Amblyopia: a multidisciplinary approach. Proctor lecture.

: Clinically different forms of amblyopia share as common denominators an inability to form well-defined and focused images in one or both eyes and, in the case of unilateral amblyopia, unequal visual input to the brain. This suggests two amblyopiogenic mechanisms which are effective, individually or in unison, in the various forms of amblyopia. The first is lack of adequate visual stimulation during infancy, causing visual deprivation. The second mechanism is based on abnormal binocular interaction. The clinical evidence and data from the animal laboratory will be reviewed in support of this dual etiological concept of amblyopia. An etiological classification of amblyopia suggested in 1972 on hypothetical grounds can be upheld on the basis of information that has accumulated since that time. Amblyopia is not a static condition but has a strong dynamic component since its severity can be modified by the type of stimulation received by the sound eye. Special emphases is placed in this lecture on this unique feature which is based on binocular interaction and is similar to the inhibition of afferent visual stimulation during suppression.

[1]  T. Powell,et al.  Cellular changes in the lateral geniculate nucleus of infant monkeys after suture of the eyelids. , 1973, Journal of anatomy.

[2]  F. H. Adler.  PHYSIOLOGY OF THE EYE , 1960 .

[3]  M. Crawford,et al.  Concomitant strabismus and cortical eye dominance in young rhesus monkeys. , 1979, Transactions of the ophthalmological societies of the United Kingdom.

[4]  G. K. Noorden.  Mechanisms of amblyopia. , 1977, Advances in ophthalmology = Fortschritte der Augenheilkunde = Progres en ophtalmologie.

[5]  F. W. Weymouth,et al.  Unequal corrected visual acuity as related to anisometropia. , 1955, A.M.A. archives of ophthalmology.

[6]  M. Crawford,et al.  Failure to preserve cortical binocularity in strabismic monkeys raised in a unidirectional visual environment. , 1981, Investigative ophthalmology & visual science.

[7]  R W Guillery,et al.  The differential effects of unilateral lid closure upon the monocular and binocular segments of the dorsal lateral geniculate nucleus in the cat , 1970, The Journal of comparative neurology.

[8]  M. Crawford,et al.  The lateral geniculate nucleus in human anisometropic amblyopia. , 1983, Investigative ophthalmology & visual science.

[9]  M C FLOM,et al.  VISUAL RESOLUTION AND CONTOUR INTERACTION. , 1963, Journal of the Optical Society of America.

[10]  G. K. Noorden,et al.  Visual Acuity of Amblyopic Eyes Under Monocular and Binocular Conditions: Further Observations , 1972 .

[11]  The effects of monocular visual deprivation: Disuse or binocular interaction? , 1976, Brain Research.

[12]  Noorden Gk.  Classification, diagnosis and natural history of amblyopia. , 1972 .

[13]  E. Smith,et al.  Behavioral studies on the effect of abnormal early visual experience in monkeys: Temporal modulation sensitivity , 1983, Vision Research.

[14]  G. K. Noorden.  Histological Studies of the Visual System in Monkeys with Experimental Amblyopia , 1973 .

[15]  L. Kiorpes,et al.  Anisometropic amblyopia in Macaca nemestrina monkeys produced by atropinization of one eye during development. , 1982, Investigative ophthalmology & visual science.

[16]  M. Wright,et al.  Is amblyopia due to inappropriate stimulation of the "sustained" pathway during development? , 1974, The British journal of ophthalmology.

[17]  M. Pugh.  Foveal Vision in Amblyopia * , 1954, The British journal of ophthalmology.

[18]  L. S. Meharg,et al.  Binocular neurons and binocular function in monkeys and children. , 1983, Investigative ophthalmology & visual science.

[19]  Velma Dobson,et al.  Visual acuity in human infants: A review and comparison of behavioral and electrophysiological studies , 1978, Vision Research.

[20]  R. Guillery.  Binocular competition in the control of geniculate cell growth , 1972, The Journal of comparative neurology.

[21]  Peter Grigg,et al.  Effects of visual deprivation and strabismus on the response of neurons in the visual cortex of the monkey, including studies on the striate and prestriate cortex in the normal animal , 1974 .

