Hyperacuity and amblyopia

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Abstract
The most frequent cause of visual loss in childhood is functional amblyopia, an abnormality of visual acuity usually associated with either anisometropia (unequal refractive errors) or strabismus (turned eye) during early development. The usual clinical investigation of the visual acuity of amblyopes involves discrimination of the high contrast letters of a Snellen chart; however, there are other aspects of acuity, for example, grating acuity (the high spatial frequency limit of vision) and Vernier acuity (the smallest perceptible misalignment). Because of the extreme precision of Vernier acuity compared with either grating or Snellen acuity, it is considered to be a form of hyperacuity which requires very precise positional information. In an effort to understand the nature of the neural abnormalities which cause the reduced acuity of amblyopes, we have measured here the Vernier acuity of amblyopic observers using an extended Vernier grating stimulus, and compared these results with their Snellen acuity and grating acuity. The results showed that different acuity losses are associated with anisometropic versus strabismic amblyopia. When scaled with respect to their grating acuity, anisometropic amblyopes, like normals, showed hyperacuity, even at high spatial frequencies, while strabismic amblyopes showed severe losses in Vernier acuity. Snellen letter acuity showed a similar deficit relative to grating acuity in strabismic but not in anisometropic amblyopes. Contrary to some previous theories which have considered that all forms of amblyopia share a comon neural basis, these results strongly support the view1,2 that different neural losses are associated with amblyopias of different aetiologies.