Showing papers by "Robert F. Hess published in 2021"

Adherence to home-based videogame treatment for amblyopia in children and adults.

Abstract: Clinical relevance: Home-based videogame treatments are increasingly popular for amblyopia treatment. However, at-home treatments tend to be done in short sessions and with frequent disruptions, which may reduce the effectiveness of binocular visual stimulation. These treatment adherence patterns need to be accounted for when considering dose-response relationships and treatment effectiveness.Background: Home-based videogame treatments are increasingly being used for various sensory conditions, including amblyopia ('lazy eye'), but treatment adherence continues to limit success. To examine detailed behavioural patterns associated with home-based videogame treatment, we analysed in detail the videogame adherence data from the Binocular tReatment of Amblyopia with VideOgames (BRAVO) clinical trial (ACTRN12613001004752).Methods: Children (7-12 years), teenagers (13-17 years) and adults (≥ 18 years) with unilateral amblyopia were loaned iPod Touch devices with either an active treatment or placebo videogame and instructed to play for a total of 1-2 hours/day for six weeks at home. Objectively-recorded adherence data from device software were used to analyse adherence patterns such as session length, daily distribution of gameplay, use of the pause function, and differences between age groups. Objectively-recorded adherence was also compared to subjectively-reported adherence from paper-based diaries.Results: One hundred and five of the 115 randomised participants completed six weeks of videogame training. Average adherence was 65% (SD 37%) of the minimum hours prescribed. Game training was generally performed in short sessions (mean 21.5, SD 11.2 minutes), mostly in the evening, with frequent pauses (median every 4.1 minutes, IQR 6.1). Children played in significantly shorter sessions and paused more frequently than older age groups (p < 0.0001). Participants tended to over-report adherence in subjective diaries compared to objectively-recorded gameplay time.Conclusion: Adherence to home-based videogame treatment was characterised by short sessions interspersed with frequent pauses, suggesting regular disengagement. This complicates dose-response calculations and may interfere with the effectiveness of treatments like binocular treatments for amblyopia, which require sustained visual stimulation.

Effect of dichoptic video game treatment on mild amblyopia - a pilot study.

Abstract: PURPOSE The effect of contrast-balanced dichoptic video game training on distance visual acuity (DVA) and stereo acuity has been investigated in severe-to-moderate amblyopia, but its effect on mild amblyopia and fixation stability has not been assessed. This pilot study aimed to evaluate the effect of home-based dichoptic video game on amblyopic eye DVA, stereo acuity and fixation stability in adults with mild amblyopia. METHODS A randomized single-masked design was adopted. The active 6-week home-based treatment was an anaglyphic, contrast-balanced dichoptic video game, and the placebo was an identical non-dichoptic game. Participants (n = 23) had mild amblyopia (amblyopic DVA ≤ 0.28 log Minimum Angle of Resolution (logMAR)). The primary outcome was change in amblyopic DVA at 6 weeks postrandomization. Near visual acuity, stereo acuity and fixation stability (bivariate contour eclipse area) were also measured. Follow-up occurred at 12 and 24 weeks postrandomization. RESULTS Mean amblyopic eye DVA was 0.21 ± 0.06 and 0.18 ± 0.06 logMAR for the active (n = 12) and placebo (n = 11) group, respectively. Amblyopic DVA improved significantly more in the active group (0.09 ± 0.05) than in the placebo group (0.03 ± 0.04 logMAR; p < 0.05). The difference between groups remained at 12 weeks postrandomization (p = 0.04) but not at 24 weeks (p = 0.43). Titmus stereo acuities improved significantly more in the active group (0.40 log arcsec) than in the placebo group (0.09 log arcsec) after 6 weeks of gameplay. The between-group difference was still present at 24 weeks postrandomization (p = 0.05). There were no differences between groups on any other secondary outcomes. CONCLUSION Home-based dichoptic video gameplay may be an effective method to improve amblyopic DVA and stereo acuity in mild amblyopia.

Some psychophysical tasks measure ocular dominance plasticity more reliably than others.

Abstract: In the recent decade, studies have shown that short-term monocular deprivation strengthens the deprived eye's contribution to binocular vision. However, the magnitude of the change in eye dominance after monocular deprivation (i.e., the patching effect) has been found to be different between different methods and within the same method. There are three possible explanations for the discrepancy. First, the mechanisms underlying the patching effect that are probed by different measurement tasks might exist at different neural sites. Second, the test-retest variability of the same test can produce inconsistent results. Third, the magnitude of the patching effect itself within the same observer can vary across separate days or experimental sessions. To explore these possibilities, we assessed the test-retest reliability of the three most commonly used tasks (binocular rivalry, binocular combination, and dichoptic masking) and the repeatability of the shift in eye dominance after short-term monocular deprivation for each of the task. Two variations for binocular phase combination were used, at one and many contrasts of the stimuli. Also, two variations for dichoptic masking were employed; the orientation of the mask grating was either horizontal or vertical. Thus, five different tasks were evaluated. We hoped to resolve some of the inconsistencies reported in the literature concerning this form of visual plasticity. In this study, we also aimed to recommend a measurement method that would allow us to better understand its physiological basis and the underpinning of visual disorders.

