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For four decades, investigations of the biological basis of critical periods in the developing mammalian visual cortex were dominated by study of the consequences of altered early visual experience in cats and nonhuman primates. The neural deficits thus revealed also provided insight into the origin and neural basis of human amblyopia that in turn motivated additional studies of humans with abnormal early visual input. Recent human studies point to deficits arising from alterations in all visual cortical areas and even in nonvisual cortical regions. As the new human data accumulated in parallel with a near-complete shift toward the use of rodent animal models for the study of neural mechanisms, it is now essential to review the human data and the earlier animal data obtained from cats and monkeys to infer general conclusions and to optimize future choice of the most appropriate animal model.

Adults recognize hundreds of familiar faces at a glance: a neighbor both at the gym and in wedding photos; actors in numerous movies, despite dramatic variability in their appearance; a high school classmate at a twenty-fifth reunion—despite physical changes associated with aging. What makes this ability so remarkable is that faces are a homogeneous class of stimuli—increasing both the challenge of telling faces apart and of recognizing someone despite changes in appearance. Here we focus on the development of the ability to recognize facial identity, underlying mechanisms, and the role of experience. We focus on behavioral development but sample the neuroscience literature when doing so is helpful. We begin with a brief synopsis of adults’ abilities, followed by a discussion of changes in these abilities during infancy and childhood.

To synthesize and appraise economic evaluations of vision screening to detect vision impairment in children.Literature searches were conducted on seven electronic databases, grey literature, and websites of agencies conducting health technology assessments. Studies were included if they (1) were full, comparative economic evaluations that used cost-utility, cost-benefit, cost-effectiveness, cost-consequence, or cost-analysis methods; (2) described screening services designed to detect amblyopia, strabismus, or uncorrected refractive errors in children under 6 years of age; and (3) published after 1994. High-quality studies were synthesized descriptively. Currencies were reported in 2019 Canadian dollars. Quality was assessed with the Pediatric Quality Appraisal Questionnaire (PQAQ).Vision screening services were conducted by paid staff, volunteers, or health care professionals in schools or clinics. Thirteen studies were published from five countries: China (n = 1), United States (n = 4), United Kingdom (n = 1), Canada (n = 1), and Germany (n = 6). Analytical techniques included cost-utility/cost-effectiveness combination (n = 2), cost-effectiveness analysis (n = 7), cost-utility analysis (n = 1), cost-benefit analysis (n = 1), cost-consequence analysis (n = 1), and cost analysis (n = 1). Incremental cost-effectiveness ratios ranged from C$1,056 to C$151,274 per additional case detected/prevented and from C$9,429 to C$30,254,703 per additional QALY gained, depending on the type of screening service and comparator. Six studies were determined to be of high quality.Vision screening to detect amblyopia for young children may be cost-effective compared with no screening if amblyopia reduced quality of life. Studies varied significantly in the type of screening services and comparators used. Methodological limitations were common. Future studies would be aided immensely by prospective studies on the impact of amblyopia on the health-related quality of life of young children and guidelines on the effective conduct of vision screening.RéSUMé: OBJECTIF: Synthétiser et évaluer des évaluations économiques de dépistages visuels visant à détecter la déficience visuelle chez les enfants. MéTHODE: Nous avons interrogé sept bases de données électroniques, la littérature grise et les sites Web d’organismes effectuant des évaluations des technologies de la santé. Nous avons inclus les études correspondant aux critères suivants : (1) évaluations économiques comparatives exhaustives utilisant l’analyse coûts-utilité, coûts-bénéfices, coûts-efficacité ou coûts-conséquences ou l’analyse des coûts; (2) décrivant des services de dépistage visant à détecter l’amblyopie, le strabisme ou les anomalies de la réfraction non corrigées chez les enfants de moins de six ans; et (3) publiées après 1994. Nous avons fait la synthèse descriptive des études de haute qualité. Les devises ont été converties en dollars canadiens de 2019. Nous avons évalué la qualité des études à l’aide de l’outil PQAQ (Pediatric Quality Appraisal Questionnaire). RéSULTATS: Les services de dépistage visuel étaient offerts par du personnel rémunéré, des bénévoles ou des professionnels de santé dans des écoles ou des cliniques. Treize études ont été publiées dans cinq pays : Chine (n = 1), États-Unis (n = 4), Royaume-Uni (n = 1), Canada (n = 1) et Allemagne (n = 6). Les techniques d’analyse employées étaient la combinaison analyse coûts-utilité/analyse coûts-efficacité (n = 2), l’analyse coûts-efficacité (n = 7), l’analyse coûts-utilité (n = 1), l’analyse coûts-avantages (n = 1), l’analyse coûts-conséquences (n = 1) et l’analyse des coûts (n = 1). Les rapports coût-efficacité différentiels s’échelonnaient entre 1 056 $ CA et 151 274 $ CA par cas supplémentaire détecté/prévenu et entre 9 429 $ CA et 30 254 703 $ CA par année de vie pondérée par la qualité (AVPQ) supplémentaire gagnée, selon le type de service de dépistage et le comparateur. Six études ont été jugées être de haute qualité. CONCLUSION: Comparativement à l’absence de dépistage, les dépistages visuels pour détecter l’amblyopie chez les jeunes enfants peuvent être efficaces par rapport à leur coût lorsque l’amblyopie réduit la qualité de vie. Le type de services de dépistage et les comparateurs utilisés variaient considérablement d’une étude à l’autre. Les contraintes méthodologiques étaient courantes. Les études futures seraient grandement favorisées par des études prospectives des incidences de l’amblyopie sur la qualité de vie liée à la santé chez les jeunes enfants et par des lignes directrices sur l’exécution efficace des dépistages visuels.

