Skip to main content
NCBI home page
Transactions of the American Ophthalmological Society logoLink to Transactions of the American Ophthalmological Society
. 1994;92:349–376.

Consequences of retinal image clarity versus occlusion (absent) versus diffusion.

A Jampolsky 1
PMCID: PMC1298516  PMID: 7886872

Abstract

A series of clinical questions and stated hypotheses suggested in the pre-1960s regarding the differences between stimuli of occlusion and diffusion are presented (Part I) and are answered and confirmed by a series of experiments and data in animals and humans. A diffusion stimulus is extremely destructive to development of the acuity system in an eye per se (as well as producing myopia), and a unilateral diffusion stimulus is also destructive to development of the binocular system. Real occlusion is a no-stimulus condition that can be used to preserve normal acuity and binocular development, and as a delay tactic to successfully counteract the detrimental effect of diffusion. Binocular input differences (especially if one is a diffusion stimulus) are a major cause of strabismus in both the immature and mature binocular systems. The hypothesis was proposed that preoperative full-time alternate occlusion in infantile esotropia enhanced the binocularity outcome (for which supportive experimental data in animals and humans from our laboratories are discussed in Part III). Animal experiments during the 1960s and 1970s are reviewed relative to the confusion and conflict generated (Part II), since many of these experiments were based on the false assumptions that the unilateral eyelid closure model was a no-stimulus condition (because of the small amount of light transmitted). In fact, it was a worst-case severe stimulus with both monocular and binocular detrimental consequences. And the unilateral eyelid closure model usually produced either undetected or ignored strabismus in the animal experiments, with such strabismus severely compounding the detrimental effects of the eyelid closure model. Further confusion was added by the amblyopia therapeutic model in animals of "reverse eyelid occlusion" (which was really reverse diffusion) and which the author maintains was a gross distortion of the clinician's real occlusive patch over the better eye in the therapy of amblyopia of the poorer eye. These confusions and conflicts were at variance with long-standing clinical percepts. Part III provides data from the series of animal and human experiments from our laboratories at Smith-Kettlewell Eye Research Institute, which clarify the confusion and conflicts of some of the animal experiments described. Our data support the original hypotheses (Part I) enabling the clinician to use occlusion measures in selected patients to expand the therapeutic timing options and to improve visual outcomes. Binocular system outcomes are shown to be improved by our recent data in animal and human experiments, thus supporting the beneficial sensory effects of preoperative full-time alternate occlusion regimes in infantile esotropia.

