Binocular Phase Combination Paradigm Research Articles

Sensory eye dominance following surgically correction for acute acquired concomitant esotropia of adulthood.

Acute acquired concomitant esotropia (AACE) is an unusual presentation characterized by acute onset of esotropia after infancy. For patients with AACE of adulthood, the outcome of surgery, which is a common treatment, often shows successful recovery of stereopsis. However, whether surgically corrected patients with AACE of adulthood achieved balanced eyes is yet unclear. Here, we used a binocular phase combination paradigm to quantitatively assess the ocular dominance of 22 surgically aligned patients with AACE of adulthood, which all had regained normal stereopsis after the surgery and 14 adult controls with normal vision. The sensory eye dominance was quantified as the interocular contrast ratio, termed balance point, at which each eye contributed equally to the perception of cyclopean grating. We found that, normal controls had a mean balance point value close to unity (0.96 ± 0.01), whereas adult AACE patients exhibited apparent interocular imbalance (0.76 ± 0.04), which was significantly different from control group (Mann-Whitney U = 135, P < 0.001, two tailed). In addition, the balance point of adults with AACE didn't correlate with the interval between onset of esotropia and the surgery (r = - 0.262, p = 0.239), or the length of postoperative follow-up period (r = 0.127, p = 0.575). Our results suggest that, for patients with AACE of adulthood whose eyes had been straightened, there is still residual sensory imbalance which may be a potential risk factor for AACE of adulthood.

Can Short-Term Ocular Dominance Plasticity Provide a General Index to Visual Plasticity to Personalize Treatment in Amblyopia?

PurposeRecently, Lunghi et al. (2016) showed that amblyopic eye’s visual acuity per se after 2 months of occlusion therapy could be predicted by a homeostatic plasticity, that is, the temporary shift of perceptual eye dominance observed after a 2-h monocular deprivation, in children with anisometropic amblyopia. In this study, we assess whether the visual acuity improvement of the amblyopic eye measured after 2 months of occlusion therapy could be predicted by this plasticity.MethodsSeven children (6.86 ± 1.46 years old; SD) with anisometropic amblyopia participated in this study. All patients were newly diagnosed and had no treatment history before participating in our study. They finished 2 months of refractive adaptation and then received a 4-h daily fellow eye patching therapy with an opaque patch for a 2-month period. Best-corrected visual acuity of the amblyopic eye was measured before and after the patching therapy. The homeostatic plasticity was assessed by measuring the temporary shift of perceptual eye dominance from 2-h occlusion of the amblyopic eye before treatment. A binocular phase combination paradigm was used for this study.ResultsWe found that there was no significant correlation between the temporary shift of perceptual eye dominance observed after 2-h occlusion of the amblyopic eye and the improvement in visual acuity in the amblyopic eye from 2 months of classical patching therapy. This result, although in disagreements with the conclusions of Lunghi et al. involving the short-term patching of the amblyopic eye, is in fact consistent with a reanalysis of Lunghi and colleagues’ data.ConclusionThe short-term changes in perceptual eye dominance as a result of short-term monocular deprivation do not provide an index of cortical plasticity in the general sense such that they are able to predict acuity outcomes from longer-term classical patching.

The Binocular Balance at High Spatial Frequencies as Revealed by the Binocular Orientation Combination Task.

How to precisely quantify the binocular eye balance (i.e., the contribution that each eye makes to the binocular percept) across a range of spatial frequencies using a binocular combination task, is an important issue in both clinical and basic research. In this study, we aimed to compare the precision of a binocular orientation combination paradigm with that of the standard binocular phase combination paradigm in measuring the binocular eye balance at low to high spatial frequencies. Nine normal adults (average age: 24.6 ± 2.0 years old) participated. Subjects viewed an LED screen dichoptically with polarized glasses in a dark room. The method of constant stimuli was used to quantitatively assess the point of subjective equality (PSE), i.e., the interocular contrast ratio when two eyes are balanced in binocular combination, for stimulus spatial frequencies from 0.5 to 8 cycles/degree. Precision was quantified by the variance [i.e., standard error (SE), obtained from 100 bootstrap estimates] associated to the PSE. Using stimuli whose interocular phase difference at the edge of the gratings was matched at 45°, we found that the orientation paradigm provides more precision than the standard binocular phase combination paradigm, especially at high frequencies (Experiment 1). Such differences remained when using stimuli that had three times larger interocular phase difference (Experiment 2) or displayed at four times higher stimuli resolution (Experiment 3). Our results indicate that a binocular combination tasked based on orientation rather than phase, provides a more precise estimate of binocular eye balance in human adults at high spatial frequencies, thus allowing a binocular balance to be assessed within the spatial region where amblyopes are most defective (i.e., high spatial frequencies).

