without strabismus), amblyopia was present more often in left than right eyes, with a relative prevalence of 59% in left eyes (95% confidence interval, 57% to 62%; P < .001 from a test of proportion, 50%). However, among subjects with strabismic-only amblyopia, there was no laterality predilection (relative prevalence of 50% in left eyes; 95% confidence interval, 47% to 54%; P = .94).

CONCLUSIONS

Anisometropic amblyopia, with or without strabismus, occurs more often in left eyes than right eyes. This finding of amblyopia laterality may be related to microtropia, sighting dominance, or other forms of ocular dominance; developmental or neurological factors; laterality in the development of refractive error; or a combination thereof.

A new interocular suppression technique for measuring sensory eye dominance

PURPOSE

Recently devised tests have implemented forms of interocular suppression (e.g., binocular rivalry) to assess eye dominance. In an effort to combine the strengths of these tests, the authors introduce a new technique for quantifying the magnitude of interocular suppression by using an easily administered psychophysical test.

METHODS

Eighty-eight observers participated in the interocular suppression test, which involved dichoptic presentation of dynamic noise to one eye and a target stimulus to the other. Observers made a form-discrimination judgment once the target emerged from suppression. The authors reasoned that the dominant eye is less susceptible to interocular suppression and as a result, perception and thus, form discrimination would be faster when the target is presented to the dominant eye as opposed to the nondominant eye. Observers' sighting dominance, acuity, contrast sensitivity, and test-retest reliability were also assessed.

RESULTS

There were significant interocular differences in mean reaction times within and across observers. Of the observers, 68% and 32% observers were categorized as right eye dominant and left eye dominant, respectively, according to the test. Moreover, 38% of observers showed strong eye dominance. Observers' discrimination accuracy (98%) and test-retest reliability (r = 0.52-0.67) were high. Consistent with results in previous studies, statistical correlations were weak between the sighting dominance test, acuity scores, contrast sensitivity measures, and the interocular suppression test.

CONCLUSIONS

This interocular suppression technique offers an efficient, reliable, quantitative method of evaluating eye dominance and may be useful in making decisions about differential refractive correction of the two eyes.

Eye dominance effects in conjunction search

We previously found a dominant eye perceptional advantage in feature search (Vision Research, 2006). We now ask if this advantage extends to difficult conjunction search, which requires focused attention and depends on different cortical hierarchy levels. We determined eye dominance by the Hole-in-the-Card test. Using red-green glasses, subjects viewed a briefly presented, backward-masked, array of red/green dotted squares and filled circles. On half of the trials a filled square target replaced one dotted square. There was significantly better performance when the target was seen by the dominant eye, suggesting its visual processing priority in slow, as in rapid search, perhaps including augmented attention to dominant eye representations. Binocular conjunction targets were found faster than monocular targets, though binocularity--as utrocular information--was insufficient to support reasonable detection levels.

Monovision: a review

In presbyopia, patients can no longer obtain clear vision at distance and near. Monovision is a method of correcting presbyopia where one eye is focussed for distance vision and the other for near. Monovision is a fairly common method of correcting presbyopia with contact lenses and has received renewed interest with the increase in refractive surgery. The present paper is a review of the literature on monovision. The success rate of monovision in adapted contact lens wearers is 59-67%. The main limitations are problems with suppressing the blurred image when driving at night and the need for a third focal length, for example with computer screens at intermediate distances. Stereopsis is impaired in monovision, but most patients do not seem to notice this. These limitations highlight the need to take account of occupational factors. Monovision could cause a binocular vision anomaly to decompensate, so the pre-fitting screening should include an assessment of orthoptic function. Various methods have been used to determine which eye should be given the distance vision contact lens and the literature on tests of ocular dominance is reviewed. It is concluded that tests of blur suppression are most likely to be relevant, but that ocular dominance is not fixed but is rather a fluid, adaptive, phenomenon in most patients. Suitable patients can often be given trial lenses that allow them to experiment with monovision in real world situations and this can be a useful way of revealing the preferred eye for each distance. Of course, no patient should drive or operate machinery until successfully adapted to monovision. Surgically induced monovision is less easily reversed than contact lens-induced monovision, and is only appropriate after a successful trial of monovision with contact lenses.