Mesopic Visual Contrast Sensitivity in Patients with Major Depression

doi:10.4236/ojd.2013.24014

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Open Journal of Depression

2013. Vol.2, No.4, 82-86

Published Online November 2013 in SciRes (http://www.scirp.org/journal/ojd) http://dx.doi.org/10.4236/ojd.2013.24014

Open Access

Mesopic Visual Contrast Sensitivity in Patients with Major

Depression

Renata M. T. B. L. Nogueira1*, Everton L. Espínola2, Aline M. Lacerda2,

Natanael A. Santos2

1Departamento de Psicologia da Universidade Federal de Pernambuco (UFPE), Recife, Brasil

2Laboratório de Percepção, Neurociências e Comportamento, Departamento de Psicologia, Universidade Federal

da Paraíba (UFPB), João Pessoa, Brasil

Email: *rm_renata@yahoo.com.br

Received October 3rd, 2013; revised November 3rd, 2013; accepted November 11th, 2013

tive Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any me-

dium, provided the original work is properly cited.

The present study evaluated the effects of major depression on visual contrast sensitivity (CS) at low

mesopic luminance (.7 cd/m2 mean luminance), a condition that has been little explored in the literature.

We measured spatial visual CS in 20 male volunteers aged 20 - 30 years, including 10 healthy individuals

and 10 medicated individuals with major depression, to linear sine-wave gratings of .25, 1.0, and 4.0

cycles per degree (cpd) of visual angle using the psychophysical staircase method with forced choice. The

average spatial visual CS in the depressed group was approximately 1.7 lower than the average spatial

visual CS in the control group. However, the post hoc test showed significant differences only at the

spatial frequencies of .25 and 1.0 cpd (p < .05), which are likely processed by the magnocellular visual

pathway. These results suggest that spatial visual CS to sine-wave gratings should be used to evaluate the

responsiveness of the visual system in patients with major depression under conditions of low luminance.

Keywords: Visual Perception; Contrast Sensitivity; Depression; Spatial Frequency; Psychophysics

Introduction

Depression can be defined as a mental disorder presented by

depressed mood, loss of pleasure and interest, feelings of guilt

and low self-esteem, sleep and appetite disturbances, low en-

ergy, and poor concentration (WHO, 2012). The annual inci-

dence of depression makes it one of the most important public

health problems, with severe socioeconomic implications, high

costs for health care, and a reduction of quality of life (Solomon,

2002). According to the World Health Organization (WHO,

2001), severe depression is the leading cause of disability and

ranks fourth among the 10 leading causes of pathology world-

wide. In fact, by 2020, depression is estimated to be the second

leading cause of disability worldwide. Studying depression us-

ing different approaches can complement clinical research and

contribute to the characterization of the basic cognitive, affec-

tive, and neurophysiological mechanisms of this disease. It may

also reveal new theoretical, behavioral, and functional aspects of

depression in general and highlight alternative means of diagnosis

and prognosis. The present study used visual contrast sensitivity

(CS) to assess the perception of patients with major depression.

Visual CS is one of the most widely used tools in the diagno-

sis and theoretical and clinical evaluation of changes in visual

perception and alterations in the central nervous system (Wes-

ner & Tan, 2006) caused by disorders or diseases, such as

schizophrenia (Slaghuis & Thompson, 2003), amblyopia (Polat,

Sagi, & Norcia, 1997), cataracts (Elliott & Situ, 1998), mercury

poisoning (Ventura et al., 2005), stroke (Santos & Andrade, 2012;

Santos, Andrade, & Fernandez Calvo, 2013), and Alzheimer’s

and Parkinson’s diseases (Polat et al., 1997; Akutsu & Legge,

1995; Bour & Apkarian, 1996; Vleugels et al., 1998).

Surveys related to visual CS and affective disorders are still

sparse, with only a few studies performed under different con-

ditions and for different purposes (Wesner & Tan, 2006; Ca-

valcanti & Santos, 2005; Szabó et al., 2004). For example,

Szabó et al. (2004) measured visual CS in volunteers with and

without seasonal affective disorder using static and dynamic

sine-wave gratings with spatial frequencies from .5 to 14.4

cycles per degree (cpd) of visual angle. The aim of that study

was to investigate the therapeutic effects of light therapy on

seasonal depression. The results showed that light therapy sig-

nificantly improved visual CS in patients at static spatial fre-

quencies below 5.7 cpd.

