This document discusses various orthoptic instruments and their therapeutic uses. It describes major amblyoscopes, diploscopes, bar readers, stereogram cards, and pigeon cantonette stereoscopes which are used for fusional exercises, amblyopia therapy, and overcoming suppression. The synoptophore is explained in detail as a haploscopic device used for fusion exercises, antisuppression exercises, and treatment of abnormal retinal correspondence. Procedures for using instruments like the diploscope, cherioscope, and pigeon cantonette stereoscope are provided.

1. ORTHOPTIC
INSTRUMENTS AND
THERAPEUTIC USE
S. ARYA DAS
B.OPTOM
B.M.C.O

2. THERAPEUTIC USE
 Fusional exercises
 Relative accommodation &convergence
 Amblyopic therapy

3. INSTRUMENTS
 Major amblyoscope
 Diploscope
 Bar readers
 Pigeon cantonett stereoscope

4. INSTRUMENTS
 Cherioscope
 Stereogram cards
 Prism bars

5. SYNOPTOPHORE
Principle
 Haploscopic device
 Based on physiological space dissociation
with the help of tubes

6. SYNOPTOPHORE
Therapeutic use:
 Antisuppression exercises
 Fusional vergence exercises
 Treatment of Abnormal retinal correspondence
 Amblyopia therapy

7. SYNOPTOPHORE
Fusion exercises:
 Tubes are set at angle of deviation
 Subject is asked to inform when object is seen
double on increasing amount of adduction

8. SYNOPTOPHORE
Fusion exercises:
 Same process is repeated with abduction
followed by adduction
 Fusion slides are used

9. SYNOPTOPHORE
Antisuppression exercises
 Auto flashing
 Kinetic Bi-retinal stimulation
 Macular massaging
 Chasing

10. SYNOPTOPHORE
Auto flashing
 Tubes are set at angle of deviation
 Two lights are extinguished with interval of
few seconds

11. SYNOPTOPHORE
Auto flashing:
 Macular sized fusion slides used
 Can be set on automatic mode of
simultaneous flashing

12. SYNOPTOPHORE
Stimulation of retinal area:
 Tubes are set at angle of deviation
 Patient asked to fix on one picture which is
not moved

13. SYNOPTOPHORE
Stimulation of retinal area:
 Observer moves other tube forward and
backward over macular area
 Patient is encouraged to see moving picture
and to say when he sees it pass across
stationary picture

14. SYNOPTOPHORE
 Stimulation of retinal area:
 Excursion and speed of movement is reduced
slowly
 Fusion slides are used

15. DIPLOSCOPE

16. DIPLOSCOPE
Principle :
 Space dissociation done by septum is the
working principle
 Used to make patient aware of position of his
visual axis

17. DIPLOSCOPE
Construction :
 Consists of metal shaft 25 cm in length
 Small metal pad called “face-piece” is located
at one end
 White card printed with D O G placed in card
holder is located at other end

18. DIPLOSCOPE
 Green square placed centrally above O and
red square centrally below
D O G

19. DIPLOSCOPE
 Metal septum is placed parallel at 6.5 cm
from card
 Four apertures are provided in metal septum
 Two horizontal apertures of 8mm diameter
are at equidistance from center of shaft and
are 15mm apart

20. DIPLOSCOPE
 One of the vertical aperture is below the left
side aperture
 Other vertical aperture is above the right side
aperture

21. DIPLOSCOPE
 Normal position of eyes:
 Right eye
 Left eye
D O
O G

22. DIPLOSCOPE
 Position 1
 Instructed to look through 2 central holes
 Letters D O are visible to right and O G to left
 If D O G is seen , indicates eyes are in
normal position

23. DIPLOSCOPE
 Position 2
 Instructed to look at point between 2
horizontal holes
 Position 3
 Instructed to look at object held half-way
between septum and his eyes

24. DIPLOSCOPE
 Position 4
 Instructed to look at a distance object and
slightly above printed card
 Images seen by each are projected in
crossed way

25. DIPLOSCOPE
 Position 4
 Useful in convergent squint to teach in
placing visual axis in divergent position
 In intermittent divergent squint to keep 4
letters equidistant from each other

26. DIPLOSCOPE
 Positions 1,2,3 requires convergence of
increasing amount
 Position 4 requires relative divergence
relative to printed card

27. CHERIOSCOPE
Principle :
 Patient‘s hand reinforces the stimulus for
suppressing hand
 Normal retinal correspondence is
required

28. CHERIOSCOPE
Construction:
 Consists of working base
 Vertical picture carrier on the side

29. CHERIOSCOPE
Construction:
 Two eyepieces of +8 DS are mounted on the
stand at distance of 12.5cms., from base
 Oblique ,tilt able mirror is provided as septum

