Letter Discrimination Task Research Articles

Customized Visual Discrimination Digital Therapy According to Visual Field Defects in Chronic Stroke Patients.

Visual perceptual learning (VPL) may improve visual field defects (VFDs) after chronic stroke, but the optimal training duration and location remain unknown. This prospective study aimed to determine the efficacy of 8 weeks of VFD-customized visual discrimination training in improving poststroke VFDs. Prospectively enrolled patients with poststroke VFDs initially received no training for 8 weeks (no-training phase). They subsequently underwent our customized VPL program that included orientation-discrimination tasks in individualized blind fields and central letter-discrimination tasks three times per week for 8 weeks (training phase). We analyzed the luminance detection sensitivity and deviation as measured using Humphrey visual field tests before and after the no-training and training phases. The vision-related quality of life was assessed at baseline and at a 16-week follow-up using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Changes in mean total deviation (MTD) scores were greater during the training phase than during the no-training phase (defective hemifield, p=0.002; whole field, p=0.004). The MTD scores improved during the training phase (defective hemifield, p=0.004; whole field, p=0.016), but not during the no-training phase (defective hemifield, p=0.178; whole field, p=0.178). The difference between the improved and worsened areas (≥6 dB changes in luminance detection sensitivity) was greater during the training phase than during the no-training phase (p=0.009). The vision-specific social functioning subscore of the NEI-VFQ-25 improved after the 16-week study period (p=0.040). Our 8-week VFD-customized visual discrimination training protocol may effectively improve VFDs and vision-specific social functioning in chronic stroke patients.

The availability of attentional resources modulates the anger superiority effect.

It is much debated whether there is an anger superiority effect (ASE) in the recognition of facial expressions. Recent research has shown that the attentional demand of a task plays a vital role in the emergence and magnitude of the ASE. However, only a visual crowding task was employed to manipulate attentional demands, and it is unclear whether the emergence and magnitude of the ASE was contingent on the availability of attentional resources in general. The present study employed a dual-task paradigm to manipulate the availability of attentional resources for facial expression discrimination in which participants were instructed to perform a central letter discrimination task and a peripheral facial expression discrimination task concurrently. Experiment 1 showed an ASE in the dual task but no ASE was yielded when the facial expression discrimination task was performed alone. Experiment 2 replicated this finding and further demonstrated a gradual shift from no ASE to an attenuated ASE and finally to a strong ASE as attentional resources that were available for facial expression discrimination gradually became limited. Together, these results suggest that the emergence and magnitude of the ASE is modulated by the availability of attentional resources, which supports an Attentional Demands Modulation Hypothesis of the ASE.

Cognitive influences on fixational eye movements

We perceive the world based on visual information acquired via oculomotor control,1 an activity intertwined with ongoing cognitive processes.2,3,4 Cognitive influences have been primarily studied in the context of macroscopic movements, like saccades and smooth pursuits. However, our eyes are never still, even during periods of fixation. One of the fixational eye movements, ocular drifts, shifts the stimulus over hundreds of receptors on the retina, a motion that has been argued to enhance the processing of spatial detail by translating spatial into temporal information.5 Despite their apparent randomness, ocular drifts are under neural control.6,7,8 However little is known about the control of drift beyond the brainstem circuitry of the vestibulo-ocular reflex.9,10 Here, we investigated the cognitive control of ocular drifts with a letter discrimination task. The experiment was designed to reveal open-loop effects, i.e., cognitive oculomotor control driven by specific prior knowledge of the task, independent of incoming sensory information. Open-loop influences were isolated by randomly presenting pure noise fields (no letters) while subjects engaged indiscriminating specific letter pairs. Our results show open-loop control of drift direction in human observers.

Perceptual Grouping Strategies in a Letter Identification Task: Strategic Connections, Selection, and Segmentation.

