Processing Deficits in Primary Visual Cortex of Amblyopic Cats

Evaluation of Ganglion Cell-Layer Complex and Macular Vessel Density in Amblyopic Eyes with Optical Coherence Tomography Angiography

Purpose: This study aimed to compare and quantify the ganglion cell complex (GCC), macular thickness, and vessel density (VD) in amblyopic eyes and their corresponding fellow eyes using optical coherence tomography angiography (OCTA). Methods: This cross-sectional study analyzed 32 unilateral amblyopic patients, examining both of their eyes. The study assessed parameters such as GCC thickness, macular thickness (total, inner, and outer layers), and VD in the optic nerve and macular region using spectral-domain OCTA. Results: This study analyzed data from 30 unilateral amblyopic patients with a mean age of 28.7 ± 18.3 years. Amblyopic eyes had lower mean best-corrected visual acuity compared with healthy eyes. However, no significant differences were found in retinal nerve fiber layer (RNFL) thickness, GCC thickness, and overall retinal thickness between amblyopic and fellow eyes when accounting for factors such as axial length and signal strength index. In patients older than 30 years, amblyopic eyes had a higher global loss volume (GLV) compared with fellow eyes (p = 0.02). In addition, blood VD within the optic disc and superficial/deep capillary plexuses in different macular regions were significantly lower in amblyopic eyes compared with fellow eyes. Conclusions: This study found significant differences in VD and the GLV index between amblyopic eyes and healthy eyes, particularly in older patients. However, there were no notable differences in macular thickness and RNFL thickness. Further research is needed to determine the clinical relevance of these findings.

Reduced interocular suppression after inverse patching in anisometropic amblyopia

Purpose

Recent investigations observed substantial enhancements in binocular balance, visual acuity, and stereovision among older children and adults with amblyopia by patching the amblyopic eye (i.e., inverse patching) for 2 h daily over 2 months. Despite these promising findings, the precise neural mechanisms underlying inverse patching remain elusive. This study endeavors to delve deeper into the neural alterations induced by inverse patching, focusing on steady-state visual evoked potentials (SSVEPs). We specifically investigate the changes in SSVEPs following monocular deprivation of either the fellow eye or the amblyopic eye in older amblyopic children and adults.

Method

Ten participants (17.60 ± 2.03 years old; mean ± SEM), clinically diagnosed with anisometropic amblyopia, were recruited for this study. Each participant underwent a 120 min patching session on their fellow eye on the first day, followed by a similar session on their amblyopic eye on the second day. Baseline steady-state visual evoked potentials (SSVEPs) measurements were collected each day prior to patching, with post-patching SSVEPs measurements obtained immediately after the patching session. The experimental design incorporated a binocular rivalry paradigm, utilizing SSVEPs measurements.

Results

The results revealed that inverse patching induced a heightened influence on neural plasticity, manifesting in a reduction of interocular suppression from the fellow eye to the amblyopic eye. In contrast, patching the fellow eye demonstrated negligible effects on the visual cortex. Furthermore, alterations in interocular suppression subsequent to inverse patching exhibited a correlation with the visual acuity of the amblyopic eye.

Conclusion

Inverse patching emerges as a promising therapeutic avenue for adolescents and adults grappling with severe anisometropic amblyopia that proves refractory to conventional interventions. This innovative approach exhibits the potential to induce more robust neural plasticity within the visual cortex, thereby modulating neural interactions more effectively than traditional amblyopia treatments.

Beyond Rehabilitation of Acuity, Ocular Alignment, and Binocularity in Infantile Strabismus

