A protocol to quantify cross-sectional and longitudinal differences in duction patterns.

Currently, there is no established system for quantifying patterns of ocular ductions. This poses challenges in tracking the onset and evolution of ocular motility disorders, as current clinical methodologies rely on subjective observations of individual movements. We propose a protocol that integrates image processing, a statistical framework of summary indices, and criteria for evaluating both cross-sectional and longitudinal differences in ductions to address this methodological gap. We demonstrate that our protocol reliably transforms objective estimates of ocular rotations into normative patterns of total movement area and movement symmetry. This is a critical step towards clinical application in which our protocol could first diagnose and then track the progression and resolution of ocular motility disorders over time.

Field-wide Quantification of Aniseikonia Using Dichoptic Localization.

SIGNIFICANCE: We validated a novel paradigm to measure aniseikonia across the visual field and used a mathematical approach that is able to describe the magnitude and shape of aniseikonia in a concise, clinically meaningful fashion. PURPOSE: The measurement of aniseikonia has been performed clinically for more than half a century; however, amalgamation of field-wide local variations in binocular spatial localization into clinically applicable global metrics has yet to be attempted. Thus, the goal of the current study was twofold: first, to measure field-wide aniseikonia and second, to compare how local and global metrics each capture optically induced aniseikonia. METHODS: Twelve visually normal observers performed a dichoptic localization task at 24 locations in the visual field. This was done in four conditions: (A) while wearing red-green filters, (B) while wearing green-red filters, (C) while wearing a monocular 5% overall size lens, and (D) while wearing a monocular 6% meridional size lens. The physical settings at perceptual equality were then used to compute both local (relative magnification) and global (coefficients for Zernike terms) descriptors of aniseikonia. RESULTS: The comparison of each lens condition to the baseline condition confirmed predicted shifts in both the sign and magnitude of aniseikonia at both the local and global levels; however, the intraobserver levels of precision were moderate, and systematic underestimations were present across all locations in conditions C and D. CONCLUSIONS: Local and global analyses derived from dichoptic localization data were both able to capture optically induced changes in binocular spatial perception; however, solutions that address the diagnostic and therapeutic challenges associated with this paradigm are needed before clinical implementation can proceed.

Effect of chromatic filters on visual performance in individuals with mild traumatic brain injury (mTBI): A pilot study / Efecto de los filtros cromáticos en la función visual de sujetos con lesión cerebral traumática leve (mTBI): Estudio Piloto

Purpose: Spectral filters have been used clinically in patients with mild traumatic brain injury (mTBI). However, they have not been formally assessed using objective techniques in this population. Thus, the aim of the present pilot study was to determine the effect of spectral filters on reading performance and visuo-cortical responsivity in adults with mTBI. Methods: 12 adults with mTBI/concussion were tested. All reported photosensitivity and reading problems. They were compared to 12 visually-normal, asymptomatic adults. There were several test conditions: three luminance-matched control filters (gray neutral density, blue, and red), the patient-selected ‘precision tint lens’ that provided the most comfort and clarity of text using the Intuitive Colorimeter System, and baseline without any filters. The Visagraph was used to assess reading eye movements and reading speed objectively with each filter. In addition, both the amplitude and latency of the visual-evoked potential (VEP) were assessed with the same filters. Results: There were few significant group differences in either the reading-related parameters or VEP latency for any of the test filter conditions. Subjective improvements were noted in most with mTBI (11/12). Conclusions: The majority of patients with mTBI chose a tinted filter that resulted in increased visual comfort. While significant findings based on the objective testing were found for some conditions, the subjective results suggest that precision tints should be considered as an adjunctive treatment in patients with mTBI and photosensitivity (AU)

Objetivo: Los filtros espectrales han sido utilizados clínicamente en pacientes con lesión cerebral traumática leve (mTBI). Sin embargo, no han sido evaluados formalmente utilizando técnicas objetivas en esta población. Por tanto, el objetivo del presente estudio piloto fue el de determinar el efecto de dichos filtros sobre el rendimiento lector y la respuesta visual-cortical en adultos con mTBI. Métodos: Se realizaron pruebas a doce adultos con mTBI/conmoción. Todos ellos reportaron fotosensibilidad y problemas lectores. Se realizó una comparación con adultos asintomáticos y con visión normal. Las pruebas se llevaron a cabo bajo diversas situaciones: uso de tres filtros de control con equivalencia de luminosidad (gris con densidad neutra, azul, y rojo), ‘lentes tintadas de precisión’, seleccionadas por el paciente, que aportaban mayor confort y claridad de texto utilizando un sistema colorimétrico intuitivo, y valores basales sin utilizar ningún filtro. Se utilizó el Visagraph para evaluar los movimientos oculares durante la lectura y la velocidad lectora de manera objetiva con cada filtro. Además, se evaluaron tanto la amplitud como la latencia de los potenciales evocados visuales (VEP) con los mismos filtros. Resultados: Se produjeron pocas diferencias grupales significativas, tanto en relación a los parámetros relacionados con la lectura como a la latencia de los VEP, en cualquiera de las situaciones de prueba de los filtros. Se notaron mejoras subjetivas en la mayoría de sujetos con mTBI (11/12). Conclusiones: La mayoría de los pacientes con mTBI eligieron un filtro coloreado que incrementó su confort visual. Aunque se detectaron hallazgos significativos basados en las pruebas objetivas para algunas situaciones, los resultados subjetivos sugieren que deben considerarse las lentes tintadas de precisión como tratamiento adyuvante en los pacientes con mTBI y fotosensibilidad (AU)

