Functional magnetic resonance imaging (fMRI) and effects of L-dopa on visual function in normal and amblyopic subjects.

PURPOSE To evaluate the effects of a single dose of levodopa on visual cortex, based on functional MRI (fMRI), and on visual function, based on psychophysical tests, in amblyopic and normal subjects. METHOD A prospective, randomized trial of a single dose of levodopa (2 mg/kg body weight) was undertaken in an institutional setting in nine normal and six amblyopic subjects, who were assessed at baseline and 90 minutes after levodopa ingestion. fMRI of occipital visual cortex was undertaken with a 1.5T GE MRI scanner utilizing the BOLD contrast technique. fMRI stimuli were two gratings (0.5, 2.0 cycles/degree of visual angle) that counterphased at 4 Hz. fMRI parameters for analysis included AREA and LEVEL of activation and a SUMMED score (AREA x LEVEL). Psychophysical tests included visual acuity, contrast sensitivity, stereoacuity, and binocular fusion. RESULTS At baseline, AREA of activation (P = .05) and SUMMED score (P = .05) were significantly less in the amblyopic compared to the dominant eyes. Psychophysically, visual acuity and contrast sensitivity were significantly worse in the amblyopic eye. Following levodopa ingestion, there was significant decrease in LEVEL of activation in the amblyopic eye, even though visual acuity showed significant improvement (P = .03). Also, amblyopes showed a significant increase and normals showed some decrease in interocular difference in LEVEL of activation (P = .04). CONCLUSION Unique information was obtained when fMRI was utilized to assess visual cortical function. While levodopa improved visual acuity in the amblyopic eye, it decreased the LEVEL of activation based on fMRI, a counterintuitive finding. The results highlight the value of utilizing fMRI to assess amblyopia and provide new directions for research.