Rowan Candy

Cortical visual impairment (CVI) is the leading cause of bilateral visual impairment in children in Western countries. This finding reflects better methods for identifying visual impairment due to CNS injury and also advances in perinatal care, which have increased the survival rate of children with neurological morbidity. This review will describe advances in the diagnosis and management of CVI. Central to our discussion is a definition of CVI that includes a decrease in visual acuity. New treatment and rehabilitative measures are badly needed for this disorder. We hope to stimulate interest in CVI, a disease that has become a significant public health problem.

purpose. Infants and children with Down syndrome show reduced visual acuity and contrast sensitivity when tested with conventional behavioral techniques. These results may reflect sensory deficits of optical or neural origin or a loss of performance in mechanisms responsible for generating the behavioral response. The purpose of this study was to compare objective acuity and contrast sensitivity measurements recorded with visual-evoked potentials (VEPs), with behavioral clinical test results in a group of children with Down syndrome and a group of control subjects. The goal was to determine whether children with Down syndrome still have a sensory deficit when tested using a procedure that is less cognitively demanding than conventional tests.methods. The subject group comprised 58 children with Down syndrome and 44 control subjects, aged 3 months to 14.15 years. Visual acuity and contrast sensitivity were measured with steady state, swept VEPs and behavioral techniques. VEP acuity was obtained from 36 children with Down syndrome and 40 control subjects, and behavioral acuity from 54 children with Down syndrome and 35 control subjects. VEP contrast sensitivity was measured in 24 children with Down syndrome and 34 control subjects, and behavioral contrast sensitivity in 42 children with Down syndrome and 25 control subjects. Group differences in visual acuity and contrast sensitivity were analyzed with an analysis of covariance (ANCOVA), with age as a covariate.results. Visual acuity thresholds were significantly lower in the group with Down syndrome than in the control group. This was true for both VEP (P< 0.01) and …

This review aims to disentangle cause and effect in the relationship between anisometropia and amblyopia. Specifically, we examine the literature for evidence to support different possible developmental sequences that could ultimately lead to the presentation of both conditions. The prevalence of anisometropia is around 20% for an inter-ocular difference of 0.5D or greater in spherical equivalent refraction, falling to 2–3%, for an inter-ocular difference of 3D or above. Anisometropia prevalence is relatively high in the weeks following birth, in the teenage years coinciding with the onset of myopia and, most notably, in older adults starting after the onset of presbyopia. It has about one-third the prevalence of bilateral refractive errors of the same magnitude. Importantly, the prevalence of anisometropia is higher in highly ametropic groups, suggesting that emmetropization failures underlying ametropia and …

Symmetry is a highly salient feature of animals, plants, and the constructed environment. Although the perceptual phenomenology of symmetry processing is well understood, little is known about the underlying neural mechanisms. Here we use visual evoked potentials to measure the time course of neural events associated with the extraction of symmetry in random dot fields. We presented sparse random dot patterns that were symmetric about both the vertical and horizontal axes. Symmetric patterns were alternated with random patterns of the same density every 500 msec, using new exemplars of symmetric and random patterns on each image update. Random/random exchanges were used as a control. The response to updates of random patterns was multiphasic, consisting of P65, N90, P110, N140 and P220 peaks. The response to symmetric/random sequences was indistinguishable from that for random/random sequences up to about 220 msec, after which the response to symmetric patterns became relatively more negative. Symmetry in random dot patterns thus appears to be extracted after an initial response phase that is indifferent to configuration. These results are consistent with the hypothesis (Lee, Mumford, Romero, & Lamme, 1998; Tyler & Baseler, 1998) that the symmetry property is extracted by processing in extrastriate cortex.

PurposeEccentric photorefraction provides an opportunity to gather rapid and remote estimates of refraction and gaze position from infants. The technique has the potential for extensive use in vision screenings and studies of visual development. The goal of this study was to assess the refraction calibration of the PowerRefractor (Multichannel Systems) for use with uncyclopleged infants.MethodsThe defocus measurements from the instrument were compared with the results of simultaneous retinoscopy in one analysis and with known amounts of defocus induced with trial lenses in another. Data were collected from infants 1 to 6 months of age and adults.ResultsThe PowerRefractor typically read< 1 D of myopia when the retinoscopy reflex was judged to be neutral at the same working distance in both infants and adults. The slopes of both infant and adult validation functions (trial lens power vs. measurement of …

Accommodation and vergence help maintain single and focused visual experience while an object moves in depth. The relative importance of retinal blur and disparity, the primary sensory cues to accommodation and vergence, is largely unknown during development; a period when growth of the eye and head necessitate continual recalibration of egocentric space. Here we measured the developmental importance of retinal disparity in 192 typically developing subjects (1.9 months to 46 years). Subjects viewed high-contrast cartoon targets with naturalistic spatial frequency spectra while their accommodation and vergence responses were measured from both eyes using a PowerRefractor. Accommodative gain was reduced during monocular viewing relative to full binocular viewing, even though the fixating eye generated comparable tracking eye movements in the two conditions. This result was consistent across three forms of monocular occlusion. The accommodative gain was lowest in infants and only reached adult levels by 7 to 10 years of age. As expected, the gain of vergence was also reduced in monocular conditions. When 4-to 6-year-old children read 20/40-sized letters, their monocular accommodative gain reached adult-like levels. In summary, binocular viewing appears necessary under naturalistic viewing conditions to generate full accommodation and vergence responses in typically developing humans.

