A systematic review on ‘Foveal Crowding’ in visually impaired children and perceptual learning as a method to reduce Crowding

Bartiméus, Institute for the Visually Impaired, Zeist, the Netherlands.
BMC Ophthalmology (Impact Factor: 1.08). 07/2012; 12:27. DOI: 10.1186/1471-2415-12-27
Source: PubMed

ABSTRACT This systematic review gives an overview of foveal crowding (the inability to recognize objects due to surrounding nearby contours in foveal vision) and possible interventions. Foveal crowding can have a major effect on reading rate and deciphering small pieces of information from busy visual scenes. Three specific groups experience more foveal crowding than adults with normal vision (NV): 1) children with NV, 2) visually impaired (VI) children and adults and 3) children with cerebral visual impairment (CVI). The extent and magnitude of foveal crowding as well as interventions aimed at reducing crowding were investigated in this review. The twofold goal of this review is : [A] to compare foveal crowding in children with NV, VI children and adults and CVI children and [B] to compare interventions to reduce crowding.
Three electronic databases were used to conduct the literature search: PubMed, PsycINFO (Ovid), and Cochrane. Additional studies were identified by contacting experts. Search terms included visual perception, contour interaction, crowding, crowded, and contour interactions.
Children with normal vision show an extent of contour interaction over an area 1.5-3× as large as that seen in adults NV. The magnitude of contour interaction normally ranges between 1-2 lines on an acuity chart and this magnitude is even larger when stimuli are arranged in a circular configuration. Adults with congenital nystagmus (CN) show interaction areas that are 2× larger than those seen adults with NV. The magnitude of the crowding effect is also 2× as large in individuals with CN as in individuals with NV. Finally, children with CVI experience a magnitude of the crowding effect that is 3× the size of that experienced by adults with NV.
The methodological heterogeneity, the diversity in paradigms used to measure crowding, made it impossible to conduct a meta-analysis. This is the first systematic review to compare crowding ratios and it shows that charts with 50% interoptotype spacing were most sensitive to capture crowding effects. The groups that showed the largest crowding effects were individuals with CN, VI adults with central scotomas and children with CVI. Perceptual Learning seems to be a promising technique to reduce excessive foveal crowding effects.

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    ABSTRACT: We used custom-designed acuity tests to compare the magnitude and extent of crowded letter recognition in children and adults. Visual acuity (logMAR) was measured monocularly in children and adults using five custom-designed letter tests with varying degrees of crowding: single letter, single letter surrounded by four flanking bars, single letter surrounded by four flanking letters, line of five letters surrounded by flanking bars, and line of five letters surrounded by flanking letters. The tests were constructed using Sloan letters and presented on an iPad (Apple Incorporated, Cupertino, CA) at 4 m using a standardized endpoint and instructions. Crowded logMAR was normalized to unflanked logMAR and results were analyzed in three groups: younger children aged 4-6 (n = 32), older children, aged 7-9 (n = 30), and adults (n = 27). Both groups of children showed a greater extent of crowding than the adults. The adult participants showed no difference in performance between single or linear presentation and letter or bar flankers. Letter flankers and linear presentation individually resulted in poorer performance in the younger children p < 0.001 and p = 0.003, respectively (mean normalized logMAR 0.17 in each case) and together had an additive effect (mean 0.24), p < 0.001. Crowding in the older children was adult-like except in the linear presentation with letter flankers, p < 0.001. These results indicate that both target-flanker similarity and linear presentation contribute more to foveal crowding in young children than in adults.
    Journal of Vision 10/2014; 14(12). DOI:10.1167/14.12.23 · 2.73 Impact Factor
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    ABSTRACT: Purpose Crowding describes the increased difficulty in identifying a target object when it is surrounded by nearby objects (flankers). A recent study (Scialfa et al., 2013) investigated the effect of age on visual crowding and found that, although crowded visual acuity was worse in older participants, crowding expressed as a ratio did not change with age. However, the spatial extent of crowding is a better index of crowding effects and remains unknown. In the present study, we used established psychophysical methods to characterise the effect of age on visual crowding (magnitude and extent) in a letter recognition task - a task more closely related to peripheral reading ability. Methods Letter recognition thresholds were determined for three different flanker separations in 54 adults (18-76 years of age) with normal vision. Additionally, the spatial extent of crowding was established by measuring spacing thresholds - the flanker-to-target separation required to produce a given reduction in performance. Uncrowded visual acuity, crowded visual acuity and spacing thresholds were expressed as a function of age, avoiding arbitrary categorisation of young and old participants. Results In contrast to an earlier report, our results showed that uncrowded and crowded visual acuities do not change significantly as a function of age. Furthermore, spacing thresholds did not change with age and approximated Bouma's law (half eccentricity). Conclusions These data show that crowding in adults is unaffected by senescence and provide additional evidence for distinct neural mechanisms mediating surround suppression and visual crowding, since the former shows a significant age effect. Finally, our data suggest that the well-documented age-related decline in peripheral reading ability is not due to age-related changes in visual crowding.
    Investigative Ophthalmology &amp Visual Science 07/2014; 55(8). DOI:10.1167/iovs.14-14181 · 3.66 Impact Factor

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