Measuring the impact of suppression on visual acuity in children with amblyopia using a dichoptic visual acuity chart

Abstract

PurposeTo develop a novel dichoptic visual acuity chart that measures the impact of interocular suppression on the visual acuity of each eye when two eyes are open.MethodsFifty-four subjects (19 anisometropic amblyopia, 20 treated amblyopia, and 15 normal children) participated in this study. The visual acuity that was tested under dichoptic-optotypes condition (i.e., presented optotypes to the untested eye) was compared with that under monocular condition (i.e., cover the untested eye with opaque patch). Visual acuity differences between these two conditions were compared among the three groups. The correlations between visual acuity differences and the depth of interocular suppression were then computed. Some participants performed the visual acuity test under dichoptic-luminance condition (i.e., presented mean luminance to the untested eye), and the test-retest reliability was established.ResultsA reduced visual acuity of the non-dominant eye was found in the dichoptic-optotypes condition for the amblyopia group (P < 0.001) and the treated group (P = 0.001); the difference in the treated group was less than that in the amblyopia group (P < 0.001) but more than that in the normal group (P = 0.026). A significant correlation was found between the visual acuity differences and the depth of suppression, which was tested with a binocular phase combination task (P = 0.005). No change was found in the dichoptic-luminance condition.ConclusionThe amblyopic eye and the previous amblyopic eye seem to suffer from a reduced visual acuity when two eyes are open due to suppression. This was successfully captured by our novel and reliable dichoptic-optotypes visual acuity chart.

Current Developments in the Management of Amblyopia with the Use of Perceptual Learning Techniques

“…Researchers, using specially designed dichoptic VA charts, showed that the amblyopic eye scored higher acuity when the fellow eye was occluded, but in binocular viewing conditions, it performed worse as a result of suppression from the dominant eye [17]. This effect was present in naive amblyopic and supposedly treated patients as well [17]. These findings support previous observations suggesting that amblyopia is indeed the result of binocular dysfunction.…”

“…This mechanism is referred to as suppression in favor of the dominant eye, causing the "weaker" eye to become amblyopic [14]. The depth of suppression is positively associated with the amount of VA reduction [14,17]. Researchers, using specially designed dichoptic VA charts, showed that the amblyopic eye scored higher acuity when the fellow eye was occluded, but in binocular viewing conditions, it performed worse as a result of suppression from the dominant eye [17].…”

“…The depth of suppression is positively associated with the amount of VA reduction [14,17]. Researchers, using specially designed dichoptic VA charts, showed that the amblyopic eye scored higher acuity when the fellow eye was occluded, but in binocular viewing conditions, it performed worse as a result of suppression from the dominant eye [17]. This effect was present in naive amblyopic and supposedly treated patients as well [17].…”