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Stability of visual acuity in amblyopic patients after visual maturity.

One hundred thirty patients with strabismic amblyopia who underwent full-time occlusion therapy (FTO) and were followed through to at least 9 years of age were evaluated to determine the stability of visual acuity after visual maturity (after 9 years of age). Of these 130 patients, 89 are included in this review. At the conclusion of the FTO therapy, 92% (82/89) had attained a visual acuity of 20/40 or better, 6% (5/89) had attained 20/50-20/100, and 2% (2/89) remained at 20/200 or less. Of the nine patients in this series in whom patching was initiated between the ages of 6 and 9 years of age, a good visual result was seen in 89% (8/9), with 63% (5/8) of those attaining 20/20 vision. The final visual acuity in this group of patients was taken at an average patient age of 15.9 years. In 75% of the patients (67/89) there was no change in visual acuity over time, while 17% (15/89) showed a one- or two-line decrease, and in 8% (7/89) vision dropped more than two lines. Of those patients who had greater than or equal to 20/40, 88% (56/64) who had a posttreatment visual acuity of 20/20 showed no change at the final evaluation, but only 50% (9/18) of those whose posttreatment vision was between 20/25 and 20/40 were stable. In those patients who needed part-time occlusion (PTO) to maintain equal visual acuity, their stability appeared to be the same as the vision of those whose vision was maintained without PTO.

Adolescent

Study on the primary visual cortex of visually impaired subjects by means of 123I-IMP SPECT and MRI.

We conducted a study of rCBF in the primary visual cortex of visually impaired subjects who have not been subjected to external stimulation for a long period, by means of 123I-IMP SPECT and MRI. The four subjects had lost their sight due to brain tumors (n = 2), glaucoma (n = 1) and trauma (n = 1). 123I-IMP SPECT showed no differences between the visually impaired group and a visually sound control group on visual analysis as well as semiquantitative analysis. MRI of the visually impaired subjects showed no organic changes, such as atrophy, in the occipital cortex. In conclusion, visually impaired subjects have no decrease in rCBF and no anatomical changes in the primary visual cortex.

Adult

Visual agnosia contrasted with visual-verbal disconnection.

Serial neuropsychological findings are contrasted in two cases: one with a syndrome of visual agnosia, the other with a disorder resulting from visual-verbal disconnection. Both patients were impaired in confrontation naming of objects and pictures, but the patient with visual-verbal disconnection was able to perform tasks of color-object matching and pantomime recognition, whereas the patient with visual agnosia could not do so, demonstrating a failure to establish meaningful nonverbal visual-visual association. Additionally, the performance of the patient with visual agnosia reflected an evolution from the apperceptive to associative forms of the disorder, suggesting that the various impairments of visual identification form a continuum of related disorders.

Agnosia

Visually perceived eye level and perceived elevation of objects: linearly additive influences from visual field pitch and from gravity.

Observing a pitched visual field (i.e. tilted around a horizontal axis in the observer's frontal plane) results in large changes in the elevation visually perceived to correspond to eye level (VPEL) and in the perceived elevation and size of stationary objects viewed against the field. With topforward pitch (top toward observer) VPEL lies above true eye level and objects appear smaller and lower; with topbackward pitch VPEL lies below true eye level and objects appear larger and higher. Oscillation of the pitched field induces synchronous perceived oscillation of elevation of a stationary target viewed against the field. Typical VPEL settings deviated from true eye level by 20 degrees with the field pitched at 40 degrees, although some individuals mislocalized by as much as 40 degrees. VPEL varied linearly with visual field pitch with individual slopes for the relation between VPEL and visual field pitch ranging from +0.42 to +0.78 (avg = +0.56). The linear correlation (r) between VPEL in darkness and against an erect visual field was +0.91. The two relations--VPEL vs visual field pitch, VPEL in darkness vs VPEL in the erect illuminated visual field (slope approximately equal to 0.5)--are both accurately predicted by the linear model: VPEL = kvV + kbB; in which V is the influence of visual field structure and B is the influence of the body-referenced mechanism which combines information regarding the orientation of the head relative to gravity, the position of the eye in the orbit, and the vertical location of the image on the retina; kv and kb are the relative weights of V and B with kv + kb = 1. In an illuminated field kv = kb approximately equal to 0.5; in the dark kv = 0, kb = 1.

