Is the Cortical Deficit in Amblyopia Due to Reduced Cortical Magnification, Loss of Neural Resolution, or Neural Disorganization?

Brain mechanism of acupuncture for children with anisometropic amblyopia: a resting functional magnetic resonance imaging study based on voxel-mirrored homotopic connectivity

AIM

To explore the brain mechanism of acupuncture for children with anisometropic amblyopia using the voxel-mirror homotopic connectivity (VMHC) analysis method of resting functional magnetic resonance imaging (rs-fMRI) technology based on clinical effectiveness.

METHODS

Eighty children with anisometropic monocular amblyopia were randomly divided into two groups: control (40 cases, 1 case of shedding) and acupuncture (40 cases, 1 case of shedding) groups. The control group was treated with glasses, red flash, grating, and visual stimulations, with each procedure conducted for 5min per time. Based on routine treatment, the acupuncture group underwent acupuncture of "regulating qi and unblocking meridians to bright eyes", Jingming (BL1), Cuanzhu (BL2), Guangming (GB37), Fengchi (GB20) acupoints were taken on both sides, with the needle kept for 30min each time. Both groups were treated once every other day, three times per week, for a total of 4wk. After the treatment, the overall curative effect of the two groups and the latency and amplitude changes of P100 wave of pattern visual-evoked potential were counted. At the same time, nine children with left eye amblyopia were randomly selected from the two groups and were scanned with rs-fMRI before and after treatment. The differences in the brain regions between the two groups were compared and analyzed with VMHC.

RESULTS

Chi-square test showed a notable difference in the total efficiency rate between the acupuncture (94.87%) and control groups (79.49%). Regarding the P100 wave latency and amplitude, the acupuncture group had significantly shorter latency and higher amplitude of P100 wave than the control group. Moreover, the VMHC values of the bilateral temporal lobe, superior temporal gyrus, and middle temporal gyrus were notably increased in the acupuncture group after treatment.

CONCLUSION

Acupuncture combined with conventional treatment can significantly improve the corrected visual acuity and optic nerve conduction in children with anisometropic amblyopia. Compared with the conventional treatment, the regulation of acupuncture on the functional activities of the relevant brain areas in the anterior cerebellum may be an effective acupuncture mechanism for anisometropic amblyopia.

Structural and functional alterations in the brains of patients with anisometropic and strabismic amblyopia: a systematic review of magnetic resonance imaging studies

Amblyopia is the most common cause of vision loss in children and can persist into adulthood in the absence of effective intervention. Previous clinical and neuroimaging studies have suggested that the neural mechanisms underlying strabismic amblyopia and anisometropic amblyopia may be different. Therefore, we performed a systematic review of magnetic resonance imaging studies investigating brain alterations in patients with these two subtypes of amblyopia; this study is registered with PROSPERO (registration ID: CRD42022349191). We searched three online databases (PubMed, EMBASE, and Web of Science) from inception to April 1, 2022; 39 studies with 633 patients (324 patients with anisometropic amblyopia and 309 patients with strabismic amblyopia) and 580 healthy controls met the inclusion criteria (e.g., case-control designed, peer-reviewed articles) and were included in this review. These studies highlighted that both strabismic amblyopia and anisometropic amblyopia patients showed reduced activation and distorted topological cortical activated maps in the striate and extrastriate cortices during task-based functional magnetic resonance imaging with spatial-frequency stimulus and retinotopic representations, respectively; these may have arisen from abnormal visual experiences. Compensations for amblyopia that are reflected in enhanced spontaneous brain function have been reported in the early visual cortices in the resting state, as well as reduced functional connectivity in the dorsal pathway and structural connections in the ventral pathway in both anisometropic amblyopia and strabismic amblyopia patients. The shared dysfunction of anisometropic amblyopia and strabismic amblyopia patients, relative to controls, is also characterized by reduced spontaneous brain activity in the oculomotor cortex, mainly involving the frontal and parietal eye fields and the cerebellum; this may underlie the neural mechanisms of fixation instability and anomalous saccades in amblyopia. With regards to specific alterations of the two forms of amblyopia, anisometropic amblyopia patients suffer more microstructural impairments in the precortical pathway than strabismic amblyopia patients, as reflected by diffusion tensor imaging, and more significant dysfunction and structural loss in the ventral pathway. Strabismic amblyopia patients experience more attenuation of activation in the extrastriate cortex than in the striate cortex when compared to anisometropic amblyopia patients. Finally, brain structural magnetic resonance imaging alterations tend to be lateralized in the adult anisometropic amblyopia patients, and the patterns of brain alterations are more limited in amblyopic adults than in children. In conclusion, magnetic resonance imaging studies provide important insights into the brain alterations underlying the pathophysiology of amblyopia and demonstrate common and specific alterations in anisometropic amblyopia and strabismic amblyopia patients; these alterations may improve our understanding of the neural mechanisms underlying amblyopia.

Deficits in Reach Planning and On-Line Grasp Control in Adults With Amblyopia

Purpose

Adults with amblyopia exhibit impairments when reaching to grasp three-dimensional objects. We examined whether their deficits derive from problems with feedforward planning of these prehension movements or in using visual feedback to control them on-line.

Methods

Twenty-one adults with mild to severe anisometropic and/or strabismic amblyopia and reduced binocularity participated, along with 21 normally sighted age- and gender-matched controls. Subjects used their preferred hand to reach for, precision grasp, and then lift cylindrical table-top objects (two sizes, two distances) using binocular, dominant eye, or amblyopic/non-sighting eye vision just to plan their movements during a 1-second task preview with vision then occluded so feedback was absent or to plan and execute them (i.e., with visual feedback fully available). Kinematic and error measures of the timing and accuracy of the reach and grasp were quantified by view and feedback and compared by ANOVA.

Results

The amblyopic adults performed generally worse than controls across all three views in both feedback conditions. With vision for planning only, their movement initiation and duration times were significantly increased, as were their initial reach times and error rates, especially when using the amblyopic eye alone, whatever its visual acuity loss. These relative planning deficits were only partially rectified with visual feedback available on-line. Relative grasp planning deficits were less evident in the amblyopia group, who instead produced significantly increased grip times and errors under binocular and amblyopic eye visual feedback conditions, although the subgroup with unmeasurable stereovision also formed wider (inaccurate) grasps across all conditions.

Conclusions

Adults with amblyopia seem to have problems constructing reliable internal spatial representations for the feedforward planning of prehension, particularly with their affected eye and mainly affecting their reach, with additional deficits in on-line grasp control related to poor binocularity.