Infantile strabismus impairs the perception of all attributes of the visual scene. High spatial frequency components are no longer visible, leading to amblyopia. Binocularity is altered, leading to the loss of stereopsis. Spatial perception is impaired as well as detection of vertical orientation, the fastest movements, directions of movement, the highest contrasts and colors. Infantile strabismus also affects other vision-dependent processes such as control of postural stability. But presently, rehabilitative therapies for infantile strabismus by ophthalmologists, orthoptists and optometrists are restricted to preventing or curing amblyopia of the deviated eye, aligning the eyes and, whenever possible, preserving or restoring binocular vision during the critical period of development, i.e., before ~10 years of age. All the other impairments are thus ignored; whether they may recover after strabismus treatment even remains unknown. We argue here that medical and paramedical professionals may extend their present treatments of the perceptual losses associated with infantile strabismus. This hypothesis is based on findings from fundamental research on visual system organization of higher mammals in particular at the cortical level. In strabismic subjects (as in normal-seeing ones), information about all of the visual attributes converge, interact and are thus inter-dependent at multiple levels of encoding ranging from the single neuron to neuronal assemblies in visual cortex. Thus if the perception of one attribute is restored this may help to rehabilitate the perception of other attributes. Concomitantly, vision-dependent processes may also improve. This could occur spontaneously, but still should be assessed and validated. If not, medical and paramedical staff, in collaboration with neuroscientists, will have to break new ground in the field of therapies to help reorganize brain circuitry and promote more comprehensive functional recovery. Findings from fundamental research studies in both young and adult patients already support our hypothesis and are reviewed here. For example, presenting different contrasts to each eye of a strabismic patient during training sessions facilitates recovery of acuity in the amblyopic eye as well as of 3D perception. Recent data also demonstrate that visual recoveries in strabismic subjects improve postural stability. These findings form the basis for a roadmap for future research and clinical development to extend presently applied rehabilitative therapies for infantile strabismus.

Association of Optic Radiation Integrity with Cortical Thickness in Children with Anisometropic Amblyopia

Previous studies have indicated regional abnormalities of both gray and white matter in amblyopia. However, alterations of cortical thickness associated with changes in white matter integrity have rarely been reported. In this study, structural magnetic resonance imaging and diffusion tensor imaging (DTI) data were obtained from 15 children with anisometropic amblyopia and 15 age- and gender-matched children with normal sight. Combining DTI and surface-based morphometry, we examined a potential linkage between disrupted white matter integrity and altered cortical thickness. The fractional anisotropy (FA) values in the optic radiations (ORs) of children with anisometropic amblyopia were lower than in controls (P < 0.05). The cortical thickness in amblyopic children was lower than controls in the following subregions: lingual cortex, lateral occipitotemporal gyrus, cuneus, occipital lobe, inferior parietal lobe, and temporal lobe (P < 0.05, corrected), but was higher in the calcarine gyrus (P < 0.05, corrected). Node-by-node correlation analysis of changes in cortical thickness revealed a significant association between a lower FA value in the OR and diminished cortical thickness in the following subregions: medial lingual cortex, lateral occipitotemporal gyrus, lateral, superior, and medial occipital cortex, and lunate cortex. We also found a relationship between changes of cortical thickness and white matter OR integrity in amblyopia. These findings indicate that developmental changes occur simultaneously in the OR and visual cortex in amblyopia, and provide key information on complex damage of brain networks in anisometropic amblyopia. Our results also support the hypothesis that the pathogenesis of anisometropic amblyopia is neurodevelopmental.

Origins of strabismus and loss of binocular vision

Strabismus is a frequent ocular disorder that develops early in life in humans. As a general rule, it is characterized by a misalignment of the visual axes which most often appears during the critical period of visual development. However other characteristics of strabismus may vary greatly among subjects, for example, being convergent or divergent, horizontal or vertical, with variable angles of deviation. Binocular vision may also vary greatly. Our main goal here is to develop the idea that such “polymorphy” reflects a wide variety in the possible origins of strabismus. We propose that strabismus must be considered as possibly resulting from abnormal genetic and/or acquired factors, anatomical and/or functional abnormalities, in the sensory and/or the motor systems, both peripherally and/or in the brain itself. We shall particularly develop the possible “central” origins of strabismus. Indeed, we are convinced that it is time now to open this “black box” in order to move forward. All of this will be developed on the basis of both presently available data in literature (including most recent data) and our own experience. Both data in biology and medicine will be referred to. Our conclusions will hopefully help ophthalmologists to better understand strabismus and to develop new therapeutic strategies in the future. Presently, physicians eliminate or limit the negative effects of such pathology both on the development of the visual system and visual perception through the use of optical correction and, in some cases, extraocular muscle surgery. To better circumscribe the problem of the origins of strabismus, including at a cerebral level, may improve its management, in particular with respect to binocular vision, through innovating tools by treating the pathology at the source.