[22]  G. Mackensen.  Monoculare und binoculare statische Perimetrie zur Untersuchung der Hemmungsvorgänge beim Schielen , 1959, Albrecht von Graefes Archiv für Ophthalmologie.

[23]  R. Guillery,et al.  Behavioral, electrophysiological and morphological studies of binocular competition in the development of the geniculo–corticalpathways of cats , 1974, The Journal of comparative neurology.

[24]  R. Hess,et al.  Residual vision in humans who have been monocularly deprived of pattern stimulation in early life , 2004, Experimental Brain Research.

[25]  R. J. L..  Introduction to Physiological Optics The Science of Seeing , 1939, Nature.

[26]  R. Guillery,et al.  The effect of lid suture upon the growth of cells in the dorsal lateral geniculate nucleus of kittens , 1973, The Journal of comparative neurology.

[27]  D M Levi,et al.  Differences in vernier discrimination for grating between strabismic and anisometropic amblyopes. , 1982, Investigative ophthalmology & visual science.

[28]  H. Ikeda.  Visual Acuity, its Development and Amblyopia 1 , 1980, Journal of the Royal Society of Medicine.

[29]  E. Smith,et al.  Effects of enucleation of the nondeprived eye on stimulus deprivation amblyopia in monkeys. , 1984, Investigative ophthalmology & visual science.

[30]  R. Blake,et al.  Physiological consequences of unilateral and bilateral eye closure in macaque monkeys: some further observations , 1975, Brain Research.

[31]  D. Hubel,et al.  EFFECTS OF VISUAL DEPRIVATION ON MORPHOLOGY AND PHYSIOLOGY OF CELLS IN THE CATS LATERAL GENICULATE BODY. , 1963, Journal of neurophysiology.

[32]  A. Tarkkanen,et al.  Incidence of loss of vision in the healthy eye in amblyopia. , 1981, The British journal of ophthalmology.

[33]  S. Sherman,et al.  Behavioral and morphological evidence for binocular competition in the postnatal development of the dog's visual system , 1975, The Journal of comparative neurology.

[34]  D. Hubel,et al.  SINGLE-CELL RESPONSES IN STRIATE CORTEX OF KITTENS DEPRIVED OF VISION IN ONE EYE. , 1963, Journal of neurophysiology.

[35]  G. V. von Noorden,et al.  Visual acuity in strabismic amblyopia under monocular and binocular conditions. , 1966, Archives of ophthalmology.

[36]  Jeffrey Moran,et al.  Long term visual deprivation in a human , 1982, Vision Research.

[37]  J. Pettigrew,et al.  Local perfusion of noradrenaline maintains visual cortical plasticity , 1978, Nature.

[38]  D E Mitchell,et al.  Behavioral evidence for prolonged sensitivity to effects of monocular deprivation in dark-reared cats. , 1980, Journal of neurophysiology.

[39]  D. Hubel,et al.  Comparison of the effects of unilateral and bilateral eye closure on cortical unit responses in kittens. , 1965, Journal of neurophysiology.

[40]  G. K. Noorden,et al.  The effects of short-term experimental strabismus on the visual system in Macaca mulatta. , 1979, Investigative ophthalmology & visual science.

[41]  H. Burian,et al.  An electro-ophthalmographic study of the behavior of the fixation of amblyopic eyes in light- and dark-adapted state: a preliminary report. , 1958, American journal of ophthalmology.

[42]  D. Mitchell,et al.  The permanence of the visual recovery that follows reverse occlusion of monocularly deprived kittens. , 1984, Investigative ophthalmology & visual science.

[43]  D. Hubel,et al.  Plasticity of ocular dominance columns in monkey striate cortex. , 1977, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[44]  F. Campbell,et al.  Differences in the neural basis of human amblyopias: The effect of mean luminance , 1980, Vision Research.

[45]  J. L. Conway,et al.  Bicuculline reversal of deprivation amblyopia in the cat , 1976, Nature.

[46]  H. Burian,et al.  Visual acuity in normal and amblyopic patients under reduced illumination. I. Behavior of visual acuity with and without neutral density filter. , 1959, A.M.A. archives of ophthalmology.