ImportanceScreening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown.ObjectiveTo evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government’s perspective.Design, Setting, and ParticipantsAn economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors.Main Outcomes and MeasuresFor each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained.ResultsSchool screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, −0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively.Conclusions and RelevanceIn this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

BACKGROUND: Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based screening program to identify and treat kindergarten children with visual problems. METHODS: We conducted a prospective cohort study offering vision screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses). RESULTS: Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p < 0.001). Referral rates to an optometrist varied across schools (mean referral rate for children in JK 53%, range 25%–83%; mean referral rate for children in SK 34%, range 12%–61%). Among 4811 children who were screened, a visual problem was detected in 516 (10.7%), including 164 (3.4%) with amblyopia and 324 (6.7%) with clinically significant refractive errors. For 347 (67.2%) of the children with a visual problem, this was their first eye examination. Rescreening in Year 2 did not lead to detection of additional problems among children who passed screening in Year 1. Regardless of location (child’s school or optometrist’s office), 1563 (68.9%) of children attended the follow-up optometry examination. Most of the children who were surveyed (291 of 322, 90.4%) indicated that they enjoyed vision screening. INTERPRETATION: Many children in Ontario with a visual problem were not being identified by the status quo in 2015–2017. We found that in-school vision screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.

Synesthesia is a neurologic trait in which specific inducers, such as sounds, automatically elicit additional idiosyncratic percepts, such as color (thus "colored hearing"). One explanation for this trait-and the one tested here-is that synesthesia results from unusually weak pruning of cortical synaptic hyperconnectivity during early perceptual development. We tested the prediction from this hypothesis that synesthetes would be superior at making discriminations from nonnative categories that are normally weakened by experience-dependent pruning during a critical period early in development-namely, discrimination among nonnative phonemes (Hindi retroflex /d̪a/ and dental /ɖa/), among chimpanzee faces, and among inverted human faces. Like the superiority of 6-mo-old infants over older infants, the synesthetic groups were significantly better than control groups at making all the nonnative discriminations across five samples and three testing sites. The consistent superiority of the synesthetic groups in making discriminations that are normally eliminated during infancy suggests that residual cortical connectivity in synesthesia supports changes in perception that extend beyond the specific synesthetic percepts, consistent with the incomplete pruning hypothesis.

Objective To test the association of material deprivation and the utilization of vision care services for young children. Study design We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their 7th birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician. Results Of 128,091 children included, females represented 48.7% of the cohort, with 74.4% living in major urban areas and 16.2% living in families receiving income assistance. Only 65% (n=82,833) had at least one comprehensive eye examination, with the lowest uptake (56.9%; n= 31,911) in the most deprived and the highest uptake (70.5%; n =19,860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95%CI 1.36, 1.51) compared with children in the most material deprived areas. Conclusions Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighbourhoods. Strategies to improve uptake and reduce inequities are warranted.

Adults need to discriminate between stimuli and recognize those previously seen. For faces, feature changes (e.g., different eyes) and spacing changes (e.g., distances between eyes) are important cues. In two experiments, we assessed the influence of these on discrimination and recognition of houses, a commonly used control in face studies. In both experiments, discrimination was better for feature than spacing changes. Memory for spacing changes was generally poor but aided by extra learning and intermixing change types. Conversely, memory for features was good, especially when there were few houses, and change type was blocked. Unexpectedly, memory was best for differences that might signal something about occupants (e.g., changes to garden or bins), perhaps akin to hairstyles for faces. Overall, results are consistent with previous work showing poor discrimination of spacing in non-face objects and extends them to show that, unlike for faces, spacing differences are also not well remembered.

Studies of children treated for dense cataracts afford an opportunity to examine the role of visual experience in driving visual perceptual development. Collectively, the data indicate that there are multiple periods during which deprivation can damage visual development, but their timing and duration cannot be predicted from the normal developmental trajectory. For lower level vision, the deficits are worse in the previously deprived eye if the deprivation had been monocular rather than binocular, but for higher level perception, that pattern reverses, perhaps because of cross-modal neural completion during the deprivation. Emerging neuroimaging evidence suggests that the neural underpinnings of vision after early visual deprivation may be abnormal, even when the deprivation ended shortly after birth and normal behavioural performance has been achieved. The implication is that in the baby with normal eyes, despite poor acuity and contrast sensitivity, visual experience at birth sets up the neural architecture for later refinement.