Full text

PDF
349

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bowering E. R., Maurer D., Lewis T. L., Brent H. P. Sensitivity in the nasal and temporal hemifields in children treated for cataract. Invest Ophthalmol Vis Sci. 1993 Dec;34(13):3501–3509. [PubMed] [Google Scholar]
  2. Christen W. G., Mower G. D. Effects of monocular occlusion and diffusion on visual system development in the cat. Brain Res. 1987 Jul 14;415(2):233–241. doi: 10.1016/0006-8993(87)90205-8. [DOI] [PubMed] [Google Scholar]
  3. Foster R. S., Paul T. O., Jampolsky A. Mangement of infantile esotropia. Am J Ophthalmol. 1976 Aug;82(2):291–299. doi: 10.1016/0002-9394(76)90436-0. [DOI] [PubMed] [Google Scholar]
  4. HUBEL D. H., WIESEL T. N. RECEPTIVE FIELDS OF CELLS IN STRIATE CORTEX OF VERY YOUNG, VISUALLY INEXPERIENCED KITTENS. J Neurophysiol. 1963 Nov;26:994–1002. doi: 10.1152/jn.1963.26.6.994. [DOI] [PubMed] [Google Scholar]
  5. Hoyt C. S. The long-term visual effects of short-term binocular occlusion of at-risk neonates. Arch Ophthalmol. 1980 Nov;98(11):1967–1970. doi: 10.1001/archopht.1980.01020040819004. [DOI] [PubMed] [Google Scholar]
  6. JAMPOLSKY A. Characteristics of suppression in strabismus. AMA Arch Ophthalmol. 1955 Nov;54(5):683–696. doi: 10.1001/archopht.1955.00930020689010. [DOI] [PubMed] [Google Scholar]
  7. JAMPOLSKY A., FLOM B. C., WEYMOUTH F. W., MOSES L. E. Unequal corrected visual acuity as related to anisometropia. AMA Arch Ophthalmol. 1955 Dec;54(6):893–905. doi: 10.1001/archopht.1955.00930020899013. [DOI] [PubMed] [Google Scholar]
  8. Jampolsky A., Norcia A. M., Hamer R. D. Preoperative alternate occlusion decreases motion processing abnormalities in infantile esotropia. J Pediatr Ophthalmol Strabismus. 1994 Jan-Feb;31(1):6–17. doi: 10.3928/0191-3913-19940101-04. [DOI] [PubMed] [Google Scholar]
  9. Mower G. D., Berry D., Burchfiel J. L., Duffy F. H. Comparison of the effects of dark rearing and binocular suture on development and plasticity of cat visual cortex. Brain Res. 1981 Sep 14;220(2):255–267. doi: 10.1016/0006-8993(81)91216-6. [DOI] [PubMed] [Google Scholar]
  10. Mower G. D., Caplan C. J., Letsou G. Behavioral recovery from binocular deprivation in the cat. Behav Brain Res. 1982 Feb;4(2):209–215. doi: 10.1016/0166-4328(82)90074-2. [DOI] [PubMed] [Google Scholar]
  11. NAWRATZKI I., JAMPOLSKY A. A regional hemiretinal difference in amblyopia. Am J Ophthalmol. 1958 Sep;46(3 Pt 1):339–344. doi: 10.1016/0002-9394(58)90258-7. [DOI] [PubMed] [Google Scholar]
  12. Naegele J. R., Held R. The postnatal development of monocular optokinetic nystagmus in infants. Vision Res. 1982;22(3):341–346. doi: 10.1016/0042-6989(82)90149-3. [DOI] [PubMed] [Google Scholar]
  13. Norcia A. M., Garcia H., Humphry R., Holmes A., Hamer R. D., Orel-Bixler D. Anomalous motion VEPs in infants and in infantile esotropia. Invest Ophthalmol Vis Sci. 1991 Feb;32(2):436–439. [PubMed] [Google Scholar]
  14. Ohashi T., Norcia A. M., Kasamatsu T., Jampolsky A. Cortical recovery from effects of monocular deprivation caused by diffusion and occlusion. Brain Res. 1991 May 10;548(1-2):63–73. doi: 10.1016/0006-8993(91)91107-c. [DOI] [PubMed] [Google Scholar]
  15. Sherman S. M. Permanence of visual perimetry deficits in monocularly and binocularly deprived cats. Brain Res. 1974 Jun 28;73(3):491–501. doi: 10.1016/0006-8993(74)90672-6. [DOI] [PubMed] [Google Scholar]
  16. WALLS G. L. A theory of ocular dominance. AMA Arch Ophthalmol. 1951 Apr;45(4):387–412. doi: 10.1001/archopht.1951.01700010395005. [DOI] [PubMed] [Google Scholar]
  17. Wiesel T. N., Raviola E. Myopia and eye enlargement after neonatal lid fusion in monkeys. Nature. 1977 Mar 3;266(5597):66–68. doi: 10.1038/266066a0. [DOI] [PubMed] [Google Scholar]
  18. Wright K. W., Wehrle M. J., Urrea P. T. Bilateral total occlusion during the critical period of visual development. Case report. Arch Ophthalmol. 1987 Mar;105(3):321–321. doi: 10.1001/archopht.1987.01060030035012. [DOI] [PubMed] [Google Scholar]

Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society

RESOURCES