Binocular benefits of optical treatment in anisometropic amblyopia.

In this study, we investigated the effect of optical treatment on sensory eye balance in anisometropic amblyopia. Fourteen individuals (age: 13.7 ± 8.4 years old) with previously untreated anisometropic amblyopia were enrolled in the study. The average magnitude of their anisometropia (spherical equivalent) was 4.02 ± 1.19 DS. Their best corrected monocular visual acuity and sensory eye balance were measured before and after a 2-month period of full refractive correction (i.e., our optical treatment). Spectacle-corrected distance visual acuity (at 5 m) was measured monocularly using the Tumbling E Chart. Sensory eye balance was quantitatively assessed using a binocular phase-combination paradigm to determine the interocular contrast ratio at which the two eyes were balanced in binocular sensory combination (i.e., the balance point). We found that both interocular contrast ratio at the balance point (p = 0.006) and visual acuity of the amblyopic eye (p < 0.001) were significantly improved after 2 months of optical treatment, often referred to as refractive adaptation. We conclude that sustained optical treatment improves interocular sensory balance in anisometropic amblyopia as well as monocular acuity. Optical treatment is a passive form of binocular therapy and a necessary first step in treating the binocular dysfunction that characterizes amblyopia.

7.2: Invited Paper: Quantification and Modulation of Stereopsis in Humans

Binocular vision in general and stereopsis in particular are fundamental to human vision and visual actions. It is widely thought that about 5% of the population have a lazy eye and lack stereo vision, so it is often supposed that most of the population (95%) have good stereo abilities. We show that this is not the case; 68% have good to excellent stereo (the haves) and 32% have moderate to poor stereo (the have‐nots). Why so many people lack good 3‐D stereo vision is unclear but it is likely to be neural and reversible.Interocular suppression and stereopsis are two important binocular functions. To date, it still remains unclear about the relationship between them. Here, we use the binocular phase combination paradigm and a comparable paradigm to provide a normative dataset for perceptual eye dominance and stereo acuity in 142 normal‐sighted human adults and analyze their correlation. We show that our eye dominance and stereopsis are not strongly correlated in the normalsighted subjects. These results thus support the idea that the binocular phase combination and stereopsis may be limited by different factors in normal‐sighted adults.At present there is no good way of reliably measuring stereopsis in the clinic other than the standard book tests designed for children. These are convenient but coarsely quantized in disparity with no measure of variance. This makes it difficult to be able to assess the significance of differences from visit to visit contingent on therapy. We report an iPod app that has been developed from laboratory studies of normal stereopsis, to measure stereo in the clinic that is not limited by these factors. The application enables measurements over the wide disparity range and not just at the finest disparities. In addition, it allows changes in stereopsis of the order of 1.9 to be statistically distinguished.Luminance plays a modulating role in the processes of several visual tasks, which in turn provides significant information for the understanding of visual processing. To study the relationship between luminance and stereopsis, we manipulated the mean luminance seen by both eyes or the interocular difference in mean luminance by using ND filters placed in front of both eyes or just one eye respectively. We found that disparity processing was little affected by a binocular change in luminance, but was greatly affected by a luminance mismatch between the two eyes. To investigate its origin we manipulated two factors, the temporal synchrony between the two eyes and the interocular contrast. Both factors are implicated in the loss of stereo performance when the mean luminance is different between the eyes, suggesting an underlying explanation in terms of temporal low‐pass filtering resulting in the combination of a luminance‐dependent temporal delay and a luminance‐dependent change in contrast gain.These results add to our knowledge of stereopsis and have therapeutic potential in re‐establishing stereopsis in patients with binocular disorders.

Straightening the Eyes Doesn't Rebalance the Brain.

