New therapy helps to improve stereoscopic vision in stroke patients

Humans view the world through two eyes, but it is our brain that combines the images from each eye to form a single composite picture. If this function becomes damaged, impaired sight can be the result. Such loss of visual function can be observed in patients who have suffered a stroke or traumatic brain injury or when the oxygen supply to the brain has been reduced (cerebral hypoxia). Those affected by this condition experience blurred vision or can start to see double after only a short period of visual effort. Other symptoms can include increased fatigue or headaches. It is been suggested that these symptoms arise because the brain is unable to maintain its ability to fuse the separate images from each eye into a single composite image over a longer period. Experts refer to this phenomenon as binocular fusion dysfunction.

‘As a result, these patients have significantly reduced visual endurance,’ explains Katharina Schaadt, a graduate psychology student at Saarland University. ‘This often severely limits a patient’s ability to work or go about their daily life.’ Working at a computer screen or reading the newspaper can be very challenging. As binocular fusion is a fundamental requirement for achieving a three-dimensional impression of depth, those affected also frequently suffer from partial or complete stereo blindness. ‘Patients suffering from stereo blindness are no longer able to perceive spatial depth correctly,’ says Schaadt. ‘In extreme cases, the world appears as flat as a two-dimensional picture. Such patients may well have difficulties in reaching for an object, climbing stairs or walking on uneven ground.’

Although about 20% of stroke patients and up to 50% of patients with brain trauma injuries suffer from these types of functional impairments, there is still no effective therapy. Researchers at Saarland University working with Anna Katharina Schaadt and departmental head Professor Georg Kerkhoff have now developed a novel therapeutic approach and have examined its efficacy in two studies. ‘Test subjects underwent a six week training program in which both eyes were exercised equally,’ explains Schaadt. The aim was to train binocular fusion and thus improve three-dimensional vision. Participants in the study were presented with two images with a slight lateral offset between them. By using what are known as convergent eye movements, patients try to fuse the two images to a single image. This involves directing the eyes inward towards the nose while always keeping the images in the field of view. With time, the two images fuse to form a single image that exhibits stereoscopic depth, i.e. the patient has re-established binocular single vision.

The team of clinical neuropsychologists at Saarland University have used this training programme on eleven stroke patients, nine patients with brain trauma injury and four hypoxia patients. After completing the training programme, a significant improvement in binocular fusion and stereoscopic vision was observed in all participants. In many cases, a normal level of stereovision was attained. ‘The results remained stable in the two post-study examinations that we performed after three and six months respectively,’ says Schaadt. ‘Visual endurance also improved significantly.’ Patients who were able to work at a computer for only 15 to 20 minutes before they began treatment found that they could work at a computer screen for up to three hours after completing the therapeutic training programme.

The results are also of theoretical value to the Saarbrücken scientists, as they provide insight into brain function and indicate that certain regions of the brain that have been become damaged can be reactivated if the appropriate therapy is used.

Rats have a double view of the world

Scientists from the Max Planck Institute for Biological Cybernetics in Tübingen, using miniaturised high-speed cameras and high-speed behavioural tracking, discovered that rats move their eyes in opposite directions in both the horizontal and the vertical plane when running around. Each eye moves in a different direction, depending on the change in the animal’s head position. An analysis of both eyes’ field of view found that the eye movements exclude the possibility that rats fuse the visual information into a single image like humans do. Instead, the eyes move in such a way that enables the space above them to be permanently in view – presumably an adaptation to help them deal with the major threat from predatory birds that rodents face in their natural environment.

Like many mammals, rats have their eyes on the sides of their heads. This gives them a very wide visual field, useful for detection of predators. However, three-dimensional vision requires overlap of the visual fields of the two eyes. Thus, the visual system of these animals needs to meet two conflicting demands at the same time; on the one hand maximum surveillance and on the other hand detailed binocular vision.

The research team from the Max Planck Institute for Biological Cybernetics have now, for the first time, observed and characterised the eye movements of freely moving rats. They fitted minuscule cameras weighing only about one gram to the animals’ heads, which could record the lightning-fast eye movements with great precision. The scientists also used another new method to measure the position and direction of the head, enabling them to reconstruct the rats’ exact line of view at any given time.

The Max Planck scientists’ findings came as a complete surprise. Although rats process visual information from their eyes through very similar brain pathways to other mammals, their eyes evidently move in a totally different way. “Humans move their eyes in a very stereotypical way for both counteracting head movements and searching around. Both our eyes move together and always follow the same object. In rats, on the other hand, the eyes generally move in opposite directions,” explains Jason Kerr from the Max Planck Institute for Biological Cybernetics.

In a series of behavioural experiments, the neurobiologists also discovered that the eye movements largely depend on the position of the animal’s head. “When the head points downward, the eyes move back, away from the tip of the nose. When the rat lifts its head, the eyes look forward: cross-eyed, so to speak. If the animal puts its head on one side, the eye on the lower side moves up and the other eye moves down.” says Jason Kerr.

In humans, the direction in which the eyes look must be precisely aligned, otherwise an object cannot be fixated. A deviation measuring less than a single degree of the field of view is enough to cause double vision. In rats, the opposing eye movements between left and right eye mean that the line of vision varies by as much as 40 degrees in the horizontal plane and up to 60 degrees in the vertical plane. The consequence of these unusual eye movements is that irrespective of vigorous head movements in all planes, the eyes movements always move in such a way to ensure that the area above the animal is always in view simultaneously by both eyes –something that does not occur in any other region of the rat’s visual field.

These unusual eye movements that rats possess appear to be the visual system’s way of adapting to the animals’ living conditions, given that they are preyed upon by numerous species of birds. Although the observed eye movements prevent the fusion of the two visual fields, the scientists postulate that permanent visibility in the direction of potential airborne attackers dramatically increases the animals’ chances of survival.