We examined the role of early visual input in visual system development by testing adults who had been born with dense bilateral cataracts that blocked all patterned visual input during infancy until the cataractous lenses were removed surgically and the eyes fitted with compensatory contact lenses. Patients viewed checkerboards and textures to explore early processing regions (V1, V2), Glass patterns to examine global form processing (V4), and moving stimuli to explore global motion processing (V5). Patients' ERPs differed from those of controls in that (1) the V1 component was much smaller for all but the simplest stimuli and (2) extrastriate components did not differentiate amongst texture stimuli, Glass patterns, or motion stimuli. The results indicate that early visual deprivation contributes to permanent abnormalities at early and mid levels of visual processing, consistent with enduring behavioral deficits in the ability to process complex textures, global form, and global motion.

Being born at extremely low birth weight (ELBW; ≤1,000 g) is associated with enduring visual impairments. We tested for long-term, higher order visual processing problems in the oldest known prospectively followed cohort of ELBW survivors. Configural processing (spacing among features of an object) was examined in 62 adults born at ELBW (Mage = 31.9 years) and 82 adults born at normal birth weight (NBW; ≥2,500 g: Mage = 32.5 years). Pairs of human faces, monkey faces, or houses were presented in a delayed match-to-sample task, where non-matching stimuli differed only in the spacing of their features. Discrimination accuracy for each stimulus type was compared between birth weight groups, adjusting for neurosensory impairment, visual acuity, binocular fusion ability, IQ, and sex. Both groups were better able to discriminate human faces than monkey faces (p

Vision impairment has a significant impact on quality of life. Seventy percent of existing vision impairment in Canada is estimated to be correctable with prescription glasses. The sizeable proportion of correctable vision impairment appears related to the barriers to access to vision care in Canada. The objective of this scoping review is to determine gaps in the understanding of barriers to accessing vision care for vulnerable populations in Canada. The Arksey and O'Malley methodological framework was adopted. Studies published in English between 2005 and September 2017 on access to primary vision care by vulnerable populations in Canada were reviewed. Electronic databases used included Ovid MEDLINE, Ovid EMBASE, SCOPUS, ProQuest, and CINAHL. The Behavioural Model of Health Services Use was used to elucidate gaps in the literature. To develop relevant policies around vision care, efforts should be made to assess all dimensions of access for vulnerable populations across Canada.

Is a short and transient period of visual deprivation early in life sufficient to induce lifelong changes in how we attend to, and integrate, simple visual and auditory information [1, 2]? This question is of crucial importance given the recent demonstration in both animals and humans that a period of blindness early in life permanently affects the brain networks dedicated to visual, auditory, and multisensory processing [1-16]. To address this issue, we compared a group of adults who had been treated for congenital bilateral cataracts during early infancy with a group of normally sighted controls on a task requiring simple detection of lateralized visual and auditory targets, presented alone or in combination. Redundancy gains obtained from the audiovisual conditions were similar between groups and surpassed the reaction time distribution predicted by Miller's race model. However, in comparison to controls, cataract-reversal patients were faster at processing simple auditory targets and showed differences in how they shifted attention across modalities. Specifically, they were faster at switching attention from visual to auditory inputs than in the reverse situation, while an opposite pattern was observed for controls. Overall, these results reveal that the absence of visual input during the first months of life does not prevent the development of audiovisual integration but enhances the salience of simple auditory inputs, leading to a different crossmodal distribution of attentional resources between auditory and visual stimuli.

Adults who missed early visual input because of congenital cataracts later have deficits in many aspects of face processing. Here we investigated whether they make normal judgments of facial attractiveness. In particular, we studied whether their perceptions are affected normally by a face’s proximity to the population mean, as is true of typically developing adults, who find average faces to be more attractive than most other faces. We compared the judgments of facial attractiveness of 12 cataract-reversal patients to norms established from 36 adults with normal vision. Participants viewed pairs of adult male and adult female faces that had been transformed 50% toward and 50% away from their respective group averages, and selected which face was more attractive. Averageness influenced patients’ judgments of attractiveness, but to a lesser extent than controls. The results suggest that cataract-reversal patients are able to develop a system for representing faces with a privileged position for an average face, consistent with evidence from identity aftereffects. However, early visual experience is necessary to set up the neural architecture necessary for averageness to influence perceptions of attractiveness with its normal potency.