30. CHERIOSCOPE
Procedure
 Patient supports his head on head rest and
looks through lenses
 One looks into mirror and other at base
 Using pair of toys such as butterfly and net

31. CHERIOSCOPE
Procedure
 Reflected image of Butterfly placed in carrier
is seen with one eye
 Other eye sees Net placed at base

32. CHERIOSCOPE
Procedure
 To overcome suppression patient must aim at
seeing butterfly and net simultaneously
 By moving net ,butterfly should exactly be
placed into it

33. CHERIOSCOPE
Procedure:
 Examiner can move the butterfly from place to
place and ask subject to catch butterfly each
time it moved
 Prisms can be used when subject is not able
to match images because of large angles

34. CHERIOSCOPE
Procedure:
 Prisms equal to amount of angle of deviation
placed are in eyepieces
 Base out prisms for esotropia and Base in
prisms for exotropia

35. BAR READERS
Types:
Thumb bar reader
Priestly Smiths Zigzag bar reader
Adjustable mayou bar reader
Head band bar reader

36. BAR READERS
 Used once appreciation of physiological
diplopia is achieved to eliminate suppression
 Used to train the patient to maintain binocular
single vision for reading accommodation and
convergence are in correct relationship for
given size of print

37. BAR READERS
Procedure
 Bar is introduced print and subjects eye
 If subject fixes binocularly on print , bar is
seen double
 But as bar obstructs small vertical strip of
words seen by one eye and a different strip
by other eye, if two eyes are functioning
properly there is no obstruction

38. BAR READERS
 Large print is read first and then practiced
with small print
 Can be given as home exercise
 Given for distance with Snellens chart viewed
in mirror at 3meters

39. PIGEON CANTONNET
STEREOSCOPE
Construction:
 Consists of stiff black cardboard folder
divided by triangular septum
 Septum is of 25cms

40. PIGEON CANTONNET
STEREOSCOPE
Construction:
 Graduated scale marked in centimeters is
printed on each flap
 Position of each flap is controlled by chord
fastened to each flap and has at its center a
small ring

41. PIGEON CANTONNET
STEREOSCOPE
Construction:
 Ring may be attached to lower or upper of
two hooks which project from edge of septum
 May be used in either of two positions

42. PIGEON CANTONNET
STEREOSCOPE
Position 1
 Chord is attached to lower hook
 Two flaps lie flat
 Mirror is covered by metal shield
 Dissociation by means of septum

43. PIGEON CANTONNET
STEREOSCOPE
Position 1
To teach alternation:
 Toys, pictures or coins can be used
 Placed on each side of septum
 Patient tries to identify as it appears

44. PIGEON CANTONNET
STEREOSCOPE
Position 1
 To overcome suppression and stimulate fusion
in cases of divergent squint
 (a) chasing
 (b)superimposing
 (c)tracing

45. PIGEON CANTONNET
STEREOSCOPE
Position 2
 Ring is attached to upper hook
 Two flaps form angle of 130 degree
 Optical system involved is of plane mirror

46. PIGEON CANTONNET
STEREOSCOPE
Position 2
 Flap on mirror side is transposed to other side
 Object is placed on reflected flap at distance of x
cms from septum

47. PIGEON CANTONNET
STEREOSCOPE
Position 2
 Image is seen at same distance on non
reflected flap
 Two objects kept at equidistance are seen
superimposed when orthophoria exists

48. PIGEON CANTONNET
STEREOSCOPE
Position 2
Anti suppression exercises:
 “In and out”
 chasing exercises

49. PIGEON CANTONNET
STEREOSCOPE
Position 2
 Toys are used mounted in short holder and in
conjunction with figure of man
 Large objects are used in cases of considerable
suppression
 Instructed to move in and out on man’s face
until suppression is overcome

50. PIGEON CANTONNET
STEREOSCOPE
Position 2
Fusion exercises:
 Break and join exercises
 Pictures are fused and patient is asked to
converge to break them

51. PIGEON CANTONNET
STEREOSCOPE
Position 2
Fusion exercises:
 Targets may be placed positions which require
greater convergence to obtain fusion
 Again relaxes his convergence to rejoin

52. STEREOGRAM CARDS
 Pair of objects printed on a card
 As their images can be fused to form a single
image
 Some cards are provided with disparity to
have stereopsis effect

53. STEREOGRAM CARDS
Procedure
 Used to train relative convergence or divergence
 Subject is asked to exercise relative divergence
relative to printed card
 Physiological diplopia creates 4 images

54. STEREOGRAM CARDS
 Two adjacent middle images gets
superimposed and fused
 Finally subject sees 3 figures
 Central fused figure and 2 monocular figures