Impact of Amblyopia on Visual Attention and Visual Search in Children

Abstract

The purpose of this study was to compare binocular visual attention, visual processing speeds, and visuo-cognitive search ability in children with and without amblyopia and investigate the association of visual acuity and binocular function with these measures. METHODS.Participants included 20 children with amblyopia (mean age = 9.0 ± 1.2 years; 15 anisometropic and 5 strabismic) and 20 children with normal vision development (9.5 ± 1.7 years). Vision assessment included visual acuity (monocular and binocular) and binocular function (Worth 4 Dot and Randot Preschool Stereotest). Visual attention and processing speeds were assessed using the three subtests of the Useful Field of View (UFOV; central processing, divided attention, and selective attention). Visuo-cognitive search was measured using static and dynamic presentations of the Trail Making Tests (TMTs), parts A and B, with increasing levels of executive function demand. All children performed these tasks binocularly. RESULTS.Children with amblyopia demonstrated slower visual processing times on the UFOV (P = 0.04), and slower completion times on the TMT search tests (P = 0.014), compared to controls. TMT performance for children with amblyopia was also more negatively impacted with increasing executive function demands on the TMT part B, compared to controls (P = 0.005). Binocular visual acuity was associated with TMT (P = 0.006) and UFOV (P = 0.07) performance, but none of the other visual function measures were related to performance on these tasks. CONCLUSIONS.Children with amblyopia exhibit deficits in higher-order visual processing skills, including visual attention and visual search, particularly with increasing executive function demands. These findings have implications for understanding the impact of amblyopia on everyday function in children.

Does non‐strabismic amblyopia affect the quality of life of adults? Findings from a qualitative study

“…It was interesting to note how a unilateral condition could affect personal grooming (e.g., applying eye make‐up), cause clumsiness (e.g., spilling stuff) and deter someone from pursuing drawing as a hobby. These findings support previous literature that identified impairments in visual attention, visuomotor behaviour, reaching and grasping, temporal eye‐hand coordination and manual dexterity in those with anisometropic amblyopia 22–28 . Although the limitations caused by anisometropic amblyopia may not be as serious as those caused by more disabling eye conditions such as diabetic retinopathy 29 or age related macular degeneration, 30 it should be noted that the QoL impacts posed by amblyopia are experienced for a longer period (many years) compared to eye diseases that are acquired later in life.…”

The role of binocular vision in the control and development of visually guided upper limb movements

“…fellow) eye [56,57]. Notably, higher-level deficits in attention, visual search or executive function were demonstrated in adults [58–64] and children [65] with amblyopia. However, not all aspects of attentional processing are affected, such as for example covert attention [66–68].…”

“…Future studies need to establish if this is the case. In the light of the recent studies showing impairments in performance of more complex behaviours such as filling out scantron cards [10] and a trail making test [65], it may be important to assess limb kinematics during tasks that require higher-level executive processing. This area is ripe for investigation.…”

Children With Amblyopia Make More Saccadic Fixations When Doing the Visual Search Task

“…Even with binocular viewing, reading rate is found to be slower 3 and deficits have been observed in image perception. 4 Fixation instability, 3 , 5 , 6 decreased visual span, 3 lack of binocular summation, 4 , 6 , 7 higher-order cortical deficits, 8 and attentional deficiencies 8 , 9 are some reasons attributed to the relatively poor performance in individuals with amblyopia. Taken together, individuals with amblyopia can have functional vision difficulties even with fellow eye or binocular viewing conditions.…”

“… 3 , 5 – 7 , 12 , 14 , 15 Specifically, fixation instability has been shown in these patients when eye movements were restricted, and attention was studied when performing a search task. 8 , 9 It is unclear what eye movement deficits will be noticed in a naturalistic and unrestrained viewing condition. Eye movement tasks such as visual search, will comprise of saccades and fixations.…”