Dynamic Visual Acuity of Normal Subjects During Vertical Optotype and Head Motion

Joseph L. Demer^-f and Firooz AmjadiX

Purpose. To characterize the effect of passive vertical head motion on dynamic visual acuity of young, normally sighted subjects wearing telescopic spectacles, and to relate this to the velocity of images on the retina. Methods. Static visual acuity was measured without motion. Dynamic visual acuity was measured during vertical, sinusoidal motion of either optotypes or of a servo-driven rotating chair in which subjects were seated. Dynamic visual acuity for head motion was measured unaided, as well as with 1.9X, 4X, and 6X telescopic spectacles. Vertical eye movements were recorded using magnetic search coils. Results. During optotype motion, acuity declined with increasing velocity to a minimum of ~ 2 0 / 2 0 0 at 100/sec. Pursuit gain (eye velocity/optotype velocity) for moving optotypes was low except for optotype velocities of 20/sec of less. Dynamic visual acuity without telescopic spectacles was not sensitive to head motion. Static visual acuity improved with increasing telescopic spectacle power, but dynamic visual acuity became progressively impaired by head motion as telescopic spectacle power was increased. Compared with static visual acuity, head motion with peak velocity of 40/sec reduced acuity two-fold for 1.9X telescopic spectacles, fourfold for 4X telescopic spectacles, and eightfold for 6X telescopic spectacles. Visual vestibulo-ocular rellex gain with telescopic spectacles increased to values markedly above 1.0, but was always less than telescopic spectacle magnification. There was visual tolerance of slip velocities of 2/sec or less, above which acuity declined in proportion to the 0.6 power of retinal slip velocity. Above 2/sec, retinal slip velocity accounted for 95% of the variance in dynamic visual acuity. Conclusions. These results confirm that acuity is sensitive to retinal image motion in the vertical direction, and extend this finding to indicate that sensitivity of acuity to vertical head motion during wearing of telescopic spectacles is attributable to retinal image slip velocity. Invest Ophthalmol Vis Sci 1993;34:1894-1906.

.Dynamic visual acuity (DVA) is that acuity obtained during relative motion of either optotypes or observer.1 It has long been known that motion reduces
From the * Jules Stein Eye Institute and ^Department oj Neurology, UCLA Medical School, and %University of California at Los Angeles, Los Angeles, California. Supported by U.S. Public Health Service grants EY-08656 and NS-10940, and grants from the Karl Kirchgessuer Foundation and Research to Prevent lilindness. JLD was a Research to Prevent lilindness William and Mary Creve International Research Scholar. Submitted for publication: December 31, 1991; accepted July 17, 1992. Proprietary Interest Category: N. Reprint Requests: Joseph L. Demer, Jules Stein Eye Institute, Comprehensive Division, 100 Stein Plaza, UCLA, Los Angeles. CA 90024-7002.

DVA as compared with static values obtained without relative motion. Classical studies involving moving optotypes have suggested that DVA decreases according to the cube of horizontal2-3 or vertical optotype velocity.4 A number of investigators have simultaneously measured horizontal eye movements during DVA testing with moving optotypes, and related reduction in DVA to limitations on pursuit tracking.5-67 Murphy measured horizontal eye movements and contrast thresholds for square wave gratings moving at veloci-

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Vertical Dynamic Visual Acuity

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ties up to 7/sec, concluding that visual sensitivity is not reduced by pursuit itself, but is limited by velocity errors in pursuit.8 Many previous studies of DVA have not measured the tracking eye movements that serve to reduce the motion of images on the retina. In fact, it is common to employ DVA as an indirect indicator of the effectiveness of pursuit tracking,9 or of vestibularevoked eye movements in stabilizing gaze during head rotation. 10 " Such studies highlight the importance of DVA in relation to self-motion of the observer in the environment.12 Even when attempting to stand completely at rest, humans exhibit significant involuntary head movements about the vertical axis (yaw), about the interaural axis (pitch), and about the anteroposterior axis (roll).1314 Maximum head velocities during running are up to 90/sec, with predominant frequencies up to 2.7 Hz for yaw and 8.2 Hz for pitch.15 The mechanics of the head and neck are such that the frequency of involuntary head movements in the pitch axis tends to be substantially higher, and often at higher velocity, than head movements in the other two rotational axes. 12131415 This implies that vertical selfrotation is likely to be significant for the visual system. The major reflex producing compensatory movements during self-rotation is the vestibulo-ocular reIlex (VOR). During vision, other mechanisms augment the VOR, producing the visual vestibulo-ocular reflex (WOR). The gain of compensatory eye movements is defined as the ratio of eye velocity to head velocity. Thus, the normal ideal gain of 1.0 implies that eye velocity is equal and opposite head velocity, stabilizing the retina in space. Very precise studies of active horizontal and vertical eye movements indicate that this is very nearly the case, but that gain averages 1-2% less than the ideal value.16 Because of this residual error, very rapid head rotations can overwhelm the WOR even in normal subjects.1017 Telescopic spectacles with magnifications of 2-8X are commonly employed as visual aids for patients with low vision, defined as significant but incomplete visual loss. Being affixed to the head, telescopic spectacles magnify the effects of head movement. With telescopic spectacles, the W O R gain required for retinal image stabilization is no longer 1.0, but is equal to the magnification of the telescopes. If WOR gain is insufficient, large retinal image slip velocities can occur with only low or moderate velocities of head movement. Even physiologic head instability during standing can reduce DVA with telescopic spectacles, as demonstrated for low vision patients wearing 4X telescopic spectacles.18 The magnification of involuntary head movements produced by telescopic spectacles appears to have significant impact on functional use of these visual aids spectacles by patients with low vision. A retrospective study of telescopic spectacle use by low vision

