Transfer and retention of oculomotor alignment rehabilitation training

Ocular alignment defects such as strabismus affect around 5% of people and are associated with binocular vision impairments. Current nonsurgical treatments are controversial and have high levels of recidivism. In this study, we developed a rehabilitation method for ocular alignment training and examined the rate of learning, transfer to untrained alignments, and retention over time. Ocular alignment was controlled with a real-time dichoptic feedback paradigm where a static fixation target and white gaze-contingent ring were presented to the dominant eye and a black gaze-contingent ring with no fixation target was presented to the nondominant eye. Observers were required to move their eyes to center the rings on the target, with real-time feedback provided by the size of the rings. Offsetting the ring of the nondominant temporal or nasal visual field required convergent or divergent ocular deviation, respectively, to center the ring on the fixation target. Learning was quantified as the time taken to achieve target deviation of 2° (easy, E) or 4° (hard, H) for convergence (CE, CH) or divergence (DE, DH) over 40 trials. Thirty-two normally sighted observers completed two training sequences separated by one week. Subjects were randomly assigned to a training sequence: CE-CH-DE, CH-CE-DE, DE-DH-CE, or DH-DE-CE. The results showed that training was retained over the course of approximately one week across all conditions. Training on an easy deviation angle transferred to untrained hard angles within convergence or divergence but not between these directions. We conclude that oculomotor alignment can be rapidly trained, retained, and transferred with a feedback-based dichoptic paradigm. Feedback-based oculomotor training may therefore provide a noninvasive method for the rehabilitation of ocular alignment defects.