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Aniseikonia Tests: the Role of Viewing Mode, Response Bias, and Size–Color Illusions

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Aniseikonia Tests: the Role of Viewing Mode, Response Bias, and Size–Color Illusions DOI: 10.1167/tvst.4.3.9 Article Aniseikonia Tests: The Role of Viewing Mode, Response Bias, and Size–Color Illusions Miguel A. Garc´ıa-Perez´ 1, Eli Peli2 1 Departamento de Metodolog´ıa, Facultad de Psicolog´ıa, Universidad Complutense, Campus de Somosaguas, Madrid, Spain 2 The Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA Correspondence: Miguel A Garc´ıa- Purpose: To identify the factors responsible for the poor validity of the most common Perez,´ Departamento de aniseikonia tests, which involve size comparisons of red–green stimuli presented Metodolog´ıa, Facultad de Psicolog´ıa, haploscopically. Universidad Complutense, Campus de Somosaguas, 28223 Madrid, Methods: Aniseikonia was induced by afocal size lenses placed before one eye. Spain; e-mail: [email protected] Observers compared the sizes of semicircles presented haploscopically via color filters. The main factor under study was viewing mode (free viewing versus short Received: 23 January 2015 presentations under central fixation). To eliminate response bias, a three-response Accepted: 23 April 2015 format allowed observers to respond if the left, the right, or neither semicircle Published: 12 June 2015 appeared larger than the other. To control decisional (criterion) bias, measurements Keywords: aniseikonia; eye move- were taken with the lens-magnified stimulus placed on the left and on the right. To ments; size perception; vernier control for size–color illusions, measurements were made with color filters in both acuity; size–color illusion arrangements before the eyes and under binocular vision (without color filters). Citation: Garc´ıa-Perez´ MA, Peli E. Results: Free viewing resulted in a systematic underestimation of lens-induced Aniseikonia tests: the role of viewing aniseikonia that was absent with short presentations. Significant size–color illusions mode, response bias, and size–color and decisional biases were found that would be mistaken for aniseikonia unless illusions. Tran Vis Sci Tech. 2015;4(3): appropriate action is taken. 9, doi:10.1167/tvst.4.3.9 Conclusions: To improve their validity, aniseikonia tests should use short presentations and include control conditions to prevent contamination from decisional/response biases. If anaglyphs are used, presence of size–color illusions must be checked for. Translational relevance: We identified optimal conditions for administration of aniseikonia tests and appropriate action for differential diagnosis of aniseikonia in the presence of response biases or size–color illusions. Our study has clinical implications for aniseikonia management. (SE),6 which are complex instruments including a Introduction head rest, rigidly fixed cells for trial lenses, and a display device. The OE does not seem to have ever Aniseikonia is a binocular condition by which the entered production, whereas production of the SE perceived size of an object differs between the eyes, was discontinued decades ago. These instruments are often caused by the retinal images of the object nowadays rarely available in clinical practice. differing in size between the eyes. Different retinal Simpler aniseikonia tests were proposed soon image sizes occur naturally in near vision for objects afterward7,8 whose use is rarely reported and whose located at meaningfully different distances from each validity was, to our knowledge, never established. An 1,2 eye but differences in perceived size can also be due alternative whose use is often reported is the New to anatomical, optical, or neural differences between Aniseikonia Test (NAT).9,10 The NAT uses a printed the eyes.3 Within a range, optical correction of set of red and green semicircles (anaglyphs) of measured aniseikonia is feasible. Early instruments different relative sizes that patients view haploscopi- designed to measure aniseikonia were the Ophthalmo- cally with red–green glasses to select the pair in which Eikonometer (OE)4,5 and the Space Eikonometer both semicircles are perceptually equal in size. The 1 TVST j 2015 j Vol. 4 j No. 3 j Article 9 Garc´ıa-Perez´ and Peli booklet where anaglyphs are printed (at six per page) ed amount of lens-induced aniseikonia and also with is held at reading distance and no complex instrument respect to measurements obtained with the SE in the is required to deliver the stimuli. A validity study horizontal and vertical meridia in the light and in the showed that the NAT underestimates natural anisei- dark. This underestimation was lower in magnitude konia as well as aniseikonia induced with size lenses than that reported by McCormack et al.11 for the NAT: (henceforth, lens-induced aniseikonia) by a factor of the slope of the relation of measured to lens-induced approximately 3.11 The underestimation was con- aniseikonia with the AI Version 1 was 0.67 in the firmed later12,13 but its cause remained unknown. A vertical meridian and 0.58 in the horizontal meridian. tiny part of it can be