patients identified a combination of two factors to be 85% accurate in predicting successful use of telescopic spectacles by motivated low vision patients: sensitivity of visual acuity with telescopes to head motion, and involuntary head instability (while standing) in the pitch axis.12 This finding has been confirmed prospectively.19 Existing data on DVA with telescopic spectacles are unsatisfactory in many respects, however. All studies employed passive head movements in the horizontal plane (yaw), despite the recognition that natural head movements are most challenging in the vertical plane (pitch). No previous study employing head movement with telescopic spectacles has related DVA to actual eye or retinal slip velocity during viewing, so the role of retinal slip has only been presumed to correspond to the literature obtained using moving optotypes. Even the existing data relating retinal image motion to DVA were obtained under conditions not representative of those encountered by low vision patients using telescopic spectacles. Reading employed Landoldt ring optotypes undergoing constant velocity ramp motions of brief duration.35 The study of Westheimer and McKee presented moving verniers or Landoldt ring optotypes so briefly that tracking eye movements were impossible.20 The elegant studies of Brown employed simultaneous eye movement recording during viewing of single Landoldt ring optotypes,2122 whereas Murphy employed variable contrast gratings repetitively alternating direction at constant speed.8 In distinction to these laboratory conditions, visually impaired patients making daily use of telescopic spectacles must deal with retinal image motion produced by substantially repetitive head movements of varying velocities, produced by tremor, transmitted heartbeat, and environmental perturbations.14 Patients may freely choose the duration of scrutiny. Alphabetic letters, arranged in lines, are the common optotypes for clinical low vision testing and correspond to functional reading tasks, whereas Landolt ring optotypes have practical drawbacks for clinical use.23 Existing data concerning DVA in normal subjects and low vision patients using telescopic spectacles employed rows of letter optotypes presented for extended periods during repetitive, sinusoidal, horizontal head motion.1219'24 Since previous studies of DVA with telescopic spectacles presented optotypes through the entire sinusoidal cycle of head motion, a variety of ocular motor strategies might have been employed to avoid retinal image slip. Such strategies might include viewing during the low velocity portions of the waveform,12 as is the case for foveation strategies of patients with congenital nystagmus.25 Practical design considerations, particularly weight limitations, dictate that the field of view of telescopic spectacles generally decreases as magnification is increased. This

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implies that eye movement strategies might vary from one telescopic spectacle power to another, which might also influence retinal image stability and DVA during head motion. Thus, actual retinal image slip cannot be confidently estimated in the absence of eye and head movement measurements under the viewing conditions employed. The aim of the current study was thus to characterize, in young, normally sighted subjects, the effect on DVA of imposed vertical head motion using telescopic spectacles of various optical powers. For comparison with previous studies of DVA with telescopic spectacles during horizontal head motion, letter optotypes and sinusoidal waveforms were chosen.1219-24 A further goal was to relate DVA during head motion with telescopic spectacles to actual retinal slip, the velocity error of images on the retina, and to compare this to data from the literature. To make comparison with previous studies easier, confirmatory measurements of DVA were also made under comparable conditions in the same subjects during vertical movement of optotypes with the head stationary. These studies of DVA with telescopic spectacles in young, normal subjects were intended to provide normative data for contemplated subsequent evaluations of the effects of aging, visual impairment, and neurologic disease. MATERIALS AND METHODS Thirteen young adult, paid volunteers gave written informed consent according to a protocol conforming to the tenets of the Declaration of Helsinki and approved by the Human Subject Protection Committee at the University of California at Los Angeles. All who participated in the study underwent ophthalmologic examination by one of the authors, and had visual acuities in each eye correctable to 20/20 or better using standard clinical optotype presentations. Average age of subjects was 30 6 years (mean SD, range 19-40); both men and women were represented. The host computer for these experiments was a Macintosh II (Apple Computer, Cupertino, CA) equipped with 16-channel analog-to-digital converter, 6-channel synchronous digital-to-analog converter (DAC), and direct memory access devices (National Instruments, Austin, TX). Custom software was written for these experiments using the Lab View laboratory software package (National Instruments). Visual acuities were measured using single rows of five white Sloan letters optically projected at 98% contrast and approximately 100 fL luminance against a black background on a matte white screen measuring 2.4 m2 and located 3 m from the subjects' eyes. The room was otherwise dark. The content of each row was balanced for equal difficulty,23 and the projector (Mast Development Company, Davenport, IA) was