We measured the typical developmental trajectory of the window of audiovisual simultaneity by testing four age groups of children (5, 7, 9, and 11 years) and adults. We presented a visual flash and an auditory noise burst at various stimulus onset asynchronies (SOAs) and asked participants to report whether the two stimuli were presented at the same time. Compared with adults, children aged 5 and 7 years made more simultaneous responses when the SOAs were beyond ± 200 ms but made fewer simultaneous responses at the 0 ms SOA. The point of subjective simultaneity was located at the visual-leading side, as in adults, by 5 years of age, the youngest age tested. However, the window of audiovisual simultaneity became narrower and response errors decreased with age, reaching adult levels by 9 years of age. Experiment 2 ruled out the possibility that the adult-like performance of 9-year-old children was caused by the testing of a wide range of SOAs. Together, the results demonstrate that the adult-like precision of perceiving audiovisual simultaneity is developed by 9 years of age, the youngest age that has been reported to date.

We charted the developmental trajectory of the perception of audiotactile simultaneity by testing three groups of children (aged 7, 9, and 11 years) and one group of adults. A white noise burst and a tap to the index finger were presented at 1 of 13 stimulus onset asynchronies (SOAs), and the participants were asked to report whether the two stimuli were simultaneous. Compared with adults, 7-year-olds made significantly more simultaneous responses at 9 of the 13 SOAs, whereas 9-year-olds differed from adults at only 2 SOAs. The precision of simultaneity perception was lower, and response errors were higher, in younger children than in adults. The 11-year-olds were adult-like on all measures, thereby demonstrating that judgments about simultaneity for audiotactile stimuli are mature by 11 years. This developmental pattern is similar to that for simultaneity perception for visuotactile stimuli but later than that for audiovisual stimuli. The longer developmental trajectories of the perception of simultaneity between touch and vision and between touch and audition may arise from the need to coordinate and recalibrate between different reference frames and different neural transmission times in each sensory system during body growth; in addition, the ubiquity of audiovisual experience in everyday life may accelerate the development of that modality pairing.

Amblyopia is a developmental disorder that affects the spatial vision of one or both eyes in the absence of an obvious organic cause; it is associated with a history of abnormal visual experience during childhood. Subtypes have been defined based on the purported etiology, namely, strabismus (misaligned eyes) and/or anisometropia (unequal refractive error). Here we consider the usefulness of these subclassifications.

A simultaneity judgment (SJ) task was used to measure the developmental trajectory of visuotactile simultaneity perception in children (aged 7, 9, 11, and 13 years) and adults. Participants were presented with a visual flash in the center of a computer monitor and a tap on their right index finger (located 20° below the flash) with 13 possible stimulus onset asynchronies (SOAs). Participants reported whether the flash and tap were presented at the same time. Compared with the adult group, children aged 7 and 9 years made more simultaneous responses when the tap led by more than 300 ms and when the flash led by more than 200 ms, whereas they made fewer simultaneous responses at the 0 ms SOA. Model fitting demonstrated that the window of visuotactile simultaneity became narrower with development and reached adult-like levels between 9 and 11 years of age. Response errors decreased continuously until 11 years of age. The point of subjective simultaneity (PSS) was located on the tactile-leading side in all participants tested, indicating that 7-year olds (the youngest age tested) are adult-like on this measure. In summary, the perception of visuotactile simultaneity is not fully mature until 11 years of age. The protracted development of visuotactile simultaneity perception may be related to the need for crossmodal recalibration as the body grows and to the developmental improvements in the ability to optimally integrate visual and tactile signals.

In my presidential address, I described the early trap I fell into of describing the super-baby capable of one after another adult perceptual ability, then how I discovered that two atypical populations of adults allowed me to study developmental mechanisms, namely, the role of early sensory input in sculpting the nervous system and the biological preparedness that constrains the experiential effects. Specifically, studies of adults who had dense central cataracts during childhood revealed that there are multiple critical periods during which visual input alters the potential of the nervous system for later refinement. Studies of adults with synesthesia generated novel hypotheses, subsequently supported experimentally, about the details of the biological preparedness that bias the child's early learning. Nevertheless, later studies indicated that considerable residual plasticity remains in adulthood.

Humans use the direction of eye gaze and facial identity to make important social judgments. We carried out the first measurements of spatial frequency (SF) tuning for judgments of eye gaze, and compared SF tuning for judgments of facial identity and eye gaze. In Experiment 1, participants discriminated between leftward and rightward shifts of gaze, or between two male faces or two female faces. Faces were masked with visual noise that blocked one of 10 SF bands. For each task and masking SF, we measured contrast thresholds for human observers, and used an ideal observer to measure the amount of visual information available to perform the task. As in previous research, low to mid SFs were most important for judgments of facial identity. Mid to high SFs were most important for judgments of eye gaze, and the highest SF important for these judgments was higher than that for identity. In Experiment 2, participants discriminated horizontal and vertical shifts of gaze. The highest SF important for judgments of gaze did not differ between the horizontal and vertical axes. However, SFs above and below this value were more important for judgments of vertical shifts of gaze than for horizontal shifts of gaze. These results suggest that the visual system relies on higher SFs for judgments of eye gaze than for judgments of facial identity, and that SF tuning is broader for judgments of vertical shifts of gaze than for horizontal shifts of gaze.