Effect of chromatic filters on visual performance in individuals with mild traumatic brain injury (mTBI): A pilot study.

PURPOSE: Spectral filters have been used clinically in patients with mild traumatic brain injury (mTBI). However, they have not been formally assessed using objective techniques in this population. Thus, the aim of the present pilot study was to determine the effect of spectral filters on reading performance and visuo-cortical responsivity in adults with mTBI. METHODS: 12 adults with mTBI/concussion were tested. All reported photosensitivity and reading problems. They were compared to 12 visually-normal, asymptomatic adults. There were several test conditions: three luminance-matched control filters (gray neutral density, blue, and red), the patient-selected 'precision tint lens' that provided the most comfort and clarity of text using the Intuitive Colorimeter System, and baseline without any filters. The Visagraph was used to assess reading eye movements and reading speed objectively with each filter. In addition, both the amplitude and latency of the visual-evoked potential (VEP) were assessed with the same filters. RESULTS: There were few significant group differences in either the reading-related parameters or VEP latency for any of the test filter conditions. Subjective improvements were noted in most with mTBI (11/12). CONCLUSIONS: The majority of patients with mTBI chose a tinted filter that resulted in increased visual comfort. While significant findings based on the objective testing were found for some conditions, the subjective results suggest that precision tints should be considered as an adjunctive treatment in patients with mTBI and photosensitivity.

The effect of spectral filters on VEP and alpha-wave responses / Efecto de los filtros espectrales sobre el PVE y las respuestas de las ondas alfa

Purpose: Spectral filters are used to treat light sensitivity in individuals with traumatic brain injury (TBI); however, the effect of these filters on normal visual function has not been elucidated. Thus, the current study aimed to determine the effect of spectral filters on objectively-measured visual-evoked potential (VEP) and alpha-wave responses in the visually-normal population. Methods: The full-field (15°H×17°V), pattern-reversal VEP (20′ check size, mean luminance 52cd/m2) was administered to 20 visually-normal individuals. They were tested with four Intuitive-Colorimeter-derived, broad-band, spectral filters (i.e., gray/neutral density, blue, yellow, and red), which produced similar luminance values for the test stimulus. The VEP N75 and P100 latencies, and VEP amplitude, were recorded. Power spectrum analysis was used to derive the respective powers at each frequency, and peak frequency, for the selected 9-11Hz components of the alpha band. Results: Both N75 and P100 latencies increased with the addition of each filter when compared to baseline. Additionally, each filter numerically reduced intra-session amplitude variability relative to baseline. There were no significant effects on either the mean VEP amplitude or alpha wave parameters. Conclusions: The Intuitive Colorimeter filters significantly increased both N75 and P100 latencies, an effect which is primarily attributable (∼75%) to luminance, and in some cases, specific spectral effects (e.g., blue and red). VEP amplitude and alpha power were not significantly affected. These findings provide an important reference to which either amplitude or power changes in light-sensitive, younger clinical groups can be compared (AU)