Amblyopic stereo vision is efficient but noisy

People with amblyopia demonstrate a reduced ability to judge depth using stereopsis. Our understanding of this deficit is limited, as standard clinical stereo tests may not be suited to give a quantitative account of the residual stereo ability in amblyopia. In this study we used a stereo test designed specifically for that purpose. Participants identified the location of a disparity-defined odd-one-out target within a random-dot display. We tested 29 amblyopic (3 strabismic, 17 anisometropic, 9 mixed) participants and 17 control participants. We obtained stereoacuity thresholds from 59% of our amblyopic participants. There was a factor of two difference between the median stereoacuity of our amblyopic (103 arcsec) and control (56 arcsec) groups. We used the equivalent noise method to evaluate the role of equivalent internal noise and processing efficiency in amblyopic stereopsis. Using the linear amplifier model (LAM), we determined the threshold difference was due to a greater equivalent internal noise in the amblyopic group (238 vs 135 arcsec), with no significant difference in processing efficiency. A multiple linear regression determined 56% of the stereoacuity variance within the amblyopic group was predicted by the two LAM parameters, with equivalent internal noise predicting 46% alone. Analysis of control group data aligned with our previous work, finding that trade-offs between equivalent internal noise and efficiency play a greater role. Our results allow a better understanding of what is limiting amblyopic performance in our task. We find this to be a reduced quality of disparity signals in the input to the task-specific processing.

Visual Crowding Reveals Field- and Axis-Specific Cortical Miswiring After Long-Term Axial Misalignment in Strabismic Patients Without Amblyopia

Purpose

Inspired by physiological and neuroimaging findings that revealed squint-induced modification of cortical volume and visual receptive field in early visual areas, we hypothesized that strabismic eyes without amblyopia manifest an increase in critical spacing of visual crowding, an essential bottleneck on object recognition and reliable psychophysical index of cortical organization.

Methods

We used real-time eye tracking to ensure gaze-contingent display and examined visual crowding in patients with horizontal concomitant strabismus (both esotropia and exotropia) but without amblyopia and age-matched normal controls.

Results

Nineteen patients with exotropia (12 men, mean ± SD = 22.89 ± 7.82 years), 21 patients with esotropia (10 men, mean ± SD = 23.48 ± 6.95 years), and 14 age-matched normal controls (7 men, mean ± SD = 23.07 ± 1.07 years) participated in this study. We found that patients with strabismus without amblyopia showed significantly larger critical spacing with nasotemporal asymmetry in only the radial axis that related to the strabismus pattern, with exotropia exhibiting stronger temporal hemifield crowding and esotropia exhibiting stronger nasal hemifield crowding, in both the deviated and fixating eyes. Moreover, the magnitude of crowding change was related to the duration and degree of strabismic deviation.

Conclusions

Using visual crowding as a psychophysical index of cortical organization, our study demonstrated significantly greater peripheral visual crowding with nasotemporal asymmetry in only the radial axis in patients with strabismus without amblyopia, indicating the existence of hemifield- and axis-specific miswiring of cortical processing in object recognition induced by long-term adaptation to ocular misalignment.

Local neuroplasticity in adult glaucomatous visual cortex

The degree to which the adult human visual cortex retains the ability to functionally adapt to damage at the level of the eye remains ill-understood. Previous studies on cortical neuroplasticity primarily focused on the consequences of foveal visual field defects (VFD), yet these findings may not generalize to peripheral defects such as occur in glaucoma. Moreover, recent findings on neuroplasticity are often based on population receptive field (pRF) mapping, but interpreting these results is complicated in the absence of appropriate control conditions. Here, we used fMRI-based neural modeling to assess putative changes in pRFs associated with glaucomatous VFD. We compared the fMRI-signals and pRF in glaucoma participants to those of controls with case-matched simulated VFD. We found that the amplitude of the fMRI-signal is reduced in glaucoma compared to control participants and correlated with disease severity. Furthermore, while coarse retinotopic structure is maintained in all participants with glaucoma, we observed local pRF shifts and enlargements in early visual areas, relative to control participants. These differences suggest that the adult brain retains some degree of local neuroplasticity. This finding has translational relevance, as it is consistent with VFD masking, which prevents glaucoma patients from noticing their VFD and seeking timely treatment.

A demonstration of cone function plasticity after gene therapy in achromatopsia

Recent advances in regenerative therapy have placed the treatment of previously incurable eye diseases within arms' reach. Achromatopsia is a severe monogenic heritable retinal disease that disrupts cone function from birth, leaving patients with complete colour blindness, low acuity, photosensitivity and nystagmus. While successful gene-replacement therapy in non-primate models of achromatopsia has raised widespread hopes for clinical treatment, it was yet to be determined if and how these therapies can induce new cone function in the human brain. Using a novel multimodal approach, we demonstrate for the first time that gene therapy can successfully activate dormant cone-mediated pathways in children with achromatopsia (CNGA3- and CNGB3-associated, 10-15 years). To test this, we combined functional MRI population receptive field mapping and psychophysics with stimuli that selectively measure cone photoreceptor signalling. We measured cortical and visual cone function before and after gene therapy in four paediatric patients, evaluating treatment-related change against benchmark data from untreated patients (n = 9) and normal-sighted participants (n = 28). After treatment, two of the four children displayed strong evidence for novel cone-mediated signals in visual cortex, with a retinotopic pattern that was not present in untreated achromatopsia and which is highly unlikely to emerge by chance. Importantly, this change was paired with a significant improvement in psychophysical measures of cone-mediated visual function. These improvements were specific to the treated eye, and provide strong evidence for successful read-out and use of new cone-mediated information. These data show for the first time that gene replacement therapy in achromatopsia within the plastic period of development can awaken dormant cone-signalling pathways after years of deprivation. This reveals unprecedented neural plasticity in the developing human nervous system and offers great promise for emerging regenerative therapies.

Crowding changes appearance systematically in peripheral, amblyopic, and developing vision

Visual crowding is the disruptive effect of clutter on object recognition. Although most prominent in adult peripheral vision, crowding also disrupts foveal vision in typically developing children and those with strabismic amblyopia. Do these crowding effects share the same mechanism? Here we exploit observations that crowded errors in peripheral vision are not random: Target objects appear either averaged with the flankers (assimilation) or replaced by them (substitution). If amblyopic and developmental crowding share the same mechanism, then their errors should be similarly systematic. We tested foveal vision in children aged 3 to 8 years with typical vision or strabismic amblyopia and peripheral vision in typical adults. The perceptual effects of crowding were measured by requiring observers to adjust a reference stimulus to match the perceived orientation of a target “Vac-Man” element. When the target was surrounded by flankers that differed by ± 30°, all three groups (adults and children with typical or amblyopic vision) reported orientations between the target and flankers (assimilation). Errors were reduced with ± 90° differences but primarily matched the flanker orientation (substitution) when they did occur. A population pooling model of crowding successfully simulated this pattern of errors in all three groups. We conclude that the perceptual effects of amblyopic and developing crowding are systematic and resemble the near periphery in adults, suggesting a common underlying mechanism.

Disruption of Positional Encoding at Small Separations in the Amblyopic Periphery

Purpose

Positional judgments in amblyopia are impaired more at the center of the visual field than in the periphery. However, the effects of visual field position frequently are confounded with stimulus separation. The purpose of this experiment was to parse the effects of stimulus separation and eccentricity on the positional deficit in amblyopia.

