Dichoptic De-Masking Learning in Adults With Amblyopia and Its Mechanisms

Recently, we reported that dichoptic de-masking training can further boost stereoacuity, but not visual acuity, in adults with amblyopia after extensive monocular perceptual training. Here, we investigated whether this dichoptic training targets on interocular suppression directly, or improves vision through high-level brain mechanisms.

Eleven adults with amblyopia first used amblyopic eyes (AEs) to perform contrast (n = 6) or orientation (n = 5) discrimination training, while resisting dichoptic noise masking from fellow eyes (FEs). Learning was indicated by increased maximal tolerable noise contrast (TNC) for AE contrast/orientation discrimination. After dichoptic training, six observers continued to use AEs to perform monocular training for nine sessions.

(1) Training of dichoptic de-masking doubled maximal TNC, but learning did not transfer much to the same task at an orthogonal orientation or a different task, showing orientation/task specificities. (2) Following a training-plus-exposure (TPE) protocol, AEs then received exposure of the orthogonal orientation by performing the other orientation/contrast discrimination task at the orthogonal orientation. After this TPE training, dichoptic learning with the original discrimination task transferred to the orthogonal orientation. (3) Dichoptic training improved AE's acuity (1.2 lines), stereoacuity (60.2%), and contrast sensitivity (mainly at higher spatial frequencies). (4) Additional monocular training did not produce further acuity and stereoacuity gains.

The initial orientation/task specificities exclude the possibility that dichoptic training reduces physiological interocular suppression. The later transfer of learning to an orthogonal orientation with TPE training suggests improvement in high-level brain processing. Dichoptic training may strengthen top-down attention to AEs to counter the impacts of attentional bias to FEs and/or physiological interocular suppression and improve stereoacuity.