Strabismus disrupts binocular synaptic integration in primary visual cortex

Visual disruption early in development dramatically changes how primary visual cortex neurons integrate binocular inputs. The disruption is paradigmatic for investigating the synaptic basis of long-term changes in cortical function, because the primary visual cortex is the site of binocular convergence. The underlying alterations in circuitry by visual disruption remain poorly understood. Here we compare membrane potential responses, observed via whole-cell recordings in vivo, of primary visual cortex neurons in normal adult cats with those of cats in which strabismus was induced before the developmental critical period. In strabismic cats, we observed a dramatic shift in the ocular dominance distribution of simple cells, the first stage of visual cortical processing, toward responding to one eye instead of both, but not in complex cells, which receive inputs from simple cells. Both simple and complex cells no longer conveyed the binocular information needed for depth perception based on binocular cues. There was concomitant binocular suppression such that responses were weaker with binocular than with monocular stimulation. Our estimates of the excitatory and inhibitory input to single neurons indicate binocular suppression that was not evident in synaptic excitation, but arose de novo because of synaptic inhibition. Further constraints on circuit models of plasticity result from indications that the ratio of excitation to inhibition evoked by monocular stimulation decreased mainly for nonpreferred eye stimulation. Although we documented changes in synaptic input throughout primary visual cortex, a circuit model with plasticity at only thalamocortical synapses is sufficient to account for our observations.

Sparse coding can predict primary visual cortex receptive field changes induced by abnormal visual input

Receptive fields acquired through unsupervised learning of sparse representations of natural scenes have similar properties to primary visual cortex (V1) simple cell receptive fields. However, what drives in vivo development of receptive fields remains controversial. The strongest evidence for the importance of sensory experience in visual development comes from receptive field changes in animals reared with abnormal visual input. However, most sparse coding accounts have considered only normal visual input and the development of monocular receptive fields. Here, we applied three sparse coding models to binocular receptive field development across six abnormal rearing conditions. In every condition, the changes in receptive field properties previously observed experimentally were matched to a similar and highly faithful degree by all the models, suggesting that early sensory development can indeed be understood in terms of an impetus towards sparsity. As previously predicted in the literature, we found that asymmetries in inter-ocular correlation across orientations lead to orientation-specific binocular receptive fields. Finally we used our models to design a novel stimulus that, if present during rearing, is predicted by the sparsity principle to lead robustly to radically abnormal receptive fields.

The responses of neurons in the primary visual cortex (V1), a region of the brain involved in encoding visual input, are modified by the visual experience of the animal during development. For example, most neurons in animals reared viewing stripes of a particular orientation only respond to the orientation that the animal experienced. The responses of V1 cells in normal animals are similar to responses that simple optimisation algorithms can learn when trained on images. However, whether the similarity between these algorithms and V1 responses is merely coincidental has been unclear. Here, we used the results of a number of experiments where animals were reared with modified visual experience to test the explanatory power of three related optimisation algorithms. We did this by filtering the images for the algorithms in ways that mimicked the visual experience of the animals. This allowed us to show that the changes in V1 responses in experiment were consistent with the algorithms. This is evidence that the precepts of the algorithms, notably sparsity, can be used to understand the development of V1 responses. Further, we used our model to propose a novel rearing condition which we expect to have a dramatic effect on development.

Effective connectivity anomalies in human amblyopia

We investigate the effective connectivity in the lateral geniculate nucleus and visual cortex of humans with amblyopia. Six amblyopes participated in this study. Standard retinotopic mapping stimuli were used to define the boundaries of early visual cortical areas. We obtained fMRI time series from thalamic, striate and extrastriate cortical regions for the connectivity study. Thalamo-striate and striate-extrastriate networks were constructed based on known anatomical connections and the effective connectivities of these networks were assessed by means of a nonlinear system identification method. The effective connectivity of all networks studied was reduced when driven by the amblyopic eye, suggesting contrary to the current single-cell model of localized signal reduction, that a significant part of the amblyopic deficit is due to anomalous interactions between cells in disparate brain regions. The effective connectivity loss was unrelated to the fMRI loss but correlated with the degree of amblyopia (ipsilateral LGN to V1 connection), suggesting that it may be a more relevant measure. Feedforward and feedback connectivities were similarly affected. A hemispheric dependence was found for the thalamo-striate feedforward input that was not present for the feedback connection, suggesting that the reduced function of the LGN recently found in amblyopic humans may not be solely determined by the feedback influence from the cortex. Both ventral and dorsal connectivities were reduced.

