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Dr. Wong's Eye Movement & Vision Neuroscience Laboratory

Brief Biography

Dr. Agnes Wong, MD, PhD, received her undergraduate degree from Boston University. She then obtained her MD degree from McGill University and completed her residency in Ophthalmology at the University of Toronto, where she also completed a PhD in Neuroscience and clinical fellowship in Neuro-Ophthalmology under the supervision of Drs. James Sharpe and Douglas Tweed. Dr. Wong then completed a combined research and clinical fellowship in Pediatric Ophthalmology and Strabismus at Washington University in St. Louis, Missouri.

Dr. Wong is currently Professor of Ophthalmology and Vision Science, Neurology, and Otolaryngology – Head and Neck Surgery at the University of Toronto. She is also the inaugural recipient of the John and Melinda Thompson Chair in Vision Neurosciences at the The Hospital for Sick Children and University of Toronto. She is a senior scientist, as well as an active staff physician, at both The Hospital for Sick Children and Toronto Western Hospital. Her research focus is on understanding the neural mechanisms of different forms of strabismus, abnormal eye movements, and amblyopia. Dr. Wong currently holds four peer-reviewed grants (including two from the Canadian Institutes of Health Research, one from the Canada Foundation for Innovation, and one from the National Institutes of Health of the USA). She has published over 60 peer-reviewed papers and she has single-authored a textbook entitled “Eye Movement Disorders”. Her work has been recognized by a number of organizations, including a New Investigator Award from the Canadian Institutes of Health Research, an inaugural Young Investigator Award from the American Association of Pediatric Ophthalmology and Strabismus, a Young Investigator Award from the North American Neuro-Ophthalmology Society, as well as an Early Researcher Award from the Ontario’s Ministry of Research and Innovation. She is a much sought-after speaker who has delivered over 110 named lectureships/visiting professorships.

Despite her busy research and clinical activities, Dr. Wong also dedicates herself to the training and mentoring of future generations of physicians and scientists. She has received numerous prestigious awards in recognition of the high quality of her clinical teaching and research supervision.

Research Interests

• Brain mechanism of abnormal eye movements 
• Brain mechanism and treatment of infantile strabismus (crossed eyes)

Research Activities 

My research focuses on the interaction between the eyes and the brain in normal and diseased states. I use sophisticated techniques to measure visual functions, eye movements, brain activities, and brain connectivity with the eyes to investigate how the normal brain functions, and how these brain functions change in the diseased states. Presently, I have three main research areas:

• Crossed Eyes in Infancy (Infantile Esotropia) is a health condition with an incidence of 8.3 per 100,000 children 18 years of age or under. Contrary to the popular belief that crossed eyes is a purely cosmetic condition, children born with crossed eyes suffer from a number of visual and eye movement impairments. Our goal is to understand the brain mechanisms that cause crossed eyes and to find a cure for it. Specifically, our research aims to answer three major questions: (1) How do the brain circuits that control vision and eye movements differ between cross-eyed and visually-normal infants? (2) How can we alter the development of these brain circuits to prevent or cure crossed eyes in infancy? (3) Can early surgery prevent maldevelopment of these brain circuits?
• Lazy Eye (Amblyopia) is a visual impairment of one or both eyes caused by inadequate use during early childhood; it cannot be corrected immediately by prescription glasses. It is the most common cause of visual impairment in one eye in the western world, and affects about 3-5% of the general population. Although tremendous amount of resources are spent on preventing and treating lazy eye, approximately 50% of children do not respond to therapies, and thus, many patients with lazy eye continue to have abnormal vision throughout their adult lives. Our goal is to understand how lazy eye affects the visual brain and to find a cure for it. Specifically, our research aims to answer four major questions: (1) How do the brain circuits in people with lazy eye differ from those with normal vision? (2) How does lazy eye affect three-dimensional (3D) depth perception and eye movements? (3) How do the eye-hand coordination skills in people with lazy eye differ from those with normal vision? (4) How can we develop more effective treatments for lazy eye?
• Double Vision (Diplopia) / Strabismus from Brain Diseases is a common and disabling feature of many diseases that affect adults, including strokes, brain tumours, diabetes, and multiple sclerosis. Our goal is to understand the brain mechanisms that cause double vision and to find a cure for it. Specifically, our research aims to answer three major questions: (1) How are the three-dimensional characteristics of eye movements altered by diseases of the brain? (2) What are the mechanisms underlying these changes, and how do they adapt over time? (3) What are the effects of different kinds of surgery on vision and on brain recovery / adaptation?