We examined interpolation in 6- and 9-year-old children and in adults, in the two most common forms of fragmentation: subjective and partially occluded contours. Experiment 1 examined the effects on adults' interpolation of contour geometry, specifically, the effect of a scale-dependent factor (i.e., retinal size) and a scale-independent factor (i.e., support ratio). For both subjective and partially occluded contours, interpolation was affected more by support ratio than absolute size. However, subjective contours were less precisely interpolated and their interpolation was affected more by support ratio than was the case for partial occlusion. Experiment 2 used a subset of retinal size and support ratio levels in children and adults. Interpolation of both subjective and occluded contours improved significantly with age, with the two types of contours equally affected by spatial constraints during early childhood. However, while interpolation of occluded contours became more precise with age and less dependent on support ratio by adulthood, interpolation of subjective contours was less improved and became even more tied to support ratio in adulthood. The implications of these differential age-related changes in the spatial constraints on interpolation of the two types of contours for the mechanisms of perceptual completion are discussed.

We examined audiovisual and visuotactile integration in the central and peripheral visual field using visual fission and fusion illusions induced by sounds or taps. The fission illusion occurs when a single flash is perceived as two flashes if paired with two beeps or taps; the fusion illusion, by contrast, occurs when two flashes are perceived as a single flash if the flashes are paired with a single beep or tap. Beeps and taps induced similar patterns of illusions: the fission illusion was larger in the periphery than in the center, whereas the fusion illusion was larger in the center than in the periphery. An analysis based on signal detection theory revealed that both a decline in discriminability and a shift in criterion were associated with the more pronounced fission induced by sounds in the periphery. In contrast, only a shift in criterion was associated with the larger fission induced by taps in the periphery, and the larger fusion induced by a sound or tap in the center. To accommodate these findings, two accounts are proposed: audiovisual signals are more likely to be integrated in peripheral than in central vision, and the interpretation of visual signals favors discontinuous percepts, especially in the periphery.

The current study investigated the impact of birth weight on the ability to recognize facial expressions in adulthood among the longest known prospectively followed cohort of extremely low birth weight survivors (ELBW

Children take many years to become as skilled as adults in differentiating among 5 faces and there is debate about the role of face experience in improving their skills. Here we tested whether the increase in exposure to the faces of children associated with entering school leads to improved face discrimination for this face category. To do so, we compared the face discrimination abilities of 3- to 4-year-old children who began attending school for the first time with those of 10 age-matched controls not yet in school. Both groups completed a 2-alternative forced-choice matching task with adult and child faces, presented both in an upright and inverted orientation, at Time 1 (within the first month of entering school for the school group) and at Time 2 (5 months later). Between Time 1 and Time 2, both groups improved in discriminating between adult faces, but only the preschoolers 15 improved for child faces. These effects were not modulated by inversion. Overall, these results suggest that, during the preschool years, a natural increase in exposure to the faces of 1 face category leads to improved discrimination of novel exemplars of this face category.

ObjectivesTo assess the diagnostic accuracy of five vision screening tools used in a school setting using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).DesignWe compared the results of the five best evidence-based screening tools available in 2014 to the results of a comprehensive eye exam with cycloplegic refraction by a licenced optometrist. Screening included Cambridge Crowded Acuity Cards, Plusoptix S12 and Spot photoscreeners, Preschool Randot Stereoacuity Test and the Pediatric Vision Scanner (PVS). Referral criteria followed AAPOS (2013) guidelines and published norms.SettingA large school in Toronto, Canada, with 25 split classrooms of junior kindergarten (JK: 4 year olds) and senior kindergarten (SK: 5 year olds) children.ParticipantsOver 2 years, 1132 eligible children were enrolled at the school. After obtaining parental consent, 832 children were screened. Subsequently, 709 children had complete screening and optometry exam data.Main outcome measuresThe presence/absence of a visual problem based on optometrist’s assessment: amblyopia, amblyopia risk factors (reduced stereoacuity, strabismus and clinically significant refractive errors) and any other ocular problem (eg, nystagmus).ResultsOverall, 26.5% of the screened children had a visual problem, including 5.9% with amblyopia. Using all five tools, screening sensitivity=84% (95% CI 78 to 89), specificity=49% (95% CI 44 to 53), PPV=37% (95% CI 33 to 42), and NPV=90% (95% CI 86 to 93). The odds of having a correct screening result in SK (mean age=68.2 months) was 1.5 times those in JK (mean age=55.6 months; 95% CI 1.1 to 2.1), with sensitivity improved to 89% (95% CI 80 to 96) and specificity improved to 57% (95% CI 50 to 64) among SK children.ConclusionsA school-based screening programme correctly identified 84% of those kindergarten children who were found to have a visual problem by a cyclopleged optometry exam. Additional analyses revealed how accuracy varies with different combinations of screening tools and referral criteria.

