The Effect of Video Game Training on the Vision of Adults with Bilateral Deprivation Amblyopia

in Seeing and Perceiving
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Amblyopia is a condition involving reduced acuity caused by abnormal visual input during a critical period beginning shortly after birth. Amblyopia is typically considered to be irreversible during adulthood. Here we provide the first demonstration that video game training can improve at least some aspects of the vision of adults with bilateral deprivation amblyopia caused by a history of bilateral congenital cataracts. Specifically, after 40 h of training over one month with an action video game, most patients showed improvement in one or both eyes on a wide variety of tasks including acuity, spatial contrast sensitivity, and sensitivity to global motion. As well, there was evidence of improvement in at least some patients for temporal contrast sensitivity, single letter acuity, crowding, and feature spacing in faces, but not for useful field of view. The results indicate that, long after the end of the critical period for damage, there is enough residual plasticity in the adult visual system to effect improvements, even in cases of deep amblyopia caused by early bilateral deprivation.

The Effect of Video Game Training on the Vision of Adults with Bilateral Deprivation Amblyopia

in Seeing and Perceiving



American Optometric Association (1994). Care of the patient with amblyopia [Online]. St. Louis: American Optometric Association. Available at [accessed].

AstleA. T.WebbB. S.McGrawP. V. (2010). Spatial frequency discrimination learning in normal and developmentally impaired human visionVision Research 5024452454.

AtteboK.MitchellP.CummingR.SmithW.JollyN.SparkesR. (1998). Prevalence and causes of amblyopia in an adult populationOphthalmology 105154159.

BavelierD.LeviD. M.LiR. W.DanY.HenschT. K. (2010). Removing brakes on adult brain plasticity: from molecular to behavioral interventionsJ. Neurosci. 301496414971.

BirnbaumM. H.KosloweK.SanetR. (1977). Success in amblyopia therapy as a function of age: a literature surveyAmer. J. Optomet. Physiol. Optics 54269275.

BoweringE. R.MaurerD.LewisT. L.BrentH. P. (1997). Constriction of the visual field of children after early visual deprivationJ. Pediat. Ophthalmol. Strabismus 34347356.

BrainardD. H. (1997). The psychophysics toolboxSpatial Vision 10433436.

BrownS. A.WeihL. M.FuC. L.DimitrovP.TaylorH. R.McCartyC. A. (2000). Prevalence of amblyopia and associated refractive errors in an adult population in Victoria, AustraliaOphthalmic Epidemiology 7249258.

ChungS. T. L.LiR. W.LeviD. M. (2006). Identification of contrast-defined letters benefits from perceptual learning in adults with amblyopiaVision Research 4638533861.

ChungS. T. L.LiR. W.LeviD. M. (2007). Crowding between first- and second-order letter stimuli in normal foveal and peripheral visionJ. Vision 7113.

ConstantinescuT.SchmidtL.WatsonR.HessR. F. (2005). A residual deficit for global motion processing after acuity recovery in deprivation amblyopiaInvestigat. Ophthalmol. Vis. Sci. 4630083012.

EllembergD.LewisT. L.MaurerD.BrarS.BrentH. P. (2002). Better perception of global motion after monocular than after binocular deprivationVision Research 42169179.

GoldbergM. C.MaurerD.LewisT. L.BrentH. P. (2001). The influence of binocular visual deprivation on the development of visual–spatial attentionDevelopment. Neuropsychol. 195381.

GottlobI.Stangler-ZuschrottE. (1990). Effect of levodopa on contrast sensitivity and scotomas in human amblyopiaInvestigat. Ophthalmol. Vis. Sci. 31776780.

GreenC. S.BavelierD. (2003). Action video game modifies visual selective attentionNature 423534537.

GreenC. S.BavelierD. (2006a). Enumeration versus multiple object tracking: the case of action video game playersCognition 101217245.

GreenC. S.BavelierD. (2006b). Effect of action video games on the spatial distribution of visuospatial attentionJ. Exper. Psychol.: Human Percept. Perform. 3214651468.