Although perceptual grouping has been widely studied, its mechanisms remain poorly understood. We propose a neural model of grouping that, through top-down control of its circuits, implements a grouping strategy involving both a connection strategy (which elements to connect) and a selection strategy (that defines spatiotemporal properties of a selection signal to segment target elements and facilitate identification). We apply the model to a letter discrimination task that investigated relationships among uniform connectedness and the grouping principles of proximity and shape similarity. Participants reported whether small circles formed a global letter E or H, and these circles could be connected by a line or be embedded in a matrix of squares. In the model, a good grouping strategy for this task consists of a connection strategy that connects circles but not squares for all conditions and a selection strategy that uses a selection signal of varying size, depending on whether squares were present. Consistent with empirical results, which were verified in two replication studies, model performance is worse with distractor squares, and line connectors improve performance only in the condition with squares. Rather than relying on abstract grouping principles, we show how the empirical results can be explained in terms of observers implementing a task-dependent grouping strategy that promotes overall performance.

Modulating verbal working memory with fronto-parietal transcranial electric stimulation at theta frequency: Does it work?

Oscillatory theta activity in a fronto-parietal network has been associated with working memory (WM) processes and may be directly related to WM performance. In their seminal study, Polanía et al. (2012) (de-)coupled a fronto-parietal theta-network by applying transcranial alternating current stimulation (tACS), and showed that anti-phase tACS led to slower and in-phase tACS to faster response times in a verbal WM task compared to placebo stimulation. In the literature, this 'synchronization-desynchronization' effect has only been partly replicated, and electric field modelling suggests that it might not be the fronto-parietal network that is primarily stimulated during in-phase tACS with a shared return electrode. This provides one possible reason for inconsistency in the literature. In this study, we aimed to reproduce the findings reported by Polanía et al. (2012). We also aimed to investigate whether in-phase theta tACS with multiple close-by return electrodes for focal stimulation of the frontal and the parietal cortex will have at least as much of a facilitatory effect as the in-phase stimulation as indicated by Polania et al. (2012). In a single-trial distributional analysis, we explored whether mean, variation and right-skewness of the response time distribution are affected. Against our hypothesis, we found no 'synchronization-desynchronization' effect by fronto-parietal theta tACS on response times using the same delayed letter discrimination task and stimulation parameters in two experiments, both between-subjects and within-subjects. However, we could show that in a more demanding 3-back task, fronto-parietal in-phase and in-phase focal theta tACS substantially improved task performance compared to placebo stimulation.

Broad and long-lasting vision improvements in youth with infantile nystagmus after home training with a perceptual learning app

Current treatments for infantile nystagmus (IN), focused on dampening the oscillating eye movements, yield little to no improvement in visual functioning. It makes sense, however, to treat the visual impairments associated with IN with tailored sensorimotor training. Recently, we therefore developed a letter discrimination training embedded in an eye movement task. This training improved visual performance of children with IN, but most children had not reached plateau performance after 10 training sessions (3,500 trials). Here, we test the effects of prolonged visual perceptual learning (14,000 trials) in 7-18-year-old children with IN, targeting visual crowding as an important bottleneck in their visual functioning. Children (n=36) were assessed before and after training and we performed follow up measurements after 6 months. The training program not only improved performance on the trained letter-discrimination tasks (uncrowded and crowded acuity improvement 0.08±0.03 logMAR and 0.19±0.05 logMAR, respectively; reduction crowding extent 0.31±0.05 logMAR). It also improved visual acuities measured with clinical vision charts at distance (5m, uncrowded 0.15±0.02 logMAR; crowded 0.18±0.02 logMAR) and at near (40cm, uncrowded 0.09±0.02 logMAR, crowded 0.10 ± 0.02 logMAR). We also observed transfer of training effects to untrained tasks such as reading (improvements in reading acuity and reading speed 0.07±0.02 logMAR and 16±2 wpm respectively) and even stereopsis (improvement of 0.22 ± 0.06 log10arcsec). In addition, we found that the training effects translated into improvements of daily-life functioning (as assessed with a functional vision questionnaire), and that they were long lasting (no significant decline after 6 months). The transfer to untrained conditions did not result from improved contrast sensitivity. We conclude that training with an engaging perceptual learning app at home elicits broad and long-lasting vision improvements in youth with IN. Improvements on self-reported functional vision scores underline the clinical relevance of perceptual learning with e-health apps for individuals with IN.