controlled by the computer to rotate among three sets of letters for each optotype size to prevent memorization. Optotype size varied from line to line by 20%, representing a logarithmic change in the minimum angle resolvable (logMAR) of approximately 0.1 unit. Optotypes ranged in size from 0.7 (20/4 Snellen) through 1.7 logMAR (20/1000). For the optotypes larger than 1.0 logMAR (20/200), fewer than five letters were presented per line, due to limitations in the size of the transparencies in the projector. Subjects' responses were monitored using an intercom, and were recorded on the audio channel of the data recorder during trials when simultaneous eye movement recording was performed. Threshold acuity was defined as the smallest optotype size for which the majority of letters were correctly identified in correct sequence. If any errors occurred on a line, threshold was specified as 0.05 log unit greater than for all letters correct on that line.24 The optotype projector beam was deflected from a front surface mirror mounted on a high performance, temperature-compensated, position feedback galvanometer (General Scanning, Watertown, MA) that pivoted about the horizontal axis. The servo driver of the galvanometer was optimized for minimum deflection time, and was under computer control by a synchronous DAC. This permitted the computer to control the vertical position of optotypes as projected on the screen. The projection beam also passed through a large aperture that ordinarily did not interfere with the beam, but which completely occluded the beam when a maximum deflection command was provided to the mirror galvanometer. Using this arrangement, optotypes could be moved sinusoidally in the vertical plane at chosen frequencies and amplitudes, but could also be extinguished (blanked) by the abrupt deflection of the beam beyond the aperture. In the current experiments employing sinusoidal optotype and head motion, the optotypes were extinguished for 50% of each cycle (50% dwell), centered about the minimum velocity portions of each half cycle (Fig. 1). This permitted viewing when optotypes were at or near the straight ahead position, which is also when optotype or head velocity was greatest. For acuity measurement, subjects were seated in a custom-made swing rotator pivoting about the interaural axis. Their heads werefirmlystrapped to a headrest on the rotator, and their legs and bodies were comfortably secured to the rotator using harnesses and belts. The rotator was driven by a servomotor (108 ft-lb, 4.5 kW, Inland Motors, Radford, VA) with a custom-designed position feedback servo under computer control via a synchronous DAC. This permitted sinusoidal rotation of the subject's head and body at peak velocities of up to 40/sec, synchronized with optotype motion. Pairs of magnetic field generator

Vertical Dynamic Visual Acuity

Dwell

1897

Position

Velocity

FIGURE 1. Diagram of timing of optotype blanking relative to motion of optotypes or the rotating chair. The horizontal axis represents time. Position and velocity traces apply to either type of relative motion, which was sinusoidal despite the more circular curves shown in the diagram. Dark horizontal bars labeled "Dwell" indicate intervals of optotype blanking, and the squares at the bottom illustrate the screen and apparent optotype motion as these would be viewed by a subject during a moving optotype presentation.

coils 1 m in diameter were mounted on the swing rotator to permit the measurement of horizontal and vertical eye and head position using the magnetic search coil technique.26 Subjects wore a headband to which was attached a search coil for the measurement of head position relative to the swing rotator. The head search coil sensor was used only to verify that subjects' heads were always moving with the rotator headrest, since decoupling of the motion of the head from the headrest in known to occur at high frequencies of head rotation. However, at 1.0 Hz, the frequency of head rotation chosen for these experiments, such decoupling was never observed to occur. Acuity during optotype motion was measured monocularly for the right eye without optical devices for emmetropic subjects, or with the subjects' customary spectacles or contact lenses for subjects with ametropia. The total duration of presentation for each optotype line was held constant at 16 sec, but the frequency and peak velocity of sinusoidal optotype motion were systematically varied as indicated in Table 1. In each case, viewing was limited to the upper velocity half of each sinusoidal cycle, for a total blanking dwell of 180. Acuity during head motion was measured monocularly for the right eye under several viewing conditions. Viewing with only simple refractive correction (if necessary) was considered the IX condition. Measurements of acuity were also made using the following telescopic spectacles: 1.9X (~16.8 field); 4X (-10.3 field); and 6X (~7.5 field). The visual field

peripheral to the telescope elements was masked, as in a previous study.24 Field diameters were sufficient to include the optotypes throughout stimulus motions. Vertical eye position was measured in selected experiments using the magnetic search coil technique, with the scleral search coil contact lens (Skalar Medical, The Netherlands) applied to the left eye.27 Topical proparacaine 0.5% was applied to the eye before insertion of the search coil contact lens, and the lens was removed within 30 minutes. Calibration was obtained for vertical saccades to targets located at 10 eccentricity from the primary position. True head position in space was taken as the sum of swing rotator position plus head position relative to the swing rotator; however, there was generally no decoupled head movement and this correction proved to be an unnecessary precaution. Eye, head, and chair position data were displayed on a digital polygraph, with electronic differentiation for display of velocities. All data were also digitally recorded on magnetic tape for later editing and digital sampling at 400 Hz by the computer. For analysis of eye movements during optotype motion, peak slow phase eye velocity was determined by inspection of the eye velocity tracings on the polygraph obtained during the reading of letters. For analysis of eye and head movements during head motion, the audio channel of the recorded data tape was used to determine the times when letter reading occurred; 5-15 consecutive sinusoidal cycles were then digitally sampled from this period for automated analysis. For trials during which eye movements were recorded during passive head movements, data were automatically analyzed by digital low pass filtering (0-42 Hz), differentiation and removal of large quick phases and saccades using velocity and duration criteria, and cross spectral analysis of eye versus head velocity to determine the phase shift of the eye velocity response. After correction for phase, a linear regression of eye velocity against head velocity was obtained, and data points found to be statistical outliers from this fit were also excluded as quick phases. This generally removed approximately 20% of points. The remaining slow phase data points were fitted cycle-by-cycle by least squares to a sinusoidal equation. Head velocity, eye velocity, and gain (eye velocity/head velocity) were TABLE l.

