Feature Counting Is Impaired When Shifting Attention Between the Eyes in Adults With Amblyopia

BACKGROUND: Feature counting requires rapid shifts of attention in the visual field and reflects higher-level cortical functions. This process is drastically impaired in the amblyopic eye of strabismic amblyopes. In this study, we hypothesized that feature counting performance in anisometropic and strabismic amblyopes is further impaired when shifts in attention is required between the eyes. MATERIALS AND METHODS: Through a mirror stereoscope, highly visible Gabor patches were presented to the same eye within a block or randomly presented to the left eye or to the right eye with an equal probability within a block. The task was to report the number of Gabors (3 to 9) as accurately as possible. Counting performance was compared between the amblyopes and the normal-vision observers and between the viewing conditions (shifting attention between the eyes versus maintaining attention in the same eye). RESULTS: When attention was maintained in the same eye, the amblyopic eye of both anisometropic and strabismic groups undercounted the number of Gabors, but achieved near-perfect performance with their fellow eye, compared to normal-vision observers. In contrast, when shifting attention randomly to the left or to the right eye, the amblyopic eye further undercounted the number of Gabors. Undercounting was also found in the fellow eye of strabismic amblyopes, but was not in the fellow eye of anisometropic amblyopes. Performance in normal-vision observers did not differ between shifting attention between the eyes and maintaining attention in the same eye. CONCLUSION: Our data showed that the amblyopic eye of both anisometropic and strabismic amblyopes further undercounted features when shifting attention between the eyes, compared to when maintaining attention in the same eye. This suggests that the ability to quickly redirect attention, particularly under interocular suppression, is impaired in amblyopia. The fellow eye of strabismic amblyopes also undercounted features when shifting attention between the eyes. However, such fellow eye abnormality was not found in anisometropic amblyopes, suggesting that different patterns of visual deficits are associated with amblyopia of different etiologies. The inability to count multiple features accurately reflects dysfunctions of high-level cortices in the amblyopic brain.