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Purpose: Do one-eyed (uniocular) humans use monocular depth cues differently from those with intact binocularity to perform depth-related visuomotor tasks that emulate complex activities of daily living? If so, does performance depend on the participant's age, duration of uniocularity and head movements?, Methods: Forty-five uniocular cases (age range 6-37 years; 2.4 months-31.0 years of uniocularity) and 46 age-similar binocular controls performed a task that required them to pass a hoop around an electrified wire convoluted in depth multiple times, while avoiding contact as indicated by auditory feedback. The task was performed with and without head restraint, in random order. The error rate and speed were calculated from the frequency of contact between the hoop and wire and the total task duration (adjusting for error time), respectively, all determined from video recordings of the task. Head movements were analyzed from the videos using face-tracking software., Results: Error rate decreased with age (P < 0.001) until the late teen years while speed revealed no such trend. Across all ages, the error rate increased and speed decreased in the absence of binocularity (P < 0.001). There was no additional error reduction with duration of uniocularity (P = 0.16). Head movements provided no advantage to task performance, despite generating parallax disparities comparable to binocular viewing., Conclusions: Performance in a dynamic, depth-related visuomotor task is reduced in the absence of binocular viewing, independent of age-related performance level. This study finds no evidence for a prolonged experience with monocular depth cues being advantageous for such tasks over transient loss of binocularity.

Purpose: Keratoconus results in image quality loss in one or both eyes due to increased corneal distortion. This study quantified the depth of monocular suppression in keratoconus due to this image quality loss using a binocular contrast rivalry paradigm., Methods: Contrast rivalry was induced in 50 keratoconic cases (11-31 years) and 12 age-matched controls by dichoptically viewing orthogonal Gabor patches of 5 cycles per degree (cpd) and 1.5 cpd spatial frequency for 120 seconds with their best-corrected spectacles and rigid gas permeable (RGP) contact lenses. The dwell time on each eye's percept was determined at baseline (100% contrast bilaterally) and at varying contrast levels (80-2.5%) in the stronger eye of keratoconus or dominant eye of controls. The contrast reduction needed in the stronger eye to balance dwell times on both eyes was considered a measure of suppression depth., Results: At baseline with 5 cpd stimuli and spectacle correction, the rivalry switches were less frequent and biased toward the stronger eye of cases, all relative to controls (P < 0.001). The contrast balance point of cases (20.51% [10.7-61%]) was lower than the controls (99.80% [98.6-100%]; P < 0.001) and strongly associated with the overall and interocular difference in disease severity (r = 0.83, P < 0.001). The suppression depth reduced for 1.5 cpd (70.8% [21.7-94%]), relative to 5 cpd stimulus (P < 0.001) and with contact lenses (80.1% [49.5-91.7%]), relative to spectacles (P < 0.001)., Conclusions: The eye with lesser disease severity dominates binocular viewing in keratoconus. The suppression depth of the poorer eye depends on the extent of bilateral disease severity, optical correction modality, and the target spatial frequency.

Purpose: To characterize binocular steady-state accommodation, pupil and convergence responses (near triad) in spasm of near reflex (SNR) before and after optical and pharmacological intervention. To identify the putative source of SNR in the neural control schema of accommodation-vergence interaction using controls-engineering modeling., Methods: Near-triad of 15 patients with SNR (9 to 23 years) was recorded using an infrared photorefractor at 2m viewing distance for 120s during clinical presentation, after optical fogging intended to relieve spasm, with cycloplegia, post-cycloplegia and long-term follow-up visits. Data were also collected without cycloplegia in 15 age-matched controls. Schor (1999) model was used to computationally simulate accommodation and vergence responses of controls and SNR., Results: Both eyes of SNR exhibited significant myopia and refraction fluctuations (<1.0Hz) during clinical presentation [median (25th to 75th IQR) refraction: -1.7D (-3.2 to -0.8D); root mean squared (RMS) deviation: 1.1D (0.5 to 1.5D)], relative to controls [0.8D (-0.03 to 1.4D); 0.2D (0.1 to 0.3D)] (p < 0.001). These decreased after optical fogging, largely eliminated with cycloplegia and partially re-appeared in the post-cycloplegia and follow-up visits. SNR responses could be modeled by increasing the gain and decay time of tonic accommodation, vis-à-vis, controls. Pupil and convergence responses in SNR were similar to controls at all visits (p > 0.1)., Conclusions: Exaggerated fluctuations of steady-state accommodation may be a signature feature of SNR, even while their pupil and convergence responses may remain unaffected. These fluctuations may arise from the tonic accommodation controller, the properties of which could be potentially altered after optical fogging to relieve the disorder.

