Binocular Vision -I

Teacher

Mr.Nagula Dinesh Kumar

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Core Courses

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Course Name : Binocular Vision I

Code(Credit) :CUTM1796 (3+2+0)

Course Objectives

• Understand the theoretical aspects of normal binocular vision, space perception, and their clinical applications.

• Study the gross anatomy and physiology of extraocular muscles and their role in binocular movement coordination.

• Learn about binocular optical defects and how they affect vision, along with strategies for their diagnosis and management.

Course Outcomes

  • CO 1: Understand the concepts of grades of Binocular vision and Fundamental theories of binocular vision.CO 2: Apply knowledge in binocular muscle coordination and integration of motor and sensory system    into binocular vision.CO 3: Identify non strabismic anomalies related to accommodationCO 4: Evaluate different types of strabismic anomalies - horizontal, vertical, torsional, paralytical& mechanical restrictive.

    CO 5: Create differential binocular visual condition practice in daily basis.

Course Syllabus

MODULE-I:

Fundamentals of Binocular Vision and Space Perception

Basics of Binocular Vision

  • Space perception, Cyclopean eye, evolution and advantages of binocular vision
  • Grades of binocular vision: simultaneous perception, fusion, stereopsis
  • Visual direction, retino-motor value, egocentric localization
  • Corresponding points and normal retinal correspondence

MODULE-II:

Binocular Vision Anomalies and Testing

Binocular Vision Anomalies

  • Horopter and Panum’s fusional area
  • Physiologic diplopia, fixation disparity, and theories of binocular vision
  • Physiologic basis of fusion, binocular rivalry, suppression, and confusion
  • Blind spot syndrome, eccentric fixation

MODULE-III:

Stereopsis and Depth Perception

Stereopsis and Depth Perception

  • Neurophysiology of stereopsis, local and global stereopsis, and fusion
  • Depth perception: non-stereoscopic clues, monocular cues and their types
  • Influence of accommodation and convergence on depth perception

MODULE-IV:

Ocular Movements and Binocular Integration

Ocular Movements and Anatomy

  • Integration of motor and sensory systems into binocular vision
  • Anatomy of extraocular muscles: Rectii, Obliques, and LPS
  • Innervation and blood supply of extraocular muscles
  • Physiology of ocular movements: Center of rotation, Axes of Fick, Actions
  • Laws of ocular motility: Donder’s, Listing’s, Sherrington’s, Hering’s laws

MODULE-V:

Binocular Defects and Management

Binocular Defects

  • Influence of binocular optical defects: visual acuity, anisometropia, aniseikonia, geometric optical effects of spectacles
  • Binocular muscular coordination: orthophoria, uniocular and binocular movements
  • Fixation and its field, saccadic and pursuit movements, versions and vergence
  • Amblyopia: Classification, etiology, investigation, and management
  • Nystagmus: Classification, etiology, investigation, and management

Practice:

  • Synoptophore for fusion, stereopsis, and simultaneous perception
  • Worth four dot test, red filter test, Bagolini test
  • Stereopsis evaluation tests, near point of accommodation (NPA), near point of convergence (NPC)
  • Extraocular motility test, Hirschberg test
  • Bruckner test, saccades and pursuit test, neutral density filters

 

References Books:

  1. Scott B Steinman; Barbara A Steinman; Ralph P Garzia: Foundations of binocular visiona clinical perspective, 2000, New York: McGraw-Hill publishers
  2. Pradeep Sharma: Strabismus simplified, First edition,1999, Modern publishers.
  3. Fiona J. Rowe: Clinical Orthoptics, second edition, 2004, Blackwell Science Ltd
  4. Gunter K. V. Nooden: Binocular vision & Ocular motility_ Theory and management of strabismus, Sixth edition, 2002, Mosby Company
  5. Mitchell Scheiman; Bruce Wick: Clinical Management of Binocular Vision Heterophoric, Accommodative, and Eye Movement Disorders, 2008, Lippincot Williams & Wilkins publishers.