The Flash-lag Effect in Amblyopia.

Abstract: Purpose Amblyopes suffer a defect in temporal processing, presumably because of a neural delay in their visual processing. By measuring flash-lag effect (FLE), we investigate whether the amblyopic visual system could compensate for the intrinsic neural delay due to visual information transmissions from the retina to the cortex. Methods Eleven adults with amblyopia and 11 controls with normal vision participated in this study. We assessed the monocular FLE magnitude for each subject by using a typical FLE paradigm: a bar moved horizontally, while a flashed bar briefly appeared above or below it. Three luminance contrasts of the flashed bar were tested: 0.2, 0.6, and 1. Results All participants, controls and those with amblyopia, showed a typical FLE. However, the FLE magnitude of participants with amblyopia was significantly shorter than that of the control participants, for both their amblyopic eye (AE) and fellow eye (FE). A nonsignificant difference was found in FLE magnitude between the AE and the FE. Conclusions We demonstrate a reduced FLE both in the AE as well as the FE of patients with amblyopia, suggesting a global visual processing deficit. We suggest it may be attributed to a more limited spatiotemporal extent of facilitatory anticipatory activity within the amblyopic primary visual cortex.

Shifting eye balance using monocularly directed attention in normal vision.

Abstract: In binocular vision, even without conscious awareness of eye of origin, attention can be selectively biased toward one eye by presenting a visual stimulus uniquely to that eye. Monocularly directed visual cues can bias perceptual dominance, as shown by studies using discrete measures of percept changes in continuous-flash suppression. Here, we use binocular rivalry to determine whether eye-based visual cues can modulate eye balance using continuous percept reporting. Using a dual-task versus single-task paradigm, we investigated whether the attentional load of these cues differentially modulates eye balance. Furthermore, both color-based and motion-based cue stimuli, non-overlaid and peripheral to the rivalry grating stimuli, were used to determine whether shifts in eye balance were stimulus specific. Aligned to cue stimulus onset, time series of percept reports were constructed and averaged across trials and participants. Specifically, for the monocular attention conditions, we found a significant shift in eye balance toward the cued eye and a significant difference in the time taken to switch from the dominating percept, regardless of whether the attention stimuli is color based or motion based. Although we did not find a significant main effect of attentional load, we found a significant interaction effect between the attentionally cued eye and attentional load on the shift in eye balance, indicating an influence of monocular attention on the shift in eye balance.

Balanced Binocular Inputs Support Superior Stereopsis.

Abstract: Purpose Our visual system compares the inputs received from the two eyes to estimate the relative depths of features in the retinal image. We investigated how an imbalance in the strength of the input received from the two eyes affects stereopsis. We also explored the level of agreement between different measurements of sensory eye imbalance. Methods We measured the sensory eye imbalance and stereoacuity of 30 normally sighted participants. We made our measurements using a modified amblyoscope. The sensory eye imbalance was assessed through three methods: the difference between monocular contrast thresholds, the difference in dichoptic masking weight, and the contribution of each eye to a fused binocular percept. We referred them as the "threshold imbalance," "masking imbalance," and "fusion imbalance," respectively. The stereoacuity threshold was measured by having subjects discriminate which of four circles were displaced in depth. All of our tests were performed using stimuli of the same spatial frequency (2.5 cycles/degree). Results We found a relationship between stereoacuity and sensory eye imbalance. However, this was only the case for fusion imbalance measurement (ρ = 0.52; P = 0.003). Neither the threshold imbalance nor the masking imbalance was significantly correlated with stereoacuity. We also found the threshold imbalance was correlated with both the fusion and masking imbalances (r = 0.46, P = 0.011 and r = 0.49, P = 0.005, respectively). However, a nonsignificant correlation was found between the fusion and masking imbalances. Conclusions Our findings suggest that there exist multiple types of sensory eye dominance that can be assessed by different tasks. We find only imbalances in dominance that result in biases to fused percepts are correlated with stereoacuity.

Cholinergic potentiation of binocular vision

Abstract: The present disclosure concerns the use of a cholinesterase inhibitor for improving binocular function and, in some embodiments, lessening an imbalance of binocular vision by promoting fusional ability and/or reducing interocular inhibition in a subject. The cholinesterase inhibitor can be used to treat or alleviate the symptoms of amblyopia or diplopia. The cholinesterase inhibitor can be a specific and reversible acetylcholinesterase inhibitor, such as, for example, donepezil (also referred to as donepezil or Aricept®).