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Binocular vision:
Highly co ordinated organization of series of sensory and motor
processes that culminate in perception of singleness and Stereoscopic
depth enabling the eye to attain single vision from 2 retinal images.

Central fixation with normal visual acquity
Accurate occulomotor control bifoveal fixation
Normal inter retinal correspondance of visual directions
Sensory mechanisms to provide haplopia
Neural mechanisms to extract selective depth

Fixation: monocular at birth.
-rudimentary in the beginning
- 2-3 wks: begins to fixate
- 4-5 wks: sustains monocular fixation
- 6 wks: fixation alternates betweenn 2 eyes
- 3months: fixation is bifoveal & conscious, rather than reflexive
-3-5 months: smooth and gliding pursuit movements, compared to
saccadic ones till then.

Disjugate vergence movements: develop after conjugate
convergence is demonstrable at 3 months, stable at 6 months.

Fusional movements: abt 3-6 mnths,
established by 1 year.

Maturation of binocular functions:
at birth: both eyes act as independent sense organs
Bifoveal fixation:
Fovea develop by 3 month providing stimulus to associate both
eyes.child learns that image is most detailed when fixed on fovea.

Relative space perception:
-objects to right of fixation send images to retinal areas in 2 eyes
with common visual direction
- crossfiring of various sensory phenomenon: eg touch with vision
If eye is not allowed to associate child never acquires
binocular vision/ fusion
vision remains monocular and alternating

Stereopsis: normal eyes & neuromuscular mechanism
stereopsis develops
all or none phenomenon cannot be trained
Theories of binocular vision
Simultaneous stimulation of corresponding points by 1 object
single visual impression with no depth quality

Simultaneous stimulation with 2 objects that differ in character
Binocular rivalry

Disparate elements stimulated by 1 object diplopia

Horizontal disparity within PANUMS area binocular single vision.

Other theories:
-motor theory
- theory of isomorphism
- alternation theory of binocular vision

Grades of binocular vision

Simultaneous perception/ 1
signals transmitted from 2 eyes to the visual cortex are percieved at
the same time

Fusion / 2
ability to produce composite picture from 2 similar picture, each
lacking some small details.

Stereopsis / 3
impression of depth/appreciation of 3 dimensions
by superimposition of 2 images of same object

Visual directions
Occulocntric direction/local sign: specific visual direction of a
retinal image location

Primary visual direction:
occulocentric direction of an object fixated along the 1
line of
vision, imaged at fovea

Secondary visual direction: (secondary line of sight)
occulocentric direction of other retinal image locations relative to
primary visual direction.

Egocentric localization:
point midway between two eyes egocenter / cyclopean eye

Egocentric direction:
direction of object in space relative to body
occulocentric direction + informaion about eye orientation in head
and head position relative to trunk
Normal retinal correspondance

Corresponding points: specific pairs of retinal image locations in 2
eyes perceived to have identical visual direction.
eg: Fovea

Normal retinal correspondance:
when image is formed at corresponding retinal points,they produce
perception of identical visual directions when viewing with 1 eye /
both eyes simultaneously, permitting single visual impression.
Veith-muller Horopter
For infinite fixation distance,a circle passing through
-the fixation point ,
-object locations imaged on other corresponding points and
-the entrance pupils of the two eyes.

Every point on the horopter forms an angle with the entrance pupils,
equal to that formed by the fixation point.

At finite distance, the surface is reduced to 2 lines passing through
the intersection of lines of sight when eyes fixate at symmetric

Only points imaged on these two meridians can be
formed on corresponding points without vertical
Physiologic diplopia
Diplopia of non fixated objects.

all object that are nearer or farther away than the horopter (beyond
normal fusional range) , are imaged on
non-corresponding points.

2 egocentric directions


We do not have constant diplopia during daily vision due to
- exclusiveness of attention directed to fixating object.
- low visual acuity of peripheral retina.

Crossed diplopia
For object closer than horopter
Point is imaged on temporal retina
each eye percieves the point on the opposite side.
Uncrossed diplopia
For Points located beyond horopter
Point is imaged on nasal retina.
Binocular fusion
Sensory fusion:
normally occurs: when images of an object fall on corresponding
retinal points they are fused into a single mental impression.
Also occurs when stimulus is similar, and not identical
eg: size, shape, form,color, luminosity,contrast.

ANATOMIC BASIS: course of nerve fibres.
by crossing at chiasma,nasal fibres of one eye are brought near
temporal fibres of the other (counterparts)
they terminate in the same cortical cell.

