A Distal Model of Congenital Nystagmus as Nonlinear Adaptive Oscillations

Congenital nystagmus (CN) is an incurable pathological spontaneous oscillation of the eyes with an onset in the first few months of life. The pathophysiology of CN is mysterious. There is no consistent neurological abnormality, but the majority of patients have a wide range of unrelated congenital visual abnormalities affecting either the cornea, lens, retina or optic nerve. In this theoretical study, we show that these eye oscillations could develop as an adaptive response to maximize visual contrast with poor foveal function in the infant visuomotor system, at a time of peak neural plasticity. We argue that in a visual system with abnormally poor high spatial frequency sensitivity, image contrast is not only maintained by keeping the image on the fovea (or its remnant) but also by some degree of image motion. Using the calculus of variations, we show that the optimal trade-off between these conflicting goals is to generate oscillatory eye movements with increasing velocity waveforms, as seen in real CN. When we include a stochastic component to the start of each epoch (quick-phase inaccuracy) various observed waveforms (including pseudo-cycloid) emerge as optimal strategies. Using the delay embedding technique, we find a low fractional dimension as reported in real data. We further show that, if a velocity command-based pre-motor circuitry (neural integrator) is harnessed to generate these waveforms, the emergence of a null region is inevitable. We conclude that CN could emerge paradoxically as an ‘optimal’ adaptive response in the infant visual system during an early critical period. This can explain why CN does not emerge later in life and why CN is so refractory to treatment. It also implies that any therapeutic intervention would need to be very early in life