Surgery to align the two eyes is commonly used in treating strabismus. However, the role of strabismic surgery on patients' binocular visual processing is not yet fully understood. In this study, we asked two questions: (1) Does realigning the eyes by strabismic surgery produce an immediate benefit to patients' sensory eye balance? (2) If not, is there a subsequent period of “alignment adaptation” akin to refractive adaptation where sensory benefits to binocular function accrue? Seventeen patients with strabismus (mean age: 17.06 ± 5.16 years old) participated in our experiment. All participants had normal or corrected to normal visual acuity (LogMAR < 0.10) in the two eyes. We quantitatively measured their sensory eye balance before and after surgery using a binocular phase combination paradigm. For the seven patients whose sensory eye balance was measured before surgery, we found no significant change [t(6) = −0.92; p = 0.39] in the sensory eye balance measured 0.5–1 months after the surgery, indicating that the surgical re-alignment didn't by itself produce any immediate benefit for sensory eye balance. To answer the second question, we measured 16 patients' sensory eye balance at around 5–12 months after their eyes had been surgically re-aligned and compared this with our measurements 0.5–1 months after surgery. We found no significant change [t(15) = −0.89; p = 0.39] in sensory eye balance 5–12 months after the surgery. These results suggest that strabismic surgery while being necessary is not itself sufficient for re-establishing balanced sensory eye dominance.

The effect of Lasik surgery on myopic anisometropes\u2019 sensory eye dominance

Lasik is a common surgery for treating anisometropia. In this study, we asked a specific question: what’s the effect of Lasik surgery on anisometropes’ sensory eye dominance? Fifteen myopic anisometropes (mean age: 23 ± 6.9 years old; 6 females) participated in our experiment. We quantitatively measured participants’ sensory eye dominance before and after the Lasik surgery using a binocular phase combination paradigm. We found no significant change of sensory eye dominance within 16 weeks (measured between 8 to 96 days, for one or two repetitions) after the surgery (t(14) = −1.44, p = 0.17). A further following on eight patients showed that patients’ two eyes were much more balanced at 16 weeks or more (measured one or two times between 112 to 408 days) after the surgery (t(7) = −3.79, p = 0.007). Our results suggest that the benefit of Lasik surgery on anisometropes’ sensory eye dominance is not immediate, a long-term ‘adaptation’ period (16 weeks or more) is necessary to enable the surgery to be truly effective.

Sensory Eye Dominance in Treated Anisometropic Amblyopia.

Amblyopia results from inadequate visual experience during the critical period of visual development. Abnormal binocular interactions are believed to play a critical role in amblyopia. These binocular deficits can often be resolved, owing to the residual visual plasticity in amblyopes. In this study, we quantitatively measured the sensory eye dominance in treated anisometropic amblyopes to determine whether they had fully recovered. Fourteen treated anisometropic amblyopes with normal or corrected to normal visual acuity participated, and their sensory eye dominance was assessed by using a binocular phase combination paradigm. We found that the two eyes were unequal in binocular combination in most (11 out of 14) of our treated anisometropic amblyopes, but none of the controls. We concluded that the treated anisometropic amblyopes, even those with a normal range of visual acuity, exhibited abnormal binocular processing. Our results thus suggest that there is potential for improvement in treated anisometropic amblyopes that may further enhance their binocular visual functioning.

On the Maintenance of Normal Ocular Dominance and a Possible Mechanism Underlying Refractive Adaptation.

Do humans with uncorrected anisometropia who have not developed anisometropic amblyopia exhibit a shift in ocular dominance nonetheless, reflecting a more subtle form of deprivation? Also, is such a change in dominance, if it occurs, permanent or could it be rectified by an extended period of optical correction? A total of 25 normal controls (27.5 ± 2.1 years; mean ± SD); 28 anisometropes (20.7 ± 5.6 years) who were fully corrected for more than 16 weeks prior to this investigation; and 24 anisometropes who had never been corrected (21.2 ± 9.8 years) participated in this study. Sensory eye dominance of observers was measured using the binocular phase combination paradigm to find an interocular contrast ratio at which the contributions of each eye to the binocularly fused percept were equal (i.e., the balance point measure of ocular dominance). Controls exhibited a balance point close to unity (0.91 ± 0.05), while the two groups of anisometropes exhibited a clear binocular imbalance (uncorrected anisometropes, 0.51 ± 0.28; corrected anisometropes, 0.70 ± 0.19); both were significantly different from controls (P < 0.001). The imbalance was less severe in corrected anisometropes compared with uncorrected anisometropes (P = 0.004). We find that anisometropia is associated with an ocular imbalance even in the absence of amblyopia. This abnormality is weaker in anisometropes who have worn an optical correction for some time, suggestive that a better optical status leads to a better binocular status.