Broad and Long-Lasting Vision Improvements in Youth With Infantile Nystagmus After Home Training With a Perceptual Learning App.

Current treatments for infantile nystagmus (IN), focused on dampening the oscillating eye movements, yield little to no improvement in visual functioning. It makes sense, however, to treat the visual impairments associated with IN with tailored sensory training. Recently, we developed such a training, targeting visual crowding as an important bottleneck in visual functioning with an eye-movement engaging letter discrimination task. This training improved visual performance of children with IN, but most children had not reached plateau performance after 10 supervised training sessions (3,500 trials). Here, we evaluate the effects of prolonged perceptual learning (14,000 trials) in 7-18-year-old children with IN and test the feasibility of tablet-based, at-home intervention. Results demonstrate that prolonged home-based perceptual training results in stable, long lasting visual acuity improvements at distance and near, with remarkably good transfer to reading and even stereopsis. Improvements on self-reported functional vision scores underline the clinical relevance of perceptual learning with e-health apps for individuals with IN.

Behavioural and neural effects of eccentricity and visual field during covert visuospatial attention

The attentional priority map plays a key role in the distribution of attention, and is modulated by bottom-up sensory as well as top-down task-dependent factors. The intraparietal sulcus (IPS) is a key candidate to hold a neural representation of the attentional priority map. In the current study, we examined the role of the IPS during covert attention to spatial locations with high or low eccentricity in one or both visual hemifields. To this end, eighteen neurologically healthy participants performed a cued letter discrimination task in which they were endogenously cued to attend to a location at a 5 or 10° eccentricity in the left and/or right visual field. We briefly presented a four-letter target array and subsequently probed perceptual performance while acquiring event-related functional MRI data. While behavioural results showed greater letter discrimination performance at the low eccentricity compared to the high eccentricity location, no neural effect of eccentricity was observed. The results further showed that attending to one visual hemifield produced higher activation in the left parietal and occipital cortex compared to attending bilaterally. Future studies may consider increasing the involvement of top-down control of attention to the cued location to study the neural effect of eccentricity, e.g., through manipulating the task difficulty.

Single-Case Neuropsychological Assessment of a Patient with a Posterior Parietal Lesion Using Behavioral Testing and Resting-State fMRI

This study integrated functional connectivity measures using resting-state fMRI and behavioral data from a single-case observation of patient (PER) one year after right-hemispheric hemorrhage in the intraparietal sulcus and superior parietal lobule (IPS/SPL). PER showed no sign of clinical neglect. Her behavioral performance in the visuo-manual pointing task and in the letter discrimination task under conditions of endogenous and exogenous attentional cueing was compared between the left (affected) and right (unaffected/control) peripheral visual fields. The resting-state fMRI demonstrated an imbalance between the right and left hemispheric frontoparietal functional connectivity within the dorsal attentional and motor networks. Although the frontal and occipital cortices were not structurally damaged, specific fronto-occipital functional connectivity was imbalanced, which was strongly associated with the behavioral changes. First, the activity in the right frontal eye field showed weaker correlations with the activity in the right inferior occipital area compared to the correlation with the activity in the left inferior occipital area. This imbalanced fronto-occipital functional connectivity was accompanied by a specific impairment in endogenous covert attention in the left visual field. Second, the activity within M1 in both hemispheres showed weaker correlations with the activity of the right cuneus compared to the correlation with the activity in the left cuneus. The imbalanced fronto-occipital functional connectivity was associated with the impairment of the reaching movement of the left and right hands towards the left visual field (optic ataxia). Altogether, our results showed that a lesion to the posterior parietal cortex affects the relationship between distal regions underlying the sensorimotor and attentional abilities

The Effect of Color on Letter Discrimination Can Be Modulated by the Global/Local Processing and Attention Level

