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How Best to Assess Suppression in Patients with High Anisometropia

Li, Jinrong*; Hess, Robert F.; Chan, Lily Y.L.; Deng, Daming§; Chen, Xiang; Yu, Minbin*; Thompson, Benjamin S.**

doi: 10.1097/OPX.0b013e31827d072c
Technical Report

Purpose: We have recently described a rapid technique for measuring suppression using a dichoptic signal/noise task. Here, we report a modification of this technique that allows for accurate measurements to be made in amblyopic patients with high levels of anisometropia. This was necessary because aniseikonic image size differences between the two eyes can provide a cue for signal/noise segregation and, therefore, influence suppression measurement in these patients.

Methods: Suppression was measured using our original technique and with a modified technique whereby the size of the signal and noise elements was randomized across the stimulus to eliminate size differences as a cue for task performance. Eleven patients with anisometropic amblyopia, five with more than 5 diopters (D) spherical equivalent difference (SED), six with less than 5 D SED between the eyes, and 10 control observers completed suppression measurements using both techniques.

Results: Suppression measurements in controls and patients with less than 5 D SED were constant across the two techniques; however, patients with more than 5 D SED showed significantly stronger suppression on the modified technique with randomized element size. Measurements made with the modified technique correlated with the loss of visual acuity in the amblyopic eye and were in good agreement with previous reports using detailed psychophysical measurements.

Conclusions: The signal/noise technique for measuring suppression can be applied to patients with high levels of anisometropia and aniseikonia if element size is randomized. In addition, deeper suppression is associated with a greater loss of visual acuity in patients with anisometropic amblyopia.

*MD, PhD

PhD, DSc




**BSc, PhD

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China (JL, LYLC, DD, XC, MY); Department of Ophthalmology, McGill University, Montreal, Canada (RH); School of Optometry, The Hong Kong Polytechnic University, Hong Kong SAR, China (LYLC); and Department of Optometry and Vision Science, Faculty of Science, The University of Auckland, Auckland, New Zealand (BST).

Minbin Yu State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Department of Optometry and Vision Science Sun Yat-sen University Guangzhou 510060 People’s Republic of China e-mail:

© 2013 American Academy of Optometry