Characteristics of Optotype Motion

Peak Velocity (deg/sec) 7.5 15 30 45 60 75 100 0. 25 0..5 1.0 1 .5 2..0 2..5 3. 33

Frequency (Hz)

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computed for each cycle, and outliers were automatically excluded using a statistical criterion previously described to be effective for the removal of low-gain artifacts.28 During optotype motion, retinal image slip velocity was considered to be the difference between optotype velocity and eye velocity. During head motion, retinal image slip velocity e was computed from eye velocity E and head velocity H using the following equation: e = E - MH, where M represents telescope magnification. RESULTS Moving Optotypes DVA was measured in 13 subjects during controlled optotype motion as specified in Table 1. These data are plotted as a function of peak optotype velocity in Figure 2. Although there was some interindividual variation, all subjects exhibited the same pattern of dependence of acuity on optotype velocity. At zero optotype velocity, representing static visual acuity (SVA), mean acuity was approximately 0 logMAR (20/ 20), and acuity declined monotonically with increasing peak optotype velocity. At a peak optotype velocity of 100/sec, DVA declined by a full log unit (20/200) relative to SVA. At this optotype velocity, the range of individual acuities was 0.65-1.15 logMAR (~20/9020/280). Individual subjects thus vary in their susceptibilities of DVA to optotype motion.
1.2

Moving Head
The same 13 subjects also underwent DVA measurements during passive whole-body, sinusoidal rotation in the vertical plane at 1.0 Hz. Peak velocity was varied from 0/sec to 40/sec, and optotypes were blanked during half of each sinusoidal cycle at intervals centered around the velocity zero crossings. The effect of this head motion on DVA with telescopic spectacles is illustrated in Figure 3. During unmagnified vision, there was little dependence of acuity on peak sinusoidal head velocity. Although statistically significant (P < 0.05, two-tailed t test), the decline in acuity relative to SVA associated with head motion at 10/sec and 40/sec was only about one half line; the decline was not significant at 20/sec. In contrast to the case of unmagnified vision, passive head motion with telescopic spectacles was associated with marked reductions in acuity in all subjects, although there was again some individual variation (Fig. 3). The 1.9X, 4X, and 6X telescopic spectacles were associated with progressive increases in SVA, respectively, although the increases were less than proportionate to optical magnification. As indicated in Figure 3, as telescopic magnification increased, DVA became increasingly sensitive to head velocity. In all cases, mean DVA with telescopic spectacles during head motion at 20/sec was less than with unmagnified vision at the same velocity. The following data obtained at a peak head velocity of 40/sec are illustrative. Using 1.9X telescopic spectacles, mean acuity declined by more than two-fold relative to SVA, with a range of -0.05-0.65 logMAR (-20/18-20/90). Using 4X telescopic spectacles, mean acuity declined by
20/320 20/200

(1)

1.0"
O) 0.8

I
75
0.2

20/50
20/32

Mean SEM
0.0

20/20

-0.2

20

40

60

80

100

20/12

Optotype Velocity - Deg/Sec FIGURE 2. Dynamic visual acuity of 13 subjects during sinusoidal optotype motion. Abscissa indicates peak sinusoidal optotype velocity, under conditions specified in Table 1.

Vertical Dynamic Visual Acuity 20/80 20/50

1899

20/32

20/20

20/12

20/8

-0.6
-5

20/5 5 10 15 20 25 30 35

Head Velocity at 1.0 Hz - deg/sec FIGURE 3. Dynamic visual acuity of 13 subjects during sinusoidal, head rotation at 1 Hz, viewing with and without telescopic spectacles of indicated powers. 1 X, no telescopes.

five-fold relative to SVA, with a range of 0.15-0.55 logMAR (~20/30-20/70). Using 6X telescopic spectacles, mean acuity declined by more than seven fold relative to SVA, with a range of 0.35-0.85 logMAR (~ 20/45-20/140). These ranges indicate that individual subjects also vary considerably in their susceptibilities of DVA to head motion while wearing telescopic spectacles.