Session Plan

Session 1

 

Topic: Space perception, Cyclopean eye

Study material :

  PDF: Binocular Vision and Space Perception

  📄 PDF: Binocular Vision Tutorial – Univ. of Iowa

  🎥 Video: YouTube Lecture

 

 

 

Session 2

 

Topic: Evolution of binocular vision & Advantages of binocular vision

Study Materials:

  📄 PDF: Stereopsis in Animals – Evolution, Function, Mechanisms

  📄 PDF: Read 2021 – Binocular Vision Across Animal Kingdom

 🌐 Article: Binocular Vision (Wikipedia)

 

 

Session 3

 

Topic: Grades of binocular vision-simultaneous perception, fusion, Stereopsis

Study Materials:

  PDF: Tyler – Binocular Vision Review

  PDF: Cyclopean Vision – Tyler

 

Session 4

 

Topic: Visual direction, Retino motor value, Egocentric localization

 

 

Study Materials:

  📄 Article: Hering’s Law of Visual Direction

  📄 Web Resource: Space Perception – Webvision Utah

 

Session 5

 

Topic: Corresponding point and normal retinal correspondence

Study Materials: PDF: Binocular Vision Tutorial – Univ. of Iowa

 

 

Session 6

 

Topic: Horopter & Panum’s fusional area

Study Materials: 📄 Article: Space Perception – Webvision Utah

 

 

Session 7

 

Topic: Physiologic diplopia , Fixation disparity

Study Materials: 

Textbook: Rowe, Clinical Orthoptics, Chapter 4: Diplopia and Fixation Disparity.

Covers physiologic diplopia (crossed/uncrossed) and fixation disparity.

Article: Binocular Functions | IntechOpen

Describes diplopia types and fixation disparity testing.

 

 

Session 8

 

Topic: Theories of binocular vision, Physiologic basis of fusion

Study Materials: PDF: Tyler – Binocular Vision Review

 Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 6: Theories of Binocular Vision.

Discusses correspondence-disparity, neurophysiological, and isomorphism theories.

 

 

 

 

Session 9

 

Topic: Binocular rivalry

Study Materials:

Textbook: Steinman et al., Foundations of Binocular Vision, Chapter 7: Binocular Rivalry and Suppression.

Explains rivalry when non-fusible images are presented.

 

 

 

Session 10

 

Topic: Suppression & Confusion

Study Materials:

Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 3: Sensory Adaptations.

Covers suppression and confusion in strabismus.

 

 

Session 11

 

Topic: Blind spot syndrome,

Study Materials:Textbook: Rowe, Clinical Orthoptics, Chapter 8: Strabismus and Sensory Adaptations. Describes blind spot syndrome and eccentric fixation.

Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 3: Sensory Adaptations.

Covers suppression and confusion in strabismus.

 

 

 

 

Session 12

 

Topic: Eccentric Fixation

Study Materials:Textbook: Steinman et al., Foundations of Binocular Vision, Chapter 9: Advanced Binocular Phenomena.

Covers dichoptic stimulation types like rivalry and suppression.

 

 

Session 13

 

Topic: Stereopsis- neurophysiology of stereopsis, local and global stereopsis and fusion

Study Materials: Textbook: Howard & Rogers, Seeing in Depth, Vol. 2, Chapter 6: Stereopsis Mechanisms.

 

Explains local/global stereopsis and neural basis in V1/V2.

https://www.jennyreadresearch.com/download/basic_science/Read2021.pdf

 

 

Session 14

 

Topic: Depth perception- non stereoscopic clues to the perception of depth under binocular condition, monocular cues and its types

Study Materials: Textbook: Howard & Rogers, Seeing in Depth, Vol. 2, Chapter 3: Monocular and Binocular Depth Cues.

Details cues like motion parallax and shading.

 

Session 15

 

Topic: Influence of accommodation and convergence on depth perception

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 7: Sensory-Motor Integration.

 

 

Session 16

 

Topic: Integration of the motor and sensory system into binocular vision

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 7: Sensory-Motor Integration.

Covers sensory fusion and motor alignment coordination.

 

 

Session 17

Topic: Anatomy of Extra Ocular Muscles - Rectii, Obliques and LPS, Innervation & Blood Supply

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 2: Anatomy of Extraocular Muscles.

Details recti, obliques, levator palpebrae superioris, and innervation.