attributed to an unnoticed design Underestimation of lens-induced aniseikonia with the error in the NAT: the Plus Aniseikonia Series was AI Version 1 has been reported in other studies.17–19 created by reducing the size of the test (green) Version 2, on the other hand, seemed to overestimate semicircle by some specified percentages, and these aniseikonia instead.18 Finally, the only published study reductions are incorrectly taken directly as the employing Version 3 has reported acceptably accurate amount of aniseikonia. If the pair is selected in which measurements of lens-induced aniseikonia in the short the test semicircle is x% smaller, the amount of presentation mode with central fixation.20 aniseikonia is not x because an image reduced by x% Misestimation of aniseikonia has been claimed to be must be enlarged instead by y% to regain its original clinically irrelevant21–23 because further checks can be size, with y ¼ 100x/(100 À x). The resultant nonlinear conducted before or after prescribing iseikonic specta- underestimation, y À x, varies with x as x2/(100 À x), cle lenses, although the process is lengthy and may be which is less than the reported amount (e.g., expensive. Yet, identifying the cause of the underesti- aniseikonia measured as 10% with the NAT would mation in the NAT and the AI Version 1 as well as the actually be 11.11%, which represents underestimation cause of the conflicting patterns of misestimation by a factor of only 1.1). across versions of the AI is a problem whose solution A more recent alternative is the Aniseikonia Inspec- could render improved tests that save time and costs to tor (AI),14 a test based on anaglyphs similar to those patients in clinical practice, also helping to prevent making up the NAT but administered via computer. analogous problems that might arise in the use of Three versions of the AI were developed over the years. psychophysical methods for the assessment of other Version 1 reproduced the video test of McCormack et visual functions. Identifying the causes of underesti- al.,11 where unlimited time is given to manipulate the size mation of the NAT and the AI (and, by contrast, the of one of the semicircles until it matches subjectively the reasons that the OE and the SE provide accurate size of the other. In Version 2, semicircles were replaced measurements) can also contribute to a better under- with rectangles, unlimited inspection time was replaced standing of the perceptual aspects of aniseikonia and, with short presentations, and the method of adjustment thus, lead to better treatment options. was replaced with a task in which observers indicate The goal of this research was to identify the causes whether the left, the right, or neither rectangle is of these patterns of misestimation and to identify the subjectively larger than the other. The measure of conditions (method, stimuli, viewing mode, etc.) for aniseikonia then arises from fitting a two-parameter accurate measurements of aniseikonia. The protocol psychometric function to the data via treatment of for data collection used in this study is more thorough ‘‘equal’’ responses as half ‘‘left’’ and half ‘‘right.’’ Finally, than those in the NAT or the AI, and permits the Version 3 defaults back to unlimited presentation time separation of sensory and decisional influences (crite- although the option for short presentations is still rion bias) on performance. Also, data analyses are available, with no other major changes. carried out separately for each observer, as group data 24 Studies on the validity of the AI offer conflicting typically obscure rather than clarify the outcomes. results. In principle, the video test11 motivating the AI The next three sections describe the reasons justifying Version 1 proved valid. In the same line, de Wit14 the choices made in the design of the study, namely reported accurate measurements of lens-induced anis- viewing conditions, stimulus characteristics, and psy- eikonia in the horizontal, vertical, and oblique meridia chophysical procedure. with the AI Version 1. Analogous results were reported Viewing Conditions for a custom-made computerized test15 that resembles the video test11 and the AI Version 1. In contrast, Comparative judgments of the size of two objects Rutstein et al.16 reported for the AI Version 1 a can be made using direct perceptual estimates of size meaningful underestimation with respect to the expect- or using indirect correlates of size. A simple demon- 2 TVST j 2015 j Vol. 4 j No. 3 j Article 9 Garc´ıa-Perez´ and Peli Figure 1. Illustration of the center of expansion of a magnifying lens, determined by the projection of its optical axis onto the object plane. Viewing is assumed to be monocular with the size lens placed stably before the eye in a way that it magnifies only the right side of the scene. (a) With the lens aiming at the vertical center of the sheet on the wall (upper sketch, not to scale), expansion of the right side of the scene occurs outward from that point so that the top and bottom edges of the sheet on the right side appear to extend vertically beyond the corresponding edges on the left side.
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