Methods

Subjects adjusted the positions of stimuli of varying separations on isoeccentric arcs. The task was simultaneous bisection and alignment of broadband, high-contrast, uncrowded targets with reference to central fixation. Ten strabismic amblyopes and five normally sighted controls performed the task dichoptically; a subset of amblyopes performed the task monocularly with the amblyopic eye. Spread (inverse of precision) and bias were measured at multiple visual field locations comprising two to three separation × four eccentricity conditions in each visual field quadrant.

Results

In normal controls, both spread and bias increased with eccentricity, and spread (but not bias) increased linearly with separation until 7° eccentricity. Strabismic amblyopes showed a different profile: spread and bias were higher at small separations at all eccentricities, such that performance showed a quadratic trend against separation. Thus, at each eccentricity, the difference in performance between groups was largest at the smallest separation.

Conclusions

These results are consistent with disruptions in Weber mechanisms of positional encoding in strabismic amblyopia, and indicate that binocular stimulation by proximal targets produces a loss of spatial precision well beyond the fovea.

Binocular versus standard occlusion or blurring treatment for unilateral amblyopia in children aged three to eight years

BACKGROUND

Current treatments for amblyopia, typically patching or pharmacological blurring, have limited success. Less than two-thirds of children achieve good acuity of 0.20 logMAR in the amblyopic eye, with limited improvement of stereopsis, and poor adherence to treatment. A new approach, based on presentation of movies or computer games separately to each eye, may yield better results and improve adherence. These treatments aim to balance the input of visual information from each eye to the brain.  OBJECTIVES: To determine whether binocular treatments in children, aged three to eight years, with unilateral amblyopia result in better visual outcomes than conventional patching or pharmacological blurring treatment.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), MEDLINE, Embase, ISRCTN, ClinicalTrials.gov, and the WHO ICTRP to 19 November 2020, with no language restrictions.

SELECTION CRITERIA

Two review authors independently screened the results of the search for relevant studies. We included randomised controlled trials (RCTs) that enrolled children between the ages of three and eight years old with unilateral amblyopia. Amblyopia was classed as present when the best-corrected visual acuity (BCVA) was worse than 0.200 logMAR in the amblyopic eye, with BCVA 0.200 logMAR or better in the fellow eye, in the presence of an amblyogenic risk factor, such as anisometropia, strabismus, or both. To be eligible, children needed to have undergone cycloplegic refraction and  ophthalmic examination, including fundal examination and optical treatment, if indicated, with stable BCVA in the amblyopic eye despite good adherence with wearing glasses. We included any type of binocular viewing intervention, on any device (e.g. computer monitors viewed with liquid-crystal display shutter glasses; hand-held screens, including mobile phones with lenticular prism overlay; or virtual reality displays). Control groups received standard amblyopia treatment, which could include patching or pharmacological blurring of the better-seeing eye. We included full-time (all waking hours) and part-time (between 1 and 12 hours a day) patching regimens. We excluded children who had received any treatment other than optical treatment; and studies with less than 8-week follow-up.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. The primary outcome of the review was the change from baseline of distance BCVA in the amblyopic eye after 16 (± 2) weeks of treatment, measured in logMAR units on an age-appropriate acuity test.

MAIN RESULTS

We identified one eligible RCT of conventional patching treatment versus novel binocular treatment, and analysed a subset of 68 children who fulfilled the age criterion of this review. We obtained data for the mean change in amblyopic eye visual acuity, adverse events (diplopia), and adherence to prescribed treatment at 8- and 16-week follow-up intervals, though no data were available for change in BCVA after 52 weeks. Risk of bias for the included study was considered to be low. The certainty of evidence for the visual acuity outcomes at 8 and 16 weeks of treatment and adherence to the study intervention was rated moderate using the GRADE criteria, downgrading by one level due to imprecision. The certainty of evidence was downgraded by two levels and rated low for the proportion of participants reporting adverse events due to the sample size.  Acuity improved in the amblyopic eye in both the binocular and patching groups following 16 weeks of treatment (improvement of -0.21 logMAR in the binocular group and -0.24 logMAR in the patching group, mean difference (MD) 0.03 logMAR (95% confidence interval (CI) -0.10 to 0.04; 63 children). This difference was non-significant and the improvements in both the binocular and patching groups are also considered clinically similar. Following 8 weeks of treatment, acuity improved in both the binocular and patching groups (improvement of -0.18 logMAR in the patching group compared to -0.16 logMAR improvement in the binocular-treatment group) (MD 0.02, 95% CI -0.04 to 0.08). Again this difference was statistically non-significant, and the differences observed between the patching and binocular groups are also clinically non-significant. No adverse event of permanent diplopia was reported. Adherence was higher in the patching group (47% of participants in the iPad group achieved over 75% compliance compared with 90% of the patching group).  Data were not available for changes in stereopsis nor for contrast sensitivity following treatment.

AUTHORS' CONCLUSIONS

Currently, there is only one RCT that offers evidence of the safety and effectiveness of binocular treatment. The authors are moderately confident that after 16 weeks of treatment, the gain in amblyopic eye acuity with binocular treatment is likely comparable to that of conventional patching treatment. However, due to the limited sample size and lack of long term (52 week) follow-up data, it is not yet possible to draw robust conclusions regarding the overall safety and sustained effectiveness of binocular treatment. Further research, using acknowledged methods of visual acuity and stereoacuity assessment with known reproducibility, is required to inform decisions about the implementation of binocular treatments for amblyopia in clinical practice, and should incorporate longer term follow-up to establish the effectiveness of binocular treatment. Randomised controlled trials should also include outcomes reported by users, adherence to prescribed treatment, and recurrence of amblyopia after cessation of treatment.

Loss and enhancement of layer-selective signals in geniculostriate and corticotectal pathways of adult human amblyopia

How abnormal visual experiences early in life influence human subcortical pathways is poorly understood. Using high-resolution fMRI and pathway-selective visual stimuli, we investigate the influence of amblyopia on response properties and the effective connectivity of subcortical visual pathways of the adult human brain. Compared to the normal and fellow eyes, stimuli presented to the amblyopic eye show selectively reduced response in the parvocellular layers of the lateral geniculate nucleus and weaker effective connectivity to V1. Compared to the normal eye, the response of the amblyopic eye to chromatic stimulus decreases in the superficial layers of the superior colliculus, while response of the fellow eye robustly increases in the deep SC with stronger connectivity from the visual cortex. Therefore, amblyopia leads to selective parvocellular alterations of the geniculostriate and corticotectal pathways. These findings provide the neural basis for amblyopic deficits in visual acuity, ocular motor control, and attention.