Purpose: Clear and single binocular vision, a prerequisite for normal human visual development, is achieved through accommodation and vergence. Anisometropia is associated with abnormal visual development, but its impact on accommodation and vergence, and therefore on the individual's visual experience, is not known. This study determined the impact of transiently induced anisometropia on accommodative and vergence performance of the typically developing human visual system., Methods: One hundred eighteen subjects (age range, 2.9 months to 41.1 years) watched a cartoon movie that moved between 80 and 33 cm under six different viewing conditions: binocular and monocular, and with ±2 diopters (D) and ±4 D of lens-induced anisometropia. Twenty-one subjects (age range, 3.1 months to 12.1 years) also watched the movie with 11% induced aniseikonia. Accommodation and vergence were recorded in both eyes using a videoretinoscope (25 Hz)., Results: The main effect of viewing condition was statistically significant for both accommodation and vergence (both P < 0.001), with monocular accommodative and vergence gains statistically significantly smaller than the binocular and four induced anisometropia conditions (P < 0.001 for both accommodation and vergence). The main effect of age approached significance for accommodation (P = 0.06) and was not significant for vergence (P = 0.32). Accommodative and vergence gains with induced aniseikonia were not statistically significantly different from the binocular condition (both P > 0.5)., Conclusions: Accommodative and vergence gains of the typically developing visual system deteriorated marginally (accommodation more than vergence) with transiently induced anisometropia (up to ±4 D) and did not deteriorate significantly with induced aniseikonia of 11%. Some binocular cues remained with ±4 D of induced anisometropia and 11% induced aniseikonia, as indicated by the accommodative and vergence gains being higher than in monocular viewing.

Purpose: Indirect observations suggest that the neural control of accommodation may undergo adaptive recalibration in response to age-related biomechanical changes in the accommodative system. However, there has been no direct demonstration of such an adaptive capability. This investigation was conducted to demonstrate short-term adaptation of accommodative step response dynamics to optically induced changes in neuromuscular demands., Methods: Repetitive changes in accommodative effort were induced in 15 subjects (18-34 years) with a double-step adaptation paradigm wherein an initial 2-D step change in blur was followed 350 ms later by either a 2-D step increase in blur (increasing-step paradigm) or a 1.75-D step decrease in blur (decreasing-step paradigm). Peak velocity, peak acceleration, and latency of 2-D single-step test responses were assessed before and after 1.5 hours of training with these paradigms., Results: Peak velocity and peak acceleration of 2-D step responses increased after adaptation to the increasing-step paradigm (9/12 subjects), and they decreased after adaptation to the decreasing-step paradigm (4/9 subjects). Adaptive changes in peak velocity and peak acceleration generalized to responses that were smaller (1 D) and larger (3 D) than the 2-D adaptation stimulus. The magnitude of adaptation correlated poorly with the subject's age, but it was significantly negatively correlated with the preadaptation dynamics. Response latency decreased after adaptation, irrespective of the direction of adaptation., Conclusions: Short-term adaptive changes in accommodative step response dynamics could be induced, at least in some of our subjects between 18 and 34 years, with a directional bias toward increasing rather than decreasing the dynamics.

Purpose: The maximum binocular vertical disparity that can be fused with disparity vergence (vertical-fusion amplitude or VFA), varies with convergence angle. VFA is larger for convergence responses to near than to far viewing distances; however, the clinical norms for changes in VFA with convergence have not been established. VFA at several convergence angles was measured to obtain a quantitative description of the changes in VFA with convergence., Methods: Fifty-six adults took part in the study. Horizontal and vertical disparity stimuli were presented on a computer monitor by using the red-green anaglyphic technique. Stimulus to convergence was altered either by changing horizontal disparity on the computer monitor (experiment I: nine horizontal disparities: 1.2-22.5 PD [Delta]) or by changing the binocular viewing distance (experiment II: five viewing distances: 25-300 cm). Convergence was held constant during an experimental session, while vertical disparity was incremented in steps of 0.05 Delta after a subjective report of fusion, until the subject reported diplopia. The maximum vertical disparity that could be fused was defined as the VFA., Results: VFA increased linearly over the range of convergence stimuli (y = 0.10x + 1.62) and intersubject variability of VFA increased marginally with the amount of convergence. Linear regression equations with similar slopes and y-intercepts were observed in experiments I and II., Conclusions: The results of the experiments provide a quantitative description of a linear relationship between VFA and convergence. The linear regression equation could be used in a clinical setting to establish norms and to screen for vertical vergence abnormalities.