We examined the properties of the foveal, parafoveal, and near peripheral cone lattice in human neonates. To estimate the ability of these lattices to transmit the information used in contrast sensitivity and visual acuity tasks, we constructed ideal-observer models with the optics and photoreceptors of the neonatal eye at retinal eccentricities of 0, 5, and 10°. For ideal-observer models limited by photon noise, the eye's optics, and cone properties, contrast sensitivity was higher in the parafovea and near periphery than in the fovea. However, receptor pooling probably occurs in the neonate's parafovea and near periphery as it does in mature eyes. When we add a receptor-pooling stage to the models of the parafovea and near periphery, ideal acuity is similar in the fovea, parafovea, and near periphery. Comparisons of ideal and real sensitivity indicate that optical and receptoral immaturities impose a significant …

Retinal image quality in infants is largely determined by the accuracy and the stability of their accommodative responses. Although the accuracy of infants' accommodation has been investigated previously, little is known about the stability of their responses. We performed two experiments that characterized the stability of infants' steady state accommodation. Analyses were performed in the time domain (root mean square [RMS] deviation) and in the frequency domain (spectral analysis). In Experiment 1, accommodation responses were recorded for a period of 3 s from the left eye of four groups of infants (8–10, 11–13, 14–19, and 20–30 weeks of age) and eight prepresbyopic adults while they focused on a small toy placed at a dioptric viewing distance of 1.0 D (at 1 m). In Experiment 2, accommodation responses were recorded for a period of 14 s from the left eye of a group of 8-to 12-week-old infants and six prepresbyopic adults while they focused on a cartoon image placed at three different dioptric viewing distances (1.25, 2.0, and 3.0 D). The data, collected using a photorefractor sampling at 25 Hz, showed two important characteristics. First, the RMS deviations and the power were quantitatively similar across different infant age groups, and they were significantly larger in infants than in adults. Second, the overall and relative power also increased with the dioptric viewing distance both in infants and adults. At all three dioptric viewing distances, the measures of power were larger in infants than in adults. These data demonstrate that infants' accommodative responses contain instabilities that are qualitatively very similar to those observed in …

Accommodative and vergence responses of the typically developing visual system are generated using a combination of cues, including retinal blur and disparity. The developmental importance of blur and disparity cues in generating these motor responses was assessed by placing the two cues in conflict with each other. Cue-conflicts were induced by placing either− 2 D lenses or 2 MA base-out prisms before both eyes of 140 subjects (2.0 months to 40.8 years) while they watched a cartoon movie binocularly at 80 cm. The frequency and amplitude of accommodation to lenses and vergence to prisms increased with age (both p< 0.001), with the vergence response (mean±1 SEM= 1.38±0.05 MA) being slightly larger than the accommodative response (1.18±0.04 D) at all ages (p= 0.007). The amplitude of these responses decreased with an increase in conflict stimuli (1 to 3 D or MA)(both p< 0.01). The coupled vergence response to− 2 D lenses (0.31±0.06 MA) and coupled accommodative response to 2 MA base-out prisms (0.21±0.02 D) were significantly smaller than (both p< 0.001) and poorly correlated with the open-loop vergence (r= 0.12; p= 0.44) and open-loop accommodation (r=− 0.08; p= 0.69), respectively. The typically developing visual system compensates for transiently induced conflicts between blur and disparity stimuli, without exhibiting a strong preference for either cue. The accuracy of this compensation decreases with an increase in amplitude of cue-conflict.

<h3 class="gsh_h3">Purpose</h3>To compare early literacy of 4- and 5-year-old uncorrected hyperopic children with that of emmetropic children.<h3 class="gsh_h3">Design</h3>Cross-sectional.<h3 class="gsh_h3">Participants</h3>Children attending preschool or kindergarten who had not previously worn refractive correction.<h3 class="gsh_h3">Methods</h3>Cycloplegic refraction was used to identify hyperopia (≥3.0 to ≤6.0 diopters [D] in most hyperopic meridian of at least 1 eye, astigmatism ≤1.5 D, anisometropia ≤1.0 D) or emmetropia (hyperopia ≤1.0 D; astigmatism, anisometropia, and myopia &lt;1.0 D). Threshold visual acuity (VA) and cover testing ruled out amblyopia or strabismus. Accommodative response, binocular near VA, and near stereoacuity were measured.<h3 class="gsh_h3">Main Outcome Measures</h3>Trained examiners administered the Test of Preschool Early Literacy (TOPEL), composed of Print Knowledge, Definitional Vocabulary, and Phonological Awareness subtests.<h3 class="gsh_h3">Results</h3>A total of 492 children (244 …