Sensory eye balance in surgically corrected intermittent exotropes with normal stereopsis.

Surgery to align a deviated or strabismic eye is often done for both functional as well as cosmetic reasons. Although amblyopia is often an impediment to regaining full binocularity in strabismics in general, intermittent exotropes, because their deviation is intermittent, have no amblyopia and some degree of stereopsis. Binocular function, including a balanced ocular dominance, could be expected to be normal after surgical correction if normal levels of stereopsis and visual acuity are postsurgically achieved. Here we used a binocular phase combination paradigm to quantitatively assess the ocular dominance in a group of surgically corrected intermittent exotropes who have normal stereo and visual acuity as defined clinically. Interestingly, we found significant interocular imbalance (balance point < 0.9) in most of the surgically treated patients (8 out 10) but in none of the controls. We conclude that the two eyes may still have a residual sensory imbalance in surgically corrected strabismus even if stereopsis is within normal limits. Our study opens the possibility that a further treatment aimed at re-balancing the ocular dominance might be necessary in surgically treated intermittent exotropia to provide more efficient binocular processing in the long term.

Binocular combination of second-order stimuli.

Phase information is a fundamental aspect of visual stimuli. However, the nature of the binocular combination of stimuli defined by modulations in contrast, so-called second-order stimuli, is presently not clear. To address this issue, we measured binocular combination for first- (luminance modulated) and second-order (contrast modulated) stimuli using a binocular phase combination paradigm in seven normal adults. We found that the binocular perceived phase of second-order gratings depends on the interocular signal ratio as has been previously shown for their first order counterparts; the interocular signal ratios when the two eyes were balanced was close to 1 in both first- and second-order phase combinations. However, second-order combination is more linear than previously found for first-order combination. Furthermore, binocular combination of second-order stimuli was similar regardless of whether the carriers in the two eyes were correlated, anti-correlated, or uncorrelated. This suggests that, in normal adults, the binocular phase combination of second-order stimuli occurs after the monocular extracting of the second-order modulations. The sensory balance associated with this second-order combination can be obtained from binocular phase combination measurements.

The effect of unilateral mean luminance on binocular combination in normal and amblyopic vision.

Luminance plays a modulating role in the processes of several visual tasks, which in turn provides significant information for the understanding of visual processing. Here, using a binocular phase combination paradigm, we studied the effect of unilateral changes in mean luminance on binocular combination in both normal and amblyopic vision. We found, in normal observers, attenuation of one eye's stimulus luminance with neutral density filters produces binocular phase combination similar to those of amblyopic subjects. Correspondingly, in amblyopic observers, reduction of the fellow eye's stimulus luminance produces binocular phase combination similar to those of normal subjects. These phenomena could be explained by an attenuated contribution of the filtered eye to the binocular phase percept due to reduced gain-control. The findings have major implications both for the study of binocular combination and for amblyopia treatment.

Interocular suppression in amblyopia for global orientation processing

We developed a dichoptic global orientation coherence paradigm to quantify interocular suppression in amblyopia. This task is biased towards ventral processing and allows comparison with two other techniques-global motion processing, which is more dorsally biased, and binocular phase combination, which most likely reflects striate function. We found a similar pattern for the relationship between coherence threshold and interocular contrast curves (thresholds vs. interocular contrast ratios or TvRs) in our new paradigm compared with those of the previous dichoptic global motion coherence paradigm. The effective contrast ratios at balance point (where the signals from the two eyes have equal weighting) in our new paradigm were larger than those of the dichoptic global motion coherence paradigm but less than those of the binocular phase combination paradigm. The measured effective contrast ratios in the three paradigms were also positively correlated with each other, with the two global coherence paradigms having the highest correlation. We concluded that: (a) The dichoptic global orientation coherence paradigm is effective in quantifying interocular suppression in amblyopia; and (b) Interocular suppression, while sharing a common suppression mechanism at the early stage in the pathway (e.g., striate cortex), may have additional extra-striate contributions that affect both dorsal and ventral streams differentially.