Grouping Effects on Foveal Spatial Interactions in Children

Landolt C-Tests With "Fixed" Arcmin Separations Detect Amblyopia But Underestimate Crowding in Moderate-to-Severe Amblyopic Children and Adults

Purpose

Crowding is exaggerated in central vision of strabismic amblyopia, impacting on reading ability. Crowding magnitude and interocular differences (IODs) in acuity are indicators for detection, assessment, and monitoring of treatment. Lateral masking (including contour interaction) also affects acuity and can mimic or ameliorate crowding. We investigated lateral masking/contour interaction and crowding impact on crowding magnitude and IOD measures in healthy and amblyopic pediatric and juvenile/adult groups using two Landolt C-tests with "fixed" arcmin separations.

Methods

Acuity (logMAR) was measured with Landolt C-tests with specified 2.6' ("crowded") and 35' ("uncrowded") separations. Crowding magnitudes (crowded - uncrowded acuities) and IODs were calculated. Participants were 69 subjects with strabismic amblyopia (n = 39 pediatric, i.e. children ≤8 years of age), 31 subjects with anisometropic amblyopia (n = 14 pediatric), and 76 healthy controls (n = 36 pediatric). Subjects with amblyopia were subgrouped by acuity as low severity (<0.4 logMAR) or high severity (≥0.4 logMAR) using the 35' separation C-test.

Results

Crowding magnitudes were greater in strabismic than in anisometropic amblyopia and control/fellow eyes. They were higher in pediatric control/fellow eyes than in juvenile/adult eyes. In high severity strabismic amblyopia, crowding magnitudes progressively and significantly reduced (slope = -0.17 ± 0.07, P < 0.05) with worsening acuity. IODs for this group were higher on the 2.6' C-test, but lower than expected. In high severity pediatric subjects with anisometropic amblyopia, seven of eight had lower IODs measured with the "crowded" than the "uncrowded" C-tests.

Conclusions

These C-tests detect amblyopia but underestimate crowding in children and adults with high severity strabismic amblyopia. Separate isolated optotype acuity and crowding distance tests may better target specific functions, while minimizing the impact of masking.

Global and high-level effects in crowding cannot be predicted by either high-dimensional pooling or target cueing

In visual crowding, the perception of a target deteriorates in the presence of nearby flankers. Traditionally, target-flanker interactions have been considered as local, mostly deleterious, low-level, and feature specific, occurring when information is pooled along the visual processing hierarchy. Recently, a vast literature of high-level effects in crowding (grouping effects and face-holistic crowding in particular) led to a different understanding of crowding, as a global, complex, and multilevel phenomenon that cannot be captured or explained by simple pooling models. It was recently argued that these high-level effects may still be captured by more sophisticated pooling models, such as the Texture Tiling model (TTM). Unlike simple pooling models, the high-dimensional pooling stage of the TTM preserves rich information about a crowded stimulus and, in principle, this information may be sufficient to drive high-level and global aspects of crowding. In addition, it was proposed that grouping effects in crowding may be explained by post-perceptual target cueing. Here, we extensively tested the predictions of the TTM on the results of six different studies that highlighted high-level effects in crowding. Our results show that the TTM cannot explain any of these high-level effects, and that the behavior of the model is equivalent to a simple pooling model. In addition, we show that grouping effects in crowding cannot be predicted by post-perceptual factors, such as target cueing. Taken together, these results reinforce once more the idea that complex target-flanker interactions determine crowding and that crowding occurs at multiple levels of the visual hierarchy.