In this article, we begin with a summary of the evidence for perceptual narrowing for various aspects of language (e.g., vowel and consonant contrasts, tone languages, visual language, sign language) and of faces (e.g., own species, own race). We then consider possible reasons for the apparent differences in the timing of narrowing (e.g., apparently earlier for own race than for own species). Throughout we consider whether the evidence fits a model of maintenance/loss or is better characterized as enhancement/attunement to exposed categories. Finally, we consider evidence on the malleability of the timing and its implications for the role of endogenous factors versus learning in controlling when narrowing occurs. Overall, the comparison across domains revealed many similarities but also striking differences which lead to suggestions for future research.

The expertise of adults in face perception is facilitated by their ability to rapidly detect that a stimulus is a face. In two experiments, we examined the role of early visual input in the development of face detection by testing patients who had been treated as infants for bilateral congenital cataract. Experiment 1 indicated that, at age 9 to 20, patients' accuracy and response times on a Mooney face detection task were normal. Experiment 2 revealed that the neural mechanisms underlying face detection in a similar group of adult patients are abnormal: the amplitude of both the P100 and N170 event-related potential were larger in patients than in visually normal controls, and the extent of augmentation was related to the duration of deprivation. Thus, early visual experience is necessary for the establishment of normal neural networks for face detection; abnormalities at these early processing stages may contribute to the deficits we previously reported in configural face processing for this patient cohort.

We investigated the efficacy of training adults to recognize full spectrum inverted faces presented with different viewpoints. To examine the role of different spatial frequencies in any learning, we also used high-pass filtered faces that preserved featural information and low-pass filtered faces that severely reduced that featural information. Although all groups got faster over the 2days of training, there was more improvement in accuracy for the group exposed to full spectrum faces than in the two groups exposed to filtered faces, both of which improved more modestly and only when the same faces were shown on the 2days of training. For the group exposed to the full spectrum range and, to a lesser extent, for those exposed to high frequency faces, training generalized to a new set of full spectrum faces of a different size in a different task, but did not lead to evidence of holistic processing or improved sensitivity to feature shape or spacing in inverted faces. Overall these results demonstrate that only 2h of practice in recognizing full-spectrum inverted faces presented from multiple points of view is sufficient to improve recognition of the trained faces and to generalize to novel instances. Perceptual learning also occurred for low and high frequency faces but to a smaller extent.

We examined the influences of face inversion and facial expression on sensitivity to eye contact in high-functioning adults with and without an autism spectrum disorder (ASD). Participants judged the direction of gaze of angry, fearful, and neutral faces. In the typical group only, the range of directions of gaze leading to the perception of eye contact (the cone of gaze) was narrower for upright than inverted faces. In both groups, the cone of gaze was wider for angry faces than for fearful or neutral faces. These results suggest that in high-functioning adults with ASD, the perception of eye contact is not tuned to be finer for upright than inverted faces, but that information is nevertheless integrated across expression and gaze direction.

Early visual deprivation impairs some, but not all, aspects of face perception. We investigated the possible developmental roots of later abnormalities by using a face detection task to test infants treated for bilateral congenital cataract within 1 hour of their first focused visual input. The seven patients were between 5 and 12 weeks old ( n = 3) or older than 12 weeks ( n = 4). Like newborns, but unlike visually normal age-matched controls, the patients looked preferentially toward config (three squares arranged as facial features) over its inverted version and none of the older patients preferred a positive-contrast face over the negative-contrast version. We conclude that postnatal changes in face perception are experience-dependent, and that interference with their typical development may contribute to later deficits in face processing.

In experiment 1, we examined developmental changes in the influence of symmetry on judgments of attractiveness by showing adults and children pairs of individual faces in which one face was transformed 75% toward perfect symmetry, while the other face was transformed by exaggerating its asymmetries by 75%. Adults and 9-year-olds, but not 5-year-olds, rated the more symmetric faces as more attractive than the less symmetric faces, although the effect was stronger in adults than 9-year-olds. The preference for symmetry was stronger for male than female faces, and stronger for adults' than children's faces. In experiment 2, comparisons of the symmetry of the original male and female faces revealed no measured differences but lower ratings by adults of symmetry in the male faces. Overall, the results suggest that the influence of symmetry on attractiveness judgments emerges after the age of 5 years, and matures after the age of 9 years. The stronger effects for adult viewers may reflect an increase in sensitivity to symmetry as experience with faces increases and/or as the visual system matures. As well, attractiveness may become more salient after puberty, so that honest signals of mate quality, such as symmetry, have a stronger effect for adult viewers, especially when judging adult faces.