Eye movements elevate crowding in idiopathic infantile nystagmus syndrome

Idiopathic infantile nystagmus syndrome is a disorder characterised by involuntary eye movements, which leads to decreased acuity and visual function. One such function is visual crowding – a process whereby objects that are easily recognised in isolation become impaired by nearby flankers. Crowding typically occurs in the peripheral visual field, although elevations in foveal vision have been reported in congenital nystagmus, similar to those found with amblyopia. Here, we examine whether elevated foveal crowding with nystagmus is driven by similar mechanisms to those of amblyopia – long-term neural changes associated with a sensory deficit – or by the momentary displacement of the stimulus through nystagmus eye movements. A Landolt-C orientation identification task was used to measure threshold gap sizes with and without either horizontally or vertically placed Landolt-C flankers. We assume that a sensory deficit should give equivalent crowding in these two dimensions, whereas an origin in eye movements should give stronger crowding with horizontal flankers given the predominantly horizontal eye movements of nystagmus. We observe elevations in nystagmic crowding that are above crowding in typical vision but below that of amblyopia. Consistent with an origin in eye movements, elevations were stronger with horizontal than vertical flankers in nystagmus, but not in typical or amblyopic vision. We further demonstrate the same horizontal elongation in typical vision with stimulus movement that simulates nystagmus. Consequently, we propose that the origin of nystagmic crowding lies in the eye movements, either through image smear of the target and flanker elements or through relocation of the stimulus into the peripheral retina.

Spared perilesional V1 activity underlies training-induced recovery of luminance detection sensitivity in cortically-blind patients

Damage to the primary visual cortex (V1) causes homonymous visual-field loss long considered intractable. Multiple studies now show that perceptual training can restore visual functions in chronic cortically-induced blindness (CB). A popular hypothesis is that training can harness residual visual functions by recruiting intact extrageniculostriate pathways. Training may also induce plastic changes within spared regions of the damaged V1. Here, we link changes in luminance detection sensitivity with retinotopic fMRI activity before and after visual discrimination training in eleven patients with chronic, stroke-induced CB. We show that spared V1 activity representing perimetrically-blind locations prior to training predicts the amount of training-induced recovery of luminance detection sensitivity. Additionally, training results in an enlargement of population receptive fields in perilesional V1, which increases blind-field coverage and may support further recovery with subsequent training. These findings uncover fundamental changes in perilesional V1 cortex underlying training-induced restoration of conscious luminance detection sensitivity in CB.

In humans, stroke damage to V1 causes large visual field defects. Spared V1 activity prior to training predicts the amount of training-induced recovery in luminance detection sensitivity. Moreover, visual training changes population receptive field properties within residual V1 circuits.

Heritable functional architecture in human visual cortex

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We analyzed retinotopic maps from monozygotic and dizygotic twin pairs.

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Visual field maps in V1-V3 are more similar in monozygotic twins.

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Heritability is greater in V1 and V3 for polar angle and population receptive field sizes.

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Eccentricity maps show lesser degree of heritability.

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Further evidence for link between cortical morphology and topology of retinotopic maps.

How much of the functional organization of our visual system is inherited? Here we tested the heritability of retinotopic maps in human visual cortex using functional magnetic resonance imaging. We demonstrate that retinotopic organization shows a closer correspondence in monozygotic (MZ) compared to dizygotic (DZ) twin pairs, suggesting a partial genetic determination. Using population receptive field (pRF) analysis to examine the preferred spatial location and selectivity of these neuronal populations, we estimate a heritability around 10–20% for polar angle preferences and spatial selectivity, as quantified by pRF size, in extrastriate areas V2 and V3. Our findings are consistent with heritability in both the macroscopic arrangement of visual regions and stimulus tuning properties of visual cortex. This could constitute a neural substrate for variations in a range of perceptual effects, which themselves have been found to be at least partially genetically determined. These findings also add convergent evidence for the hypothesis that functional map topology is linked with cortical morphology.

Visual Neuropsychology in Development: Anatomo-Functional Brain Mechanisms of Action/Perception Binding in Health and Disease

Vision is the main entrance for environmental input to the human brain. Even if vision is our most used sensory modality, its importance is not limited to environmental exploration. Rather it has strong links to motor competences, further extending to cognitive and social aspects of human life. These multifaceted relationships are particularly important in developmental age and become dramatically evident in presence of complex deficits originating from visual aberrancies. The present review summarizes the available neuropsychological evidence on the development of visual competences, with a particular focus on the associated visuo-motor integration skills in health and disease. With the aim of supporting future research and interventional settings, the goal of the present review is to constitute a solid base to help the translation of neuropsychological hypotheses into straightforward empirical investigations and rehabilitation/training protocols. This approach will further increase the impact, ameliorate the acceptance, and ease the use and implementation of lab-derived intervention protocols in real-life situations.

The Flash-lag Effect in Amblyopia

Purpose

Amblyopes suffer a defect in temporal processing, presumably because of a neural delay in their visual processing. By measuring flash-lag effect (FLE), we investigate whether the amblyopic visual system could compensate for the intrinsic neural delay due to visual information transmissions from the retina to the cortex.

Methods

Eleven adults with amblyopia and 11 controls with normal vision participated in this study. We assessed the monocular FLE magnitude for each subject by using a typical FLE paradigm: a bar moved horizontally, while a flashed bar briefly appeared above or below it. Three luminance contrasts of the flashed bar were tested: 0.2, 0.6, and 1.

Results

All participants, controls and those with amblyopia, showed a typical FLE. However, the FLE magnitude of participants with amblyopia was significantly shorter than that of the control participants, for both their amblyopic eye (AE) and fellow eye (FE). A nonsignificant difference was found in FLE magnitude between the AE and the FE.

Conclusions

We demonstrate a reduced FLE both in the AE as well as the FE of patients with amblyopia, suggesting a global visual processing deficit. We suggest it may be attributed to a more limited spatiotemporal extent of facilitatory anticipatory activity within the amblyopic primary visual cortex.

Amblyopia

Amblyopia is a neurodevelopmental abnormality that results in physiological alterations in the visual pathways and impaired vision in one eye, less commonly in both. It reflects a broad range of neural, perceptual, oculomotor, and clinical abnormalities that can occur when normal visual development is disrupted early in life. Aside from refractive error, amblyopia is the most common cause of vision loss in infants and young children. It causes a constellation of perceptual deficits in the vision of the amblyopic eye, including a loss of visual acuity, position acuity, and contrast sensitivity, particularly at high spatial frequencies, as well as increased internal noise and prolonged manual and saccadic reaction times. There are also perceptual deficits in the strong eye, such as certain types of motion perception, reflecting altered neural responses and functional connectivity in visual cortex (Ho et al., 2005). Treatment in young children consists of correction of any refractive error and patching of the strong eye. Compliance with patching is challenging and a substantial proportion of amblyopic children fail to achieve normal acuity or stereopsis even after extended periods of treatment. There are a number of promising experimental treatments that may improve compliance and outcomes, such as the playing of action video games with the strong eye patched. Although there may be a sensitive period for optimal effects of treatment, there is evidence that amblyopic adults may still show some benefit of treatment. However, there is as yet no consensus on the treatment of adults with amblyopia.