Human infants can discriminate the orientation of lines within the first week after birth (Atkinson et al., 1988; Slater et al., 1988) but have immature orientation-selective pattern masking until after 6 months of age (Morrone and Burr, 1986). Here the development of orientation processing is further examined using a visual-evoked potential paradigm and normalization models of pattern masking. Contrast response functions were measured for 1 cycle per degree (cpd) gratings, counterphase-reversed in contrast at either 3.3 or 5.5 Hz. A second 1 cpd, 20% contrast, 8.3 Hz grating of either the same or orthogonal orientation was added as a mask. Evoked responses associated with the test grating, the mask, and intermodulation between the two were individually extracted using spectral analysis of the scalp-recorded EEG. Adults exhibited orientation selectivity in the masking of their test component responses and in …

Psychophysical thresholds and neuronal responses for isolated stimuli are strongly modified by nearby stimuli in the visual field. We studied the orientation and position specificity of these contextual interactions using a dual-frequency visual-evoked potential technique in developing human infants and adults. One set of small, oriented stimulus elements (targets) was tagged with a temporal frequency f₁ of 4.52 Hz. The addition of an abutting second set of similar patches (flankers) tagged at f₂ = 2.58 Hz had three effects: (1) The flankers reduced the second and fourth harmonic responses to the targets. This reduction was independent of flanker orientation or position and age. (2) The response to the combination of targets and flankers also contained nonlinear interaction terms (1f₁ ± 1f₂) that were tuned for flanker orientation and position in adults, but only for flanker orientation in infants 8-31 weeks of age. (3 …

purpose. To examine the development of rivalry, dichoptic masking, and binocular interactions in infants more than 5 months of age using the visual evoked potential (VEP).methods. VEPs were recorded in 35 infants between 5 and 15 months of age and 23 adults between 13 and 59 years of age. Counterphasing, sinusoidal, 1 cycle/deg gratings were presented dichoptically. Responses from each eye were isolated by “tagging” each half-image with a different temporal frequency (5 or 7.5 Hz). Observers were presented with fixed 80% contrast gratings in each eye in experiment 1. Rivalry was detected on the basis of a negative correlation between the simultaneously measured response amplitudes at the second harmonics of the two eye-tagging frequencies. In a second analysis of the same data, response amplitudes recorded under dichoptic viewing conditions were compared to those obtained in a monocular control condition (dichoptic masking). In experiment 2, a 40% fixed-contrast grating was presented to one eye, whereas the other eye viewed a grating that was swept in contrast from 1% to 67%. Dichoptic masking was measured as the reduction in the fixed-grating response caused by the variable contrast grating.results. Experiment 1: although adults showed evidence of VEP amplitude alternations between the eyes for cross-oriented half-images (physiological rivalry), infants did not. This immature response to rivalrous stimuli occurred despite the presence of responses at nonlinear combination frequencies recorded with gratings of the same orientation in each eye, a definitive indication of binocular interaction. In addition, both iso-and …

purpose. A young infant’s environment routinely consists of moving objects. The dynamics of the infant accommodative system are almost unknown and yet have a large impact on habitual retinal image quality and visual experience. The goal of this study was to record infants’ dynamic accommodative responses to stimuli moving at a range of velocities.methods. Binocular accommodative responses were recorded at 25 Hz. Data from infants 8 to 20 weeks of age and pre-presbyopic adults were analyzed. A high-contrast image of a clown was moved between 20-and 50-cm viewing distances at four velocities (a step, 50 cm/s, 20 cm/s, and 5 cm/s).results. Most infants who had clear responses were able to initiate their response within a second of stimulus onset. The infants were able to discriminate the different stimulus velocities and to adjust their response velocities and durations in an appropriate fashion.conclusions. The data indicate that by the third postnatal month infants are able to respond with latencies within a factor of two of adults’ and that there is little immaturity in the motor capabilities of the accommodative system compared with the sensory visual system at the same age.

<h3 class="gsh_h3">Purpose</h3>Achieving simultaneous single and clear visual experience during postnatal development depends on the temporal relationship between accommodation and vergence, in addition to their accuracies. This study was designed to examine one component of the dynamic relationship, the latencies of the responses.<h3 class="gsh_h3">Methods</h3>Infants and adults were tested in three conditions (i) binocular viewing of a target moving in depth at 5 cm/s (closed loop) (ii) monocular viewing of the same target (vergence open loop) (iii) binocular viewing of a low spatial frequency Difference of Gaussian target during a prism induced step change in retinal disparity (accommodation open loop).<h3 class="gsh_h3">Results</h3>There was a significant correlation between accommodation and vergence latencies in binocular conditions for infants from 7 to 23 weeks of age. Some of the infants, as young as 7 or 8 weeks, generated adult-like latencies of less than 0.5 s …