Eye Movements Compensatory eye movements during DVA were measured in five of the subjects. Optotypes were extinguished except around the straight-ahead position, as before. During measurements, subjects read optotypes approximately two lines larger than their individually measured thresholds. The magnetic search coil contact lens was applied to each subject's occluded left eye, during viewing by the right eye. For moving optotypes, peak velocities of 7.5, 15, 45, and 75/sec were employed. Typical eye movements during reading of moving optotypes are illustrated in Fig. 4 (upper). Surprisingly, despite optotype blanking except around the straight-ahead position, slow-phase velocity was essentially sinusoidal, although only part of the sinusoidal optotype motion was visible. Catch-up saccades occasionally occurred (Fig. 4, upper), and eye position closely approximated that of the optotypes. The peakto-peak position amplitude of the eye tracking responses was typically equal to the total displacement of the optotypes during their presentation, 4.8. This suggests that foveal position error was minimal. The ocular motor strategy of all subjects was simply to at-

tempt smooth sinusoidal tracking of optotype motion when optotypes were visible, and to continue sinusoidal tracking when they were not, with catch-up saccades as needed to correct for position errors. However, peak smooth eye velocity approximated the stimulus only at the 7.5/sec; at higher optotype velocities, eye velocity fell behind (Fig. 5). Peak eye velocity never exceeded 12/sec at any optotype velocity. During passive head motion, slow phase eye velocity was also sinusoidal, but much higher velocities were observed than during optotype motion (Fig. 4, midde and lower). The relationship between peak eye velocity and peak head velocity and the dependence upon telescopic spectacle power, are illustrated in Fig. 6. At head velocities of 10/sec and 20/sec, increasing telescopic spectacle power was associated with increasing eye velocity, but at 40/sec head velocity, eye velocity began to saturate at a maximum of 80/sec. The relationship between eye velocity and head velocity is replotted in terms of gain in Fig. 7. This illustrates that gain approached but did not achieve optical magnification at a head velocity of 10/sec, and declined at higher head velocities for 4X and 6X telescopic spectacles. For 1.9X telescopic spectacles, gain increased as head velocity was increased from 10/sec to 20/ sec, and did not change further as head velocity was increased to 40/sec. Retinal Slip Velocity Retinal slip velocity was computed from the data for both optotype motion and head motion, and was plotted in logarithmic form against DVA measured in the

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Eye Position Eye Velocity Moving Optotypes - 1.5 Hz, 45/sec

Eye Position

Velocity

Eye

\J
Moving Chair, 1.0 Hz, 40/sec, 1.9X

Eye Position

Eye Velocity

Moving Chair, 1.0 Hz, 40/sec, 4X FIGURE 4. Eye movements recorded using the magnetic search coil affixed to the nonviewing eye of one subject during dynamic visual acuity testing. Each pair of tracings consists of vertical eye position and vertical eye velocity obtained by electronic differentiation. Upward eye movements are signified by upward deflections of the tracings. Upper tracings, moving optotypes. Note prominent catch-up saccades. Middle tracings, moving head, with ] .9X telescopic spectacles. Lower tracings, moving head, with 4X telescopic spectacles.

same subjects (Fig. 8). The use of multiple telescopic spectacle powers permitted examination of a broad range of retinal slip velocities. The plots suggest that for 2/sec or less the visual system tolerates retinal image slip without appreciable decrement in DVA, but that DVA declines markedly with slip above this. Because the measure of acuity is logarithmic, the effect of telescopic spectacles is to shift the curves for head motion downward according to telescope magnification. Because telescopic spectacles also magnify head movements that are not fully compensated by eye movements, increasing telescope power also shifts the curves to the right. Above 2/sec, the curves for each viewing condition appear to be linear and approximately parallel to one another. Linear regression for

each curve yielded coefficients of determination > 0.91, with slopes ranging from 0.53 for optotype motion to 0.92 for 6X telescopic spectacles. If acuity values are normalized for each telescopic spectacle power by the addition of the logarithmic value of magnification, DVA values for all telescopes can be pooled and plotted together against retinal slip velocity (Fig. 9). For retinal slip velocities greater than 2/sec, all DVA values tightly clustered about a linear relationship with the logarithm of slip velocity (R2 = 0.954). This was true regardless of viewing condition and telescopic spectacle power, and strongly suggests that retinal slip velocity is responsible for the reduction in DVA. In contrast, for retinal slip velocities at or below 2/sec, linear regression suggested no

Vertical Dynamic Visual Acuity 20

1901

Optotype Velocity - deg/sec

FIGURE 5. Mean eye velocity of five subjects during dynamic visual acuity task near threshold for optotypes motion under conditions specified in Table 1. Not all subjects contributed data at every point.

significant relationship between DVA and retinal slip (Fig. 9, R2 = 0.003). This suggests that acuity is not sensitive to retinal slip velocity of 2/sec or less. For retinal slip velocities greater than 2/sec, the slope of the line relating DVA to the logarithm of reti-

nal slip velocity was 0.64 (Fig. 9). Thus, acuity A in logMAR is related to retinal slip velocity s by the following equation:
A = K + 0.64 log(s),

(2)

100

o
0)

O
Q)

0) LU

10

20

30

40

50

Head Velocity at 1.0 Hz - deg/sec

FIGURE 6. Mean vertical eye velocity of five subjects during dynamic visual acuity task near threshold for sinusoidal head motion at 1.0 Hz with and without telescopic spectacles of indicated powers. IX, unmagnified vision.

