Learning with a lazy eye: a potential treatment for amblyopia

A game platform for treatment of amblyopia

We have developed a prototype device for take-home use that can be used in the treatment of amblyopia. The therapeutic scenario we envision involves patients first visiting a clinic, where their vision parameters are assessed and suitable parameters are determined for therapy. Patients then proceed with the actual therapeutic treatment on their own, using our device, which consists of an Apple iPod Touch running a specially modified game application. Our rationale for choosing to develop the prototype around a game stems from multiple requirements that such an application satisfies. First, system operation must be sufficiently straightforward that ease-of-use is not an obstacle. Second, the application itself should be compelling and motivate use more so than a traditional therapeutic task if it is to be used regularly outside of the clinic. This is particularly relevant for children, as compliance is a major issue for current treatments of childhood amblyopia. However, despite the traditional opinion that treatment of amblyopia is only effective in children, our initial results add to the growing body of evidence that improvements in visual function can be achieved in adults with amblyopia.

Spatial frequency discrimination learning in normal and developmentally impaired human vision

Perceptual learning effects demonstrate that the adult visual system retains neural plasticity. If perceptual learning holds any value as a treatment tool for amblyopia, trained improvements in performance must generalise. Here we investigate whether spatial frequency discrimination learning generalises within task to other spatial frequencies, and across task to contrast sensitivity. Before and after training, we measured contrast sensitivity and spatial frequency discrimination (at a range of reference frequencies 1, 2, 4, 8, 16 c/deg). During training, normal and amblyopic observers were divided into three groups. Each group trained on a spatial frequency discrimination task at one reference frequency (2, 4, or 8 c/deg). Normal and amblyopic observers who trained at lower frequencies showed a greater rate of within task learning (at their reference frequency) compared to those trained at higher frequencies. Compared to normals, amblyopic observers showed greater within task learning, at the trained reference frequency. Normal and amblyopic observers showed asymmetrical transfer of learning from high to low spatial frequencies. Both normal and amblyopic subjects showed transfer to contrast sensitivity. The direction of transfer for contrast sensitivity measurements was from the trained spatial frequency to higher frequencies, with the bandwidth and magnitude of transfer greater in the amblyopic observers compared to normals. The findings provide further support for the therapeutic efficacy of this approach and establish general principles that may help develop more effective protocols for the treatment of developmental visual deficits.