Visual Cortical Function Changes After Perceptual Learning with Dichoptic Attention Tasks in Adults with Amblyopia: A...

Background: Amblyopia is a neurodevelopmental disorder of vision, commonly caused by strabismus or anisometropia during early childhood. While studies demonstrated that perceptual learning improves visual acuity and stereopsis in adults with amblyopia, accompanying changes in visual cortical function remain unclear. Methods: We measured functional magnetic resonance imaging (fMRI) responses before and after perceptual learning in seven adults with amblyopia. Our learning tasks involved dichoptic high-attention-demand tasks that avoided V1 function-related tasks and required high-level cortical functions (e.g., intraparietal sulcus) to train the amblyopic eye. Results: Perceptual learning induced low-level visual cortical function changes, which were strongly associated with the etiology of amblyopia and visual function improvements. Anisometropic amblyopes showed functional improvements across all regions of interest (ROIs: V1, V2, V3, V3A, and hV4), along with improvements in visual acuity and stereoacuity. In contrast, strabismic amblyopes showed robust improvements in visual cortical functions only in individuals who experienced significant gains in visual acuity and stereoacuity. Notably, improvements in V1 functions were significantly correlated with the magnitude of visual acuity and stereoacuity improvements when combining both anisometropic and strabismic amblyopes. Conclusions: Our findings provide evidence that learning occurs in both high-level and low-level cortical processes. Our study suggests that early intervention to correct eye alignment (e.g., strabismus surgery) is critical for restoring both visual and cortical functions in strabismic amblyopia.