In a pilot study, Cavalcanti e Santos (2005) measured con-

trast thresholds in adult volunteers with and without major de-

pression under high photopic luminance conditions using

non-Cartesian radial visual stimuli at spatial frequencies of .25,

1.0, and 4.0 cpd. The results showed that patients with major

depression had a loss of or lower CS for all spatial frequencies

compared with volunteers without neuropsychiatric disorders.

Wesner & Tan (Wesner & Tan, 2006) measured contrast

thresholds in patients with seasonal depression and major de-

pression and volunteers without depression using static and

dynamic visual stimuli modulated by Gabor’s function with

spatial frequencies from .3 to 12 cpd under photopic luminance

*Corresponding author.

R. M. T. B. L. NOGUEIRA ET AL.

Open Access 83

conditions. The results showed that participants with depression

had higher visual CS than the group without depression at high

static spatial frequencies of 6.0 and 12 cpd. The authors argued

that depression can increase the CS to frequencies that are pro-

cessed by the parvocellular visual pathway.

The present study evaluated the effects of major depression

on spatial visual CS by measuring achromatic visual CS in

adult volunteers with and without major depression using a

psychophysical method. The present study was motivated by

the assumption that depression alters the central nervous system

and affects numerous sensory, cognitive, and emotional func-

tion to promote changes in visual pathways (Wesner & Tan,

2006). Visual CS is an objective tool, noninvasive, and widely

used clinically to contribute to a greater understanding of the

sensory mechanisms associated with symptoms of depression.

Methods

Participants

Twenty 20- to 30-year-old male volunteers participated in the

study. Ten of the participants had no neuropsychiatric diseases

(mean age, 20.8 ± 1.2 years), determined by the Beck Depres-

sion Inventory, and 10 of the participants had a diagnosis of

major depression (mean age, 23.9 ± 4.0 years) according to the

Diagnostic and Statistical Manual of Mental Disorders, 4th

edition, text revision (American Psychiatric Association, 2000).

The patients with major depression were selected and ranked by

psychiatrists from the Centro de Atenção Psicossocial (CAPS;

João Pessoa, Paraíba, Brazil) and were taken to the Laboratório

de Percepção, Neurociências e Comportamento where the vis-

ual tests were conducted. Additional information about the pa-

tients with major depression is presented in Table 1.

All of the volunteers had normal visual acuity of 6/6 (inclu-

sion criterion) tested with directional “E” Rasquin optotype

cards (Xenônio, São Paulo, SP, Brazil) and were free of eye dis-

eases and neurological disorders (exclusion criterion), with the

exception of major depression or disorders related to major depres-

sion. The participation of the volunteers conformed to ethical as-

pects relevant to research that involves human subjects (National

Health Council Resolution no. 196/96, Health Ministry, Brazil). The

protocol was submitted to and approved by the Ethics Committee of

the Health Sciences Center, Universidade Federal da Paraíba. The

participation of the volunteers was voluntary and occurred only

after written informed consent was provided by them.

Visual Stimuli and Equipment

The test stimuli were achromatic linear sine-wave gratings

(.7 cd/m2 mean luminance) with spatial frequencies of .25, 1.0, and

4.0 cpd. The non-test stimuli were gray and contained only the

mean luminance. The diameter of the resulting patterns subtended

approximately 7.2 degrees at a distance of 150 cm (i.e., the stan-

dardized distance between the monitor and volunteer). Contrast

was defined according to Michelson’s formula (Michelson, 1891):

















CLxmax LxminLxmax Lxmin 





x is the luminance at a given point on the sine wave,

with x measured radially from the center.



xmax and





xmin are the maximum and minimum luminances of the

pattern, respectively. C is the contrast. The spatial average lu-

minance of the grating is given by









xmax Lxmin



The stimuli were presented on a 19-inch color cathode ray

tube video monitor (1024 × 768 resolution, 70 Hz refresh rate).