Gravitation

Visual acuity in a population aged 70 years or older; prevalence and causes of visual impairment.

Visual acuity and the prevalence and causes of impaired vision were studied in an epidemiological cross-sectional population study of inhabitants aged 70 years or older in three communities in the county of Oulu, Finland. 500 of the 560 eligible persons (89.3%) were examined. Information on visual acuity was obtained for 476 co-operative persons (85.0%). 59.0% had a visual acuity of 0.3-0.6 in the better eye. 10.1% (48 persons) had low vision and 1.9% (9 persons) were blind as categorized according to the classification of visual impairment by the World Health Organization. Experienced visual capacity did not, however, always correspond to objective tests. Age-related maculopathy and cataract were the leading causes of visual deterioration. Age-related maculopathy was the main cause of low vision and blindness in 4.6% of the population. In 1.3% the etiology was cataract, and in 2.1% both early age-related maculopathy and cataract were present without obvious dominance. Cataract was often associated with other conditions. Glaucoma was considered the main cause of visual deterioration in 1.5%, diabetic maculopathy in 0.6% and macula pucker in 0.4%. In 1.5% the visual deterioration was due to other causes.

Aged

Effect of selective visual interference on visualization.

The extent of visual processing involved in visualizing objects was investigated by the use of selective visual interference. Subjects read concrete words and visualized them. This produced an approximately ten-fold increase in the slope of the latencies of wholistic visualization as a function of set size compared to that when subjects responded after listening to the descriptions of the objects. Males produced significantly steeper slopes than females in both listening and reading conditions, indicating that they find visualization more difficult. It is concluded that the interference on the visualization task was in the main disrupting active visual processing as no spatial manipulation of the objects was required.

Auditory Perception

Layer-specific labelling of cat visual cortex after stimulation with visual noise: a [3H]2-deoxy-d-glucose study.

Tritiated 2-deoxy-D-glucose (2-DG) was used to demonstrate layer specific uptake of 2-DG at the cellular level in the visual cortex of the cat after stimulation with different kinds of visual stimuli. Two-dimensional static Gaussian visual noise drifting across the visual field led to an increased accumulation of 2-DG in layers III and V as compared to the amount of radioactivity in layer IV. In unstimulated control tissue of visual cortex a homogeneous pattern of labelling was found. Horizontal bars moving vertically across the visual field increased the uptake in layer IV more than in all other layers. Analysis of the 2-DG uptake at the cellular level revealed that visual noise activated two bands of cells, one above and one below layer IV, whereas bar stimuli activated cells mainly in layer IV. Accumulation of 2-DG was always higher in the perikarya than in the surrounding neuropil. These results confirm the physiologically recorded properties of cells in different cortical layers.

Animals

Visual hemispheric dominance induced in split brain cats during development: a model of deficient interhemispheric transfer derived from physiological evidence in single visual cortex cells.