The relationship between retinal cone density and cortical magnification in human albinism

The human fovea lies at the center of the retina and supports high-acuity vision. In normal visual system development, the highest acuity is correlated with both a high density of cone photoreceptors in the fovea and a magnified retinotopic representation of the fovea in the visual cortex. Both cone density and the cortical area dedicated to each degree of visual space—the latter describing cortical magnification (CM)—steadily decrease with increasing eccentricity from the fovea. In albinism, peak cone density at the fovea and visual acuity are decreased, but seem to be within normal limits in the periphery, thus providing a model to explore the correlation between retinal structure, cortical structure, and behavior. Here, we used adaptive optics scanning light ophthalmoscopy to assess retinal cone density and functional magnetic resonance imaging to measure CM in the primary visual cortex of normal controls and individuals with albinism. We find that retinotopic organization is more varied among individuals with albinism than previously appreciated. Additionally, CM outside the fovea is similar to that in controls, but also more variable. CM in albinism and controls exceeds that which might be predicted based on cone density alone, but is more accurately predicted by retinal ganglion cell density. This finding suggests that decreased foveal cone density in albinism may be partially counteracted by nonuniform connectivity between cones and their downstream signaling partners. Together, these results emphasize that central as well as retinal factors must be included to provide a complete picture of aberrant structure and function in albinism.

Impact of Amblyopia on the Central Nervous System

Amblyopia is a common perceptual disorder resulting from abnormal visual input during development. The clinical presentation and visual deficits associated with amblyopia are well characterized. Less is known however, about amblyopia's impact on the central nervous system (CNS). While early insights into the neuropathophysiology of amblyopia have been based on findings from animal models and postmortem human studies, recent advances in noninvasive magnetic resonance imaging (MRI) techniques have enabled the study of amblyopia's effects in vivo. We review recent retinal and neuroimaging research documenting amblyopia's structural and functional impact on the CNS. Clinical imaging provides some evidence for retinal and optic nerve abnormalities in amblyopic eyes, although the overall picture remains inconclusive. Neuroimaging studies report clearer changes in both structure and function of the visual pathways. In the optic nerves, optic tracts, and optic radiations of individuals with amblyopia, white-matter integrity is decreased. In the lateral geniculate nuclei, gray matter volume is decreased and neural activity is reduced. Reduced responses are also seen in the amblyopic primary visual cortex and extrastriate areas. Overall, amblyopia impacts structure and function at multiple sites along the visual processing hierarchy. Moreover, there is some evidence that amblyopia's impact on the CNS depends on its etiology, with different patterns of results for strabismic and anisometropic amblyopia. To clarify the impact of amblyopia on the CNS, simultaneous collection of retinal, neural, and perceptual measures should be employed. Such an approach will help (1) distinguish cause and effect of amblyopic impairments, (2) separate the impact of amblyopia from other superimposed conditions, and (3) identify the importance of amblyopic etiology to specific neural and perceptual deficits.

Rethinking amblyopia 2020

Recent work has transformed our ideas about the neural mechanisms, behavioral consequences and effective therapies for amblyopia. Since the 1700's, the clinical treatment for amblyopia has consisted of patching or penalizing the strong eye, to force the "lazy" amblyopic eye, to work. This treatment has generally been limited to infants and young children during a sensitive period of development. Over the last 20 years we have learned much about the nature and neural mechanisms underlying the loss of spatial and binocular vision in amblyopia, and that a degree of neural plasticity persists well beyond the sensitive period. Importantly, the last decade has seen a resurgence of research into new approaches to the treatment of amblyopia both in children and adults, which emphasize that monocular therapies may not be the most effective for the fundamentally binocular disorder that is amblyopia. These approaches include perceptual learning, video game play and binocular methods aimed at reducing inhibition of the amblyopic eye by the strong fellow eye, and enhancing binocular fusion and stereopsis. This review focuses on the what we've learned over the past 20 years or so, and will highlight both the successes of these new treatment approaches in labs around the world, and their failures in clinical trials. Reconciling these results raises important new questions that may help to focus future directions.

Influence of prior and visual information on eye movements in amblyopic children

This study analyzed the characteristics of pursuit and assessed the influence of prior and visual information on eye velocity and saccades in amblyopic and control children, in comparison to adults. Eye movements of 41 children (21 amblyopes and 20 controls) were compared to eye movements of 55 adults (18 amblyopes and 37 controls). Participants were asked to pursue a target moving at a constant velocity. The target was either a 'standard' target, with a uniform color intensity, or a 'noisy' target, with blurry edges, to mimic the blurriness of an amblyopic eye. Analysis of pursuit patterns showed that the onset was delayed, and the gain was decreased in control children with a noisy target in comparison to amblyopic or control children with a standard target. Furthermore, a significant effect of prior and visual information on pursuit velocity and saccades was found across all participants. Moreover, the modulation of the effect of visual information on the pursuit velocity by group, that is amblyopes or controls with a standard target, and controls with a noisy target, was more limited in children. In other words, the effect of visual information was higher in control adults with a standard target compared to control children with the same target. However, in the case of a blurry target, either in control participants with a noisy target or in amblyopic participants with a standard target, the effect of visual information was larger in children.

Triple visual hemifield maps in a case of optic chiasm hypoplasia

In humans, each hemisphere comprises an overlay of two visuotopic maps of the contralateral visual field, one from each eye. Is the capacity of the visual cortex limited to these two maps or are plastic mechanisms available to host more maps? We determined the cortical organization of the visual field maps in a rare individual with chiasma hypoplasia, where visual cortex plasticity is challenged to accommodate three hemifield maps. Using high-resolution fMRI at 7T and diffusion-weighted MRI at 3T, we found three hemiretinal inputs, instead of the normal two, to converge onto the left hemisphere. fMRI-based population receptive field mapping of the left V1-V3 at 3T revealed three superimposed hemifield representations in the left visual cortex, i.e. two representations of opposing visual hemifields from the left eye and one right hemifield representation from the right eye. We conclude that developmental plasticity including the re-wiring of local intra- and cortico-cortical connections is pivotal to support the coexistence and functioning of three hemifield maps within one hemisphere.

Studying Cortical Plasticity in Ophthalmic and Neurological Disorders: From Stimulus-Driven to Cortical Circuitry Modeling Approaches

Unsolved questions in computational visual neuroscience research are whether and how neurons and their connecting cortical networks can adapt when normal vision is compromised by a neurodevelopmental disorder or damage to the visual system. This question on neuroplasticity is particularly relevant in the context of rehabilitation therapies that attempt to overcome limitations or damage, through either perceptual training or retinal and cortical implants. Studies on cortical neuroplasticity have generally made the assumption that neuronal population properties and the resulting visual field maps are stable in healthy observers. Consequently, differences in the estimates of these properties between patients and healthy observers have been taken as a straightforward indication for neuroplasticity. However, recent studies imply that the modeled neuronal properties and the cortical visual maps vary substantially within healthy participants, e.g., in response to specific stimuli or under the influence of cognitive factors such as attention. Although notable advances have been made to improve the reliability of stimulus-driven approaches, the reliance on the visual input remains a challenge for the interpretability of the obtained results. Therefore, we argue that there is an important role in the study of cortical neuroplasticity for approaches that assess intracortical signal processing and circuitry models that can link visual cortex anatomy, function, and dynamics.