This study explored whether the color of letters could influence letter discrimination task performances and whether this effect of color could be modulated by processing level (global vs. local) and attention level of color (color-attended vs. color-unattended). We used the Navon letters in red, green, or white as stimuli at a relatively small (Experiment 1) or large visual angle (Experiments 2, 3, and 4). Each experiment included two tasks: color-attended task in which participants were told to respond only to target letters in a designated color; color-unattended task in which color was task-irrelevant. Experiment 1 found that the responses to red stimuli were significantly faster than those to the other color stimuli in the color-attended task. In Experiment 2, the same pattern occurred only at the local level in the color-attended task. Experiments 3 and 4 further controlled the brightness and chroma of stimuli and the results replicated the enhancement effect of red at the local level in the color-attended task and demonstrated an interference effect of red and green in the color-unattended task. These results suggested that red facilitated letter discrimination at the local processing level, reflecting the effect of avoidance motivation evoked by red on cognition and behavior which was consistent with color-in-context model. Moreover, this study found that the effect of color was modulated by attention level of color, and the interference effect of color in the color-unattended task confirmed that the color effect might mainly arise from controlled processes but not automatic processes.

Explicitly versus implicitly driven temporal expectations: No evidence for altered perceptual processing due to top-down modulations.

Learning the statistical regularities of environmental events is a powerful tool for enhancing performance. However, it remains unclear whether this often implicit type of behavioral facilitation can be proactively modulated by explicit knowledge about temporal regularities. Only recently, Menceloglu and colleagues (Attention, Perception & Psychophysics, 79(1), 169-179, 2017) tested for differences between implicit versus explicit statistical learning of temporal regularities by using a within-paradigm manipulation of metacognitive temporal knowledge. The authors reported that temporal expectations were enhanced if participants had explicit knowledge about temporal regularities. Here, we attempted to replicate and extend their results, and to provide a mechanistic framework for any effects by means of computational modelling. Participants performed a letter-discrimination task, with target letters embedded in congruent or incongruent flankers. Temporal predictability was manipulated block-wise, with targets occurring more often after either a short or a long delay period. During the delay a sound was presented in half of the trials. Explicit knowledge about temporal regularities was manipulated by changing instructions: Participants received no information (implicit), information about the most likely cue-target delay (explicit), or received 100% valid cues on each trial (highly explicit). We replicated previous effects of target-flanker congruence and sound presence. However, no evidence was found for an effect of explicit knowledge on temporal expectations using Bayesian statistics. Concordantly, computational modelling suggested that explicit knowledge may only influence non-perceptual processing such as response criteria. Together, our results indicate that explicit metacognitive knowledge does not necessarily alter sensory representations or temporal expectations but rather affects response strategies.

Inter-trial variability in brain activity as an indicator of synergistic effects of HIV-1 and drug abuse

BackgroundThe objective of this investigation was to detect evidence of the synergism in the effects of HIV-1 and drug abuse on brain function that has been hypothesized but rarely shown. The investigation incorporated several noteworthy improvements in the approach. It used urine toxicology tests to exclude participants complicated by recent methadone use and illicit drug use. Also, it defined drug abuse on a scale that considered symptom severity. Most importantly, it examined inter-trial variability in brain activity as a potentially more sensitive indicator of group differences and functional impairment than the across-trial average. Methods173 participants were assigned to groups defined by their HIV-1 serostatus and Drug Abuse Screening Test score (DAST < vs. > = 6). They completed a simple letter discrimination task including rare target and rare nontarget stimuli. Event-related electroencephalographic responses and key press responses were measured on each trial. During a separate assessment, posturographic measures were recorded. ResultsThe inter-trial standard deviation of P300-like activity was superior to the mean amplitude of this activity in differentiating the groups. Unlike the mean, it revealed synergistic statistical effects of HIV and drug abuse. It also correlated significantly with static ataxia. ConclusionsInter-trial variability in P300-like activity is a useful marker for detecting subtle and episodic disruptions in brain function. It demonstrates greater sensitivity than the mean amplitude for detecting differences across groups. Also, as a putative indicator of a disruption in the attentional monitoring of behavior, it predicts subtle impairments in gross motor function.