The effects of cancellation of both interhemispheric callosal transfer and interocular interactions, were studied in early monocularly deprived cats. The main purpose of this study was therefore to prove whether unilateral hemispheric dominance would result under these conditions and to what extent each hemisphere will be functionally independent. Secondly, we have attempted to establish such an experimental model physiologically, on the single cell level. Interhemispheric transfer was surgically canceled by sagittal transection of the corpus callosum. In addition, the ocular projections were separated by sagittal transection of the optic chiasm in the transbuccal approach. This condition had practically induced visual split brain condition in these cats. These manipulations were carried out concurrently with monocular deprivation (SBDK group) which was surgically done by eye closure during the critical period of development of the visual system. Thus, the hemisphere ipsilaterally to the visually deprived eye had developed under conditions of deficient visual experience while the hemisphere ipsilaterally to the normal eye had developed under conditions of unaltered visual experience. A group of cats (SBK) similarly operated but equally binocularly exposed during development was served as controls. In addition, adult cats similarly operated during adulthood either chronically or acutely were studied to evaluate the effects of interhemispheric and interocular separation. Other groups of cats were also studied for comparison, and included sham operated and normal adult cats. At adulthood, electrophysiological studies were done on these cats, in which action potentials were extracellularly recorded from single cells in the visual cortex (area 17-18 boundary) following anesthesia and paralysis. Stimulation was carried out manually and by a computer driven optical system, presenting on a tangent screen light bars at various spatial positions, orientations and directions. Receptive fields were thus mapped for all neurons and their dimensions and eccentricities were measured. The responsiveness, ocular dominance and other parameters were also studied for these cells. The results in the early deprived cats and in their controls, had shown a full separation between the two hemispheres, as reflected in the almost absolute ipsilateral eye responsiveness (> 97.0% cells). In comparison, in the sham operated and in the normal control cats only minor proportions of cells (13.0-18.7%) have been found as ipsilaterally and monocularly driven, showing almost full interhemispheric and interocular interaction. The main difference, however, in the results between the early monocularly deprived cats and their controls is that in the first group the two hemispheres were asymmetric concerning the amount of visual activation and in the second one they were very symmetric.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals

Patterned light flash evoked short latency activity in the visual system of visually normal and in amblyopic subjects.

In a previous experimental study on anaesthetized cat it was shown that a short latency (35-40 ms) cortical potential changed polarity due to the presence or absence of a pattern in the flash stimulus. The results suggested one pathway of neuronal activation in the cortex to a pattern that was within the level of resolution and another to patterns that were not. It was implied that a similar difference in impulse transmission to pattern and non-pattern stimuli may be recorded in humans. The present paper describes recordings of the short-latency visual evoked response to varying light flash checkerboard pattern stimuli of high intensity in visually normal and amblyopic children and adults. When stimulating the normal eye a visual evoked response potential with a peak latency between 35 to 40 ms showed a polarity change to patterned compared to non-patterned stimulation. The visual evoked response resolution limit could be correlated to a visual acuity of 0.5 and below. In amblyopic eyes the shift in polarity was recorded at the acuity limit level. The latency of the pattern depending potential was increased in patients with amblyopia compared to normal, but not directly related to amblyopic degree. It is concluded that the short latency, visual evoked response that mainly represents the retino-geniculo-cortical activation may be used to estimate visual resolution below 0.5 in acuity level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Responses to visual stimulation and relationship between visual, auditory, and somatosensory inputs in mouse superior colliculus.

The superior colliculus was studied in anesthetized mice by recording from single cells and from unit clusters. The topographic representation of the visual filed was similar to what has been found in other mammals, with the temporal part of the contralateral visual field projecting posteriorly and the inferior visual field projecting laterally. At the anterior margin of the tectum receptive fields recorded through the contralateral eye and invaded the ipsilateral visual hemifield for up to 35 degrees, suggesting that the entire visual field through one eye is represented on the contralateral superior colliculus. Cells located closest to the tectal surface had relatively small receptive fields, averaging 9 degrees in center diameter; field sizes increased steadily with depth. The prevailing cell type in the stratum zonal and superficial gray responded best to a small dark or light object of any shape moved slowly through the receptive-field center or to turning a small stationary spot on or off. Large objects or diffuse light were usually much less effective. Less than one-quarter of superficial layer cells showed directional selectivity to a moving object, the majority of these favoring up and nasal movement. The chief visual cell type in the stratum opticum and upper part of the intermediate gray resembled in the newness neurons described for many other vertebrates: they had large receptive fields and responded best to up and nasal movement of a small dark or light object, whose optimal size was similar to the optimum for upper-layer cells. If the same part of the receptive field was repeatedly stimulated there was a marked tendency to habituate. Only very few cels responded to the ipsilateral eye. Intermixed with visual cells in the upper part of the intermediate gray were cells that responded to somatosensory or auditory stimuli. Here bimodal and trimodal cells were also seen. In deeper layers somatosensory and auditory modalities tended to take over. These two modalities were not segregated into sublayers but rather seemed to be arranged in clusters. Responses to somatosensory and auditory stimuli were brisk, showing little habituation to repeated stimulation.