Topographical profiles of macula and optic nerve head in concomitant strabismus patients as measured using OCT and CSLO

PURPOSE

Investigate morphological changes of macula and optic nerve head (ONH) in concomitant strabismic patients using optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy (CSLO).

METHODS

A cross-sectional study conducted from April 2017 to February 2018 at the Zhongshan Ophthalmic Center, Sun Yat-sen University. Spectral-domain (SD)-OCT and CSLO were used to observe morphological changes of macula and ONH in concomitant strabismic patients with normal vision and healthy controls. In each subject, a 6-mm diameter zone centered at the fovea was scanned and topographical images of the ONH and peripapillary retina were generated. Fundus parameters were recorded and analyzed.

RESULTS

A total of 138 cases, including 29 patients with concomitant esotropia (ET), 38 constant exotropia (XT), 42 intermittent exotropia (IXT), and 29 healthy controls, were recruited. Compared with controls, OCT revealed that the thickness of nasal intraretinal layers (IRLs) in ET patients was significantly increased, particularly in ganglion cell layer (GCL) and inner nuclear layer (INL). In XT patients, the temporal half of outer retinal layers (ORLs) showed significant increases in thickness. CSLO findings revealed significant changes in the ONH of ET patients consisting of a thinner retinal nerve fiber layer (RNFL) and a decreased RNFL cross-sectional area, height variation contour, maximum contour depression, and contour line modulation (CLM) temporal-superior area. The nasal-superior cup area and rim volume in XT patients were significantly increased.

CONCLUSION

Topographical profiles of the macula and ONH in concomitant strabismic patients with normal vision present with specific regularities.

Comparison of human population receptive field estimates between scanners and the effect of temporal filtering

Background: Population receptive field (pRF) analysis with functional magnetic resonance imaging (fMRI) is an increasingly popular method for mapping visual field representations and estimating the spatial selectivity of voxels in human visual cortex. However, the multitude of experimental setups and processing methods used makes comparisons of results between studies difficult. Methods: Here, we compared pRF maps acquired in the same three individuals using comparable scanning parameters on a 1.5 and a 3 Tesla scanner located in two different countries. We also tested the effect of low-pass filtering of the time series on pRF estimates. Results: As expected, the signal-to-noise ratio for the 3 Tesla data was superior; critically, however, estimates of pRF size and cortical magnification did not reveal any systematic differences between the sites. Unsurprisingly, low-pass filtering enhanced goodness-of-fit, presumably by removing high-frequency noise. However, there was no substantial increase in the number of voxels containing meaningful retinotopic signals after low-pass filtering. Importantly, filtering also increased estimates of pRF size in the early visual areas which could substantially skew interpretations of spatial tuning properties. Conclusion: Our results therefore suggest that pRF estimates are generally comparable between scanners of different field strengths, but temporal filtering should be used with caution.

Comparison of human population receptive field estimates between scanners and the effect of temporal filtering

Background: Population receptive field (pRF) analysis with functional magnetic resonance imaging (fMRI) is an increasingly popular method for mapping visual field representations and estimating the spatial selectivity of voxels in human visual cortex. However, the multitude of experimental setups and processing methods used makes comparisons of results between studies difficult. Methods: Here, we compared pRF maps acquired in the same three individuals using comparable scanning parameters on a 1.5 and a 3 Tesla scanner located in two different countries. We also tested the effect of low-pass filtering of the time series on pRF estimates. Results: As expected, the signal-to-noise ratio for the 3 Tesla data was superior; critically, however, estimates of pRF size and cortical magnification did not reveal any systematic differences between the sites. Unsurprisingly, low-pass filtering enhanced goodness-of-fit, presumably by removing high-frequency noise. However, there was no substantial increase in the number of voxels containing meaningful retinotopic signals after low-pass filtering. Importantly, filtering also increased estimates of pRF size in the early visual areas which could substantially skew interpretations of spatial tuning properties. Conclusion: Our results therefore suggest that pRF estimates are generally comparable between scanners of different field strengths, but temporal filtering should be used with caution.

Altered Spontaneous Brain Activity of Children with Unilateral Amblyopia: A Resting State fMRI Study

Objective

This study is aimed at investigating differences in local brain activity and functional connectivity (FC) between children with unilateral amblyopia and healthy controls (HCs) by using resting state functional magnetic resonance imaging (rs-fMRI).

Methods

Local activity and FC analysis methods were used to explore the altered spontaneous brain activity of children with unilateral amblyopia. Local brain function analysis methods included the amplitude of low-frequency fluctuation (ALFF). FC analysis methods consisted of the FC between the primary visual cortex (PVC-FC) and other brain regions and the FC network between regions of interest (ROIs-FC) selected by independent component analysis.

Results

The ALFF in the bilateral frontal, temporal, and occipital lobes in the amblyopia group was lower than that in the HCs. The weakened PVC-FC was mainly concentrated in the frontal lobe and the angular gyrus. The ROIs-FC between the default mode network, salience network, and primary visual cortex network (PVCN) were significantly reduced, whereas the ROIs-FC between the PVCN and the high-level visual cortex network were significantly increased in amblyopia.

Conclusions

Unilateral amblyopia may reduce local brain activity and FC in the dorsal and ventral visual pathways and affect the top-down attentional control. Amblyopia may also alter FC between brain functional networks. These findings may help understand the pathological mechanisms of children with amblyopia.

Integration of past and current visual information during eye movements in amblyopia

Combination of signals based on their reliability is an increasingly popular model for sensorimotor processing. However, how reliability is estimated, or how such estimation is affected by prolonged exposure to noisy inputs, is still unknown. In this study, we compare patients with unilateral functional amblyopia with control subjects tracking either a reliable target, or a blurry, unreliable target, in a task of repeated, sustained smooth pursuit. We provide evidence for a lower weight of visual information during smooth pursuit in amblyopic and control subjects tracking a blurry target, with no significant difference of prior information weight. In contrast, we found no evidence of lower visual information weight in the catch-up saccades of amblyopic subjects. We conclude that oculomotor performance in unilateral amblyopia mostly lays within the continuum between our control groups, without significant differences in the relative weights of prior and visual information. However, smooth pursuit exhibits additional deficits that might result from abnormal visual development.