[47]  G. K. Noorden,et al.  Form deprivation without light deprivation produces the visual deprivation syndrome inMacaca Mulatta , 1977, Brain Research.

[48]  E. Smith,et al.  Stereoblind monkeys have few binocular neurons. , 1984, Investigative ophthalmology & visual science.

[49]  D H Hubel,et al.  Autoradiographic demonstration of ocular-dominance columns in the monkey striate cortex by means of transneuronal transport. , 1974, Brain research.

[50]  W. H. Meinberg.  Worth's Squint or the Binocular Reflexes and the Treatment of Strabismus , 1939, The Indian Medical Gazette.

[51]  G. K. Noorden,et al.  Heredity in microtropia. , 1969, Archives of ophthalmology.

[52]  Experimental amblyopia. , 1972, Israel journal of medical sciences.

[53]  M. Crawford.  The visual deprivation syndrome. , 1978, Ophthalmology.

[54]  H. Burian,et al.  Visual Acuity in Normal and Amblyopic Patients Under Reduced Illumination: II. The Visual Acuity at Various Levels of Illumination , 1959 .

[55]  P. Brabant,et al.  Prognosis for vision in amblyopia after the loss of the good eye. , 1984, Archives of ophthalmology.

[56]  P. D. Spear,et al.  Quantitative studies of cell size in the cat's dorsal lateral geniculate nucleus following visual deprivation , 1977, The Journal of comparative neurology.

[57]  R. F. Hess,et al.  The threshold contrast sensitivity function in strabismic amblyopia: Evidence for a two type classification , 1977, Vision Research.

[58]  R D Freeman,et al.  A Neural Effect of Partial Visual Deprivation in Humans , 1972, Science.

[59]  D M Levi,et al.  Psychophysical investigations of the temporal modulation sensitivity function in amblyopia: spatiotemporal interactions. , 1982, Investigative ophthalmology & visual science.

[60]  D. Hubel,et al.  RECEPTIVE FIELDS OF CELLS IN STRIATE CORTEX OF VERY YOUNG, VISUALLY INEXPERIENCED KITTENS. , 1963, Journal of neurophysiology.

[61]  R Held,et al.  Astigmatism in infants. , 1978, Science.

[62]  E. Smith,et al.  Effects of enucleation of the fixating eye on strabismic amblyopia in monkeys. , 1986, Investigative ophthalmology & visual science.

[63]  M. Crawford,et al.  Morphological and physiological changes in the monkey visual system after short-term lid suture. , 1978, Investigative ophthalmology & visual science.

[64]  J. Dowling,et al.  Experimental amblyopia in monkeys. II. Behavioral studies in strabismic amblyopia. , 1970, Archives of ophthalmology.

[65]  D. Hubel,et al.  Binocular interaction in striate cortex of kittens reared with artificial squint. , 1965, Journal of neurophysiology.

[66]  R G Boothe,et al.  Postnatal development of vision in human and nonhuman primates. , 1985, Annual review of neuroscience.

[67]  G. K. Noorden,et al.  Histology of the monkey lateral geniculate nucleus after unilateral lid closure and experimental strabismus: further observations. , 1975, Investigative ophthalmology.

[68]  R S Harwerth,et al.  Spatial contrast sensitivity deficits in monkeys produced by optically induced anisometropia. , 1985, Investigative ophthalmology & visual science.

[69]  R. Hess,et al.  The luminance-dependent nature of the visual abnormality in strabismic amblyopia , 1978, Vision Research.

[70]  F. Billson,et al.  Ophthalmological examination of the infant. Developmental aspects. , 1982, Survey of ophthalmology.

[71]  C. Blakemore,et al.  Development of the neural basis of visual acuity in monkeys: speculation on the origin of deprivation amblyopia. , 1979, Transactions of the ophthalmological societies of the United Kingdom.

[72]  J. Dowling,et al.  Experimental amblyopia in monkeys. I. Behavioral studies of stimulus deprivation amblyopia. , 1970, Archives of ophthalmology.