Clinical Care Activities

Dr. Wong maintains an active clinical practice, specializing in Neuro-Ophthalmology and Strabismus. Neuro-ophthalmology deals with neurologic disorders of the visual system. Since approximately 45 per cent of the brain is related to the visual system, many brain abnormalities cause visual disturbances. These visual disturbances, if left undetected or untreated, often deteriorate and cause severe disability or become life-threatening. Dr. Wong applies her specialized training to help these patients. In addition, Dr. Wong specializes in strabismus, and offers medical as well as surgical therapy for these patients. She also conducts active research in understanding and finding a cure for childhood strabismus.

Areas of Specialty

• Neuro-Ophthalmology
• Strabismus

External Funding

• Canadian Institutes of Health Research (Principal Investigator) 
• Canadian Foundation of Innovation (Principal Investigator 
• Ontario Ministry of Research and Innovation (Principal Investigator) 
• E.A. Baker Foundation for Prevention of Blindness, Canadian National Institute for the Blind (Principal Investigator) 
• National Institutes of Health, USA (Co-Investigator)

Achievements

Research Awards: 

• Early Researcher Award – from the Ontario Ministry of Research and Innovation (2006)
• Young Investigator Award – from the North American Neuro-Ophthalmology Society (2003)
• Young Investigator Award (Inaugural) – from the American Association of Pediatric Ophthalmology and Strabismus (2003)
• New Investigator Award – from the Canadian Institutes of Health Research (2002)

Clinical Teaching Awards (from University of Toronto): 

• Distinguished Teacher Award (2010)
• Resident Teaching Award (2005, 2006, and 2007)
• Dr. Fred Feldman Teaching Award (2005, 2007 and 2010)
• PAIRO Excellence in Clinical Teaching Award (Nominee) (2005)
• J.D. Morin Award (2003)

Awards for Research Supervision: 

• Award for Excellence in Ophthalmic Research (First Prize)
• Canadian Ophthalmological Society (2009)
• Third Prize (Clinical Research Section)The 2nd Canadian National Medical Student Research Symposium (2010)
• Best Student Paper, Annual Ophthalmology Research Day, University of Toronto (2005, 2006, 2007, 2008, 2009, 2010 and 2011)
• Best Fellow Paper, Annual Ophthalmology Research Day, University of Toronto (2009)
• George Brown Award (Best paper in Clinical Science), The 21st Medical Students Research Day, University of Toronto (2007),
• Best Student Paper, North American Neuro-Ophthalmology Society Meeting (2006, 2008)
• Best Research Paper, Annual Meeting of the Canadian Association of Pediatric Ophthalmologists (2006)
• Gold Award – Pfizer Film Festival for surgical technique and medical cases, Royal Australian and New Zealand College of Ophthalmologists Meeting (2005)
• Best Fellow Award (Inaugural), Frank B. Walsh Session of the 30th Annual North American Neuro-ophthalmology Society Meeting (2004)
• Best Research Paper, Canadian Neuro-Ophthalmology Society Meeting (2004)
• Alumni Award (for Best Fellow Paper), Annual Ophthalmology Research Day, University of Toronto (2003)

Publications

67. Wong AM, Colpa L, Chandrakumar M. Ability of an Upright-Supine Test to differentiate Skew Deviation from other Vertical Strabismus Causes. Archives of Ophthalmology 2011; 129 (12):1570-1575.

66. Niechwiej-Szwedo E, Goltz H, Chandrakumar M, Hirji Z, Wong AM. Effects of anisometropic amblyopia on visuomotor behaviour: III. Temporal eye-hand coordination during reaching. Investigative Ophthalmology & Visual Science 2011; 52:5853-5861.

65. Chandrakumar M,  Blakeman A, Goltz H, Sharpe JA, Wong AM. The static ocular counterroll reflex in skew deviation. Neurology 2011; 77:638-644.

64. Niechwiej-Szwedo E, Goltz H, Chandrakumar M, Hirji Z, Wong AM. Niechwiej-Szwedo E, Goltz H, Chandrakumar M, Hirji Z, Crawford JD, Wong AM. Effects of anisometropic amblyopia on visuomotor behaviour: II. Visually-guided reaching. Investigative Ophthalmology and Visual Science 2011;52:795-803.

63. Mirabella G, Hay S, Wong AM. Deficits in perception of real-world scenes in patients with a history of amblyopia. Archives of Ophthalmology 2011;129:176-183.  

62. Niechwiej-Szwedo E, Goltz H, Chandrakumar M, Hirji Z, Wong AM. Effects of anisometropic amblyopia on visuomotor behaviour: I. Saccadic eye movements. Investigative Ophthalmology and Visual Science. 2010;51:6348-54.