Acoustic Stimulation

Benefit from visual cues in auditory-visual speech recognition by middle-aged and elderly persons.

The benefit derived from visual cues in auditory-visual speech recognition and patterns of auditory and visual consonant confusions were compared for 20 middle-aged and 20 elderly men who were moderately to severely hearing impaired. Consonant-vowel nonsense syllables and CID sentences were presented to the subjects under auditory-only, visual-only, and auditory-visual test conditions. Benefit was defined as the difference between the scores in the auditory-only and auditory-visual conditions. The results revealed that the middle-aged and elderly subjects obtained similar benefit from visual cues in auditory-visual speech recognition. Further, patterns of consonant confusions were similar for the two groups.

Acoustic Stimulation

Visually guided behavior of monkeys after early binocular visual deprivation.

Four infant monkeys were binocularly deprived of vision through their first year of life. After the end of the deprivation their visually guided behavior was followed for one year. Behavioral tests were performed to assess their visual functions. The performance of the deprived monkeys was compared with the performance of three normally sighted monkeys. The following functions were tested: the monkey's ability to detect a moving light spot, to track a moving object, to grasp an object, to chatter the teeth in response to a threatening face, to pick pellets from a board, to respond to a sudden visual threat and to move about in a wide space. The visually deprived monkeys remained severely visually handicapped. They were able to detect a moving light spot in a darkened room and to recognize the movement of large objects. However, they continued bumping into objects and used tactile exploration when moving about in a wide space. They never learned to respond to a threatening face, which for a normal monkey is part of the normal behavioral repertoires. The persistently poor visually guided behavior of these monkeys is in agreement with the electrophysiological findings in the posterior parietal association cortex of these monkeys; early visual deprivation permanently reduces the number of visually responsive cell groups in this association area.

Animals

Visual loss in pseudotumor cerebri. Incidence and defects related to visual field strategy.

Visual field examinations were performed serially on 20 patients with pseudotumor cerebri using a modified Armaly-Drance visual field strategy with a Goldmann perimeter as well as an automated perimeter (Octopus). Visual loss was found in 75% of eyes using the manual strategy and in 77.5% of eyes with automated threshold perimetry. This incidence of visual loss is 50% greater than any previously reported series. All major defects detected were present with both types of perimetry. Both strategies were more sensitive for documenting visual loss than previously described strategies. Since therapy for pseudotumor cerebri is determined by the degree and progression of visual loss, a specific sensitive strategy, rather than routine screening perimetry, should be used for determination of visual loss.

Adult

Comparison of preoperative 10-Hz visual evoked potentials to contrast sensitivity and visual acuity after cataract extraction.

Cataract patients whose surgical outcomes were in question were referred for testing by visual evoked potentials, elicited through closed eyelids by a luminance stimulus (flash) that appeared 10 times per second. Visual evoked potentials were rated as normal (predicted acuity of 20/50 or better) or abnormal (predicted acuity of 20/60 or worse). Postoperative Arden and Optronix contrast sensitivities and visual acuities were determined in 37 patients who had no intraoperative or early postoperative complications. Arden grating scores of less than 100 were rated as normal. The optimal and cutoff spatial frequency values were determined for the Optronix scores. Optimal and cutoff values of greater or equal to 1 c/deg and 12 c/deg, respectively, were rated as normal. Visual acuities were considered normal at 20/50 or better. Preoperative visual evoked potentials were quantitatively compared to the postoperative contrast sensitivities and visual acuities by 2 x 2 contingency tables. The accuracy of prediction was 79% for the visual acuities, 62% for the Optronix optimal values, 70% for the Optronix cutoff values and 62% for the Arden gratings.

Aged

Normal visual fields measured with Octopus-Program G1. II. Global visual field indices.

