Discriminating anisometropic amblyopia from myopia based on interocular inhibition

Amblyopia screening during childhood is critical for early detection and successful treatment. In the current study, we develop and evaluate a screening method that exploits the imbalanced interocular inhibition between amblyopic and fellow eyes. In nineteen subjects with anisometropic amblyopia and twenty-two age-matched subjects with myopia, we measured the area under the contrast sensitivity functions (AUCSFs) in eight monocular conditions defined by the tested eye (left, right), patching of the untested eye (translucent, opaque), and refractive status (corrected, uncorrected). For each tested eye, we defined the inhibition index as the ratio between the AUCSF values obtained in the translucent and opaque patching conditions of the untested eye. To evaluate the screening potential of the inhibition index, we compared results from patients with amblyopia and myopia. With and without optical correction, the index was significantly lower in the amblyopic eye than in the fellow eye of the amblyopic subjects and both eyes of the myopic subjects. No significant difference was found among the two eyes of the myopic subjects and the fellow eyes of the amblyopic subjects. With the inhibition index as the predictor, a logistic regression model successfully discriminated amblyopic eyes from myopic eyes with 100% accuracy in the uncorrected condition. In the corrected condition, with the inhibition index and interocular visual acuity difference as predictors, amblyopic eyes were likewise discriminated from myopic eyes with 100% accuracy. This pattern of CSF changes, caused by the different patching modes of the untested eye, provides a potential CSF signature to discriminate anisometropic amblyopia from myopia.

[1]  Michael Dorr,et al.  Rapid and reliable assessment of the contrast sensitivity function on an iPad. , 2013, Investigative ophthalmology & visual science.

[2]  Vasily Vorobyov,et al.  Strabismic suppression is mediated by inhibitory interactions in the primary visual cortex. , 2005, Cerebral cortex.

[3]  S. Stevenson,et al.  Post-retinal processing of background luminance , 1999, Vision Research.

[4]  Boris I Gramatikov,et al.  Pediatric Vision Screener 1: instrument design and operation. , 2004, Journal of biomedical optics.

[5]  Mark A. Pitt,et al.  A Hierarchical Adaptive Approach to Optimal Experimental Design , 2014, Neural Computation.

[6]  M. Clarke,et al.  Amblyopia , 2006, The Lancet.

[7]  Deborah Giaschi,et al.  Quantitative measurement of interocular suppression in children with amblyopia , 2011 .

[8]  Tuomas J. Lukka,et al.  Bayesian adaptive estimation: The next dimension , 2006 .

[9]  P. King-Smith,et al.  Efficient and unbiased modifications of the QUEST threshold method: Theory, simulations, experimental evaluation and practical implementation , 1994, Vision Research.

[10]  George Sperling,et al.  A gain-control theory of binocular combination. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[11]  Zhong-Lin Lu,et al.  Generating high gray-level resolution monochrome displays with conventional computer graphics cards and color monitors , 2003, Journal of Neuroscience Methods.

[12]  Kurt Simons,et al.  Amblyopia characterization, treatment, and prophylaxis. , 2005, Survey of ophthalmology.

[13]  Jiawei Zhou,et al.  Deficient binocular combination reveals mechanisms of anisometropic amblyopia: signal attenuation and interocular inhibition. , 2011, Journal of vision.

[14]  Robert F Hess,et al.  A Compact Clinical Instrument for Quantifying Suppression , 2011, Optometry and vision science : official publication of the American Academy of Optometry.

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

[16]  Denis G Pelli,et al.  A double dissociation of the acuity and crowding limits to letter identification, and the promise of improved visual screening. , 2014, Journal of vision.

[17]  Christina Bougatsos,et al.  Screening for Visual Impairment in Children Ages 1–5 Years: Update for the USPSTF , 2011, Pediatrics.

[18]  Aart C Kooijman,et al.  Relationship between contrast sensitivity and spherical aberration: Comparison of 7 contrast sensitivity tests with natural and artificial pupils in healthy eyes , 2009, Journal of cataract and refractive surgery.

[19]  Luis A. Lesmes,et al.  Bayesian adaptive estimation of threshold versus contrast external noise functions: The quick TvC method , 2006, Vision Research.

[20]  D H Brainard,et al.  The Psychophysics Toolbox. , 1997, Spatial vision.

[21]  The effect of different forms of monocular occlusion on measures of central visual function , 1998, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[22]  C. Suttle,et al.  A novel apparatus for interocular interaction evaluation in children with and without anisometropic amblyopia , 2012, Clinical & experimental optometry.

[23]  Chang-Bing Huang,et al.  qCSF in clinical application: efficient characterization and classification of contrast sensitivity functions in amblyopia. , 2010, Investigative ophthalmology & visual science.

[24]  M. Maguire,et al.  Sensitivity of Screening Tests for Detecting Vision In Preschoolers-targeted Vision Disorders When Specificity Is 94% , 2005, Optometry and vision science : official publication of the American Academy of Optometry.