61. Tychsen L, Richards M, Wong AM, Foeller P, Bradley D, Burkhalter A. The neural mechanism for latent (fusion-maldevelopment) nystagmus. Journal of Neuro-Ophthalmology 2010;30:276-83.

60. Chandrakumar M, Hirji Z, Blakeman A, Goltz H, Mirabella G, Wong AM. Effects of earth-fixed vs head-fixed target on ocular counterroll. Archives of Ophthalmology 2010;128:413-417.

59. Wong AM. Understanding skew deviation and a new clinical test to differentiate it from trochlear nerve palsy. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2010;14:61-67.

58. Wu J, Nazemi F, Schofield J, Mirabella G, Wong AM. Effectiveness of telescopic magnification in the treatment of amblyopia. Archives of Ophthalmology 2010;128:297-302.

57. Lei S, Iyengar S, Shan L, Cherwek DH, Murthy S, Wong AM.  GAPO Syndrome: A case associated with bilateral interstitial keratitis and hypothyroidism. Clinical Dysmorphology 2010;19:79-81.

56. Tischfield MA, Baris HN, Wu C, Rudolph G, Van Maldergem L, He W, ChanW, Andrews C, Demer JL, Robertson RL, Mackey DA, Ruddle JB, Bird TD, Gottlob I, Pieh C, Traboulsi EI, Pomeroy SL, Hunter DG, Soul JS, Newlin A, Sabol LJ, Doherty EJ, de Uzcátegui CE, de Uzcátegui N, Collins ML, Sener EC, Wabbels B, Hellebrand H, Meitinger T, de Berardinis T, Magli A, Schiavi C, Pastore-Trossello M, Koc F, Wong AM, Levin AV, Geraghty MT, Descartes M, Flaherty M, Jamieson RV, Møller HU, Meuthen I, Callen DF, Kerwin J, Lindsay S, Meindl A, Gupta ML, Pellman D, Engle EC. Human TUBB3 mutations perturb microtubule dynamics, kinesin interactions, and neuronal circuitry. Cell 2010;140:74-87.

55. Cheung RT, Wong AM. Optic nerve hypoplasia associated with chromosome 9 inversion. Canadian Journal of Ophthalmology. 2009; 44 (5):610-611.

54. Goltz H,  Mirabella G, Leung JC, Blakeman A, Colpa L, Abuhaleeqa K, Wong AM. Effects of age, viewing distance and target complexity on static ocular counterroll.  Vision Research 2009;49:1848-1852.

53. Schlenker M, Mirabella G, Goltz H, Kessler P, Blakeman A, Wong AM. The translational vestibulo-ocular reflex in patients with skew deviation. Investigative Ophthalmology and Visual Science.  2009; 50:168-174.

52. Wong AM. Timing of surgery for infantile esotropia: Sensory and motor outcomes.  Canadian Journal of Ophthalmology. 2008; 43:643-651.

51. Hasany A, Wong AM, Foeller P, Bradley D, Tychsen L. Duration of binocular decorrelation in infancy predicts the severity of nasotemporal pursuit asymmetries in strabismic macaque monkeys. Neuroscience. 2008; 156:403-411.  

50. Tychsen L, Richards M, Wong AM, Demer J, Bradley D, Burkhalter A, Foeller P. Decorrelation of cerebral visual inputs as the sufficient cause of infantile esotropia. American Orthoptic Journal. 2008;58:60-69.

49. Gerth C, Mirabella G, Li X, Wright T, Westall C, Colpa L, Wong AM. Timing of surgery for infantile esotropia in humans: Effects on cortical motion visual evoked responses. Investigative Ophthalmology and Visual Science. 2008; 49:3432-3437.

48. Parulekar MV, Dai S, Buncic JR, Wong AM. Head position-dependent changes in ocular torsion and vertical misalignment in skew deviation. Archives of Ophthalmology. 2008; 126(7):899-905.

47. Sharpe JA, Wong AM, Fouladvand M. Ocular motor nerve palsies: Implications for diagnosis and mechanisms of repair. Progress in Brain Research. 2008; 171:59-66.

46. Tychsen L, Richards M, Wong AM, Foeller P, Burkhalter A, Narasimhan A, Demer J. Spectrum of Infantile Esotropia in Primates: Behavior, Brains and Orbits. Journal of the American Association for Pediatric Ophthalmology and Strabismus. 2008; 12:375-380.

45. Parulekar MV, Halliday W, Brent M, Kong K, Wong AM. Tubular aggregate myopathy associated with retinal degeneration. Canadian Journal of Ophthalmology. 2008; 43:361-363.

