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We investigated the validity of replacing cycloplegic retinoscopy with a noncycloplegic, "near" retinoscopy technique. We refracted a group of 31 infants (less than 2 years) and 43 children (greater than 2 years) with both techniques, grading our level of confidence in the result. Near retinoscopy gave on average a less hypermetropic result than cycloplegic retinoscopy by 0.39 D. The difference was significant in infants and for low levels of examiner confidence. However, a repeatability study showed that much of the variability in the infant group could be attributed to the poor repeatability of either retinoscopy technique. Agreement between the two techniques is improved by changing the suggested adjustment factor from 1.25 to 1.00 D for children and to 0.75 D for infants.

Monocular optokinetic nystagmus (MOKN) was measured (EOG) in response to horizontally moving square wave gratings (0.2 c/deg, 27 and 35 deg/s) in 58 children with amblyopia and/or strabismus (experimental group); the data were compared with that collected from 24 children (aged 3-8 years) with no visual problems (control group). We found OKN asymmetries most often associated with strabismus of early age of onset (less than 2 years). In these children the MOKN asymmetry often occurred in both eyes. In children with later onset strabismus the asymmetry was often confined to the amblyopic eyes. We repeated the measurements on 18 experimental children after 1-3 years of treatment (patching the dominant eye) and compared the results with those recorded in 12 fully binocular control children retested after 1-2 years. Large OKN asymmetries before treatment were still present after the patching treatment. However there was a small, but significant (P = 0.05, t-test), improvement in the nasal-temporal (N-T) slow-phase velocity in the affected eyes of the experimental group, which was not correlated with improvements in visual acuity or linked to the presence of strabismus and/or amblyopia. The main contributing factors to asymmetric OKN affecting both eyes of early onset strabismus seem to be to poor binocularity which would not improve during patching treatment. OKN asymmetries in amblyopic eyes may also result from reduced cortical sensitivity from that eye, which may be minimally improved by patching treatment. Our results suggest a shorter sensitive period of development for OKN pathways than for the development of cortical visual pathways.

A preliminary study measured the contrast sensitivity function (CSF) in 30 children (aged 3 months-5 years). Preferential looking techniques were used to assess CSF to sine wave gratings displayed on one of two screens. To find a meaningful contrast sensitivity procedure we compared the results with a shorter procedure using an edge stimulus. The following problems were encountered: measuring the contrasts required to detect four or five different spatial frequencies took time, resulting in boredom and loss of attention in our subjects; there was poor correlation between CSF and edge detection; an interesting artefact resulted in a plateau rather than a low frequency fall-off in the CSF of five of the children greater than 30 months old. This artefact may have resulted from peripheral rather than central retinal responses and/or motion artefacts in the stimulus onset. A follow up study with 41 additional children aged 3-36 months limited the contrast testing to that of the spatial frequency corresponding to the peak of the CSF. The shortened procedure, plus a lot of encouragement, resulted in higher contrast sensitivities in all but the oldest age group and successful monocular contrast measurements. In order to avoid artefacts arising from peripheral vision, children were encouraged to look at each screen before responding.

This paper contains a brief description of the new treatment for functional amblyopia introduced by Banks et al. (1978). The ways in which this treatment might stimulate the cells of the visual cortex by means of a high-contrast grating, of continuously changing orientation and selective spatial frequency, are discussed in terms of the normal visual system. Published studies of the effectiveness of the technique in improving vision are reviewed.

Eye movements were recorded from amblyopic and non-amblyopic eyes during monocular viewing of a small target on either a patterned or a patternless background. A continuous measure of autokinesis was also obtained. The variance in eye position was greater in amblyopic eyes than in non-amblyopic eyes. The presence of a patterned background did not reduce the variance in eye position of amblyopic eyes. Autokinesis was greater in amblyopic eyes, but was not correlated with the eye movements. A patterned background significantly reduced the magnitude of autokinesis in amblyopic eyes. These results provide support for the hypothesis that a patterned background improves the accuracy of visual direction by reducing spurious extraretinal signals.