 

 

Session 18

Topic: Physiology of Ocular movements - Center of rotation, Axes of Fick,

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 3: Physiology of Eye Movements.

Explains center of rotation and Fick’s axes (X, Y, Z).

 

 

Session 19

Practice session:

Topic Action, Laws of ocular motility - Donder’s and Listing’s law,

 

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 4: Laws of Ocular Motility.

Discusses Donder’s and Listing’s laws.

 

 

Session 20

Practice Session:

Topic: Synoptophore for fusion, stereopsis and simultaneous perception

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 9: Orthoptic Instruments.

 

 

Session 21

Practice session:

Topic: Worth four dot test

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 5: Diagnostic Testing.

 

 

Session 22

Topic: Sherrington’s law, Hering’s law

 

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 4: Laws of Ocular Motility.

 

 

Session 23

Topic: Influence of binocular optical defects- visual acuity, anisometropia,

 

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 6: Anisometropia and Aniseikonia.

 

 

Session 24

 

Topic: anisokenia, geometric

 

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 6: Anisometropia and Aniseikonia.

 

 

Session 25

Topic: optical effects of spectacles

 

Study Materials:  Textbook: Sharma, Strabismus Simplified, Chapter 10: Optical Corrections.

 

 

Session 26

Topic: Binocular muscular co-ordination – orthophoria

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 5: Orthophoria and Heterophoria.

 

 

 

Session 27

Practice session:

Topic:  Neutral density filters

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 5: Diagnostic Testing.

 

Session 28

Topic: Uniocular & Binocular movements – Fixation & its field, saccadic & pursuits,

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 3: Physiology of Eye Movements.

Covers fixation, saccades, and pursuits.

 

 

Session 29

Topic: Version &Vergence lecture

 

Study Materials:Textbook: Rowe, Clinical Orthoptics, Chapter 6: Vergence and Version Movements.

Explains version (conjugate) and vergence (disjugate) movements.

 

 

Session 30

Topic: Amblyopia :Classsification

 

Study Materials: Textbook: Sharma, Strabismus Simplified, Chapter 7: Amblyopia.

Classifies amblyopia (strabismic, anisometropic, deprivation).

 

 

Session 31

Topic: Amblyopia :Aeitiology, Investigation,

 

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 7: Amblyopia.

Discusses causes and diagnostic tests (e.g., visual acuity, cover test).

 

 

 

Session 32

Topic: Amblyopia :Investigation, Management

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 7: Amblyopia Management.

Details investigation and treatments (e.g., patching, atropine).

 

 

 

Session 33

Topic: Amblyopia :Investigation, Management

 

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 7: Amblyopia.

Covers advanced management techniques (e.g., vision therapy).

 

 

Session 34

Topic: Nystagmus: Classsification ,Aeitiology

 

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 10: Nystagmus.

Classifies nystagmus (congenital, acquired, jerk, pendular) and causes.

 

 

Session 35

Topic: Nystagmus: Investigation, management

 

Study Materials: Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 12: Nystagmus.

Covers diagnostics (e.g., electronystagmography) and treatments.

 

 

Session 36

Practice Session:

Topic: Saccades and pursuit test

Study Materials: Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 8: Eye Movement Disorders.

Describes saccade and pursuit testing protocols.

 

Session 37

Practice Session:

Topic: Bagolini test:

Textbook: Rowe, Clinical Orthoptics, Chapter 9: Orthoptic Instruments.

Explains Bagolini glasses for retinal correspondence and suppression.

 

Study Materials:

 

Session 38

Topic: Nystagmus: Classsification ,Aeitiology, Investigation, Management

 

Study Materials:

 

Textbook: Von Noorden, Binocular Vision and Ocular Motility, Chapter 12: Nystagmus.

Comprehensive nystagmus overview.

 

 

Session 39

Practice Session:

Topic: Red filter test;

Textbook: Scheiman & Wick, Clinical Management of Binocular Vision, Chapter 5: Diagnostic Testing.

Explains red filter test methodology.

 

Session 40

Practice Session:

Topic: stereopsis evaluation tests,;

 

Study Materials: Textbook: Rowe, Clinical Orthoptics, Chapter 9: Orthoptic Instruments.

Covers random-dot and contour stereo tests.

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