HarveyL. (1986). Efficient estimation of sensory thresholdsBehav. Res. Methods 18623632.

HaysR. D.MangioneC. M.EllweinL.LindbladA. S.SpritzerK. L.McDonnellP. J. (2003). Psychometric properties of the National Eye Institute — Refractive Error Quality of Life instrumentOphthalmology 11022922301.

HenschT. K. (2005). Critical period plasticity in local cortical circuitsNature Rev. Neurosci.6877888.

HuangC.-B.ZhouY.LuZ.-L. (2008). Broad bandwidth of perceptual learning in the visual system of adults with anisometropic amblyopiaProc. Nat. Acad. Sci. 10540684073.

HuangC.-B.ZhouJ.LuZ.-L.FengL.ZhouY. (2009). Binocular combination in anisometropic amblyopiaJ. Vision 9114.

JeonS. T.HamidJ.MaurerD.LewisT. L. (2010). Developmental changes during childhood in single-letter acuity and its crowding by surrounding contoursJ. Exper. Child Psychol. 107423437.

KontsevichL. L.TylerC. W. (1999). Bayesian adaptive estimation of psychometric slope and thresholdVision Research 3927292737.

Le GrandR.MondlochC. J.MaurerD.BrentH. P. (2001). Neuroperception: early visual experience and face processingNature 410890.

Le GrandR.MondlochC. J.MaurerD.BrentH. P. (2004). Impairment in holistic face processing following early visual deprivationPsycholog. Sci. 15762768.

Le VayS.WieselT. N.HubelD. H. (1980). The development of ocular dominance columns in normal and visually deprived monkeysJ. Compar. Neurol. 191151.

LeguireL. E.RogersG. L.BremerD. L. (1990). Amblyopia: the normal eye is not normalJ. Pediat. Ophthalmol. Strabismus 273238.

LeguireL. E.RogersG. L.WalsonP. D.BremerD. L.McGregorM. L. (1998). Occlusion and levodopa-carbidopa treatment for childhood amblyopiaJ. Amer. Assocn Pediat. Ophthalmol. Stabismus 2257264.

LesmesL. A.JeonS.-T.LuZ.-L.DosherB. A. (2006). Bayesian adaptive estimation of threshold versus contrast external noise functions: the quick TvC methodVision Research 4631603176.

LesmesL. A.LuZ.-L.BaekJ.AlbrightT. D. (2010). Bayesian adaptive estimation of the contrast sensitivity function: the quick CSF methodJ. Vision 10121.

LeviD. M.KleinS. A. (1985). Vernier acuity, crowding and amblyopiaVision Research 25979991.

LeviD. M.PolatU. (1996). Neural plasticity in adults with amblyopiaProc. Nat. Acad. Sci. 9368306834.

LewisT. L.MaurerD.TytlaM. E.BoweringE. R.BrentH. P. (1992). Vision in the ‘good’ eye of children treated for unilateral congenital cataractOphthalmology 9910131017.

LewisT. L.MaurerD.BrentH. P. (1995). Development of grating acuity in children treated for unilateral or bilateral congenital cataractInvestigat. Ophthalmol. Vis. Sci. 3620802095.

LewisT. L.EllembergD.MaurerD.WilkinsonF.WilsonH. R.DirksM.BrentH. P. (2002). Sensitivity to global form in glass patterns after early visual deprivation in humansVision Research 42939948.

LiX.LuZ.-L.XuP.JinJ.ZhouY. (2003). Generating high gray-level resolution monochrome displays with conventional computer graphics cards and color monitorsJ. Neurosci. Methods 130918.

LiR. W.KleinS. A.LeviD. M. (2008). Prolonged perceptual learning of positional acuity in adult amblyopia: perceptual template retuning dynamicsJ. Neurosci. 281422314229.

LiR.PolatU.MakousW.BavelierD. (2009). Enhancing the contrast sensitivity function through action video game trainingNature Neurosci. 12549551.

LiR. W.NgoC.NguyenJ.LeviD. M. (2011). Video-game play induces plasticity in the visual system of adults with amblyopiaPLoS Biol. 9111.