Adaptation of the vestibulo-ocular reflex (VOR) is demonstrated by changes in gain in response to discrepancies between visual and vestibular stimulation. The authors have investigated the effect of monocular asymmetries of OKN in amblyopia upon adapting the gain of the VOR. Adaptation was investigated by modifying the horizontal balance of the VOR. While monocularly fixating a head referenced spot for 2 min, subjects were sinusoidally oscillated on a chair inside an optokinetic drum that rotated in one direction (left or right) at the peak velocity of sinusoidal chair rotation. The VOR was then measured during continued sinusoidal body oscillation in darkness for 1 min. Imbalance of the horizontal VOR gain equalled the ratio of slow phase velocities in the rightward and leftward directions. After rotating the drum in the nasalward direction, an increase was observed in slow phase gain of the VOR in the nasalward direction for either eye of our amblyopes that was significantly greater than similar changes in gain for the normals. Increased VOR gains for the amblyopic group following temporalward stimulation were significantly less than the nasal aftereffect. Gain changes of the VOR in normals had similar magnitudes following nasal or temporal stimulation. These results suggest that disturbances of OKN in amblyopia are common to the pathways that modify the slow phase gain of the VOR.

Open loop optokinetic eye movements were measured in response to monocular nasalward and temporalward visual field movement presented at four selected retinal sites in 6 strabismic amblyopes and 4 normal observers. Stimulus sites included the central retina (10 X 10 deg), a large field (40 X 32 deg), a large peripheral field with the center (10 X 10 deg) blocked out and a hemiretinal field (15 X 32 deg) excluding the fovea. We found directional preferences of OKN in amblyopia to nasalward stimulus movement for the foveal and concentric peripheral stimuli. The results of peripheral hemiretinal optokinetic stimulation of amblyopic subjects revealed a deficient OKN slow phase response from the temporal hemiretina, particularly for temporalward stimulus movement. There was no marked asymmetry of OKN in the normal group for the concentric stimuli. A normal preference was found for nasalward and temporalward stimulus field movement imaged on the nasal and temporal hemiretinae respectively. These results are interpreted in terms of a model of cortical and subcortical pathways for OKN derived from comparative studies of cat and monkey.

The decreased acuity in amblyopic eyes may be the outcome of motor and/or sensory anomalies. Eccentric fixation could be a major contributor. The sensory loss may result from some impairment in the sustained system, possibly caused by inadequate stimulation at a sensitive period for development. Strabismic amblyopia tends to be more of a central retinal problem, the peripheral retina approaching normal activity. As in non-amblyopic eyes, amblyopes have size-selective channels, but perhaps there is insufficient co-operation between these channels.

The time course for the development of binocular vision is similar to the time course for the development of mature, symmetrical, monocular optokinetic nystagmus in response to movements of the visual field in the nasalward or temporalward direction. If binocular vision does not develop normally, then the monocular optokinetic response remains immature, or asymmetric. This paper examines the connection between the development of symmetrical OKN and binocular vision, and relates how disturbances in visual development affect the ability of postural reflex eye movements to adapt to changes in the visual environment.

Asymmetrical optokinetic nystagmus (OKN) means that OKN has a lower gain (slow-phase eye velocity/stimulus velocity) for monocular temporalward than nasalward visual field motion. OKN tends to be asymmetric in amblyopia, leading to suggestions of a link between OKN asymmetry and binocularity in the literature. The present study measured OKN in 13 amblyopes and five normal subjects. In an attempt to identify those binocular cells used in the OKN response, the degree of OKN asymmetry was compared with binocularity assessed by two different techniques: (1) stereopsis and (2) interocular transfer of threshold elevation (IOT). Horizontal monocular OKN was recorded for three different stimulus velocities in each subject. All the amblyopes were found to be stereoblind, although three amblyopes showed OKN asymmetries close to those found for the normal group. More association was seen between interocular transfer of the threshold elevation and OKN asymmetry; not all amblyopes demonstrated reduced IOT, but those amblyopes with no IOT all had OKN asymmetries more than 125% of the mean of the normal group. However, no association was seen between the amount of OKN asymmetry and the degree of IOT. The results are discussed in terms of the role of different groups of binocular neurones for OKN and the effect of the sensitive periods of development on these binocular neurones.