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4.0 3.53.0-

Investigative Ophthalmology & Visual Science, May 1993, Vol. 34, No. 6

* ix
*
"

1.9X
4X

-^

6X

c
C O

2.52.01.51.0" 0.50.0

O
t

O
>

Mean SEM
10 20 30 40
50

Head Velocity at 1.0 Hz - deg/sec

FIGURE 7. Mean vertical VVOR gain of five subjects during dynamic visual acuity task near threshold for sinusoidal head motion at 1.0 Hz with and without telescopic spectacles of indicated powers. 1 X, unmagnified vision.

where K is a constant. Taking exponentials, acuity a in MAR is related to retinal slip velocity s by
a = Ks0M.

nal slip velocity, regardless of whether the slip velocity is due to optotype or head motion, and regardless of telescopic spectacle power used, if any. DISCUSSION As shown in Figure 2, this investigation confirms the finding of Miller that vertical motion of optotypes re-

(3)

This implies that the minimum angle resolvable is approximately proportional to the 0.64 power of reti-

1.0- 0.8*-

20/200
Moving Optotypes
1X

_ o i 0.6-I
a
< 0.4-

-*" 1.9X Telescopes * - 4X Telescopes *"" 6X Telescopes

20/125 20/80 20/50 20/32 20/20

0.2 i

1
Q

c >

-0.2 i
-0.4

Mean SEM

20/12 20/8 1000

10

100

Retinal Slip Velocity - deg/sec

FIGURE 8. Relationship between dynamic visual acuity and retinal image slip velocity in the same five subjects, measured for sinusoidal vertical motion of optotypes, or of the head, during normal vision (IX), or of telescopic spectacles of the powers indicated in the key. In some cases error limits were smaller than the size of symbols plotted.

Vertical Dynamic Visual Acuity

1.4 DC < O 1.21.0 20/500

1903

Normalized Acuity

20/320 20/200 20/125 Slope = 0.64 R 2 = 0.954 20/80 20/50

3 U

0.8 i
0.6-

j> O

(Q 3 (A

0.4Slope = 0.01
0.2 0.0

I c
Q

R2 r 0.003

^20/32 20/20 Mean SEM

10
100

-0.2

20/12 1000

Retinal Slip Velocity - deg/sec

FIGURE

9. The data of Fig. 8 have been normalized by addition of the logarithmic value of magnification of each telescopic spectacle used, equivalent to multiplying the threshold acuity values by magnification. This demonstrates the effect of retinal slip on acuity, independent of the effect of telescope magnification on image size. For retinal slip velocities up to 2/sec (dotted line), DVA was independent of retinal slip. For higher slip velocities, there was a close linear correlation (solid line) relating decreasing DVA (increasing logMAR) with the logarithm of retinal slip velocity.

duces acuity progressively with increasing optotype velocity, although because Miller employed Landolt ring optotypes, the somewhat greater reduction in acuity found here is probably attributable to differences in optotype presentation. 4 The behavior reflected in Figure 2 is also typical of many studies of DVA for horizontally moving optotypes.6>7>21>29f30'31 Thus the results of the sinusoidally moving optotype experiment suggest that the Sloan optotypes employed here produce DVA data comparable to that obtained by previous investigators who used different optotypes and types of motion. A number of studies have investigated eye movements during DVA tasks for horizontal optotype motion. The studies of Reading, 5 Barmack,6 and Brown7 employed infrared reflectance or electro-oculography to monitor horizontal eye movement during single ramp movements of optotypes. Murphy used an optical lever technique to measure tracking of gratings moving horizontally with a repetitive waveform.8 All four authors observed tracking eye movements that failed to match optotype motion except at low optotype velocities. Barmack also demonstrated that there is a predictive component to the tracking. 6 Although the present experiments employed a repetitive sinusoidal motion, the observation of poor pursuit tracking at the higher velocities (Figs. 4 and 5) is consistent with

these previous investigations. The contribution of a predictive mechanism is also suggested by the persistently sinusoidal waveform of eye movements observed here (Fig. 4), despite blanking of optotypes during half of each cycle. There is. good evidence in humans of the continuation of horizontal predictive pursuit for disappearing targets,32>33>34>35>36 and prediction has also been reported to contribute to vertical visual-vestibular interaction. 37 Aside from the use of prediction to continue smooth sinusoidal motion during optotype blanking, no other ocular motor strategy was evident during viewing of moving optotypes. The current study also examined the effect of vertical rotation of the subject on DVA. Sinusoidal motion was chosen, both for mechanical feasibility and for comparison with previous data. 24 The frequency of 1.0 Hz was chosen both for comparison with previous data and because it is in the range of physiologic head movements. 131415 Under conditions when the VVOR was effective in fully compensating for head rotation, acuity was insensitive to head motion (Fig. 3). With telescopic spectacles, W O R gain did not match spectacle magnification and acuity became increasingly impaired by head motion as telescopic spectacle power increased from 1.9X to 6X (Fig. 3). This effect is quite similar to that of horizontal head motion under similar conditions. 24 Even at 10/sec head velocity with 1.9X