In 1949, Donald Hebb published his now famous book Organisation of Behaviour: A Neuropsychological Theory (Hebb, 1949). He presented a novel hypothesis about how the baby learns to see. A naive organism, be it infant or animal, he claimed first seeks out local points of maximum stimulation. When first presented with a triangle, for example, the naif will look at the corners and scan them repeatedly. At the same time, there will be motor tug from the lines abutting the corners, pulling the eye toward nearby corners, which are, in turn, scanned repetitively. The repeated scanning of local elements leads slowly to the development of a cell assembly for each element that is capable of functioning briefly on its own, as a closed system. The baby in our example slowly develops three diffuse cell assemblies, one for each corner of the triangle, while at the same time developing expectations about what will happen when he or she moves the eyes along a line connecting two corners. Those links become what Hebb termed phase sequences. At first, there is interference from other elements in the visual field, such as the nest, or the wallpaper, or even mom, but if they occur irregularly at the same time as the triangle, they get eliminated from the cell assemblies forming for each corner and the phase sequences linking them. Eventually the combination of these cell assemblies and their phase sequences leads to the perception of a whole triangle.This is an example of Hebb's mechanism for experiencedependent plasticity. The repeated scanning and sequencing leads to lasting cellular changes that allow more rapid firing, more stability, and larger percepts. It is an example of his general principle that "neurons that fire together, wire together": any two cells or systems that are repeatedly active at the same time are likely to become associated such that activity in one facilitates activity in the other. Hebb summarized his argument like this:Perception depends on learning first to see the parts of an object clearly, a process involving a series of visual fixations, and proceeds from seeing, at first, an amorphous mass containing several foci (the corners), to seeing a distinctive figure at a glance. Even at this final stage we know the perception of the whole is dependent on eye movements for maximal clarity. (p. 101)My doctoral supervisor, Phil Salapatek, arrived at Yale for his graduate training with Bill Kessen in the early 1960s when Hebb's theories were prominent but controversial, because they contradicted the prevailing views of both the Gestaltists and the behaviorists. The Gestaltists had used many perceptual primitives such as good continuation and common fate to explain why elements are grouped into a figure or relegated to the background. But their work was based on demonstrations with adults; Hebb argued that these perceptual primitives had originated from experience interacting with the world. The behaviorists advocated for learning, like Hebb, but their mechanisms of classically conditioned associations and reinforcement required that there be an external consequence for learning to occur, unlike Hebb's development of cell assemblies and phase sequences based only on repeated, sequential interaction with a stimulus.Up until the early 1960s, tests of Hebb's ideas had been limited to experiments with animals and human adults, intact or with specific brain damage. Kessen's lab had both the insight that studies of newborns could be used to test Hebb's ideas and the technical savvy to gather those data. For his doctoral research, Salapatek built a system for measuring newborns' eye movements as they scanned a simple triangle. A typical result is in Figure 1. On the left are the fixations of two control infants while they scanned a blank field (the triangle was not presented to the baby but inserted as a reference for the analyses); on the right are the scans of two typical newborns presented with the triangle for almost 2 min (Salapatek & Kessen, 1966). …

Summary Temporal simultaneity provides an essential cue for integrating multisensory signals into a unified perception. Early visual deprivation, in both animals and humans, leads to abnormal neural responses to audiovisual signals in subcortical and cortical areas [1–5]. Behavioral deficits in integrating complex audiovisual stimuli in humans are also observed [6, 7]. It remains unclear whether early visual deprivation affects visuotactile perception similarly to audiovisual perception and whether the consequences for either pairing differ after monocular versus binocular deprivation [8–11]. Here, we evaluated the impact of early visual deprivation on the perception of simultaneity for audiovisual and visuotactile stimuli in humans. We tested patients born with dense cataracts in one or both eyes that blocked all patterned visual input until the cataractous lenses were removed and the affected eyes fitted with compensatory contact lenses (mean duration of deprivation = 4.4 months; range = 0.3–28.8 months). Both monocularly and binocularly deprived patients demonstrated lower precision in judging audiovisual simultaneity. However, qualitatively different outcomes were observed for the two patient groups: the performance of monocularly deprived patients matched that of young children at immature stages, whereas that of binocularly deprived patients did not match any stage in typical development. Surprisingly, patients performed normally in judging visuotactile simultaneity after either monocular or binocular deprivation. Therefore, early binocular input is necessary to develop normal neural substrates for simultaneity perception of visual and auditory events but not visual and tactile events.

We examined the role of early visual input in visual system development by testing adults who had been born with dense bilateral cataracts that blocked all patterned visual input during infancy until the cataractous lenses were removed surgically and the eyes fitted with compensatory contact lenses. Patients viewed checkerboards and textures to explore early processing regions (V1, V2), Glass patterns to examine global form processing (V4), and moving stimuli to explore global motion processing (V5). Patients' ERPs differed from those of controls in that (1) the V1 component was much smaller for all but the simplest stimuli and (2) extrastriate components did not differentiate amongst texture stimuli, Glass patterns, or motion stimuli. The results indicate that early visual deprivation contributes to permanent abnormalities at early and mid levels of visual processing, consistent with enduring behavioral deficits in the ability to process complex textures, global form, and global motion.