What happens to an individual visual working memory representation when it is interrupted?

This study tested the hypothesis that even the simplest cognitive tasks require the storage of information in working memory (WM), distorting any information that was previously stored in WM. Experiment 1 tested this hypothesis by requiring observers to perform a simple letter discrimination task while they were holding a single orientation in WM. We predicted that performing the task on the interposed letter stimulus would cause the orientation memory to become less precise and more categorical compared to when the letter was absent or when it was present but could be ignored. This prediction was confirmed. Experiment 2 tested the modality specificity of this effect by replacing the visual letter discrimination task with an auditory pitch discrimination task. Unlike the interposed visual stimulus, the interposed auditory stimulus produced little or no disruption of WM, consistent with the use of modality-specific representations. Thus, performing a simple visual discrimination task, but not a simple auditory discrimination task, distorts information about a single feature being maintained in visual WM. We suggest that the interposed task eliminates information stored within the focus of attention, leaving behind a WM representation outside the focus of attention that is relatively imprecise and categorical.

Gender Differences in the Automatic Attention to Romantic Vs Sexually Explicit Stimuli

IntroductionGender differences in sexual responses and cognitive and emotional processing to romantic and sexually explicit stimuli have been reported. However, these differences seem to depend on the automaticity of the task that is being used, thus suggesting that gender differences may be the result of specific mechanisms rather than a generalized effect. AimTo expand previous basic processes research on gender differences to romantic vs sexually explicit stimuli, focusing on potential differentiating mechanisms influencing male and female sexual responses, we aim to investigate gender differences on automatic attention to sexual stimuli, and to test its relationship with sexual excitation proneness. Methods26 women and 30 men (heterosexual) performed an automatic attention task, in which romantic and sexually explicit stimuli were presented as distractors, that is, stimuli to be ignored, while a concurrent letter discrimination task was performed, followed by a self-report task assessing subjective sexual and emotional responses to the stimuli. Main Outcome MeasuresPercentage of accuracy and response times (RTs) to discriminate the target letters were used as markers of automatic attention, with lower accuracy and longer RTs reflecting a higher degree of attentional capture by the distractor stimuli (romantic and sexually explicit). Participants completed self-report ratings on emotional valence, general arousal, and sexual arousal toward romantic and sexually explicit stimuli. They further reported on their sexual excitation proneness. ResultsFindings revealed that sexually explicit pictures yielded more automatic attention capture. However, this effect was superseded by pornography consumption, which likely reflects a habituation mechanism. Also, data revealed gender-x type of picture interaction effects only at the self-report task, with men rating sexually explicit stimuli as more sexually exciting, and women rating these stimuli as less pleasant. No relationship was found between automatic attention proxies and sexual excitation proneness. Clinical TranslationWhile therapeutic strategies are used as tools to improve attention to sexual stimuli (and, hence, increase sexual arousal), the current findings suggest that the specific pathways by which attention influences sexual response are still to be established. Also, gender differences on the subjective appraisal of sex stimuli suggest that therapeutic approaches, consisting on exposure techniques, must recognize gender specificities. Strengths & LimitationsTo our knowledge, this is the first study applying an automatic attention task to the field of sex research, thus adding new inputs to the topic of attention, gender differences, and sexual response. However, there is very limited research in the field of automatic attention, which may limit the interpretation of our findings, at the moment. ConclusionWhereas both genders do not seem to differ in automatic attention toward romantic and sexually explicit stimuli, their responses do differ in their subjective appraisal of the stimuli. Furthermore, despite theoretical assumptions on the relationship between attention and sexual response, automatic attention seemed not to be related to sexual excitation proneness. Carvalho J, Czop O, Rocha M, et al. Gender differences in the automatic attention to romantic vs sexually explicit stimuli. J Sex Med 2018;15:1083–1092.

Do alerting signals increase the size of the attentional focus?