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telescopic spectacles, WOR gain was not sufficient to prevent retinal slip, although gain with the same telescopes was greater at higher head velocities (Fig. 7), and much higher eye velocities were achieved under other testing conditions (Fig. 6). Thus, although the ocular motor system was capable of achieving WOR gain sufficient to prevent retinal slip at low head velocity, it did not do so, supporting the supposition of Skavenski et al that some small amount of retinal image motion is preferred for optimal visual processing.38 When telescopic spectacles are worn, however, the retinal image motion at higher velocities creates an adverse effect on DVA. It is interesting to note that at a peak head velocity of 20/sec or greater, DVA with telescopic spectacles of any power was less than without any telescopic spectacles. Such head velocities, which are well within the physiologic range during ambulation, completely defeat the visual advantage of telescopic spectacles.1415 This explains the general inability of visually impaired patients to make use of telescopic spectacle low vision aids while walking, and the common strategy of periodically stopping to "spot" objects of interest through the telescopes.1219 Presumably, those with poorer visual-vestibular interaction, and consequently lower WOR gain, would experience greater reduction in DVA. Since significant involuntary head movements all three rotational axes occur even during attempts to stand motionless,14 inadequate W O R gain explains the observed reduction in acuity with 4X telescopic spectacles during free standing, as compared with stabilization of the head against afixedobject.18 This also agrees with reports that some low vision patients with particularly severe head tremor can make use of telescopic spectacles only when bracing their heads against fixed objects such as lamp posts or walls.1219 For such patients with severe head tremor, an alternative might be the use of handheld telescopic visual aids, which do not magnify head movements because they are not mechanically coupled to the head. Simultaneous measurements were made of eye movements so the current data permit estimation of the contribution of retinal image slip velocity, velocity error, to the reduction in DVA during vertical motion. However, the problem is complicated by the covariation in these studies of three potential factors in the reduction of acuity. Retinal position and velocity errors are necessarily correlated, to a degree depending on the duration of optotype presentation, which itself is a significant determinant of acuity.7 Consistent with realistic conditions of telescopic spectacle use, in the current study relative motion was repetitive and optotype presentation was of such long duration that viewing time may be safely assumed not to limit acuity. Conditions were always chosen so that relative motion

crossed the straight-ahead position, the assumed foveal direction, and saccades were permitted to recenter the presentation. Thus, it may be assumed that retinal position error was zero for at least portions of all stimulus presentations. During moving optotype presentations, the maximum position displacement of the optotypes was 2.4, further limiting the potential position error even in the absence of tracking eye movements. The effects of retinal position error have been estimated. Using optotypes moving in circular paths of different radii, Ludvigh estimated that the position error of images relative to the fovea contributes relatively little to the reduction in acuity due to image motion.39 Ludvigh's data suggested that acuity of better than 20/30 is present with a position error of 2. The relative contribution of retinal position error has also been studied by Brown using brief presentations of horizontally moving optotypes at various eccentricities from fixation.22 Brown found that dynamic visual acuity at 2.5 eccentricity varies with image velocity in a manner quite similar to that at fixation, although static acuity decreases by roughly half. The current finding of an effect on DVA of retinal slip only more than 2/sec (Fig. 9) confirms, in a larger group of subjects, the data of Westheimer and McK.ee, who employed presentations of horizontally and vertically moving optotypes so brief that tracking was impossible, and found no reduction in DVA for slip velocities of less than 2.5-3.0/sec.20 It also agrees with the findings of Murphy, who employed horizontally moving gratings and found a marked increase in threshold contrast for retinal image speeds exceeding 2/sec.8 Above this range of retinal slip velocity, acuity in the present study declined with increasing slip in similar fashion regardless of viewing condition. The present study thus demonstrates the applicability of prior data on retinal image velocity and acuity to the special but clinically important situation of vertical self-rotation during the wearing of highly magnifying telescopic spectacle visual aids. The source of retinal image motionoptotype movement, eye movement, or head movementis thus unimportant to the effect of image motion on DVA. Although the present findings regarding DVA during optotype motion merely confirm and extend the cited studies to a higher range of retinal slip, our quantitative findings about the effect of telescopic spectacles during head motion are new. Telescopic spectacles merely shifted the parallel curves relating DVA to retinal slip as dictated by optical magnification of the images and of the imposed head movements (Fig. 8). This finding was not entirely predictable, because a number of other optical characteristics of telescopic spectacles change concurrently with magnification, including field size and image brightness. The present data suggest that, in