Amblyopia Affects the ON Visual Pathway More than the OFF

Visual information reaches the cerebral cortex through parallel ON and OFF pathways that signal the presence of light and dark stimuli in visual scenes. We have previously demonstrated that optical blur reduces visual salience more for light than dark stimuli because it removes the high spatial frequencies from the stimulus, and low spatial frequencies drive weaker ON than OFF cortical responses. Therefore, we hypothesized that sustained optical blur during brain development should weaken ON cortical pathways more than OFF, increasing the dominance of darks in visual perception. Here we provide support for this hypothesis in humans with anisometropic amblyopia who suffered sustained optical blur early after birth in one of the eyes. In addition, we show that the dark dominance in visual perception also increases in strabismic amblyopes that have their vision to high spatial frequencies reduced by mechanisms not associated with optical blur. Together, we show that amblyopia increases visual dark dominance by 3-10 times and that the increase in dark dominance is strongly correlated with amblyopia severity. These results can be replicated with a computational model that uses greater luminance/response saturation in ON than OFF pathways and, as a consequence, reduces more ON than OFF cortical responses to stimuli with low spatial frequencies. We conclude that amblyopia affects the ON cortical pathway more than the OFF, a finding that could have implications for future amblyopia treatments.SIGNIFICANCE STATEMENT Amblyopia is a loss of vision that affects 2-5% of children across the world and originates from a deficit in visual cortical circuitry. Current models assume that amblyopia affects similarly ON and OFF visual pathways, which signal light and dark features in visual scenes. Against this current belief, here we demonstrate that amblyopia affects the ON visual pathway more than the OFF, a finding that could have implications for new amblyopia treatments targeted at strengthening a weak ON visual pathway.

Population receptive field tuning properties of visual cortex during childhood

Visuospatial abilities such as contrast sensitivity and Vernier acuity improve until late in childhood, but the neural mechanisms supporting these changes are poorly understood. We tested to which extent this development might reflect improved spatial sensitivity of neuronal populations in visual cortex. To do this, we measured BOLD-responses in areas V1-V4 and V3a, whilst 6- to 12-year-old children and adults watched large-field wedge and ring stimuli in the MRI scanner, and then fitted population receptive field (pRF) tuning functions to these data (Dumoulin and Wandell, 2008). Cortical magnification and pRF tuning width changed with eccentricity at all ages, as expected. However, there were no significant age differences in pRF size, shape, cortical magnification, or map consistency in any visual region. These findings thus strongly suggest that spatial vision in late childhood is not substantially limited by the spatial tuning of neuronal populations in early visual cortex. Instead, improvements in performance may reflect more efficient read-out of spatial information in early visual regions by higher-level processing stages, or prolonged tuning to more complex visual properties such as orientation. Importantly, this in-depth characterisation of the pRF tuning profiles across childhood, paves the way for in-vivo-testing of atypical visual cortex development and plasticity.

How Ocular Dominance and Binocularity Are Reflected by the Population Receptive Field Properties

Purpose

The neural substrate of binocularity and sighting ocular dominance in humans is not clear. By utilizing the population receptive field (pRF) modeling technique, we explored whether these phenomena are associated with amplitude and pRF size differences.

Methods

The visual field maps of 13 subjects were scanned (3-T Skyra) while viewing drifting bar stimuli. Both eyes (binocular condition), the dominant eye and the nondominant eye (two monocular conditions) were stimulated in separate sessions. For each condition, pRF size and amplitude were assessed. Binocular summation ratios were calculated by dividing binocular by mean monocular values (amplitude and pRF size).

Results

No differences in pRF size were seen between the viewing conditions within each region, that is, either between binocular and monocular or between dominant and nondominant viewing conditions. Binocular amplitudes were higher than the monocular amplitudes, but similar among the dominant and nondominant eyes. Binocular summation ratios derived from amplitudes were significantly higher than one (∼1.2), while those ratios derived from pRF size were not. These effects were found in all studied areas along the visual hierarchy, starting in V1.

Conclusions

Neither the amplitude nor the pRF size show intereye difference and therefore cannot explain the different roles of the dominant and the nondominant eyes. Binocular, as compared to monocular vision, resulted in higher amplitudes, while receptive fields' sizes were similar, suggesting increased binocular response intensity as the basis for the binocular summation phenomenon. Our results could be applicable in imaging studies of monocular disease and studies that deal with nondisparity binocularity effects.

How Visual Cortical Organization Is Altered by Ophthalmologic and Neurologic Disorders

Receptive fields are a core property of cortical organization. Modern neuroimaging allows routine access to visual population receptive fields (pRFs), enabling investigations of clinical disorders. Yet how the underlying neural circuitry operates is controversial. The controversy surrounds observations that measurements of pRFs can change in healthy adults as well as in patients with a range of ophthalmological and neurological disorders. The debate relates to the balance between plasticity and stability of the underlying neural circuitry. We propose that to move the debate forward, the field needs to define the implied mechanism. First, we review the pRF changes in both healthy subjects and those with clinical disorders. Then, we propose a computational model that describes how pRFs can change in healthy humans. We assert that we can correctly interpret the pRF changes in clinical disorders only if we establish the capabilities and limitations of pRF dynamics in healthy humans with mechanistic models that provide quantitative predictions.

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.

Cortical correlates of amblyopia

There are many levels of disorder in amblyopic vision, from basic acuity and contrast sensitivity loss to abnormal binocular vision and global perception of motion and form. Amblyopia treatment via patching to restore acuity often leaves other aspects of vision deficient. The source for these additional deficits is unclear. Neural correlates of poor binocular function and acuity loss are found in V1 and V2. However, they are generally not sufficient to account for behaviorally measured vision loss. This review summarizes the known cortical correlates of visual deficits found in association with amblyopia, particularly those relevant to binocular vision and higher-order visual processing, in striate and extrastriate cortex. Recommendations for future research address open questions on the role of suppression and oculomotor abnormalities in amblyopic vision, and underexplored mechanisms such as top-down influences on information transmission in the amblyopic brain.

Spatial summation across the visual field in strabismic and anisometropic amblyopia

Ricco's area (the largest area of visual space in which stimulus area and intensity are inversely proportional at threshold) has previously been hypothesised to be a result of centre/surround antagonism in retinal ganglion cell receptive fields, but recent evidence suggests a sizeable cortical contribution. Here, Ricco's area was measured in amblyopia, a condition in which retinal receptive fields are normal, to better understand its physiological basis. Spatial summation functions were determined at 12 visual field locations in both eyes of 14 amblyopic adults and 15 normal-sighted controls. Ricco's area was significantly larger in amblyopic eyes than in fellow non-amblyopic eyes. Compared to the size of Ricco's area in control eyes, Ricco's area measured significantly larger in amblyopic eyes. Additionally, Ricco's area in the fellow, non-amblyopic eye of amblyopic participants measured significantly smaller than in control eyes. Compared to controls, Ricco's area was larger in amblyopic eyes and smaller in fellow non-amblyopic eyes. Amblyopia type, binocularity, and inter-ocular difference in visual acuity were significantly associated with inter-ocular differences in Ricco's area in amblyopes. The physiological basis for Ricco's area is unlikely to be confined to the retina, but more likely representative of spatial summation at multiple sites along the visual pathway.