Motor fusion:
ability to align eyes to maintain sensory fusion.
stimulus: retinal disparity

Panums fusional space
space in front and behind the horopter where objects located can
be fused into a single image without producing diplopia.
Smallest at the fixation point.
Retinal Panums area corresponds to depth of panums fusional space.
Fixation disparity:
primary line of sight of 1 eye misses fixation point slightly,being
either underconverged or overconverged
as disparity is less than size panums area no diplopia occurs

Theories of binocular fusion

Synergy hypothesis of Panum
Local sign hypothesis
Eye movement hypothesis of Helmholtz
Supression hypothesis of du Tour and Verhoeff

neurophysiologically 4 classes of neurons have been defined by
Hubel and Wiesel
1. Binocular corresponding (BC)
2. Binocular disparate (BD)
3. Monocular right
4. Monocular left
Physiologic hypothesis

Steriopsis is the visual appreciation of 3 dimensions during binocular
vision, occuring through fusion of signals from disparate elements.

Temporal disparities gives impression of nearness of an object.
Nasal disparity gives impression of remoteness of an objecct.
Vertical disparities do not produce stereoscopic effect.

Requirements: - bifoveal fixation
-good visual acuity
- fusion
FINE STEREOPSIS: highly specific pattern matching process
operating over narrow range of spatial disparities( probably not more
than 0.5 degrees)

COARSE STEREOPSIS: less specific process that can operate on
dissimilar visual images(form, luminance, contrast)
separated by several degrees in spatial position(7 to 10 degrees)

Stereoscopic acuity:
-minimal disparity beyond which no stereoscopic effect is produced.
- stereoacuity is best at fovea, decreases towards periphery
-normally :depth difference between two images with relative
disparity of 10 arc sec can be discriminated
-beyond 600 m, no true stereopsis,
monocular clues take over.

Depth perception
Distances of objects from each other or the observer

1. Stereopsis
2. Nonstereoscopic clues retinal disparity
3. Monocular clues ( nonstereoscopic clues to spatial orientation)
- parallactic movements
-linear perspective
-overlay of contours
-distance from horizon
-influence of highlights, shadows, light
-aerial perspective
4. Influence of accomodation and convergence.

Overlay of contours highlights and shadows

Binocular vision tests
1. Test for simultaneous macular perception

2. Test for fusion

3. Test for stereopsis
- vectograph test
- titmus stereo test
- random dot stereogram test (RDT)
- TNO random dot test
- Lang test
- frisby test
- sterescopic contours induced optokinetic nystagmus test
- television random dot stereotest

4. Simple motor task tests
- two pencil test
Titmus stereo test Random dot test(RDT)
TNO Test 2 pencil test

Disturbances in development of BSV
Time of onset of defect in visual system is most important
18 months to 2 yrs: prognosis for eventual bifoveal single vision is
At later age: normal function maybe regained with adequate

Anomalies in development of BSV:
- Diplopia & confusion
- Supression
- Amblyopia
- Abnormal retinal correspondance.
Diplopia & confusion
Objects in the plane of fixation are percieved as double.

Misalignment of visual axis in deviated eye

retinal image of fixed target is seen in different egocentric directions
(2 visual directions)

DIPLOPIA and Visual confusion
Intolerable visual environment

ARC Supression


Horror fusionis: intractable diplopia due to absence of
central supression

Active cortical inhibition of vision in one eye.
can be : - selective
- facultative
- constant (monocular strabismus)

-partial loss of sight in one or both eyes in the absence of
ophthalmoscopic or any other marked signs.
-maybe due to anisometropic
- strabismic
- stimulus deprivation(amblyopia exanopsia)
-amblyopia sets in early if strabismus begins in
early years of life.

Abnormal retinal correspondance
Active cortical adjustment in the directional values of 2 eyes
The fovea of one eye and a peripheral retinal element of another
eye acquire common visual direction.
Types :
Harmonious ARC:
Unharmonious ARC:

- gives patient a form of BSV
- stabilizes angle of deviation
- better visual adjustment, as there maybe depth perception

- difficult to establish normal retinal correspondance

BSV: singlevision from 2 retinal images with depth perception.

3 grades of BSV: simultaneous perception, fusion, stereopsis

Object locations on horopter give same visual directions
Object locations within panums fusional area, can be fused to give
single image

Stereopsis occurs due to spatial disparity
temporal disparity: nearness of object
nasal disparity: remoteness of object

Disturbances in BSV: diplopia & confusion

Adlers physiology of eye
Squint and orthoptics A K Khurana
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