The stimuli were controlled by a computer through VGA and

DVI video connectors. The dynamic range of the contrasts that

the monitor could present was expanded more than 64 times by

a BITS++ digital video processor (Cambridge Research Sys-

tems, Rochester, Kent, England, 2002), resulting in 14 bits per

channel or 42 bits per pixel, allowing the presentation of more

than 16,384 (or 214) grayscale levels. This allowed the testing of

contrast thresholds while enabling high-contrast resolution. The

BITS++ processor was controlled by C++ software developed

by our research group. It generated and controlled the stimulus

presentation and recorded the observer responses to calculate

contrast threshold values.

The monitor was calibrated with LightScan software and an

optical photometer (Cambridge Research Systems, Rochester,

Kent, England, 2002). The monitor output was gamma-cor-

rected using 48 points from 0 to 255 (gamma = 1.8). The mi-

nimum and maximum luminance values of the screen were .5

and .9 cd/m2, respectively, and the background luminance was

the minimum luminance itself. The laboratory room was 2.5 

2.0 m, with one Philips 20W fluorescent lamp. The walls were

gray to better control ambient lighting during the experiment.

Table 1.

Characterization of the experimental group.

Patient* Age (Years)

Beck Depression

Inventory Time of Disease

(Years) Sex Drug Education

P1 23 Moderate depression2 Female Fluoxetine Graduate

P2 20 Moderate depression2 Female Fluoxetine Academic

P3 26 Moderate depression2 Male Fluoxetine Academic

P4 22 Moderate depression1 Female Fluoxetine Academic

P5 30 Severe depression 2 Female Fluoxetine Academic

P6 19 Mild depression 1 Female Risperidone Academic

P7 28 Severe depression 2 Female Venlafaxine, Clonazepam, Zolpidem Academic

P8 29 Moderate depression2 Female Floral de Bach Graduate

P9 22 Moderate depression1 Female No drug Academic

P10 20 Mild depression 1 Male No drug Graduate

*The characteristics of the participants in the control group (i.e., age, sex, and education level) were similar to the experimental group. See the average ages of the two

groups in the Participants section.

R. M. T. B. L. NOGUEIRA ET AL.

Open Access

Procedure

The participants viewed the stimuli binocularly with natural

pupils at a distance of 150 cm. A fixed chair and forehead-chin

support were used to control the viewing distance. The visual

CS of all of the participants was estimated using a temporal

two-alternative forced-choice staircase method (Wetherill &

Levitt, 1965). The procedure for measuring the threshold for

each frequency consisted of presenting successive pairs of sim-

ple stimuli, one of which was the test stimulus that should be

identified by the participant (i.e., the first or second stimulus of

each pair). The order of the presentation of the stimuli and fre-

quencies was randomized by the software. The criterion used to

alternate the contrast during the experimental session was three

consecutive hits to reduce contrast by 20%, and one error to

increase contrast by the same percentage.

Threshold measurements began with the test stimulus con-

trast set at a suprathreshold level (contrast = 1). Each time the

volunteer gave a correct answer, the contrast was decreased

successively until he made an error. The software recorded the

last perceived contrast value. The contrast was then raised until

the volunteer could perceive the stimulus again. In this case, the

software recorded the first perceived contrast value. The ex-

perimental session automatically ended after the software re-

corded six staircase contrast values. Each threshold measure-

ment was repeated for each spatial frequency. The contrast

threshold calculated for each volunteer was the mean of the 12

contrast values (six at the test and six at the retest).

A stimulus sequence was presented during each experi-

mental session, starting with a beep and followed immediately

by the presentation of the first stimulus for 2 s. A 1 s interval

elapsed between stimuli, followed by the presentation of the

second stimulus for 2 s and the volunteer’s response. All of the

participants responded within the 3-s interval. A correct re-

sponse was followed by another beep. The interval between

trials was 3 s, regardless of a correct or incorrect response (or

choice). The beeps that indicated the beginning of the stimulus

pair presentation and correct choice were different.

