Just how useless is an amblyopic eye?

Abstract

Purpose: The extent to which individuals with amblyopia are visually disadvantaged has generated renewed research interest. Investigation of the contribution of the amblyopic eye to visual performance under habitual conditions is a key component of this issue. This study aims to evaluate the contribution of each eye to a simple light detection task when both eyes are open and in their habitual motor position.Methods: A custom program on the Humphrey Field Analyzer (Carl Zeiss Meditec Inc., Dublin, CA, USA) was used to measure detection thresholds for a blue light on a yellow background along the horizontal meridian at two degree intervals to an eccentricity of 25 degrees either side of fixation. Three viewing conditions were used: (1) both eyes open, (2) a yellow filter in front of the amblyopic eye and (3) a yellow filter in front of the fellow eye. The purpose of the yellow filter was to produce minimal dissociation as it only prevented the eye behind the filter from seeing the blue stimulus; the fixation mark and the background remained visible to both eyes. Participants included 10 visual normals and 16 volunteers with amblyopia.Results: Within the sample of amblyopes there were three basic patterns of results, and each applied to around one third of the group: (1) habitual sensitivity governed by the sensitivity of the fellow eye at each stimulus location, (2) habitual sensitivity exceeding the sensitivities of either eye at each stimulus location and (3) a pattern of contribution that varied across the range of eccentricities. Surprisingly, in one amblyope the habitual sensitivity appeared to be governed by the sensitivity of the amblyopic eye. The pattern of contribution of each eye to the habitual sensitivity did not vary in a manner that was predictable by the visual acuity deficit or the presumed aetiology of the amblyopia. The control sample showed either pattern 2 (70%) or pattern 3 (30%).Conclusions: The amblyopic eye did not contribute to the habitual performance in approximately one‐third of cases in this simple detection task. Thus, in many cases the amblyopic eye may be a useful contributor to visual performance in the binocular field. This challenges the traditional view that an amblyopic eye is useful only for peripheral vision.