To complement results from individual test locations, clinicians also evaluate indices, as they give a succinct overview of the visual field. This, however, requires exact knowledge of their variability. The present study was designed to determine normal interindividual variability of global visual field indices and incorporates a data base of a multicenter study performed with Octopus 201 perimeters using Program G1. The 824 fields thus obtained included 139 fields of 139 healthy volunteers who had undergone two previous visual fields and completed all three phases of program G1. The index mean sensitivity showed a significant and linear decrease with increasing age, 0.064 dB/year of life. The indices loss variance, corrected loss variance, and short-term fluctuation did not correlate significantly with age. Percentiles are given for these visual field indices. While within the limits of normal values provided by the manufacturer for these indices, these results suggest that visual fields with "borderline" values require further clinical investigation in reliable, experienced subjects. The results may help clinicians to better evaluate global visual field indices and, therefore, to detect loss of visual function earlier.

Adult

Development of the kitten visual cortex depends on the relationship between the plane of eye movements and visual inputs.

1. Previous experiments have demonstrated that eye movements, acting through the extraocular muscle (EOM) proprioceptive afferents, are necessary for the development of orientation selectivity in the cells of the kitten visual cortex. New experiments were carried out to study the effect of the plane of eye movements on the preferred orientation acquired by the visual cortical cells. 2. Dark-reared (DR) kittens were operated on at 5-6 weeks of age. In the first series of experiments, 4 out of the 6 EOMs were removed bilaterally in such a way that both eyes could only move in a single plane, either vertical or horizontal. In the second series of experiments, the same operation was performed on one eye which was also sutured shut and, on the other side, the EOM were deafferented by intracranial section of the ophthalmic branch of Vth nerve and the eye left open. 3. 1-4 days after surgery the kittens were given 6 h of visual experience and 12 h later were prepared for visual cell recording in Area 17. 4. In kittens of the first series: orientation selectivity developed in the majority (60-65%) of visual cells, most of which encoded horizontal orientations when the eyes had moved in the vertical plane and vertical orientations when the eyes had moved in the horizontal plane. These results show that the plane of eye movements during early visual experience influences the distribution of preferred orientations with an orthogonal relation. Ocular dominance histograms were "strabismic like". 5. In kittens of the second series: orientation selectivity developed in 40-50% of cells, about half of which were tuned for the orientation orthogonal to the direction of movement of the occluded eye, as in experiment I. The seeing, deafferented eye, presumably would have sent normal visual inputs centrally, corresponding to displacements on the retina in every direction since the ocular motility of that eye had not been disturbed. However, proprioceptive information about its movements was suppressed. As only some of the EOMs of the occluded eye were still present and connected, the conclusion is that the observed influence of the plane of eye movements acts through the proprioceptive afferents.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals

Hemiretinal differences in the effect of a rotating visual background on the subjective visual vertical.

Sixteen normal subjects were tested for their accuracy in judging the verticality of a visual edge before or during exposure to a moving visual background. All subjects showed a counter-rotation of the subjective visual vertical as a consequence of movement of the visual background. The effect was stronger for binocular than monocular viewing and for nasal than temporal hemiretina stimulation. No hemispheric asymmetries were observed. These results show a predominance of the crossed visual pathways originating from the nasal hemiretinae in a visual effect presumably involving a visual-vestibular interaction.

Adolescent

Visual imagery and visual semantics in the cerebral hemispheres in schizophrenia.

Divided visual field tasks were given to normal subjects, and patients with schizophrenia and affective disorder, to investigate hemisphere differences in the visual processing of standardised pictorial stimuli. There were two conditions: in the first, subjects were asked to decide whether a common entity represented by a picture was living or non-living, a task involving a categorical judgement based on semantic information; a left hemisphere task. In the second condition, subjects judged whether these depictions represented entities which were bigger or smaller than a cat; a right hemisphere task requiring visual imagery to compare spatial dimensions. It was found that the patient groups, while showing slower reaction time (RT) overall, both displayed a right hemisphere (RH) advantage on the imagery task. Furthermore, the schizophrenics' RHs showed the normal relationship between closeness of size comparison and RT, additional evidence that the visual imagery mechanism is intact. However, these patients failed to show the expected left hemisphere advantage on the visual-semantic task. There was a suggestion that performance on the semantic task was related to the experience of vivid imagery in normals and visual hallucinations in the schizophrenics. The possible contribution of hemispheric imbalance in the production of visual hallucinations from a disordered semantic system is discussed.

Adult