All of the participants received the following instructions:

“Pairs of circles will appear on the screen, one after the other.

One of them will be totally gray, whereas the other will contain

light and dark gratings (bars) inside it. When the circle with

light and dark gratings (bars) appears first, you must press the

left mouse button (button 1); when the circle with light and

dark gratings (bars) appears second, you should press the right

mouse button (button 2).”

The experiments began only when the experimenter was

confident that the participants understood and responded ac-

cording to the directions. In this context, instructions were re-

peated in a training and familiarization session with the ex-

perimental conditions.

After each experimental session, the software produced a re-

cord sheet with the 12 staircase contrast values from each par-

ticipant, six in the test and six in the retest. Values were

grouped according to mental condition (i.e., participants with-

out major depression [control group] and participants with ma-

jor depression [experimental group]). All of the staircase con-

trast threshold values were converted into CS values (1/thresh-

old).

All 240 staircase contrast values (12 from each volunteer) for

each spatial frequency were used to conduct a Tukey Two-

Sided Outlier Test. The 3, 4, and 8 outlier values for .5, 1.0, and

4.0 cpd, respectively, identified by the Tukey test were set to

equal the group mean calculated in the absence of the outlier.

After the Tukey Outlier Test, the means of the staircase contrast

values were used to calculate their individual linear CS values.

Results

A one-way analysis of variance (ANOVA) applied to CS re-

vealed significant differences between groups (F3,396 = 80.5, p

< .05) and a significant interaction (F3,396 = 905.2, p < .05).

Thus, the control and experimental groups had different con-

trast sensitivity (p < .05).

The Tukey Honestly Significant Difference post hoc test

showed significant differences between the groups only at low

spatial frequencies of .25 and 1.0 cpd (p < .05). The differences

between groups at the spatial frequency of 4.0 cpd were not

significantly different (p > .05). The participants with major

depression generally required higher contrast to detect the spa-

tial frequencies of .25 and 1.0 cpd than the participants without

any neuropsychiatric disease.

The results showed that the maximum CS in the control

group occurred at frequencies of .25 and 1.0 cpd, whereas the

maximum CS in the experimental group occurred at the fre-

quency of .25 cpd (Figure 1). The data also showed that the

participants without any neuropsychiatric disease were 1.57-,

2.14-, and 1.28-times more sensitive to spatial frequencies

of .25, 1.0, and 4.0 cpd, respectively, than the patients with

major depression.

Discussion

The present study measured visual CS using a psychophysi-

cal staircase method, with forced choice between two temporal

alternatives under mesopic luminance conditions. The research

hypothesis was that major depression would alter the response

of the visual system or the basic sensory mechanisms involved

in processing visual patterns, altering contrast sensitivity to

sine-wave gratings with spatial frequencies of .25, 1.0, and 4.0

cpd.

Figure 1.

The estimated contrast sensitivity in adult volunteers is presented as a

spatial frequency function of .25, 1.0, and 4.0 cpd. The continuous

curve (─■─) represents the control group (without major depression),

and the dotted curve (---▲---) represents the experimental group (with

major depression). The error bars indicate standard errors of the mean

(p = .05).

