Binocular summation of contrast remains intact in strabismic amblyopia

Strabismic amblyopia is typically associated with several visual deficits, including loss of contrast sensitivity in the amblyopic eye and abnormal binocular vision. Binocular summation ratios (BSRs) are usually assessed by comparing contrast sensitivity for binocular stimuli (sens(BIN)) with that measured in the good eye alone (sens(GOOD)), giving BSR = sens(BIN)/sens(GOOD). This calculation provides an operational index of clinical binocular function, but does not assess whether neuronal mechanisms for binocular summation of contrast remain intact. This study was conducted to investigate this question.

Horizontal sine-wave gratings were used as stimuli (3 or 9 cyc/deg; 200 ms), and the conventional method of assessment (above) was compared with one in which the contrast in the amblyopic eye was adjusted (normalized) to equate monocular sensitivities.

In nine strabismic amblyopes (mean age, 32 years), the results confirmed that the BSR was close to unity when the conventional method was used (little or no binocular advantage), but increased to approximately radical2 or higher when the normalization method was used. The results were similar to those for normal control subjects (n = 3; mean age, 38 years) and were consistent with the physiological summation of contrast between the eyes. When the normal observers performed the experiments with a neutral-density (ND) filter in front of one eye, their performance was similar to that of the amblyopes in both methods of assessment.

The results indicate that strabismic amblyopes have mechanisms for binocular summation of contrast and that the amblyopic deficits of binocularity can be simulated with an ND filter. The implications of these results for best clinical practice are discussed.