Anisometropic Amblyopia: Interocular Contrast and Viewing Luminance Effects on Aniseikonia

PURPOSE: To demonstrate an aniseikonia test for anisometropic amblyopia (ATAA) that uses variable viewing luminance at different interocular contrast levels. METHODS: The test consists of a direct size comparison task based on a computer. The subject is asked to adjust the size of a dichoptically dissociated paired square target. One square was always presented at 100% contrast to the amblyopic eye/nondominant eye, whereas its counterpart was presented to the fellow eye at six contrast levels. Measurements were performed at two luminance backgrounds: (1) a white square on a black background (WoB) and (2) a black square on a white background (BoW). To test the feasibility of this approach, 16 patients with anisometropic amblyopia and 23 normal controls were recruited. RESULTS: The Aniseikonia Index (AI) calculated from the ATAA increased when the difference in the interocular contrast increased in both the patients with anisometropic amblyopia and controls under BoW and WoB conditions. The mean AI differed dramatically between the BoW and WoB conditions in patients with amblyopia but not in normal subjects. CONCLUSIONS: Our model predicted interocular differences in contrast to the measurement of aniseikonia. Execution of the AI in individuals with amblyopia should consider that their responses to different luminance viewing conditions could be asymmetric. TRANSLATIONAL RELEVANCE: The ATAA has the potential to optimize optical correction for the management of aniseikonia in individuals with anisometropic amblyopia.