44. Richards M, Wong AM, Foeller P, Bradley D, Tychsen L. Duration of binocular decorrelation predicts the severity of latent (fusion maldevelopment) nystagmus in strabismic macaque monkeys. Investigative Ophthalmology and Visual Science. 2008;49:1872-1878.

43. Wong AM. Eye Movement Disorders. New York: Oxford University Press. 2008. ISBN13: 978-0-19-532426-6.

42. Niechwiej-Szwedo E, Gonzalez EG, Verrier MC, Wong AM, Steinbach MJ. Localization in the frontal plane is not susceptible to manipulation of afferent feedback via the Jendreassik Maneuver. Vision Research. 2008;48:724-732.  

41. Fesharaki M, Karagiannis P, Tweed D, Sharpe JA, Wong AM. Adaptive neural mechanism for Listing’s law revealed in patients with skew deviation caused by brainstem or cerebellar lesion. Investigative Ophthalmology and Visual Science 2008;49:204-214.

40. Sin L, Tychsen L, Foeller P, Bradley D, Wong AM. Early versus delayed correction of infantile strabismus in macaque monkeys: Effects on long-term eye alignment. Neuro-Ophthalmology 2007;31:167-169.

39. Richards M, Tychsen L, Foeller P, Bradley D, Wong AM. Early versus delayed correction of infantile strabismus in macaque monkeys: Effects on horizontal binocular connections in the striate cortex. Neuro-Ophthalmology 2007;31:171-174.  

38. Niechwiej-Szwedo E, Gonzalez EG, Bahl B, Verrier MC, Wong AM, Steinbach MJ. Manipulation of extraocular muscle afference has no effect on higher order perceptual judgments. Vision Research 2007;47:3315-3323.  

37. Kessler P, Tomlinson D, Blakeman A, Rutka J, Ranalli P, Wong AM. The high-frequency/acceleration head-heave test in detecting otolith diseases. Otology & Neurotology 2007;28:896-904.

36. Wong AM. An update on opsoclonus. Current Opinion in Neurology 2007;20:25-31.

35. Niechwiej-Szwedoa E, Gonzáleza E, Begae S, Verrier MC, Wong AM, Steinbach MJ. Proprioceptive role for palisade endings in extraocular muscles: Evidence from the Jendrassik Maneuver. Vision Research 2006;46:2268-2279.  

34. Wong AM, McReelis K, Sharpe JA. Saccade dynamics in peripheral versus central sixth nerve palsies. Neurology 2006;66:1390-1398.

33. Eizenman M, Sapir-Pichhadze R, Westall CA, Wong AM, Lee H, Morad Y. Eye movement responses to disparity vergence stimuli with artificial monocular scotomas. Current Eye Research 2006; 31:471-480.  

32. Wong AM, Sharpe JA. Cerebellar skew deviation and the torsional vestibulo-ocular reflex. Neurology 2005;65:412-419.  

31. Sharpe JA, McReelis K, Wong AM. Recovery of peripheral versus central nerves identified by saccadic velocity after abducens neuropathy. Annals of the New York Academy of Sciences 2005;1039: 417-429.  

30. Wong AM, Burkhalter A, Tychsen L. Suppression of metabolic activity caused by infantile esotropia and strabismic amblyopia in striate visual cortex of macaque monkeys. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2005;9:37-47.  

29. Wong AM. Listing’s law: Clinical significance and implications for ocular motor control. Survey of Ophthalmology 2004:49:563-575.

28. Tychsen L, Wong AM, Burkhalter A. Paucity of horizontal connections for binocular vision in V1 of naturally-strabismic macaques: Cytochrome-oxidase compartment specificity. Journal of Comparative Neurology. 2004 474:261-275.  

27. Muni RH, Wennberg R, Mikulis DJ, Wong AM. Bilateral horizontal gaze palsy in presumed paraneoplastic brainstem encephalitis associated with a benign ovarian teratoma. Journal of Neuro-Ophthalmology. 2004:24:114-118.  

26. Tychsen L, Wong AM, Foeller P, Bradley D. Early versus delayed repair of infantile strabismus in macaque monkeys: II. Effects on motion visually evoked potentials. Investigative Ophthalmology and Visual Science 2004 45:821-827.  

25. Sharpe JA, Tweed D, Wong AM. Adaptations and deficits in the vestibulo-ocular reflex after peripheral ocular motor palsies. Annals of the New York Academy of Sciences 2003; 1004:111-122.  

24. Guirgis MF, Wong AM, Tychsen L. Infantile glaucoma and punctal atresia in a child with caudal regression syndrome. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2003; 7:298-299.  