Previous research has shown that the presentation of an auditory alerting signal before a visual target increases the interference from flanking distractors. Recently, it has been suggested that this increase in interference may be due to an expansion of the spatial focus of attention. In five experiments, this hypothesis was tested by using a probe technique dedicated to measuring variations in the size of the attentional focus: In the majority of trials, participants performed a letter discrimination task in which their attention was focused on a central target letter. In a randomly intermixed probe task, the size of the attentional focus was measured by letting participants respond to a probe occurring at varying positions. In all experiments, reaction time (RT) to the probe increased from the most central to more lateral probe positions. This V-shaped probe-RT function, however, was not flattened by the presentation of an alerting signal. Overall, this pattern of results is inconsistent with the hypothesis that alerting signals increase the attentional focus. Instead, it is consistent with nonspatial accounts that attribute the increase in interference to an alerting effect on perceptual processing, which then leads to a detrimental effect at the level of response selection.

The cognitive loci of the display and task-relevant set size effects on distractor interference: Evidence from a dual-task paradigm.

The congruency effect of a task-irrelevant distractor has been found to be modulated by task-relevant set size and display set size. The present study used a psychological refractory period (PRP) paradigm to examine the cognitive loci of the display set size effect (dilution effect) and the task-relevant set size effect (perceptual load effect) on distractor interference. A tone discrimination task (Task 1), in which a response was made to the pitch of the target tone, was followed by a letter discrimination task (Task 2) in which different types of visual target display were used. In Experiment 1, in which display set size was manipulated to examine the nature of the display set size effect on distractor interference in Task 2, the modulation of the congruency effect by display set size was observed at both short and long stimulus-onset asynchronies (SOAs), indicating that the display set size effect occurred after the target was selected for processing in the focused attention stage. In Experiment 2, in which task-relevant set size was manipulated to examine the nature of the task-relevant set size effect on distractor interference in Task 2, the effects of task-relevant set size increased with SOA, suggesting that the target selection efficiency in the preattentive stage was impaired with increasing task-relevant set size. These results suggest that display set size and task-relevant set size modulate distractor processing in different ways.

Predictors of Sensitivity to Perceptual Learning in Children With Infantile Nystagmus

To identify predictors of sensitivity to perceptual learning on a computerized, near-threshold letter discrimination task in children with infantile nystagmus (idiopathic IN: n = 18; oculocutaneous albinism accompanied by IN: n = 18). Children were divided into two age-, acuity-, and diagnosis-matched training groups: a crowded (n = 18) and an uncrowded training group (n = 18). Training consisted of 10 sessions spread out over 5 weeks (grand total of 3500 trials). Baseline performance, age, diagnosis, training condition, and perceived pleasantness of training (training joy) were entered as linear regression predictors of training-induced changes on a single- and a crowded-letter task. An impressive 57% of the variability in improvements of single-letter visual acuity was explained by age, training condition, and training joy. Being older and training with uncrowded letters were associated with larger single-letter visual acuity improvements. More training joy was associated with a larger gain from the uncrowded training and a smaller gain from the crowded training. Fifty-six percent of the variability in crowded-letter task improvements was explained by baseline performance, age, diagnosis, and training condition. After regressing out the variability induced by training condition, baseline performance, and age, perceptual learning proved more effective for children with idiopathic IN than for children with albinism accompanied by IN. Training gains increased with poorer baseline performance in idiopaths, but not in children with albinism accompanied by IN. Age and baseline performance, but not training joy, are important prognostic factors for the effect of perceptual learning in children with IN. However, their predictive value for achieving improvements in single-letter acuity and crowded letter acuity, respectively, differs between diagnostic subgroups and training condition. These findings may help with personalized treatment of individuals likely to benefit from perceptual learning.