Selectivity as well as sensitivity loss characterizes the cortical spatial frequency deficit in amblyopia

The processing deficit in amblyopia is not restricted to just high spatial frequencies but also involves low-medium spatial frequency processing, for suprathreshold stimuli with a broad orientational bandwidth. This is the case in all three forms of amblyopia; strabismic, anisometropic, and deprivation. Here we use both a random block design and a phase-encoded design to ascertain (1) the extent to which fMRI activation is reduced at low-mid spatial frequencies in different visual areas, (2) how accurately spatial frequency is mapped across the amblyopic cortex. We report a loss of function to suprathreshold low-medium spatial frequency stimuli that involves more than just area V1, suggesting a diffuse loss in spatial frequency processing in a number of different cortical areas. An analysis of the fidelity of the spatial frequency cortical map reveals that many voxels lose their spatial frequency preference when driven by the amblyopic eye, suggesting a broader tuning for spatial frequency for neurons driven by the amblyopic eye within this low-mid spatial frequency range.

Visual Processing in Amblyopia: Human Studies

Within the last five years, there have been a number of exciting new advances in our knowledge and understanding of amblyopia. This article reviews recent psychophysical studies of naturally occurring amblyopia in humans. These studies suggest that: 1) There are significant differences in the patterns of visual loss among the clinically defined categories of amblyopes. A key factor in determining the nature of the loss is the presence or absence of binocularity. 2) Dysfunction within the amblyopic visual system first occurs in area V1, and the effects of amblyopia may be amplified downstream. 3) There appears to be substantial neural plasticity in the amblyopic brain beyond the "critical period."

Comparison of contrast-response functions from multifocal visual-evoked potentials (mfVEPs) and functional MRI responses

Contrast response functions (CRFs) from multifocal visual-evoked potential (mfVEP) and BOLD fMRI responses were obtained using the same stimuli to test the hypothesis of a linear relationship between the mfVEP and BOLD fMRI responses. Monocular mfVEP and BOLD fMRI responses were obtained using an 8 degrees in diameter, dartboard pattern stimulus with reversing checkerboards. Six contrast conditions (4%, 8%, 16%, 32%, 64%, and 90%) were run. The mfVEP, largely generated in V1, was compared to the BOLD fMRI signal from V1 and extrastriate cortex. Retinotopic maps of each subject were acquired and used to localize the V1 area. For all subjects, the CRFs for the mfVEPs and BOLD fMRI responses showed good agreement, suggesting that they both share the same functional relationship with underlying neural activity. In particular, this result is consistent with the assumption that the relationship between the BOLD response and underlying neural activity is linear, although the particular linear model proposed by D. J. Heeger, A. C. Huk, W. S. Geisler, and D. G. Albrecht (2000) does not fit the results.

Pattern motion selectivity in population responses of area 18

It is commonly believed that the complexity of visual stimuli represented by individual neurons increases towards higher cortical areas. However, even in early visual areas an individual neuron's response is influenced by stimuli presented outside its classical receptive field. Thus, it has been proven difficult to characterize the coding of complex stimuli at the level of single neurons. We therefore investigated population responses using optical imaging in cat area 18 to complex stimuli, plaids. Plaid stimuli are composed of two superimposed gratings moving in different directions. They may be perceived as either two separate surfaces or as a global pattern moving in intermediate direction to the components' direction of motion. We found that in addition to activity maps representing the individual components' motion, plaid stimuli produced activity distributions matching the predictions from a pattern-motion model in central area 18. Thereby, relative component- and pattern-like modulations followed the degree of psychophysical pattern bias in the stimulus. Thus, our results strongly indicate that area 18 exhibits a substantial response to pattern-motion signals at the population level suggesting the presence of intrinsic or extrinsic mechanisms that allow for integration of motion responses from far outside the classical receptive field.

Amblyopie fonctionnelle : évaluation en IRM fonctionnelle de la réponse corticale visuelle après traitement

PURPOSE

Functional MRI evaluation of the cortical response in treated amblyopic patients.