Mathworks (2008). MATLAB. 2008a ed.

MitchellD. E.MacKinnonS. (2002). The present and potential impact of research on animal models for clinical treatment of stimulus deprivation amblyopiaClin. Exper. Optomet. 85518.

MondlochC. J.GrandR. L.MaurerD. (2002). Configural face processing develops more slowly than featural face processingPerception 31553566.

MowerG. D.BurchfielJ. L.DuffyF. H. (1982). Animal models of strabismic amblyopia: physiological studies of visual cortex and the lateral geniculate nucleusDevelopment. Brain Res. 5311327.

NewsomeW. T.PareE. B. (1988). A selective impairment of motion perception following lesions of the middle temporal visual area (mt)J. Neurosci. 822012211.

PizzorussoT.MediniP.LandiS.BaldiniS.BerardiN.MaffeiL. (2006). Structural and functional recovery from early monocular deprivation in adult ratsProc. Nat. Acad. Sci. 10385178522.

PolatU.Ma-NaimT.BelkinM.SagiD. (2004). Improving vision in adult amblyopia by perceptual learningProc. Nat. Acad. Sci. 10166926697.

RobbinsR.NishimuraM.MondlochC.LewisT.MaurerD. (2010). Deficits in sensitivity to spacing after early visual deprivation in humans: a comparison of human faces, monkey faces, and housesDevelopment. Psychobiol. 52775781.

RogersJ. D.Sanchez-SaffonA.FrolA. B.Diaz-ArrastiaR. (2003). Elevated plasma homocysteine levels in patients treated with levodopa: association with vascular diseaseArch. Neurol. 605964.

RyffC. D. (1989). Happiness is everything, or is it? explorations on the meaning of psychological well-beingJ. Personality Social Psychol. 5710691081.

SaleA.Maya VetencourtJ. F.MediniP.CenniM. C.BaroncelliL.De PasqualeR.MaffeiL. (2007). Environmental enrichment in adulthood promotes amblyopia recovery through a reduction of intracortical inhibitionNature Neurosci. 10679681.

SekulerR.BallK. (1986). Visual localization: age and practiceJ. Optic. Soc. Amer. A 3864867.

ThompsonB.MansouriB.KoskiL.HessR. F. (2012). From motor cortex to visual cortex: the application of noninvasive brain stimulation to amblyopiaDevelopment. Psychobiol. 54263273.

VetencourtJ. F. M.SaleA.ViegiA.BaroncelliL.De PasqualeR.O’LearyO. F.CastrénE.MaffeiL. (2008). The antidepressant fluoxetine restores plasticity in the adult visual cortexScience 320385388.

WebberA. L.WoodJ. (2005). Amblyopia: prevalence, natural history, functional effects and treatmentClin. Exper. Optomet. 88365375.

WickB.WingardM.CotterS.ScheimanM. (1992). Anisometropic amblyopia: is the patient ever too old to treat? Optomet. Vision Sci. 69866878.

ZhouY.HuangC.XuP.TaoL.QiuZ.LiX.LuZ.-L. (2006). Perceptual learning improves contrast sensitivity and visual acuity in adults with anisometropic amblyopiaVision Research 46739750.


