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      Contrast Sensitivity and Stereoacuity in Successfully Treated Refractive Amblyopia

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          Abstract

          Purpose

          To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia.

          Methods

          A retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues.

          Results

          Statistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test.

          Conclusions

          Full recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.

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          Most cited references53

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          Amblyopia and binocular vision.

          Gary Birch (2013)
          Amblyopia is the most common cause of monocular visual loss in children, affecting 1.3%-3.6% of children. Current treatments are effective in reducing the visual acuity deficit but many amblyopic individuals are left with residual visual acuity deficits, ocular motor abnormalities, deficient fine motor skills, and risk for recurrent amblyopia. Using a combination of psychophysical, electrophysiological, imaging, risk factor analysis, and fine motor skill assessment, the primary role of binocular dysfunction in the genesis of amblyopia and the constellation of visual and motor deficits that accompany the visual acuity deficit has been identified. These findings motivated us to evaluate a new, binocular approach to amblyopia treatment with the goals of reducing or eliminating residual and recurrent amblyopia and of improving the deficient ocular motor function and fine motor skills that accompany amblyopia. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Stereopsis and amblyopia: A mini-review.

            Amblyopia is a neuro-developmental disorder of the visual cortex that arises from abnormal visual experience early in life. Amblyopia is clinically important because it is a major cause of vision loss in infants and young children. Amblyopia is also of basic interest because it reflects the neural impairment that occurs when normal visual development is disrupted. Amblyopia provides an ideal model for understanding when and how brain plasticity may be harnessed for recovery of function. Over the past two decades there has been a rekindling of interest in developing more effective methods for treating amblyopia, and for extending the treatment beyond the critical period, as exemplified by new clinical trials and new basic research studies. The focus of this review is on stereopsis and its potential for recovery. Impaired stereoscopic depth perception is the most common deficit associated with amblyopia under ordinary (binocular) viewing conditions (Webber & Wood, 2005). Our review of the extant literature suggests that this impairment may have a substantial impact on visuomotor tasks, difficulties in playing sports in children and locomoting safely in older adults. Furthermore, impaired stereopsis may also limit career options for amblyopes. Finally, stereopsis is more impacted in strabismic than in anisometropic amblyopia. Our review of the various approaches to treating amblyopia (patching, perceptual learning, videogames) suggests that there are several promising new approaches to recovering stereopsis in both anisometropic and strabismic amblyopes. However, recovery of stereoacuity may require more active treatment in strabismic than in anisometropic amblyopia. Individuals with strabismic amblyopia have a very low probability of improvement with monocular training; however they fare better with dichoptic training than with monocular training, and even better with direct stereo training.
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              Dichoptic training enables the adult amblyopic brain to learn.

              Adults with amblyopia, a common visual cortex disorder caused primarily by binocular disruption during an early critical period, do not respond to conventional therapy involving occlusion of one eye. But it is now clear that the adult human visual cortex has a significant degree of plasticity, suggesting that something must be actively preventing the adult brain from learning to see through the amblyopic eye. One possibility is an inhibitory signal from the contralateral eye that suppresses cortical inputs from the amblyopic eye. Such a gating mechanism could explain the apparent lack of plasticity within the adult amblyopic visual cortex. Here we provide direct evidence that alleviating suppression of the amblyopic eye through dichoptic stimulus presentation induces greater levels of plasticity than forced use of the amblyopic eye alone. This indicates that suppression is a key gating mechanism that prevents the amblyopic brain from learning to see. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Invest Ophthalmol Vis Sci
                Invest Ophthalmol Vis Sci
                IOVS
                Investigative Ophthalmology & Visual Science
                The Association for Research in Vision and Ophthalmology
                0146-0404
                1552-5783
                06 January 2022
                January 2022
                : 63
                : 1
                : 6
                Affiliations
                [1 ]State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
                [2 ]Centre for Eye and Vision Research, 17W Science Park, Hong Kong
                [3 ]School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
                [4 ]Liggins Institute, The University of Auckland, Auckland, New Zealand
                Author notes
                Correspondence: Jinrong Li, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlie South Road, Guangzhou, China; lijingr3@ 123456mail.sysu.edu.cn.
                Benjamin Thompson, School of Optometry and Vision Science, University of Waterloo, 200 Columbia Ave W, Waterloo, ON N2L3G1, Canada; ben.thompson@ 123456uwaterloo.ca .

                YJ and QY contributed equally as co-first authors.

                BT and JL contributed equally as co-last authors.

                Article
                IOVS-21-34049
                10.1167/iovs.63.1.6
                8742522
                34989762
                00a181ad-9cb5-4150-bc38-f499e773f4bb
                Copyright 2022 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 03 December 2021
                : 20 October 2021
                Page count
                Pages: 7
                Categories
                Eye Movements, Strabismus, Amblyopia and Neuro-Ophthalmology
                Eye Movements, Strabismus, Amblyopia and Neuro-Ophthalmology

                amblyopia,treated,contrast sensitivity,stereoacuity
                amblyopia, treated, contrast sensitivity, stereoacuity

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