23. Wong AM, Foeller P, Bradley D, Burkhalter A, Tychsen L. Early versus delayed repair of infantile strabismus in macaque monkeys: I. Ocular motor effects. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2003; 7:200-209.  

22. Wong AM, Tychsen L. Effects of extraocular muscle tenotomy on congenital nystagmus in macaque monkeys. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2002; 6:100-107.  

21. Guirgis MF, Wong AM, Tychsen L. Congenital restrictive external ophthalmoplegia and gustatory epiphora associated with fetal isotretinoin toxicity. Archives of Ophthalmology 2002; 120:1094-1095.  

20. Wong AM, Tweed D, Sharpe JA. Vertical misalignment in unilateral sixth nerve palsy. Ophthalmology 2002; 109:1315-1325.  

19. Wong AM, Tweed D, Sharpe JA. Hyperdeviation and static ocular counterroll in unilateral abducens nerve palsy. Annals of the New York Academy of Sciences 2002; 956:523-526.  

18. Wong AM, Tweed D, Sharpe JA. Implementation of Listing's law in patients with unilateral sixth nerve palsy. Annals of the New York Academy of Sciences 2002; 956:520-522.  

17. Wong AM, Sharpe JA, Tweed D. Adaptive neural mechanism for Listing=s law revealed in patients with fourth nerve palsy. Investigative Ophthalmology and Visual Science 2002; 43: 1796-1803.  

16. Wong AM, Tweed D, Sharpe JA. Adaptive neural mechanism for Listing’s law revealed in patients with sixth nerve palsy. Investigative Ophthalmology and Visual Science 2002; 43:112-119.  

15. Wong AM, Tweed D, Sharpe JA. The vestibulo-ocular reflex in fourth nerve palsy: Deficits and adaptation. Vision Research 2002; 42:2205-2218.

14. Wong AM, Sharpe JA. Adaptations and deficits in the vestibulo-ocular reflex after third nerve palsy. Archives of Ophthalmology 2002; 120:360-368.

13. Wong AM, Tweed D, Sharpe JA. Adaptations and deficits in the vestibulo-ocular reflex after sixth nerve palsy. Investigative Ophthalmology and Visual Science 2002; 43:99-111.  

12. Wong AM, Musallam S, Tomlinson RD, Shannon P, Sharpe JA. Opsoclonus in three dimensions: Oculographic, neuropathologic and modelling correlates. Journal of the Neurological Sciences 2001: 189:71-81.  

11. Yap C, Wong AM, Naor J, Rootman DS. Corneal temperature reversal after storage in Chen medium compared with Optisol GS. Cornea 2001; 20:501-504.  

10. Wong AM, Sharpe JA. A comparison of tangent screen, Goldmann and Humphrey perimetry in the detection and localization of occipital lesions. Ophthalmology 2000; 107:527-544.  

9. Wong AM, Lueder GT, Burkhalter A, Tychsen L. Anomalous retinal correspondence: neuroanatomic mechanism in strabismic monkeys and clinical findings in strabismic children. Journal of the American Association for Pediatric Ophthalmology and Strabismus 2000; 4:168-174.  

8. Wong AM, Sharpe JA. Representación del campo visual en la corteza occipital humana. Selected publication for Spanish edition of Archives of Ophthalmology 1999; 10:152-162.  

7. Wong AM, Sharpe JA. Representation of the visual field in human occipital cortex: A magnetic resonance imaging and perimetric correlation. Archives of Ophthalmology 1999; 117(2):208-217.  

6. Wong AM, Lam WC, Sharpe JA. Terson's syndrome in subarachnoid hemorrhage. Journal of Neuro-Ophthalmology 1998; 18 (2):148-149.

5. Wong AM, Héon E. Helicoid peripapillary chorioretinal degeneration associated with abetalipoproteinemia. Archives of Ophthalmology 1998; 116(2):250-251.

4. Lam WC, Wong AM, Chen JC. Scleral ectasia in rhegmatogenous retinal detachment. Canadian Journal of Ophthalmology 1996; 31(5):241-244.  

3. Wong AM, Sharpe JA. Fourth nerve palsy in migraine. Neuro-ophthalmology 1996; 16(1):51-54.

2. Wong AM. The inhumanity of "fairness": Rationing resources for re-constructive breast surgery. Canadian Medical Association Journal 1995; 52(4):577-579. .

1. Wong AM. The Oregon approach to health care: Its applicability to Canada. In: Boan JA ed. Proceedings of the Fifth Canadian Conference on Health Economics. Regina, Saskatchewan: Canada Plains Research Centre, 1994. p.47-58.