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    Examples of tasks included in the pre- and post-test battery. Task A. An example of a stimulus used in the crowding task. Patients discriminated the orientation of the letter E surrounded by 3-bar flankers of the same size as the letter. The orientations of the flankers were determined randomly trial by trial. Crowding threshold was defined as the distance required to discriminate the orientation of the central letter 79.1% of the time. The size of the E was determined by the patient’s single letter acuity. Task B. A sample trial sequence used to measure the spatial contrast sensitivity function. Patients indicated which of the two intervals contained a sine-wave grating that varied in contrast and spatial frequency. In both intervals, white, caret-shaped stimulus placeholders appeared to demarcate where the grating might appear. Task C. A sample trial sequence used to measure the temporal contrast sensitivity function. Patients indicated which of the two intervals contained a flickering pattern that varied in contrast across four temporal frequencies. As in measuring spatial contrast sensitivity, caret-shaped placeholders were presented in each interval to demarcate the area where the grating might appear. Task D. A sample trial sequence used to measure contrast thresholds in noise. After a fixation cross, patients discriminated the orientation of a sine-wave grating that was temporally interleaved with noise frames. Contrast thresholds were measured in noise, the strength of which varied across trials. Task E. A static illustration of the global motion display. The dots with arrows represent signal dots moving upward. The remaining dots represent noise dots moving in random directions. Thresholds were defined as the minimum percentage of coherently moving signal dots necessary for accurate identification of upward or downward motion. Task F. A sample trial sequence for the facial processing task. For both upright and inverted sequences, each member of a pair of faces was flashed briefly and separated by a noise mask. Patients judged if the members of the pair were the same or different. Task G. A sample trial sequence for the Useful Field of View (UFOV) task. After a fixation box appeared in the middle of the screen, the target (small white triangle) enclosed in a square flashed briefly in one of 24 locations distributed across three eccentricities. After a noise mask, patients indicated on the radial spoke where the target had appeared. In the no-distractor condition, only the target enclosed in a square appeared before the mask. In the distractor condition, both the target and the square placeholders of all possible target locations appeared simultaneously.

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    Panel A shows patients’ visual acuity (VA) in log minimum angle of resolution (logMAR) when tested with the worse eye alone (left panel), the better eye alone (middle panel), and binocularly (right panel) before (pre) versus after (post) the 40 h of video game training. The black cross in each panel represents the mean acuity with a horizontal standard error of the mean for the post-test acuity and a vertical standard error of the mean for the pre-test acuity. Panel B shows logMAR changes in normal controls between pre- and post-test without training. The format is the same as in Panel A except that the mean of their results from each eye tested alone are combined under the monocular graph.

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    Single letter acuity (Panel A) and crowding (Panel B) before versus after 40 h of video game training. Other details as in Fig. 2A.

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    Panel A shows the mean change (±1 s.e.) in sensitivity across spatial frequencies before and after video game training when tested with the worse eye, the better eye, and binocularly. Pre- and post-ratios (PPR) were calculated by dividing post-sensitivity by pre-sensitivity; PPR = 1 represents no change, PPR > 1 represents improvement, and PPR < 1 represents deterioration. Panel B shows the mean change (±1 s.e.) in sensitivity across spatial frequencies without training when normal controls were tested monocularly and binocularly. Other details are same as in Fig. 4A.

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    Temporal contrast sensitivity changes for patients (Panel A) and normal controls (Panel B). Details are same as in the corresponding panels of Fig. 4.

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    Panel A shows the mean contrast threshold as a function of external noise strength averaged across seven patients tested under the three viewing conditions (worse eye, better eye, and binocularly) except for the Patient 7 who was tested only with his worse eye. Each dot represents the mean threshold (+1 standard error) measured using the quick-TvC method before (gray symbols) and after (black symbols) video game play. Panel B shows mean contrast thresholds across external noise strength for five normal controls (one of the subjects was not able to do the task) when tested monocularly.

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    Global motion coherence thresholds with the speeds of 4 deg⋅s−1 (Panel A) and 18 deg⋅s−1 (Panel B) for patients. Panel C shows global motion coherence thresholds with the speed of 4 deg⋅s−1 for normal controls (the faster speed was not tested). Other details are the same as in Fig. 2.

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    Panel A shows accuracy on the test of configural face perception before (pre) versus after (post) 40 h of video game play. Data for upright faces are shown in the left panel and for inverted faces on the right panel. All testing was completed only under binocular viewing conditions. Panel B shows the results for normal controls with the same format as Panel A. Other details are the same as in Fig. 2, except the locations of the axes for pre- and post-test were reversed so that, as in previous figures, improvements from pre- to post-test would still be indicated by values above the dotted identity line.

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    Duration of target presentation for Useful Field of View in tests without distractors (Panel A) and with distractors (Panel B). Other details as in Fig. 2A.

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