Vertical Dynamic Visual Acuity young normal subjects, the major effects of head motion on DVA with telescopic spectacles can be accounted for by consideration of W O R eye movements and magnification only. Other optical factors therefore play minor roles at best. The present data, although demonstrating a consistent relationship between vertical motion and DVA in a group of normally sighted, young adult subjects, also demonstrate individual variability in both DVA and concurrent eye movements. These individual differences have potential significance, because DVA has been suggested to be an important determinant of function for many important tasks. Among the normally sighted elderly, DVA has been found to be the factor most significantly associated with frequency of automobile driving,40 and is significantly better among student athletes than among their nonathletic peers. 41 It has been well established that DVA and spontaneous vertical head motion are predictive of rehabilitative success in patients who attempt use of telescopic spectacles as low vision aids.19 Although the effect of age on vertical W O R gain is unknown, horizontal W O R gain with telescopic spectacles is known to decline significantly with age. 42 The present study, linking visual tracking and W O R eye movements to DVA via the mechanism of retinal image slip, suggests that vertical eye movement reflex performance may have considerable functional implications for everyday life. This supposition could be tested by further studies of DVA and retinal slip in populations, such as the elderly and visually impaired, in whom greater variations in performance might be expected. Key Words dynamic visual acuity, low vision, telescopic spectacles, vestibulo-ocular reflex, visual-vestibular interaction. Acknowledgments The authors thank Laura A. Hovis for assisting with recruitment and testing of subjects, Douglas Wong for software support, James Li for production of optotype transparencies, and Hongxing Dai for construction of optical apparatus. References 1. Miller JW, Ludvigh EJ. The effect of relative motion on visual acuity. Surv Ophthalmol. 1 962; 7:83-116. 2. Ludvigh E, Miller JW. Study of visual acuity during the ocular pursuit of moving test objects. I. Introduction. J Opt Sac Am. 1958;48:799-802. 3. Reading VM. Visual resolution as measured by dynamic and static tests. Pjlugers Arch. 1972;333:17-26. 4. Miller JW. Study of visual acuity during the ocular pursuit of moving test objects. II. Effects of direction of movement, relative movement, and illumination. J OptSocAm. 1958;48:803-808.

1905 5. Reading VM. Analysis of eye movement responses and dynamic visual acuity. Pjlugers Arch. 1972; 333:27-34. 6. Barmack NH. Dynamic visual acuity as an index of eye movement control. Vision Res. 1970; 10:1377-1391. 7. Brown B. Dynamic visual acuity, eye movements and peripheral acuity for moving targets. Vision Res. 1972; 12:305-321. 8. Murphy BJ. Pattern thresholds for moving and stationary gratings during smooth eye movement. Vision Res. 1978; 18:531-536. 9. Borland RC, Nicholson AN. Visual motor co-ordination and dynamic visual acuity. Br J Clin Pharmacol. 1984;18(suppl 1):69S-72S. 10. Benson AJ, Barnes GR. Vision during angular oscillation: The dynamic interaction of visual and vestibular mechanisms. Aviation Space Environ Med. 1978;49: 340-345. 11. Longridge NS, Mallinson Al. A discussion of the dynamic illegible E test: A new method of screening for aminoglyccoside vestibulotoxicity. Otolaryngol Head NeckSurg. J984;92:671-677. 12. Demer JL, Porter FI, Goldberg J, Jenkins HA, Schmidt K, and Ulrich I. Predictors of functional success in telescopic spectacle use by low vision patients. Invest Ophthalmol Vis Sd. 1989; 30:1652-1665. 13. Demer JL, Porter FI, Goldberg J, Schmidt K, Haddock RD. Effect of telescopic spectacles on head stability in three axes. In: Topical. Meeting on Noninvasive Assessment of the Visual, System, 1989 Technical Digest. Series, vol. 7. Washington, DC: Optical Society of America; 1989:144-147. 14. Demer JL, Goldberg J, Porter FI. Effect of telescopic spectacles on bead stability in normal and low vision. / Vestibular Res: Equilibrium and. Orientation.. 1991; 1:109-122. 15. Grossman GE, Leigh RJ, Abel LA, Lanska DJ, Thurston SE. Frequency and velocity of rotational bead perturbations during locomotion. Exp Brain Res. 1988;70:470-476. 16. Ferman L, Collewijn H, Jansen TC, Van den Berg AV. Human gaze stability in the horizontal, vertical, and torsional direction during voluntary head movements, evaluated with a three-dimensional scleral induction coil technique. Vision Res. 1987;27:81 1-828. 17. Guedry RE, LentzJM, Jell RM. Visual-vestibular interactions: 1. influence of peripheral vision on suppression of the vestibulo-ocular reflex and visual acuity. Avial Space Environ Med. 1979;50:205-21 1. 18. Porter FI, Goldberg J, Denier JL. Sensitivity of visual acuity to spontaneous head motion while wearing telescopic spectacle low vision aids. ARVO Abstracts. Invest Ophthalmol. Vis Sd. 1989;30(suppl):399. 19. Demer JL, Porter FI, Goldberg J, Schmidt K. Validation of physiologic predictors of successful telescopic spectacle use in low vision. Invest Ophthalmol Vis Sci. 1991;32:2826-2834. 20. Westheimer G, McKee SP. Visual acuity in the presence of retinal image motion. J Opt Soc Am. 1975;65:847-850.

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