Evaluation of visual plasticity in patients with refractive amblyopia treated using a visual perceptual learning system.

BACKGROUND: Amblyopia is a neurological deficit in binocular vision that affects 3% of the population and is the result of disruptions in early visual development. OBJECTIVE: In this study, we used a visual perceptual learning system for the short-term treatment of children with ametropic amblyopia and evaluated the clinical efficacy of this system in terms of visual plasticity. METHODS: We conducted a retrospective analysis of the clinical data of 114 children (228 eyes) with refractive amblyopia, who were aged 6.51 ± 1.51 years. Prior to the treatment, we evaluated all children with amblyopia using the visual information processing test. We determined the type of amblyopic defect according to the type of amblyopia, corrected visual acuity, and advanced visual function test results. Based on the type of defect, each child with amblyopia was given short-term visual perception training for 10 days. Finally, we compared the results of visual acuity and visual information processing tests before and after the treatment. RESULTS: The best-corrected visual acuity of patients was better after 10 days of visual training than that before training (P< 0.05). The perceptual eye position after training improved with statistically significant differences in horizontal and vertical perceptual eye position (both P< 0.05) compared to that before training. The number of amblyopic children without suppression in both eyes was 81 cases (71.1%) after training which was higher than that (65 cases, or 57.0%) before training, with a statistically significant difference (P< 0.05). Binocular fine stereopsis and dynamic stereopsis improved after training with a statistically significant difference (both P< 0.05). CONCLUSION: In this study, it was found that patients with amblyopia showed visual plasticity. Moreover, continuous visual perceptual learning improved the best-corrected visual acuity and recovered stereopsis in children with refractive amblyopia.

Application of piggy-back lens in the correction of severe keratoconus: A case study.

OBJECTIVE: This is a case study on the application of a piggy-back lens in the correction of severe keratoconus. METHODS: From the results of general eye examination, refractive state examination, and corneal morphology examination on the patient, it was determined that corneal protrusion and deformation of the right eye were obvious. The right eye was corrected using a piggy-back lens and the left eye with a rigid gas-permeable contact lens (RGPCL) alone. RESULTS: The right-eye lens fit well and the lens coverage was good. Both the static and dynamic fit results for the left-eye lens were good. After wearing the glasses for one month, the patient attended a review and stated that the lenses were comfortable to wear. The patient's vision was good after wearing the lenses. No obvious congestion was found in the conjunctiva under a slit lamp. The effects on both eyes of wearing RGPCLs were favorable. The corneal curvature reduced and the corneal thickness only changed to a small degree. CONCLUSION: For keratoconus patients, application of a piggy-back lens can improve corrected visual acuity, comfort levels, and safety, prolong the wearing time, and enhance the effect of orthokeratology.

The Modulation of Laser Refractive Surgery on Sensory Eye Dominance of Anisometropia.

PURPOSE: To evaluate the effect of laser refractive surgery on sensory eye dominance of anisometropia. METHODS: A total of 156 subjects with nonanisometropic myopia and 70 subjects with anisometropic myopia were enrolled in the first part of the study. The dichoptic motion coherence threshold technique was applied to collect the normal dataset and distribution of sensory eye dominance. The second part of the study included 40 subjects with nonanisometropic myopia and 40 subjects with anisometropic myopia who received the femtosecond laser-assisted in situ keratomileusis (Fs-LASIK). A comprehensive ophthalmologic evaluation was performed with particular attention to sensory eye dominance preoperatively and one-week and one-month postoperatively. The ocular dominance index (ODI) was applied to evaluate the subject's overall degree of sensory ocular dominance. Visual acuity, sighting eye dominance, and stereo acuity were also accessed. RESULTS: In experiment one, the mean ODI in the nonanisometropic group and the anisometropic group was 1.48 ± 0.63 and 1.95 ± 1.07, respectively. The ODI values of the anisometropic group were significantly higher than those of the nonanisometropic group (Mann-Whitney U test, P < 0.001). The demographics information and the distribution of ODI values in both groups are summarized in tables and figures. In experiment two, all LASIK procedures were uneventful and no postoperative complications were observed during the postoperative follow-up. Preoperatively, the ODI values of the anisometropic LASIK group were significantly higher than those of the nonanisometropic LASIK group, which was consistent with the results of part 1. However, one week after operation, the mean ODI values of the anisometropic LASIK group had significantly decreased from 1.89 ± 1.09 to 1.39 ± 0.44. And, the mean ODI values slightly increased to 1.65 ± 0.61 one-month postoperatively. In the nonanisometropic LASIK group, there were no statistically significant differences of ODI changes among preoperative, post-one-week and post-one-month visits. The demographics information and the changes of ODI of both LASIK groups are summarized in tables and figures. CONCLUSION: Stronger sensory eye dominance is seen in the subjects with anisometropic myopia compared to subjects with nonanisometropic myopia. The strong sensory dominance of anisometropia becomes more balanced at one week of postoperation but returns to the preoperative level after one month. Laser refractive surgery had a short-term modulation of sensory eye dominance.

The effects of monocular training on binocular functions in anisometropic amblyopia.

Intensive monocular perceptual learning can improve visual acuity, contrast sensitivity, and vernier acuity in the amblyopic eye in adults with amblyopia. It is however not clear how much monocular training can enhance binocular visual functions. In the current study, we aimed to evaluate effects of monocular training on a variety of binocular functions. Nineteen anisometropic amblyopes (18.5±1.26yrs, mean±s.e.) were trained in a grating contrast detection task near each individual's cutoff spatial frequency for 6-10days (630 trials/day). Visual acuity, stereoacuity, monocular and binocular contrast sensitivity functions (CSF), binocular phase combination and binocular rivalry were tested before and after training. Although monocular training can improve visual acuity and contrast sensitivity and eye dominance of the amblyopic eye, the magnitudes of improvements did not correlate with each other; the impact of monocular training on binocular phase combination was not significant. The results strongly suggest that structured monocular and binocular training is needed to fully recover deficient visual functions in anisometropic amblyopia.