MATERIAL AND METHODS

Clinical and functional MRI exploration of ten patients, seven men and three women aged from 21 to 59 years, with strabismus management during childhood. Functional evaluations were performed on a 1.5 Tesla MR device, with four monocular functional sessions, two stimulations per eye. Alternating rest and active phases displayed still and flickering black and white checkerboards with spatial and temporal frequencies of 1 degree/8Hz and 15'/4Hz. Anatomical realignment and statistical analysis were performed using SPM99 (Statistical Parametric Mapping) to compare the four sessions in individuals.

RESULTS AND DISCUSSION

In patients presenting a visual acuity of the amblyopic eye less than 0.7, stimulation of this eye induced lower response in V1, V3, and V5 in comparison with the contralateral eye stimulation. Unexpectedly, in patients recovering normal or subnormal acuity, the amblyopic eye gave comparable or enhanced response in these areas. Additional response was found in the secondary visual cortex, the cuneus, the lingual gyrus, and in parietal, frontal, and orbitofrontal areas. These results suggest a variation in cortical response depending on the efficacy of the treatment. Recovered amblyopic eye, even with acuity less than the contralateral eye, may induce a reinforced cortical sensitivity to visual stimulus. Secondary visual areas may contribute to an attentional process in image perception and analysis. Cortical plasticity may be observed several years after amblyopia treatment.

CONCLUSION

Our study substantiates the importance of an effective and early treatment of functional amblyopia, inducing cortical plasticity with reinforced attention and sensitivity to visual perception.

Visual processing in amblyopia: animal studies

In the past five years, substantial progress has been made in our knowledge of the neural basis of amblyopia. Recent advances based on animal models are described, along with new psychophysical data showing perceptual deficits in amblyopic animals that are not explained by simple losses in contrast sensitivity. Studies of contour integration and integration of motion and form signals in the presence of noise show that 1) there are fundamental losses in temporal as well as spatial vision, 2) the losses extend to the fellow eye in many cases, 3) amblyopic animals are especially impaired in the presence of background noise, and 4) these losses must depend on a process downstream from area V1 in the extrastriate cortex.

Haphazard neural connections underlie the visual deficits of cats with strabismic or deprivation amblyopia

Identification of the neural basis of the visual deficits experienced by humans with amblyopia, particularly when associated with strabismus (strabismic amblyopia), has proved to be difficult in part because of the inability to observe directly the neural changes at various levels of the human visual pathway. Much of our knowledge has necessarily been obtained on the basis of sophisticated psychophysical studies as well as from electrophysiological explorations on the visual pathways in animal models of amblyopia. This study combines these two approaches to the problem by employing similar psychophysical probes of performance on animal models of two forms of amblyopia (deprivation and strabismic) to those employed earlier on human amblyopes (Hess & Field, 1994, Vis. Res., 34, 13397-13406). The tests explore two competing explanations for the visual deficits, namely an evenly distributed loss of neural connections (undersampling) with the amblyopic eye as opposed to disordered connections with this eye (neural disarray). Unexpectedly, the results in animal models of deprivation amblyopia were not in accord with expectations based upon an even distribution of lost connections with the amblyopic eye. However, the results were similar to those observed in a strabismic amblyopic animal and to strabismic amblyopic humans. We suggest that deprivation amblyopia may be accompanied by an uneven loss of connections that results in effective neural disarray. By contrast, amblyopia associated with strabismus might arise from neural disarray of a different origin such as an alteration of intrinsic cortical connections.

Hemodynamic signals correlate tightly with synchronized gamma oscillations

Functional imaging methods monitor neural activity by measuring hemodynamic signals. These are more closely related to local field potentials (LFPs) than to action potentials. We simultaneously recorded electrical and hemodynamic responses in the cat visual cortex. Increasing stimulus strength enhanced spiking activity, high-frequency LFP oscillations, and hemodynamic responses. With constant stimulus intensity, the hemodynamic response fluctuated; these fluctuations were only loosely related to action potential frequency but tightly correlated to the power of LFP oscillations in the gamma range. These oscillations increase with the synchrony of synaptic events, which suggests a close correlation between hemodynamic responses and neuronal synchronization.