[25]  C. Blakemore,et al.  Physiology of suppression in strabismic amblyopia. , 1996, The British journal of ophthalmology.

[26]  Visual loss during interocular suppression in normal and strabismic subjects , 1994, Vision Research.

[27]  J. Hardin,et al.  Compliance with vision-screening guidelines among a national sample of pediatricians. , 2002, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.

[28]  R. Hess,et al.  Interocular suppression in amblyopia for global orientation processing. , 2013, Journal of vision.

[29]  Vision Research , 1961, Nature.

[30]  M. I. Ehrlich,et al.  Preschool vision screening for amblyopia and strabismus. Programs, methods, guidelines, 1983. , 1983, Survey of ophthalmology.

[31]  Lynne Kiorpes,et al.  Factors limiting contrast sensitivity in experimentally amblyopic macaque monkeys , 1999, Vision Research.

[32]  Linda Lundström,et al.  Quick contrast sensitivity measurements in the periphery. , 2014, Journal of vision.

[33]  C. Tyler,et al.  Bayesian adaptive estimation of psychometric slope and threshold , 1999, Vision Research.

[34]  R. F. Hess,et al.  Binocular integration of contrast information in amblyopia , 1992, Vision Research.

[35]  J. Atkinson,et al.  Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening , 1996 .

[36]  D G Pelli,et al.  The VideoToolbox software for visual psychophysics: transforming numbers into movies. , 1997, Spatial vision.

[37]  Gui-shuang Ying,et al.  Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study. , 2004, Ophthalmology.

[38]  J. Naor,et al.  Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia. , 2000, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[39]  Yasunari Yokota,et al.  Facilitation of perceptual filling-in for spatio-temporal frequency of dynamic textures , 2005 .

[40]  R. Hess,et al.  Interocular suppression in normal and amblyopic vision: spatio-temporal properties. , 2012, Journal of vision.

[41]  S. Loudon,et al.  Rapid, high-accuracy detection of strabismus and amblyopia using the pediatric vision scanner. , 2011, Investigative ophthalmology & visual science.

[42]  Pengjing Xu,et al.  Perceptual learning improves contrast sensitivity and visual acuity in adults with anisometropic amblyopia , 2006, Vision Research.

[43]  Wolf Singer,et al.  Binocular interaction in the peripheral visual field of humans with strabismic and anisometropic amblyopia , 1981, Vision Research.

[44]  Zhong-Lin Lu,et al.  Contrast and Phase Combination in Binocular Vision , 2010, PloS one.

[45]  Zhong-Lin Lu,et al.  Bayesian adaptive estimation of the contrast sensitivity function: the quick CSF method. , 2010, Journal of vision.

[46]  Maria S Castanes.  Major review: The underutilization of vision screening (for amblyopia, optical anomalies and strabismus) among preschool age children. , 2003, Binocular vision & strabismus quarterly.

[47]  R. Ingram.  Refraction as a basis for screening children for squint and amblyopia. , 1977, The British journal of ophthalmology.

[48]  A. Watson,et al.  A standard model for foveal detection of spatial contrast. , 2005, Journal of vision.

[49]  David G Hunter,et al.  Amblyopia: diagnostic and therapeutic options. , 2006, American journal of ophthalmology.

[50]  Tim S. Meese,et al.  Contrast masking in strabismic amblyopia: Attenuation, noise, interocular suppression and binocular summation , 2008, Vision Research.

[51]  G. Maehara,et al.  The role of suppression in amblyopia , 2011 .

[52]  D Regan,et al.  Contrast sensitivity, visual acuity and the discrimination of Snellen letters in multiple sclerosis. , 1981, Brain : a journal of neurology.

[53]  马楠,et al.  Amblyopia , 2016 .

[54]  F. Duffy,et al.  Microiontophoretic bicuculline restores binocular responses to visual cortical neurons in strabismic cats , 1984, Brain Research.

[55]  J. Karnon,et al.  The clinical effectiveness and cost-effectiveness of screening programmes for amblyopia and strabismus in children up to the age of 4-5 years: a systematic review and economic evaluation. , 2008, Health technology assessment.

[56]  A. Watson,et al.  Quest: A Bayesian adaptive psychometric method , 1983, Perception & psychophysics.

[57]  R. Hess,et al.  Time course of dichoptic masking in normals and suppression in amblyopes. , 2014, Investigative ophthalmology & visual science.

[58]  Yong Tang,et al.  A normative framework for the study of second-order sensitivity in vision. , 2014, Journal of vision.

[59]  D. G. Green,et al.  Optical and retinal factors affecting visual resolution. , 1965, The Journal of physiology.

[60]  M. He,et al.  Visual functions and interocular interactions in anisometropic children with and without amblyopia. , 2011, Investigative ophthalmology & visual science.

[61]  Hugh R. Wilson,et al.  A deficit in strabismic amblyopia for global shape detection , 1999, Vision Research.

[62]  J. Sjöstrand,et al.  Prevention of Amblyopia and the Concept of Cure , 1997, European journal of ophthalmology.