Faces are adaptively coded relative to visual norms that are updated by experience, and this adaptive coding is linked to face recognition ability. Here we investigated whether adaptive coding of faces is disrupted in individuals (adolescents and adults) who experience face recognition difficulties following visual deprivation from congenital cataracts in infancy. We measured adaptive coding using face identity aftereffects, where smaller aftereffects indicate less adaptive updating of face-coding mechanisms by experience. We also examined whether the aftereffects increase with adaptor identity strength, consistent with norm-based coding of identity, as in typical populations, or whether they show a different pattern indicating some more fundamental disruption of face-coding mechanisms. Cataract-reversal patients showed significantly smaller face identity aftereffects than did controls (Experiments 1 and 2). However, their aftereffects increased significantly with adaptor strength, consistent with norm-based coding (Experiment 2). Thus we found reduced adaptability but no fundamental disruption of norm-based face-coding mechanisms in cataract-reversal patients. Our results suggest that early visual experience is important for the normal development of adaptive face-coding mechanisms.

Patients treated for bilateral congenital cataract are later impaired on several hallmarks of adults' expertise with upright faces but report no problem with remembering faces. Here, we provide the first formal data on their face memory. We compared 12 adults with a history of visual deprivation from bilateral congenital cataracts to 24 age-matched controls with normal vision on their ability to recognize famous and recently learned faces, and on their subjective impression of their face memory. Bilateral congenital cataract patients demonstrated a prosopagnosic-like deficit, being slower and less accurate in recognizing both famous faces and recently learned faces, despite not differing on most questions about their impression of their face memory. Patients' results on three perceptual tasks (the composite face effect, the Benton test of recognizing faces through a change in point of view, and the Jane test of sensitivity to feature spacing) were also not correlated with their face memory deficits. These results suggest that early visual input is necessary not only for perceptual expertise in differentiating among unfamiliar upright faces, but also for normal accuracy in remembering the identity of individual faces. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 56: 96-108, 2014.

Amblyopia is a condition involving reduced acuity caused by abnormal visual input during a critical period beginning shortly after birth. Amblyopia is typically considered to be irreversible during adulthood. Here we provide the first demonstration that video game training can improve at least some aspects of the vision of adults with bilateral deprivation amblyopia caused by a history of bilateral congenital cataracts. Specifically, after 40 h of training over one month with an action video game, most patients showed improvement in one or both eyes on a wide variety of tasks including acuity, spatial contrast sensitivity, and sensitivity to global motion. As well, there was evidence of improvement in at least some patients for temporal contrast sensitivity, single letter acuity, crowding, and feature spacing in faces, but not for useful field of view. The results indicate that, long after the end of the critical period for damage, there is enough residual plasticity in the adult visual system to effect improvements, even in cases of deep amblyopia caused by early bilateral deprivation.

Adults use eye contact as a cue to the mental and emotional states of others. Here, we examined developmental changes in the ability to discriminate between eye contact and averted gaze. Children (6-, 8-, 10-, and 14-year-olds) and adults (n = 18/age) viewed photographs of a model fixating the center of a camera lens and a series of positions to the left/right or upward/downward and judged whether the model’s gaze was direct or averted to the left/right or upward/downward. The horizontal range of fixation positions leading to the perception of direct gaze (the cone of gaze) was more than 50% larger in 6-year-olds than in adults, but it was adult-like and smaller than the vertical cone of gaze by 8 years of age. The vertical cone of gaze was large and statistically adult-like by age 6, with only a small linear reduction thereafter. In all age groups, the horizontal cone of gaze was centered on the bridge of the participant’s nose and the vertical cone was centered slightly below the participant’s eye height. These findings indicate that until after age 6, relatively poor sensitivity to direct versus averted gaze limits children’s ability to use gaze cues to make social judgments.

Adults are experts at recognizing faces but there is controversy about how this ability develops with age. We assessed 6- to 12-year-olds and adults using a digitized version of the Benton Face Recognition Test, a sensitive tool for assessing face perception abilities. Children’s response times for correct responses did not decrease between ages 6 and 12, for either upright or inverted faces, but were significantly longer than those of adults for both face types. Accuracy improved between ages 6 and 12, ignificantly more for upright than inverted faces. Inverted face recognition improved slowly until late childhood, whereas there was a large improvement in upright face recognition between ages 6 and 8, with a further enhancement after age 12. These results provide further evidence that during childhood face processing undergoes protracted development and becomes increasingly tuned to upright faces.

We used opposing figural aftereffects to investigate whether there are at least partially separable representations of upright and inverted faces in patients who missed early visual experience because of bilateral congenital cataracts (mean age at test 19.5 years). Visually normal adults and 10-year-olds were tested for comparison. Adults showed the expected opposing aftereffects for upright and inverted faces. Ten-year-olds showed an adultlike aftereffect for upright faces but, unlike the adult group, no aftereffect for inverted faces. Patients failed to show an aftereffect for either upright or inverted faces. Overall, the results suggest that early visual input is necessary for the later development of (at least partially) separable representations of upright and inverted faces, a developmental process that takes many years to reach an adult-like refinement.