Partial correlation analysis reveals abnormal retinotopically organized functional connectivity of visual areas in amblyopia

Amblyopia is a prevalent developmental visual disorder of childhood that typically persists in adults. Due to altered visual experience during critical periods of youth, the structure and function of adult visual cortex is abnormal. In addition to substantial deficits shown with task-based fMRI, previous studies have used resting state measures to demonstrate altered long-range connectivity in amblyopia. This is the first study in amblyopia to analyze connectivity between regions of interest that are smaller than a single cortical area and to apply partial correlation analysis to reduce network effects. We specifically assess short-range connectivity between retinotopically defined regions of interest within the occipital lobe of 8 subjects with amblyopia and 7 subjects with normal vision (aged 19–45). The representations of visual areas V1, V2, and V3 within each of the four quadrants of visual space were further subdivided into three regions based on maps of visual field eccentricity. Connectivity between pairs of all nine regions of interest in each quadrant was tested via correlation and partial correlation for both groups. Only the tests of partial correlation, i.e., correlation between time courses of two regions following the regression of time courses from all other regions, yielded significant differences between resting state functional connectivity in amblyopic and normal subjects. Subjects with amblyopia showed significantly higher partial correlation between para-foveal and more eccentric representations within V1, and this effect associated with poor acuity of the worse eye. In addition, we observed reduced correlation in amblyopic subjects between isoeccentricity regions in V1 and V2, and separately, between such regions in V2 and V3. We conclude that partial correlation-based connectivity is altered in an eccentricity-dependent pattern in visual field maps of amblyopic patients. Moreover, results are consistent with known clinical and psychophysical vision loss. More broadly, this provides evidence that abnormal cortical adaptations to disease may be better isolated with tests of partial correlation connectivity than with the regular correlation techniques that are currently widely used.

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Cortical functional connectivity abnormalities exist in amblyopia at a scale finer than previously reported.

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Connectivity changes within primary visual cortex are consistent with known loss of function.

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Connectivity changes between visual areas are consistent with concept of deafferentation.

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Partial correlation differentiates patients from controls, whereas correlation does not.

Reduced response cluster size in early visual areas explains the acuity deficit in amblyopia

Focal visual stimulation typically results in the activation of a large portion of the early visual cortex. This spread of activity is attributed to long-range lateral interactions. Such long-range interactions may serve to stabilize a visual representation or to simply modulate incoming signals, and any associated dysfunction in long-range activation may reduce sensitivity to visual information in conditions such as amblyopia. We sought to measure the dispersion of cortical activity following local visual stimulation in a group of patients with amblyopia and matched normal. Twenty adult anisometropic amblyopes and 10 normal controls participated in this study. Using a multifocal stimulation, we simultaneously measured cluster sizes to multiple stimulation points in the visual field. We found that the functional MRI (fMRI) response cluster size that corresponded to the fellow eye was significantly larger as opposed to that corresponding to the amblyopic eye and that the fMRI response cluster size at the two more central retinotopic locations correlated with amblyopia acuity deficit. Our results suggest that the amblyopic visual cortex has a diminished long-range communication as evidenced by significantly smaller cluster of activity as measured with fMRI. These results have important implications for models of amblyopia and approaches to treatment.

Two cortical deficits underlie amblyopia: A multifocal fMRI analysis

Amblyopia is a relatively common (incidence 3%) developmental disorder in which there is loss of vision as a consequence of a disruption to normal visual development. Although the deficit is monocular and known to be of cortical origin, the nature of the processing deficit is controversial. Human behavioral studies have identified two main deficits - a loss of contrast sensitivity and perceived spatial distortions. Here we use a multifocal fMRI approach to ascertain, in a group of anisometropic amblyopes, whether these two deficits have a single common cause or whether they are the result of two underlying independent cortical disorders. We found that fMRI magnitudes were attenuated in amblyopic eye stimulation, and that there was poor fidelity for co-localization of the activity clusters between the amblyopic and fellow-fixing eye stimulation. These effects varied across eccentricities and correlate with the degree of amblyopia but not with one another, suggesting two independent cortical deficits: a reduced responsiveness as well as reduced fidelity of spatial representation. These deficits are independent of eccentricity within the central field and consistent across early cortical visual areas.

Latent binocular function in amblyopia

Recently, psychophysical studies have shown that humans with amblyopia do have binocular function that is not normally revealed due to dominant suppressive interactions under normal viewing conditions. Here we use magnetoencephalography (MEG) combined with dichoptic visual stimulation to investigate the underlying binocular function in humans with amblyopia for stimuli that, because of their temporal properties, would be expected to bypass suppressive effects and to reveal any underlying binocular function. We recorded contrast response functions in visual cortical area V1 of amblyopes and normal observers using a steady state visually evoked responses (SSVER) protocol. We used stimuli that were frequency-tagged at 4Hz and 6Hz that allowed identification of the responses from each eye and were of a sufficiently high temporal frequency (>3Hz) to bypass suppression. To characterize binocular function, we compared dichoptic masking between the two eyes in normal and amblyopic participants as well as interocular phase differences in the two groups. We observed that the primary visual cortex responds less to the stimulation of the amblyopic eye compared to the fellow eye. The pattern of interaction in the amblyopic visual system however was not significantly different between the amblyopic and fellow eyes. However, the amblyopic suppressive interactions were lower than those observed in the binocular system of our normal observers. Furthermore, we identified an interocular processing delay of approximately 20ms in our amblyopic group. To conclude, when suppression is greatly reduced, such as the case with our stimulation above 3Hz, the amblyopic visual system exhibits a lack of binocular interactions.

Short-term monocular occlusion produces changes in ocular dominance by a reciprocal modulation of interocular inhibition

Ocular dominance can be modulated by short-term monocular deprivation. This changes the contribution that each eye makes to binocular vision, an example of adult cortical neuroplasticity. Optical imaging in primates and psychophysics in humans suggest these neuroplastic changes occur in V1. Here we use brain imaging (MEG) in normal adults to better understand the nature of these neuroplastic changes. The results suggest that short-term monocular deprivation, whether it be by an opaque or translucent patch, modulates dichoptic inhibitory interactions in a reciprocal fashion; the unpatched eye is inhibited, the patched eye is released from inhibition. These observations locate the neuroplastic changes to a level of visual processing where there are interocular inhibitory interactions prior to binocular combination and help to explain why both binocular rivalry and fusional tasks reveal them.

The Necessity of Amblyopia

A general property of nervous system development is that correlated activity is used to organize topographic projections. This correlated activity is typically produced by electrical coupling of adjacent neurons; however, electrical coupling is not possible for retinal ganglion cells in separate eyes that need to be precisely mapped to the same place in the brain. This forces the visual system to rely on environmental stimuli to produce the correlated activity that drives the development of binocularity, with amblyopia as necessary consequence when visual experience is abnormal. The characteristic visual deficits in both the amblyopic and the sound eyes can be understood in the context of these normal developmental processes. The auditory system provides another example-where precise connections between paired sense organs must rely on environmental stimuli for normal development-in which the analogous condition of amblyaudia occurs.