Objetivo: Los filtros espectrales se utilizan para tratar la sensibilidad a la luz en individuos con lesión cerebral traumática (TBI); sin embargo, no se ha esclarecido el efecto de estos filtros sobre la función visual normal. Por ello, el estudio actual trató de determinar el efecto de los filtros espectrales sobre el potencial evocado visual (PVE) y las respuestas de las ondas alfa, medido objetivamente en la población con visión normal. Métodos: Se aplicó un PVE de campo completo (15°H×17°V), y patrón invertido (tamaño de estímulo de 20’, y luminancia media de 52cd/m2) a veinte individuos con visión normal. Se realizó la prueba utilizando cuatro filtros espectrales de banda ancha, derivados del Colorímetro Intuitivo (densidad gris/neutra, azul, amarillo y rojo), que produjeron unos valores de luminancia similares para los estímulos de la prueba. Se registraron las latencias N75 y P100, y la amplitud del PVE. Se utilizó el análisis del espectro de potencia para calcular las respectivas potencias en cada frecuencia, así como la frecuencia máxima, para los componentes seleccionados de 9-11Hz de la banda alfa. Resultados: Ambas latencias N75 y P100 se incrementaron con la incorporación de cada filtro, en comparación a la línea basal. Además, cada filtro redujo numéricamente la variabilidad de la amplitud intra-sesión, en relación a la línea basal. No se produjeron efectos significativos sobre la amplitud del PVE medio o los parámetros de la onda alfa. Conclusiones: Los filtros del Colorímetro Intuitivo redujeron considerablemente las latencias N75 y P100, un efecto que es principalmente atribuible a la luminancia (∼75%), y en algunos casos a los efectos espectrales específicos (es decir, el azul y el rojo). La amplitud del PVE y la potencia alfa no se vieron significativamente afectados. Estos hallazgos aportan una importante referencia para poder comparar tanto los cambios de amplitud como de potencia en los grupos clínicos de personas más jóvenes, con sensibilidad a la luz (AU)

The effect of spectral filters on VEP and alpha-wave responses.

PURPOSE: Spectral filters are used to treat light sensitivity in individuals with traumatic brain injury (TBI); however, the effect of these filters on normal visual function has not been elucidated. Thus, the current study aimed to determine the effect of spectral filters on objectively-measured visual-evoked potential (VEP) and alpha-wave responses in the visually-normal population. METHODS: The full-field (15°H×17°V), pattern-reversal VEP (20' check size, mean luminance 52cd/m(2)) was administered to 20 visually-normal individuals. They were tested with four Intuitive-Colorimeter-derived, broad-band, spectral filters (i.e., gray/neutral density, blue, yellow, and red), which produced similar luminance values for the test stimulus. The VEP N75 and P100 latencies, and VEP amplitude, were recorded. Power spectrum analysis was used to derive the respective powers at each frequency, and peak frequency, for the selected 9-11Hz components of the alpha band. RESULTS: Both N75 and P100 latencies increased with the addition of each filter when compared to baseline. Additionally, each filter numerically reduced intra-session amplitude variability relative to baseline. There were no significant effects on either the mean VEP amplitude or alpha wave parameters. CONCLUSIONS: The Intuitive Colorimeter filters significantly increased both N75 and P100 latencies, an effect which is primarily attributable (∼75%) to luminance, and in some cases, specific spectral effects (e.g., blue and red). VEP amplitude and alpha power were not significantly affected. These findings provide an important reference to which either amplitude or power changes in light-sensitive, younger clinical groups can be compared.

Objective Assessment of Eye Dominance Using the VEP: A Pilot Study.

OBJECTIVES: To develop a clinical protocol for the determination of eye dominance using an objective method (i.e., the visual evoked potential [VEP]), and furthermore to determine the correlation of these objective findings with clinical subjective tests of eye dominance to provide guidance in clinical monovision refractive correction. METHODS: The Diopsys NOVA-TR system was used to record the VEP amplitude and latency of 10 visually-normal, presbyopic, adult subjects aged 50 to 70 years ((Equation is included in full-text article.)=60, SEM=0.17 years). First, eye dominance was assessed in two ways: a sensory-based "sensitivity to blur task" and a motor-based "sighting task." Next, while monocularly defocused, subjects binocularly viewed a black-and-white checkerboard (20-min arc size), pattern-reversal stimulus under 7 different test conditions: (1) baseline, (2) dominant (DE) eye blurred +1 diopter (D), (3) nondominant (NDE) eye blurred +1 D, (4) DE +2 D, (5) NDE +2 D, (6) DE +3 D, and (7) NDE +3 D. RESULTS: Under nearly all conditions (22/24=92%), the amplitude and latency were significantly different from baseline with any amount of defocus (P<0.05). Monocular defocus decreased, and increased, the mean binocular VEP amplitude and latency, respectively. There were no significant differences in either the binocular VEP amplitude or latency values when comparing defocused dominant vs. nondominant eyes. CONCLUSIONS: Eye dominance type (i.e., sensory or motor) and status (i.e., DE or NDE) did not provide a differential effect with respect to the VEP findings. Thus, the VEP technique does not show promise as an objective adjunct in the fitting of monovision correction.

Amacrine cell subtypes differ in their intrinsic neurite growth capacity.