R. M. T. B. L. NOGUEIRA ET AL.

Open Access 85

Major depression likely does not equally interfere with the

anatomical and physiological mechanisms related to the proc-

essing of the tested visual spatial frequencies. The decrease

observed in visual spatial CS in patients with major depression

was statistically significant only at the low spatial frequencies

(.25 and 1.0 cpd), which are probably processed preferentially

by the magnocellular visual pathway, especially when consid-

ering low luminance used in the study (Lee, Martin, & Valberg,

1989; Livingstone & Hubel, 1987; Murray, Parry, & Carden,

1987; Valberg & Rudvin, 1997; Vassilev, Stomonyakov, &

Manahilov, 1994). According to Souza et al. (2007), at low

spatial frequencies of .4 - .8 cpd, only the magnocellular visual

pathway appears to be relevant for the cortical response. No

significant differences in CS were found between the control

group and experimental group at the highest spatial frequency

tested (4.0 cpd). Therefore, major depression may preferentially

damage the magnocellular visual pathway rather than affect the

mechanisms that process high spatial frequencies, which may

involve the parvocellular visual pathway. This hypothesis relies

on the possibility that magnocellular channels are activated by

spatial frequencies below 2.0 cpd, whereas parvocellular chan-

nels are activated by spatial frequencies above 4.0 cpd (Adams

& Courage, 2010; Burbeck & Kelly, 1981). Importantly, how-

ever, the levels of scotopic and photopic contrast appear to be

the dominant factor for the functional activity of the magnocel-

lular and parvocellular pathways, respectively, rather than the

spatial frequency itself (Skottun & Skoyles, 2011).

We cannot definitively state that the alterations found in vis-

ual perception or CS solely resulted from changes in the central

nervous system produced by major depression. Other factors

are likely involved. For example, antidepressants, such as flu-

oxetine, venlafaxine, and others, act by modulating the func-

tion of the central nervous system. The present study did not

seek to control the effects of antidepressants on visual CS

measures. Typical and atypical antipsychotic medications can

also differentially change perceived contrast (Chen et al., 2003).

Changes in visual CS caused by major depression were ex-

pected in the present study, based on studies that reported that

neuropsychiatric disorders affect cognition and central nervous

system function (Bubl et al., 2010; Duman, Heninger, & Nes-

tler, 1997; O’Donnell et al., 2002; Slaghuis, 1998; Wolman &

Stricker, 1990). Some studies used electrooculography (EOG)

(Lam et al., 1991; Fountoulakis, Foutiou, Iacovides, & Kaprinis,

2005) and flash electroretinography (ERG) (Fountoulakis et al.,

2005; Hébert et al., 2004; Lavoie et al., 2009) to evaluate pa-

tients with seasonal depression and reported the presence of

changes in the retina at the photoreceptor level, which resulted

in decreased light sensitivity in depressive patients compared

with the control group. Both EOG and ERG are useful tools,

the results of which indirectly reflect dopamine activity in the

retina. Several studies have related decreased dopamine activity

with specific depressive symptoms. For example, Harris, Cal-

vert, Leendertz e Phillipson (1990) suggested that lower dopa-

mine levels in the brain in depressed patients result in a de-

crease in visual CS. Bodis-Wollner e Tzelepi (1998) proposed

that dopamine D2 receptors affect the ability to visually detect

high spatial frequencies, whereas D1 receptors affect the ability

to visually detect low spatial frequencies. These authors argued

that decreased dopamine levels could attenuate the inhibition

modulated by horizontal cells, which are involved with the

perception of visual CS, thus resulting in a reduction of this

visual function.

Szabó et al. (2004) reinforced the hypothesis that major de-

pression damages the magnocellular visual pathway. These

authors found a decrease in CS at a low spatial frequency (.5

cpd). However, these results are different from the results re-

ported by Wesner e Tan (2006), who found no losses in visual

CS in patients with depression but greater CS to higher spatial

frequencies. The authors argued that depression can increase

the CS to spatial frequencies processed by the parvocellular

visual pathway. However, Wesner e Tan (2006) used different

stimuli (i.e., a gabor patch) and luminance, rendering direct

comparisons between their results and the present study diffi-

cult.

The present study investigated whether major depression al-

ters visual CS at low levels of luminance. The results showed a

reduction of CS in patients with major depression compared

with healthy volunteers who were matched for age, sex, and

educational level. However, unclear is whether the changes

observed were caused by depression itself, medications, or a

combination of both. Only three of the 10 participants in the

experimental group did not use medications. Finding patients

with major depression who use only a single medication is dif-

ficult, but new research needs to systematically investigate the

effect of medication on visual spatial CS. Overall, the present

data suggest that major depression caused changes in the mag-

nocellular pathway, a pathway that is important in the process-

ing of spatial frequencies under low luminance conditions.

Acknowledgements

We thank all of the volunteers who participated in this re-

search and the psychiatrists from the Centro de Atenção Psi-

cossocial (CAPS; João Pessoa, Paraíba, Brazil) who diagnosed

the patients with major depression. Research was supported by

CNPq # 303822/2010-4.

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