Exogenous attention to fear: Differential behavioral and neural responses to snakes and spiders

Research has consistently shown that threat stimuli automatically attract attention in order to activate the defensive response systems. Recent findings have provided evidence that snakes tuned the visual system of evolving primates for their astute detection, particularly under challenging perceptual conditions. The goal of the present study was to measure behavioral and electrophysiological indices of exogenous attention to snakes, compared with spiders – matched for rated fear levels but for which sources of natural selection are less well grounded, and to innocuous animals (birds), which were presented as distracters, while participants were engaged in a letter discrimination task. Duration of stimuli, consisting in a letter string and a concurrent distracter, was either presented for 180 or 360ms to explore if the stimulus duration was a modulating effect of snakes in capturing attention. Results showed a specific early (P1) exogenous attention-related brain potential with maximal amplitude to snakes in both durations, which was followed by an enhanced late attention-related potential (LPP) showing enhanced amplitudes to spiders, particularly under the longer exposure durations. These results suggest that exogenous attention to different classes of threat stimuli follows a gradual process, with the most evolutionary-driven stimulus, i.e., snakes, being more efficient at attracting early exogenous attention, thus more dependent on bottom-up processes.

Perceptual Learning in Children With Infantile Nystagmus: Effects on 2D Oculomotor Behavior.

To determine changes in oculomotor behavior after 10 sessions of perceptual learning on a letter discrimination task in children with infantile nystagmus (IN). Children with IN (18 children with idiopathic IN and 18 with oculocutaneous albinism accompanied by IN) aged 6 to 11 years were divided into two training groups matched on diagnosis: an uncrowded training group (n = 18) and a crowded training group (n = 18). Target letters always appeared briefly (500 ms) at an eccentric location, forcing subjects to quickly redirect their gaze. Training occurred twice per week for 5 consecutive weeks (3500 trials total). Norm data and test-retest values were collected from children with normal vision (n = 11). Outcome measures were: nystagmus characteristics (amplitude, frequency, intensity, and the expanded nystagmus acuity function); fixation stability (the bivariate contour ellipse area and foveation time); and saccadic eye movements (latencies and accuracy) made during a simple saccade task and a crowded letter-identification task. After training, saccadic responses of children with IN improved on the saccade task (latencies decreased by 14 ± 4 ms and gains increased by 0.03 ± 0.01), but not on the crowded letter task. There were also no training-induced changes in nystagmus characteristics and fixation stability. Although children with normal vision had shorter latencies in the saccade task (47 ± 14 ms at baseline), test-retest changes in their saccade gains and latencies were almost equal to the training effects observed in children with IN. Our results suggest that the improvement in visual performance after perceptual learning in children with IN is primarily due to improved sensory processing rather than improved two-dimensional oculomotor behavior.

Perceptual Learning in Children With Infantile Nystagmus: Effects on Visual Performance.

To evaluate whether computerized training with a crowded or uncrowded letter-discrimination task reduces visual impairment (VI) in 6- to 11-year-old children with infantile nystagmus (IN) who suffer from increased foveal crowding, reduced visual acuity, and reduced stereopsis. Thirty-six children with IN were included. Eighteen had idiopathic IN and 18 had oculocutaneous albinism. These children were divided in two training groups matched on age and diagnosis: a crowded training group (n = 18) and an uncrowded training group (n = 18). Training occurred two times per week during 5 weeks (3500 trials per training). Eleven age-matched children with normal vision were included to assess baseline differences in task performance and test-retest learning. Main outcome measures were task-specific performance, distance and near visual acuity (DVA and NVA), intensity and extent of (foveal) crowding at 5 m and 40 cm, and stereopsis. Training resulted in task-specific improvements. Both training groups also showed uncrowded and crowded DVA improvements (0.10 ± 0.02 and 0.11 ± 0.02 logMAR) and improved stereopsis (670 ± 249″). Crowded NVA improved only in the crowded training group (0.15 ± 0.02 logMAR), which was also the only group showing a reduction in near crowding intensity (0.08 ± 0.03 logMAR). Effects were not due to test-retest learning. Perceptual learning with or without distractors reduces the extent of crowding and improves visual acuity in children with IN. Training with distractors improves near vision more than training with single optotypes. Perceptual learning also transfers to DVA and NVA under uncrowded and crowded conditions and even stereopsis. Learning curves indicated that improvements may be larger after longer training.