PURPOSE: Amacrine cell neurite patterning has been extensively studied in vivo, and more than 30 subpopulations with varied morphologies have been identified in the mammalian retina. It is not known, however, whether the complex amacrine cell morphology is determined intrinsically, is signaled by extrinsic cues, or both. METHODS: Here we purified rat amacrine cell subpopulations away from their retinal neighbors and glial-derived factors to ask questions about their intrinsic neurite growth ability. In defined medium strongly trophic for amacrine cells in vitro, we characterized survival and neurite growth of amacrine cell subpopulations defined by expression of specific markers. RESULTS: We found that a series of amacrine cell subtype markers are developmentally regulated, turning on through early postnatal development. Subtype marker expression was observed in similar fractions of cultured amacrine cells as was observed in vivo, and was maintained with time in culture. Overall, amacrine cell neurite growth followed principles very similar to those in postnatal retinal ganglion cells, but embryonic retinal ganglion cells demonstrated different features, relating to their rapid axon growth. Surprisingly, the three subpopulations of amacrine cells studied in vitro recapitulated quantitatively and qualitatively the varied morphologies they have in vivo. CONCLUSIONS: Our data suggest that cultured amacrine cells maintain intrinsic fidelity to their identified in vivo subtypes, and furthermore, that cell-autonomous, intrinsic factors contribute to the regulation of neurite patterning.

Objective assessment of the human visual attentional state.

PRIMARY OBJECTIVE: The purpose of this study was to develop an objective way to assess human visual attention using the alpha-band component of the visual-evoked potential (VEP). DESIGN AND METHODS: Six different attentional conditions were tested: eyes-open, eyes-closed, eyes-closed with backwards number counting, and three rapid-serial visual presentation (RSVP) tasks. Eighteen visually normal, young-adult subjects (ages 21-28 years) were tested binocularly at 1 m for each condition on two separate days. The Diopsys™ NOVA-TR system was used to obtain the visual-evoked potential (VEP) and extracted alpha wave and its related power spectrum. Additionally, the Visual Search and Attention Test (VSAT) was administered as a subjective measure of visual attention. RESULTS: Subjects exhibited significant decreases in power in the alpha band when comparing the eyes-closed with the eyes-open conditions, with power in the eyes-closed condition being, on average, twice as large. The response from the other four conditions did not reflect the differential attentional demands. The ratio of the power in the eyes-closed condition to the eyes-open condition in the lower-alpha frequencies (8-10 Hz) was found to be significantly correlated with the group's performance on the VSAT, especially the 10-Hz component. CONCLUSIONS: An individual's ability to attenuate their alpha component during visual processing may be a predictor of their visual attentional state. These findings solidify the role of the VEP alpha subcomponent as an objective electrophysiological correlate of visual attention, which may be useful in the diagnosis and treatment of human visual attention disorders in the future.

Effect of test duration on the visual-evoked potential (VEP) and alpha-wave responses.

PRIMARY OBJECTIVE: The purpose of this study was to assess the effect of test duration on the visual-evoked potential (VEP) and related alpha power spectrum measures. DESIGN AND METHODS: Two conditions (eyes-closed and eyes-open) were tested using four different durations: 10, 20, 45, and 60 s. The Diopsys™ NOVA-TR system was used to obtain the visual-evoked potential (VEP) and extracted alpha wave with its related power spectrum. Sixteen visually normal, young-adult subjects (aged 22-25 years) participated in the experiment. The stimulus for the eyes-open condition consisted of a black-and-white, alternating checkerboard pattern with a small central fixation target. All trials were performed during one session. RESULTS: Regarding the VEP parameters, only variability of the VEP amplitude changed significantly with test duration. Sentence should end with a period, not a colon. It decreased with increasing test duration, with the 45- and 60-s trials showing similarly low variability. Regarding the alpha-wave parameters, test duration did not have a significant effect on either the mean alpha power or its variability across trials. CONCLUSIONS: The findings demonstrate that forty-five-second test durations are sufficient to minimize intra-session variability of the VEP amplitude and latency measurements, whereas 10-s test durations may be sufficient for accurate measurement of the alpha wave. Optimization of test duration allows for repeatable measures with less total test time. This is especially important for special clinical populations.

Smoking and age-related macular degeneration: biochemical mechanisms and patient support.

A small percentage of the population associates smoking with ocular disease. Most optometrists do not stress the importance of smoking cessation to their patients, and the centrality of smoking regarding the risk for ocular disease is not emphasized in optometric education. Age-related macular degeneration has strong epidemiological associations with smoking, and so serves as an appropriate model for the adverse effects of cigarette smoke on the eye. This article aims to provide basic scientific information to optometrists and optometry students so that they can better understand the pathogenesis of age-related macular degeneration and provide education and support to their patients wishing to stop smoking.